HomeMy WebLinkAboutSeptic New 743 Governor's Highway FEE
TO THE BUILDING DEPARTMENT Application No. ��
TOWN OF SOUTH WINDS OR Date �
I hereby apply for permit to build a sewage disposal system for a
(Residence, boarding house, hotel, etc.)
Owned by of
—' 743
And located aty '
To be built by of
in accordance with detailed information stated below.
Signed ,j
(Applicant)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
GENERAL INFORMATION
1 . Estimated population of premises (present) — (future) y
2. Description of premises (including number of bedrooms)
No. Fixtures
(Above basement): Water Closets / Urinals Lavatories /
Bath tubs / Showers Kitchen Sinks _Laundry Tubs
Garbage Grinder m List basement fixtures
3. Water Supply Kind of Well
(Public, well , spring, cistern)
Location of well and underground water piping ;;,j
Method of obtaining or storing supply_
(Pumps , tank, etc.)
4. Character of soil at proposed location of leaching system, including depths of
various strata "dl_�
(sand, loam, clay , hardpan, rock, etc. --Use test pits.)
5. Elevation of highest ground water � oJ ` o�o —
(with reference to both present & future grade)
y -
Description of proposed system (Furnish drawings of same , with plot plan showing
system including location, size , grade and material of house sewer and locations
of ground or surface water drains , wells and bodies of surface water.)
Septic Tank
Dimensions Capacity below flow line
Inlet and outlet arrangements
Facilities for cleaning Distance from dwellings on same
property to , on adjoining property
Automatic Dosing Apparatus , if any (describe)
Soil Absorption System
If cesspools , No. diameter ft.; depth below inlet ft.
a
If tile field or leaching trenches , total length is 260 ft.
Width of trenches 2- ft. , depth of broken stone or screened gravel P 6 ft.
Stone or gravel will be covered by Distance between
r (tar paper alt hay)
trenches 6o 'WN,uL ft. Distance from water supply on same property 76,
on adjoining property /G a
f
Secondary Treatment, if other than soil abss�orrpptio
Describe in detail and locate on map ,('.01' W'-d�
System was designed b �� yy
Above information furnished by
No discharge of sewage or sewage effluent into any watercourse should be permitted
without approval of the State Department of Health and State Water Commission.
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