HomeMy WebLinkAboutSeptic New 55 Gordon Drive TOWN OF SOUTH WI N DSOR
BUILDING DEPARTMENT
South Windsor, Connecticut
Application for Permit to Install or Repair Individual Sewage Disposal System
Application No.
TO THE BUILDING DEPARTMENT: Date — — 19 -
A permit is requested for repair or construction of an individual sewage disposal system concerning which the
following information is submitted:
1. Owner of Property /j Address of Owner
2. Location of Property II Lot. No.
3. Type of Structure No. of Bedrooms
(Dwelling,Comm cial Bu:='
4. Number of Families or Persons to Occupy Premises_ 1
5. Plumbing Fixtures: Water Closets iL— Urinals Lavatories --7— Bathtubs -*7
Showers f Kitchen Sinks Laundry Tubs Garbage Grinder Other
6. Liquid Capacity of Septic Tan Material of Septic Tank�'S�T
7. Soil Conditions: Type of Soil Maximum ground water table /
(Sand,Gravel,Clay,etc.)
8. If not served by public water supply: Distance from Owner's well from adjacent wells
9. Distance to nearest water course, drainage ditch, storm drain or embankment
10. Percolation Tests: Time for 1" drop in soil test Classification of soil
11. Minimum square feet of effective seepage area required J
r
12. Leaching System: Number of trenches Length / �� Width Total 7
Other 6 Z�Z P1
Signature Z, -
Licensed Installer)
(Sketch showing all minimum distances and other details required below)
Permit Issued 19 By
Installation Completed, Inspected and Approved 19 By
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1
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Idol flAl
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P('Cn(_i:'TY CE
NC, XI.ITH '41 NDSOR, CONN.
F�eing Lot No. 2` on mav-� entitled "Map of ROLLING PARK Section 11
Lots 12-3 1 Cr i f f-i`n F :Y i ndsory i I I e loads South 'W i ndsor, Conn.
cafe I " = 40' Aor . 15, 1o64 revised June 4, 1065 Hayden L.
Griswold '. E . "
HAYnEN 1— GRI StJOLD C. E .
i ;
SOUTH WINDSOR HEALTH DEPARTMENT APFLICATIO`1 1.10.
IRPE ZGAS"IOff ?'OR .SMOZ DTSPCSAL SYMM, c Ir,
owmw LOCATION '✓- 6 or dot-" 0,
?1=0 TION TESTS: (Reaord all. tests) SOIL MOISTTAS":
Data , med., ov, etc
✓-ay�iy
TEST READINGS
a= l =2 #2 acLE acu. #114 Time Reading Time Reeding Time Rescting Time Readin;
10 a
/o a5%y
T" ATIOR OF TQT ?=-Ts
. Depth Pr*sca]c �Sai� .Persalatioa ??sat
Lwation
-
1
2
3
4
CBSM7A,.'I0N FITS: (.Record all'pits) S 13 IV Ground 'dater Tablet 14esr Hmac., Below
Data
ErCRIP!'I(�+a
PIT 4 PZT 3 ??T C I PIT D
v
rr
lncL1-t
3 6 --1C1� �vr5c f
d/i u �'t K
TA8O W1,10R OF 03yE VAMT AR Pr'"S
Ground Soil
Pit Loeaticst Dep Le3_8_ At vat_ �"o'-
A
3
C
D
Ova