HomeMy WebLinkAbout1968-1-22 - 154 Gray Road - Septic ApplicationTOWN OF SOUTH W I N DSOR
BUILDING DEPARTMENT
South Windsor, Connecticut
Application for Permit to Install or Repair Individual Sewage Disposal System
Application No.
TO THE BUILDING DEPARTMENT: Date. ,/ — . _ Z 19�F
A permit is requested for repair or construction of an individual sewage disposal system concerning which the
following information is su mitted: ..lai4 A.l C N ,
1. Owner of Propert Address of Owner rr��
2. Location of Propert .c 1S4 R/f ;?.W Lot. No.
3. Type of Structure No. of Bedrooms
(Dwelltng. Commercial Building, Store, eiF)
4. Number of Families or Persons to -Occupy Premises
5. Plumbing Fixtures: Water Closets ?— Urinals Lavatories 2—Bathtubs
Showers Kitchen Sinks Laundry Tubs Garbage Grinder Other
6. Liquid Capacity of Septic Tan Material of Septic TankPE'�i! _
7. Soil Conditions: Type of Soil Maximum ground water table
Sand, ravel, 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 c Classification of soil
11. Minimum square feet of effective seepagto
Number of trenches Length Width / Total
5ignatur
( Licensed Installer 1
(Sketch showing all minimum distances and other details required below)
12. Leaching System
Other
S C;voy iq�[J
Permit Issued_
. 19 By
Installation Completed, Inspected and Approved ^ _ _ _T . _19
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