HomeMy WebLinkAboutSeptic New 92 Mark Drive TOWN OF SOUTH WI N DSOR
BUILDING DEPARTMENT
South Windsor, Connecticut
Application for Permit to Install or Repair Individual Sewage Disposal System
E Application No. 7 -;r/7
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: �/ n
1. Owner of Property/i/ Q�-� gme4"l—aw. Address of Owner_
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2. Location of Property -Z / Lot. No. J 6
3. Type of Structure /a� No. of Bedrooms
welling,Commercial Building,Store,etc.)
4. Number of Families or Persons to Occupy Premises_
5. Plumbing Fixtures: Water Closets_t Urinals Lavatories a Bathtubs
Showers _ Kitchen Sinks, Laundry Tubs 4 Garbage Grinder d Other
6. Liquid Capacity of Septic Tank l Material of Septic Tank��n
7. Soil Conditions: Type of Soil Maximum ground water table
(Sa ,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 A
11. Minimum square feet of effective seepage area required 1-�7---5'- ,
12. Leaching System: Number of trenches Length Width 3'a 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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GRAiAA -3T. T L S ;E TF,N MEDALLiCN HOMES. INC.
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I HEREBY CERTIFY �' —�elotG'�
THIS PLAN TO BE ENGINEERING AND LAND SURVEYING
SUBSTANTIALLY
CORRECT; 740 NO. MAIN STREET, CROSSROADS PLAZA
NO. 3732 WEST HARTFORD 7. CONNECTICUT
�4ti GISTEVto p� SCALE DATE REVISED D W
O SURVE
I0j7163 6335
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