HomeMy WebLinkAboutSeptic Repair 255 Avery Street - - TOWN OF SOUTH SO I D R 0 W N
BUILDING DEPARTMENT
South Windsor, Connecticut
Application for Permit to Install or Repair Individual Sewage Disposal System
Application No.
TO THE BUILDING DEPARTMENT: Date. 51! d_� 19
A permit is requested for repair or construction of an individual sewage disposal system concerning which the
following information is submitted: '2 rL? D
1. Owner of Property v P / l/ dress of Owner
2. Location of Property. 12 Lot. No.
3. Type of Structure I JAI 44 No. of Bedrooms
(Dwelling,Commercial Building,S��)
4. Number of Families or Persons to Occupy Premises ��✓��
5. Plumbing ixtures: Water Closets__ Urinals Lavatories_ Bathtubs_
Showers Kitchen Sinks Laundry Tubs Garbage Grinder Other 4,&46FA-
6. Liquid Capacity of Septic Tank 4r6"C� Material of Septic Tank C'Ck' �C-- g---`
7. Soil Conditions: Type of Soil e 4n ` 1�[G (i��CI�-V EL Maximum ground water table
(Sand, avel,Clay,etc.)
8. If not served by public water supply: Distance from Owner's well from adjacent wells y c tf-T
I
9. Distance to nearest water course, drainage ditch, st rm d am or
embankment
10. Percolation Tests: Time for 1" drop in soil test C 0 Classification of soil
11. Minimum square feet of effective seepage area required
12. Leaching System: Number of trenches r� Length Width Total
Other
a
Signature
lensed Ins a er)
(Sketch showing all minimum distances and other details required below)
At
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Permit Issued 19 By
Installation Completed, Inspected and Approved 19 By