HomeMy WebLinkAboutMisc Repair 911 Avery Street Y0-6T
OWN OF SOUTH WI N DSOR
BUILDING DEPARTMENT
South Windsor, Connecticut
Application for Permit to Install or Repair Individual Sewage Disposal S em
Application No.
TO THE BUILDING DEPARTMENT: Date_�`7—/17-1^ 1
A permit is requested for repair or construction of an individual sewage disposal system concerning whi the
following information is submitted,l l�
=g 1. Owner of Property ��11/V l�(//4R-1t!:Z],, Address of Owner
2. Location of Property Lot. No.
3. Type of Structure (44 No. of Bedrooms_
{T (Dwelling,Commercial Building,Store,etc.)
4. Number of Families or Persons to Occupy Premisesma-
5. Plumbing Fi tures: Water Closets Urinals "' Lavatories Bathtubs
Showers Kitchen Sinks�Laundry Tubs �0#ffabZge Grinder Other
6. Liquid Capacity of Septic Tanks - Material of Septic Tank
7. Soil Conditions: Type of Soil ('1 , r ve,ci441,e ,) Maximum ground water tableWnd `
8. If not served by public water supply: Distance from Owner's wel from adjacent wells �
9. Distance to nearest water course, drainage ditch, s rm drain or embankment Ca ?
10. Percolation Tests: Time for 1" drop in soil test as fiDio oil
11. Minimum square feet of effective seepage area r ui
12. Leaching System:
Number of trenches gth Width Total
Other t-GC n �� iF� �Z C �` L
R
h
Signature a
AWLItensed Installer)
(Sketch showing all minimum distances and other details required below)
�rl
LCIC
��-"r`�► �t SSG��i_ ,
s�o^
a Ufa )Q r�
Pef*lit Issued 19 By
Installation Completed,Inspected and Approved:/`7V �FPr���R�sv_ 19 67 By