HomeMy WebLinkAboutSeptic New 112 Gordon Drive j` 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._ T 0 19
A permit is requested for repair or construction of an individual sewage disposal system concerning which t e
following information is submitted:
1. Owner of PropertyAddress of Owner
2. Location of PropeJX rty r
Lot. No.
3. Type of Structure No. of Bedrooms_
(D elling,Commercial Building,Store,—etc.)
4. Number of Families or Persons to Occupy Premises_
5. Plumbing Fixtures: Water Closets 2— Urinals Lavatories 7 Bathtubs_
Showers_ Kitchen Sinks Laundry Tubs Garbage Grinder Other
6. Liquid Capacity of Septic Tank_I d D 6 Material of Septic Tank
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 -f .-` Classification of soil
11. Minimum square feet of effective seepage area required
12. Leaching System: Number of trenches Length Width Total
Other
Signaturey--�
(Licensed Installer)
(Sketch showing all minimum distances and other details required below)
Permit Issued 19 By
Installation Completed, Inspected and Approved —10— BY
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Sti6 y �'`~ PROPERTY OF
NO.. ALAN DRIVE SOUTH 'W I NDSOR, CONN
Being Lot No. 21 on :map ent it Ied "Property of Rolling Park Homes,
:A ne South Windsor, Conn. Scale ! 60` Jan' ary 10, 1957"
'Scale 1
HAYI)EN L. GR I SWOLP. C .E.
FOR BUILDING P"JOSES ONLY p
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