HomeMy WebLinkAbout19770-6-4 - 112 Gray Road - Septic Application'p"'' TOWN OF SOUTH WI N DSOR Aw&.,,T
BUILDING DEPARTMENT A1414
South Windsor, Connecticut
Application for Permit to Install or Repair Individual Sewage Disposal System
Application No. O &OV ?O —'s.
TO THE BUILDING DEPARTMENT: Date 40V •l"a4r 19714_
A permit is requested for repair or construction of an individual sewage disposal system concerning which the
following information is submitted
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1. Owner of Property_ _ Address of Owner
2. Location of Property -1 1 A% C._+! gm&b �#r 3 Lot. No. �p
3. Type of Structure Wz t/. es No. of Bedrooms_ .3
(Dwelling, Commercial Building, Stare, etc.)
4. Number of Families or Persons to Occupy Premises OAfir_tIj_ �^,r/.+�►tV
5. Plumbing Fixtures: Water Closets Urinals Lavatories Bathtubs
Showers Kitchen Sinks Laundry Tubs Garbage Grinder Other
6. Liquid Capacity of Septic Tank Awl* !944 t a r4 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 A4(Al" C. 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 4VM1#%far.3 Classification of soil
11. Minimum square feet of effective seepage area requiredlLrFT AFA Asa isTOrAAL 6 I./firi9
12, Leaching System: Number of trenche s-10AAF* ill LengthA01 Fr Width .?.S 97 Total 907. 95l pT.
Other r• A A S~fttA1i Y Owl S �wZJT sal
r Signature , 7
QQ { Lice ed Installer )
(Sketch showing all minimum distances and oth�r�T#tiTs+req RrdI w
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Permit Issued 04j/ T ,4E 19 9.0 By
_,tallation Completed, Inspected and Approved tgo XaMF 197_ By.
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TOWN OF SOUTH WINDSOR
TOWN HALL
SOUTH WINDSOR, CONN. 06074
DEPARTMENT POLLUTION CONTROL
Date
The Sanitary Sewer . Septic System
at .
or lot # ...:= `......... has been installed and completed
in accordance with the Town of South Windsor ordinances
and regulations.
Accepted and Approved
By _ Date