HomeMy WebLinkAbout1968-5-1 - 222 Graham Road - Septic ApplicationTOWN OF SOUTH W1 N DSOR 41?� a
BUILDING DEPARTMENT C
South Windsor, Connecticut 4-z
Application for Permit to Install or Repair Individual Sewage Disposal System _
Application No.��
TO THE BUILDING DEPARTMENT: Date Y � — lg
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 a% ] -z,atea Address of Owner_ Z� Z z-_� L; •r h a, .._ _
2. Location of Property, 2 w ��v a,��w. lc�= Lot. No.
3. Type of Structure. I -AD � � � � No. of Bedrooms
( Dwelling, Commercial Building, Store, etc.)
4. Number of Families or Persons to Occupy Premises—L.......
5. Plumbing Fixtures: Water Closets � Urinals L.avator[e.s_ J Bathtubs
Showers--/-- Kitchen Sinks Laundry Tubs Garbage Grinder — Other
6. Liquid Capacity of Septic Tank Q9o4n (--Y i iltlaterial 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 4% `�5 from adjacent wells
9. Distance to nearest water course, drainage ditch, storm drain or embankment % Cc f
10. Percolation Tests: Time for 1" drop in soil test Classification of soil
11. Minimum square feet of effective seepage area required
12. Leaching System: Number of trenches Length) Width �� Total �d
Other
Signature �r
11 Licensed Installe
(Sketch showing all minimum distances and other details required belo 1
Nerj
Permit Issued 19 By.
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Installation Completed, Inspected and Approved [x- /74A,�`_ lg 6
By.
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