HomeMy WebLinkAbout1963-12-19 - 1101 John Fitch Boulevard - Septic ApplicationTOWN OF SOUTH WINDSOR
BUILDING DEPARTMENT
South Windsor,Connecticut
Application for Permit to Install or Repair Individual Sewage Disposal System#"‘MApplicationNo.
TO THE BUILDING DEPARTMENT:Date gjpQ /T 19 Cf
A permit is requested for repair or construction of an individual sewage disposal system concerning which the
following information is submitted:
Owner of P,rop rty 5%Vl/Z:gzé Address of Owner 637 WMZ/g /
Location
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of Prope
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zwvr‘xy an saw/f»g2“<7 Lot.No.
Type of Structure
/I((xii/a frigi?L dawiy a ér“No.of Bedroom
(Dwelling,Commercial Bulldmg,Store etc )
Number of Familles or Persons to Occupy Premlses /
Plumblng Flxtures:Water Closets Urlnals Lavatories 2 Bathtub
Showers Kitchen Sinks Laundry Tubs Garbage Grinder Other
Liquid Capacity of Septic Tan k
aximum ground water table 5 ¢Yt a
aterial of Septic Tanki 6
Soil Conditions:Type of Soi l
()Sand,Gravel,Clay,etc.
If not served by public water supply:Distance from Owner’s wel rom adjacent welllf s
D1stance to nearest water course drainage dltch storm drain or embankment
10.
11.Minimum square feet of effective seepage area required
12.
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Signature/’V‘r
Percolation Tests:Time for 1”drop in soil test .km .’Classmcatmn of s011 [’1’//
Leaching System:Number of trenches )7 Length K ‘2 T
Width a7 e5?“Total
Other
(Licensed Installer)-’
(Sketch showing all minimum distances and other details required below)
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Permit Issued 19 By
Installation Completed,Inspected and Approved r/‘<'-£JI'TY (5417Kk "C 19 4.,s By
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