HomeMy WebLinkAboutSeptic New 96 Greenfield Drive e -
TOWN OF SOUTH WI N DSOR
R � 1
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 `_ �� Address of Owner _- T L t,�
�;
J,
2. Location of Property �. Lot. No. C;- �
3. Type of Structure ='r A" No. of Bedrooms -�
(Dwelling,Commercial Fuilding,Store,etc.)
4. Number of Families or Persons to Occupy Premises_
5. Plumbing Fixtures: Water Closets Urinals_ Lavatories Bathtubs
Showers_ Kitchen Sinks I Laundry Tubs Garbage Grinder Other
6. Liquid Capacity of Septic Tank Material of Septic Tank
7. Soil Conditions: Type of Soil Maximum ground water table
(Band,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
12. Leaching System: Number of trenches - Length/s* de-:T Width �.S FT Total
Other
Signature ✓ "
(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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. ;WiAIC-4 CON/V•-- — DATE: , -UVA—Y_ _l46 8-- 8CAL.E:.
: HAMP0EN, COUNTY BOOK OF Pl—ANS;
PAGE ' IVO: LOT ,NO 6 P, - ^ FLAN Ne%-
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$E,C ;BOOK: MASS, Lic, No- _ _ENGINEERING COMPANY INC.