HomeMy WebLinkAbout1962-5-11 - 121 Bourbon Street - Septic ApplicationFEE
TO THE BUILDING DEPARTMENT Application No. -��
TOWN OF SOUTH W,INDSOR Date
I hereby apply for permit to build a sewage disposal system for a
_
(Residence, boarding house, hotel, etc.)
Owned by 4f' of V 7 o* 7' 1o#
And located at-A� a �s 0�
�-- �---
To be built by^T� r~- of A 59! 'zA-w *J*ye.f ANA di
in accordance with detailed information stated below.
Signed
(Applicant)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
GENERAL INFQ.RMA' ION
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___Z_Kitchen Sinks I Laundry Tubs _ AyE
Garbage Grinder ,4,,0,&,E-List basement fixtures
3. Water Supply_ _ Kind of Well ,�}� f4- r lei
(Public, well , spring, cistern)
Location of well and underground water piping . ;" . tf �'ips�iri a rear
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, loam, clay, hardpan, rock, etc. --Use test pits.)
5. Elevation of highest ground water
(with reference to both present & future grade)
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 Capacity below flow line
Inlet and outlet arrangements
Facilities for cleaning Distance from dwellings on same
OrM
property /„ 10 , on adjoining property
Automatic Dosing Apparatus, if any (describe)
Soil Absorption S stci»
If cesspools, No. ; diameter ft.; depth below inlet ft.
If tile field or leaching trenches , total length is {eft.
Width of trenches ft. ,depth of broken stone or screened gravel__ / ft.
Stone or gravel will be covered by �r,,�„� A Z 7' . Distance between
(tar paper, salt hay)
trenches._ /2 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 .
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.
4121 1pelolaenw 0—
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