HomeMy WebLinkAbout1967-6-5 - 116 Buckland Road - Septic ApplicationTOWN OF SOUTH WINDSOR
BUILDING DEPARTMENT t'�
South Windsor, Connecticut IYA
Application for Permit to Tolffiffioliaw Repair Individual Sewage Disposal System -
4 % r LP Application No.
TO THE BUILDING DEPARTMENT: I f
A permit is requested for repair or construction of an individual sewage disposal system concerning which the
following information is submitted:
1. Owner of Property &Z_Z Address of Owner ;—
2. Location of Property( t// , _ _._ _ Lot. No.
3. Type of Structure ,�� 1� � I�� Q gt No. of Bedrooms_ _
( Dwoullng, commercial Building. Store, etc.)
4. Number of Families or Persons to Occupy Premises` - _
5. Plumbing Fixtures: Water Closets 9 Urinals,_ _ 4vatorles�-1,_ Bathtubs --_?
Showers_ Kitchen Sinks__ __J Laundry Tubs_ Garbage Grinder_ Other❑
r 6. Liquid Capacity of Septic Tank _ off! 4 o Material of Septic Tank �?
7. Soil Conditions: Type of Soil Maximum ground water table -
( and, Gravel. Clay, etc.) J
8. If not served b / y public water supply: Distance from Owners well %� U from adjacent wells
9. Distance to nearest water course, drainage ditch, storm drain or embankment_ �4 A
10. Percolation Tests: Time for 1" drop in soil test 3 &21 &_4 Classification of soil, A-
ll. Minimum square feet of effective seepage area required
12. Leaching System: Number of trenches % Length $' Wid Total
Other
Signature-z"'Alb I 40,u UN a
[ erase stellar)
(Sketch showing all minimum distances and other details required below)
Permit Issued 19 By,
Installation Completed, Inspected and Approved DS" !MAl,F- 19-A7 By
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