HomeMy WebLinkAboutSeptic Repair 1249 John Fitch Boulevard TOWN OF SOUTH WI N DSOR
BUILDING DEPARTMENT
South Windsor, Connecticut
Application for Permit to Install orlegaii1ndividual Sewage Disposal System
Application No.
TO THE BUILDING DEPARTMENT, Date._ �/- y 19e-
A permit is requested fo air construction of an individual sewage disposal system concerning which the
following information is submitted:
1. Owner of Property 0. 4C Address of Owner T ks
p, / D ✓7
2. Location of Property .�4!a# �,rC H Lot. No.
3. Type of Structure 1� (,6/�/9.�4lnr No. of Bedrooms
(Dwelling,Commercial Building,Store,etc.)
4. Number of Families or Persons to Occupy Premises_
5. Plumbing Fixtures: Water Closets Urinals Lavatories Bathtubs
Showers Kitchen Sinks 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
(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 Classification of soil
11. Minimum square feet of effective seepage area required
12. Leaching System: Number of trenches Length Width Total
Other C-? L -Z O V/
Signature
(Licensed Installer)
(Sketch showing all minimum distances and other details required below)
Permit Issued 19 By
Installation Completed, Inspected and Approved 19 By
FEE
TO THE BUILDING DEPARTMENT Application No. T
TOWN OF SOUTH WINDSOR Dated / ! G 2
I hereby apply for permit to•-build a sewage disposal system for a
�S'Tv �c �/"A�icw�a✓ iJRo✓�s/o,�/s,
(Residence', boarding house, hotel, etc.)
Owned by of J'o . —cJ t�rc�ro
And located at .02 v �T� �—
To be built by of
in accordance with detailed information stated below.
Signed
(Applican
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
GENERAL INFORMATION
1 . Estimated population of premises (present) (future)
2. Description of premises (including number of bedrooms) ,LYai�f-
No. Fixtures
(Above basement): Water Closets Urinals Lavatories
Bath tubs Showers Kitchen Sinks Laundry Tubs
Garbage Grinder List basement fixtures
3. Water Supply pu 6�/ Kind of Well
(Public, well, spring, cistern)
Location of well and underground water piping
Method of obtaining or storing supply
(Pumps , tank, etc.)
4. Character of soil at proposed location of leaching system, including depths of
various strata _r d
(sand, loam, clay, hardp n, rock, etc. --Use test pits.)
5. Elevation of highest ground water ,
(with reference to both present & future grade)
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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_Alo . C Capacity below flow line J 7,S d
Inlet and outlet arrangements_
Facilities for cleaning Distance from dwellings on same
property 3s^ F�`— on adjoining property /i-
Automatic Dosing Apparatus , if any (describe)
Soil Absorption System
If cesspools , No. diameter ft.; depth below inlet ft.
If tile field or leaching trenches , total length is ��—o ft.
Width of trenches o2 o ft. , depth of broken stone or screened gravel J ft.
Stone or gravel will be covered byfi Distance between
(tar paper, salt hay)
trenches ft. Distance from water supply on same property
on adjoining property
Secondary Treatment, if other than soil absorption.
Describe in detail and locate on map
System was designed by `` /� L:, �1
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,