HomeMy WebLinkAboutSeptic New 69 Hazel Street TOWN OF SOUTH WI N DSOR
BUILDING DEPA,RTMEN.T
South Windsor, Connecticut
Application for Permit to Install or Repair Individual Sewage Disposal System
Application No.
TO THE BUILDING DEPARTMENT: Date /Va 19a
A permit is requested for repair or construction of an individual sewage disposal system concerning which the
following information is submitted:: 1
1. Owner of Property—� d' e�SAddress of Owner
2. Location of Property G 9 YAxe Lot. No.
3. Type of Structure -A/0 No. of Bedrooms_Jr
(Dwellin ommercial Building,Store,etc.)
4. Number of Families or Persons to Occupy Premises_ 4/V4e
5. Plumbing Fixtures: Water Closets ?— Urinals Lavatories L Bathtubs
Showers_ Kitchen Sinks, Laundry Tubs / Garbage Grinder Other
6. Liquid Capacity of Septic Tank /aDe!) Material of Septic Tanis
7. Soil Conditions: Type of Soil Maximum ground water table 14-10N<�
(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 A,14 ✓e
10. Percolation Tests: Time for 1" drop in soil test _Classification of soil_ l/
11. Minimum square feet of effective seepage area required ' Z 5�-
12. Leaching System: Number of trenches Length Width �Q Total X7
Other
Signatur / / r
(Licensed Installer)
(Sketch showing all minimum distances and other details required below)
Permit Issued 19 By
Installation Completed, Inspected and Approved 19 By
Ot-, ' ,
HAZEL DR/gL�
sbuTM Wt*D8Qtt, CON14
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HAYP S Allo 1,1 1f"F�tB 70AUS SOUTH V INoe,A1! ! !'O#i'
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^' Ohv, y. Z HEREBY CERTIFYf�
THIS PLAN TO BE
SUBSTANTIALLY ENGINEERING AND LAND SURVEYING
CORRECT; 740 NO. MAIN STREET, CROSSROADS PLAZA
WEST HARTFORD 7, CONNECTICUT
ECALZ• ..., DAT EV16
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