HomeMy WebLinkAboutSeptic New 12 Palmer Drive FEE
TO THE BUILDING DEPARTMENT Application No. ���
TOWN OF SOUTH WINDSOR Date_ '//7/G
I hereby apply for permit to build a sewage disposal system for a
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(Residence , boarding house, hotel , etc.)
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Owned by of 1-2,g� cry.•
And located at �
To be built by 4.1 of
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in accordance with detailed information stated below.
Signed
(Applicant)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
GENERAL INFORMATION
1 , Estimated population of premises (present) (future)
2. Description of premises (including number of bedrooms)
No. Fixtures
(Above basement): Water Closets Urinals Lavatories
Bath tubs Showers _Kitchen Sinks�_Laundry Tubs /
Garbage Grinder List basement fixtures
3. Water Supply Kind of Well
(P lic, well, spring, cistern)
Location of well an 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, to , clay ardpan, roc etc. --Use test pits.)
5. Elevation of highest ground water �iy.,.�_
(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 yly 1z Capacity below flow line 9�
Inlet and outlet arrangements r
Facilities for cleaning ,- Distance from dwellings on same
property 4 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 190 ft.
Width of trenches_ _ft. , depth of broken stone or screened gravel -ft.
Stone or gravel will be covered by . Distance between
(tar paper, sa h
trenches ,� ft. Distance from water upply 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
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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Kerin(- t'a ra ;.m,r, :ice l.e I HI , Nov . 1 ) 1960 Hayden t .
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i hereby w ity this map to be
substantially correct and that no
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