HomeMy WebLinkAbout1971-3-1 - 10 Hayes Road - Septic ApplicationApplication for Permit to Install or Repair Individual Sewage Disposal System
Application No.¢¢
TO THE BUILDING DEPARTMENT:Date,a!M Age H 19 j]A permit is'requested for repair or construction of an individual sewage disposal system concerning which thefollowinginformationissubmitted:
1.Owner of Propert N.a b .i Address of Owner snM‘
2.Location of Property j.M‘s kg (u‘N‘R ”AVIS ¢§&#HkM)Lot.No.£08 (19:6)
3.Type of Structure No.of Bedrooms 3(Dwelling,Commercial Building,Store,etc.)
4.Number of Families or Persons to Occupy Premises t ‘l
5.Plumbing Fixtures:Water Closets Urinals Lavatories Bathtubs
Showers Kitchen Sinks Laundry Tubs Garbage Grinder Other
6.Liquid Capacity of Septic Tank Material of Septic Tank Re t1 a
7.Soil Conditions:Type of S011 ¢¢AV "E Maximum ground water tablea_y (Sand Gravel Clay,etc )
8.If not served by public water supply:Distance from Owner’s well from adjacent well
9.Distance to nearest water course,drainage ditch,storm drain or embankment
10.Percolation Tests:Time for 1”drop in soil test Classification of soi
11.Minimum square feet of effective seepage area required
12.Leaching System:Number of trenches Iggg Q2.)Length “g ¢f Width z.£51"Totan‘o cg ‘T
Other 9L0$IOX a we -coa€a.w‘
Signature v/l/4/V’741/v7‘i a [z g/
(Libensed4Q er)I “{(9-331019)Sketch showmg all minimum distances and at r detals requir d below
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TOWN OF SOUTH WINDSOR
BUILDI NG DEPARTMENT PU‘MIT‘3"..._..._—South Windsor,Connec ticut NA 7r°1-
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Permit Issued o MA c u 19 ‘7!By
Installation Completed,Inspected and Approved 02 MAdc H 19 7’y
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