HomeMy WebLinkAboutSeptic Repair 60 Ash Road TOWN OF SOUTH WI N DSOR '
BUILDING DEPARTMENT
South Windsor, Connecticut
Application for Permit to I Individual Sewage DisposaSystem
Application No. �/ /
TO THE BUILDING DEPARTMENT: Dater 19_�
A permit is requested for repair or construction of an individual sewagt disposal system concerning which the
following information is suubitted:
1. Owner of Property . 'f Address of Owner
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_
5. Plumbing Fixtures: Water Closets 3 Urinals Lavatories_ Bathtubs_
Showers_ Kitchen Sinks Laundry Tubs Garbage Grinder Other
6 Liquid Capacity of Septic Tank Z&tLl d Material of Septic Tank C-e r" C q
7. Soil Conditions: Type of Soil C I'a U Maximum ground water table �n
(Sand,_Gravel,Clay,etc.)
8. If not served by public water supply: Distance from Owner's well 2�- rom adjacent wells� U
9. Distance to nearest water course, drainage ditch, storm drain or embankment. -7'-- 1-�d,
10. Percolation Tests: Time for 1" drop in soil test �//�}�lYa �1 Classification of soil C-
11. Minimum square feet of effective seepage area required 12 O J /�� 1oQ
12. Leaching System: Number of trenches 3 Length A90 Width q Total
Other 6 r /A ( I 0-" aQ�,� .`
Si nature
g sed Installer)
(Sketch showing all minimum distances and other details required below)
Permit Issued 19 By
Installation Completed, Inspected and Approved 19 By
AGREEMENT
BOTH THE LICENSED INSTALLER AND THE INSPECTOR GARANTEE THE WORKMANSHIP
AND THE QUALITY OF THE•`MATERIALS USED IN THIS--JOB BUT DQ NOT-GARANTEE
THAT THIS SYSTEM WILL BE ADEQUATE" FOl THE' EXISTING SOIL=:AND USAGr. IT IS-
WITH THIS UNDERSTANDING THAT THIS AGREEMENT IS MADZI- BETWEEN THESE* THREE
PARTIES:
_ 00
HOME OWNER* ** -- - --
LICENSED INSTALLER**O* -
AD M WISNIEWSKI
INSPECTOR***------------------
.
1l.
IP _
DIrIANCa ; h0c°;6 -fn TAMA: 7a
?'oML Tb rAb. sQ Fr kPt-A
r E r c.A/
IV id
-
e '7101
Vk
f
3�
i
_ 1
IT
T 4- —A
�� E