HomeMy WebLinkAbout1967-3-2 - 1700 Ellington Road - Septic ApplicationTOWN OF SOUTH WI N DSOR �f
BUILDING DEPARTMENT4��%I
South Windsor, Connecticut• ZV
Application for Permit to Install or Repair Individual Sewage Disposal Systemf
Application No. r ��
TO THE BUILDING DEPARTMENT: Date
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_ _ _ Address of Owner �` : /, —
2. Location of Prop
3. Type of Structur
,ot. No.
of ]Bedrooms_
4. Number of Families or Persons to Occupy Premises
5. Plumbing Fixtures: Water Closets Urinals Lavatories_] Bathtubs
Showers L f_ Kitchen Sinks0 Laundry Tubs r--�Garbage Grinder !-- Other �!
6. Liquid Capacity of Septic Tank -XI `Al-e Material of Septic Tank_
7. Soil Conditions: Type of Soil Maximum ground water table
(Sand, Gravel, Clay, etc.)
8. If not served by public water supply: Distance from Owner's well from adjacent wells
9. Distance to nearest water course, drainage ditch, storm drain or embankment
10. Percolation Tests: Time for 1" drop in soil test -Classification of soil
11. Minimum square feet of effective seepage area re aired
12. Leaching System: Number of trenches Length Widt Total
Other
Signature �
icensed Ingtallcr}
(Sketch showing all minimum distances an other details required below)
Permit Issued 19 By
Installation Completed, Inspected and Approved 19 By
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