HomeMy WebLinkAboutSeptic New 55 Ann Road (��-c fret 5 3 d _ .
TOWN OF SOUTH WI N DSOR ,
BUILDING DEPARTMENTJr' �yJ
South Windsor, Connecticut
Application for Permit to Install or Repair Individual Sewage Disposal System
Application o.
TO THE BUILDING DEPARTMENT: Date 0�ti lg
A permit is requested for repair or construction of an individual sewage disposal system concerning which the
following information is submitted:
1. Owner of Propertyy ddress of Owner_ /T/�/fi�
2. Location of Property / Lot. No.
3. Type of Structure No. of Bedrooms
(Dwelling,Commercial Building,Store,etc.)
4. Number of Families or Persons to Occupy Premises I &S.4 Al.r,
5. Plumbing Fixtures: Water Closets Urinals Lavatories / Bathtubs _
Showers Kitchen Sinks__ Laundry Tubs'—" Garbage Grinder a..-- Other_
6. Liquid Capacity of Septic Tank �//5,,1,,1 0 if L.. Material of Septic Tank l=.U k C ��'-
7. Soil Conditions: Type of Soil /7l�'� �"� -�f Maximum ground water table 4f
(Sand,Gravel,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, stoy m in or embankment
10. Percolation Tests: Time for 1" drop in soil test ' dr e Classification of soil Tllf�
11. Minimum square feet of effective seepage area required
12. Leaching System: Number of trenches— Length �_ Width .� :� Total
Olt
Other. C G 4- !• 6 �T
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Signature
icensed Installer
(Sketch showing all minimum distances and other details required below)
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Permit Issued 19 By
Installation Completed, Inspected and Approved 19 66 By
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