HomeMy WebLinkAboutSeptic New 20 Palmer Drive FEE
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TO THE BUILDING DEPARTMENT Application No. `s
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TOWN OF SOUTH WINDSOR Date_�r�/�
I hereby apply for permit to build a sewage disposal system fora
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(Residence, boarding house , hotel , etc.)
Owned by of
And located at
To be built by (�y� of .
in accordance with detailed information stated below.
Signed �_� ,/
�' (Applicant)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
GENERAL INFORMATION
1 . Estimated population of premises (present) [;l (future)
2. Description of premises (including number of bedrooms) I.?
No. Fixtures
(Above basement): Water Closets_ Urinals Lavatories /
Bath tubs _Showers / Kitchen Sinks Laundry Tubs_
Garbage Grinder List basement fixtures
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3. Water Supply —�" G-P. I 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
(sand, loa clay , h rdpan, rock, etc. --Use test pits.)
5. Elevation of highest ground water 4A!6___
(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 c V A./ i Capacity below flow line F&-V
Inlet and outlet arrangements
Facilities for cleaning Distance from dwellings on same
property / 0 on adjoining property
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 ).P
Width of trenches _ft. , depth of broken stone or screened gravel
Stone or gravel will be covered by — Distance between
(tar paper, salt 139YK
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
Above information furnished by_ p� U
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.
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