HomeMy WebLinkAbout1966-6-10 - 21 Hollis Road - Septic ApplicationApplication for Permit
Application No.
TO THE BUILDING DEPARTMENT:Date \TLI/Vé l/6
A permit is requested for repair or construction of an individual sewage disposal system concerning which the
following information is submitted:
Owner of Property (age:yi C 4 §xv '1”Address of Owner 1//j/,\/A’\wr‘I
Location of Property D j ffa [:fl r /)/‘Lot.No.
Type of Structure ,/)o ,///,V—;:No.of Bedrooms V gr
Repair lndividual Sewage Disposal System
19 Q 6’
F sour IN s R f
BUILDING DEPARTMENT
South Windsor,Connecticut
4.
(Dwelling,Commercial Building,Store,etc.)
Number of Families or Persons to Occupy Premises yin éL c/o /€’a
Plumbing Fixtgres:Water Closets Urinals Lavatories Bathtubs g
Showers 1‘Kitchen Sinks g Laundry Tubs Garbage Grinder Other
Liquid Capacity or Septic Tank <3“?Material of Septic Tank,*IJ’Véc '/
Soil Conditions:Type of Soil \
If not served by public water supply:Distance from Owner’s well 7‘7jg/from adjacent wells 7L /J‘‘(V‘/
Distance to nearest water course,drainage ditch,storm drain or embankment 7L VKC"/
Percolation Tests:Time for 1"drop in soil test ‘2 I};{M I .Classification of soil ---
/W1 W)Maximum ground water table ~r81
(San'd,G'ravel,Clay,etc.)
10.
L
11.Minimum square feet of effective seepage area required
12.Leaching System:Number of trenches 'Length a.1'I "Width X /Total ¢bfxe /
Other
Slgnature K /,A.
(Licensed Installer)
(Sketch showing ail minimum distances and other details required below)
--test m $1;if}
l
Permit Issued 19 By-
Installation Completed,Inspected and Approved 19 By