HomeMy WebLinkAbout1966-7-21 - 175 Clark Street - Septic Applicationf .�
TOWN OF SOUTH WI N DSOR �'Qj�`�fJ�/
BUILDING DEPARTMENT
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South Windsor, Connecticut
Application for Permit to Install or Repair Individual Sewage Disposal System
Application No. _
TO THE BUILDING DEPARTMENT: Date == r 19 i =
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 14 L- .& Cf. V,� j�r Address
of Owner � t- �-/rlr
2. Location of Property.rh /e f 75 04dft< `��'-�� Lot. No.
3. Type of Structure d c e- zV71
No. of Bedrooms .
(Dwelling, Commercial Building, Store, etc.)
4. Number of Families or Persons to Occupy Premises,
5. Plumbing Fixtures: Water Closets Urinals CJ Lavatories % Bathtubs
Showers (J , Kitchen Sinks_ Laundry Tubs_ Garbage Grinder 2, Other
6. Liquid Capacity of Septic Tank 1 D D Material of Septic Tank C /��' r•,, f
7. Soil Conditions: Type of Soil Maximum ground water table_
( d, Gravel, Clay, etc.)
8. If not served by public water supply: Distance from Owner's well f' %j-/ from adjacent wells f U
9. Distance to nearest water course, drainage ditch, storm drain or embanknient 7I'-
4
10. Percolation Tests: Time for 1" drop in soil test 11 lk� , /Y Classification of soil-
_ �
11. Minimum square feet of effective seepage area required
12. Leaching System: Number of trenches -3 LengthfS`-5-' ' .) Width 3e, Tutal
Other
Signature.:=(Licensed rnataIler)
(Sketch showing all minimum distances and other details required below)
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Permit Issued
19 By,
Installation Completed, Inspected and Approved 9, 1 19 Io L By