HomeMy WebLinkAboutSeptic New 112 Gray Road TOWN OF
SOUTH WI N DSOR
BUILDING DEPARTMENT '
South Windsor, Connecticut
Application for Permit to Install or Repair Individual Sewage Disposal System
Application No. m 6tW Poo Y
TO THE BUILDING DEPARTMENT: Dat 19�
A permit is requested for repair or construction of an individual sewage disposal system concerning which the
following information is submitted: (Zobe("f 2a.bL,-a.
1. Owner of Property Address of O',wner
2. Location of Property r �.e.� ea t @---Ah N!s Lot. No. 3(p
3. Type of Structure tWit t,twhc No. of Bedrooms .3
(Dwelling,Commercial Building,St/ore,etc.)
4. Number of Families or Persons to Occupy Premises Om4r !i) 14LV
5. Plumbing Fixtures: Water Closets Urinals Lavatories Bathtubs
Showers Kitchen Sinks Laundry Tubs Garbage Grinder Other
6. Liquid Capacity of Septic TankL 4000 SrA!.t o of Material of Septic Tank
w
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 AdC &t t. 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_ .fi'M1W&/tr/5 Classification of soil
11. Minimum square feet of effective seepage area required14 SAY A1FA AWraAgtA t rar•#A, dC qq r'i9A
12. Leaching System: Number of trenches' 0114 r IIt LengthAOS RT Width_ P.S 07 Total 90%t ip pr
Other PAit f'•A /4r bi pyjn ya Apri or/S A0rA,,"/1'1r/M S
Signature
QQ (Lice�j�ed Installer)
(Sketch showing all minimum distances and othl�r�etbTs req Rr�d�belowl• �3G4`10
Permit Issued 04 %%7st o44F 19 94s By
Installation Completed, Inspected and Approved By
TOWN OF SOUTH WINDSOR
TOWN HAIL
SOUTH WINDSOR, CONN. 06074
DEPARTMENT POLLUTION C',ONTROL
Date . . . . . . . . . . . . . . . . . . . . . . .
The Sanitary Sewer . . . . . . . . Septic System . . . . . . . . . .
at . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . o . . . . . . . .
or lot #. . . . . . . . . . . . . . . has been installed and completed M
in accordance with the Town of South Windsor ordinances
and regulations.
Accepted attd Approved
By -- Date - - —
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