HomeMy WebLinkAboutPublic Health New 620 Avery Street lme;l
TOWN OF SOUTH WI N DSOR ee44d
BUILDING DEPARTMENT
South Windsor, Connecticut
Application for Permit to Install or Repair Individual Sewage Disposal System
Application No. 16
TO THE BUILDING DEPARTMENT: Date�C 19
A permit is requested for repair or construction of an individual sewage disposal system oncerning which the
following information is M submitted: (�
1. Owner of Property,, !S. 90 GE f- J _W�ddress of Owner__L����Y
2. Location of Property J , Lot. No.
3. Type of Structure D U/ LL�IV No. of Bedrooms_
Dwelling,Commercial Building,Store,etc.)
4. Number of Families or Persons to Occupy Premises t 2 jE ,EAJU 1L
5. Plumbing Fixtures: Water Closets Urinals Lavatories f Bathtubs _
Showers_ Kitchen Sinks_ Laundry Tubs Garbage Grinder Other
6 Liquid Capacity of Septic Tank Material of Septic Tank Per. L
7. Soil Conditions: Type of Soil Maximum ground water table T i
4I-Sahli,Gravel,Clay,etc.)
8. If not served by public water supply: Distance from Owner's well 1'/Efrom adjacent wells
9. Distance to nearest water course, drainage ditch, storm drain or embankment tv r) N f
10. Percolation Tests: Time for 1" drop in soil test Ad @ rre ll/ Classification of soil le=A Y
.11. Minimum square feet of effective seepage area required r� c1
12. Leaching System: Number of trenches � Length Width 'J7 Total'
a
Other V)U �— 40 e O f�'GO L 1 1)
X
Signature G
Licensed Install )
(Sketch showing all minimum distances and other details required below)
Permit Issued 19 By q
Installation Completed, Inspected and Approved 19 By t