HomeMy WebLinkAboutSeptic Repair 220 Avery Street fe e-
TOWN OF SOUTH WINDSOR uke
BUILDING DEPARTMENT
South Windsor, Connecticut
Application 'for Permit to Install or Repair Individual Sewage Disposal System
Application No. ,
TO THE BUILDING DEPARTMENT: Date. '� C , __19Ze
A permit is requested for repair or construction of an individual sewage disposal system concerning which the
following information is submitted:
1. Owner of Property S e a Address of Owner 2;,, . o&/L cr
2. Location of Property _& Lot. No.
3. Type of Structure No. of Bedrooms
(Dwelling,Commercial Building,Store,etc.) (s
4. Number of Familie or Persons to Occupy Premises 0��
5. Plumbing Fixt s: W er Closet- Urinals Lavatories Bat a
Showers Kitc n Sinks d T s a age Gri er
6. Liquid Cap ity o a ria Septic T ,
7. Soil Conditio T e of Soil Maximum ground water table
(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, storm drain or embankment
10. Percolation Tests: Time for l" drop in soil test Classification of soil
11. Minimum square feet of effective seepage area required
12. . Leaching System: Number of trenches Length Width Total
Other L Ltf t `
Signature C
Licensed Installer)
(Sketch showing all minimum distances and other details required below)
G
Permit Issued 19 By
Installation Completed, Inspected and Approved 19 By