HomeMy WebLinkAboutSeptic New 1023 Avery Street rep�TOWN OF SOUTH WINDSOR
BUILDING DEPARTMENT d
South Windsor, Connecticut oZ
Application for Permit to Install or Repair Individual Sewage Disposal System 9 �
Application No.
TO THE BUILDING DEPARTMENT: Date 19 y y
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 Address of Owner -
2. Location of Property_ Lot. No T
3. Type of Structure No. of Bedrooms_
(Dwellin ommercial Building,Store,etc.)
4. Number of Families or Persons to Occupy Premises_
5. Plumbing Fixtures: Water Closets Urinals 0, Lavatories_ Bathtubs
Showers— Kitchen Sinks Laundry Tubs_g Garbage Grinder d Other
8., Liquid Capacity of Septic Tank Material of Septic Tank f
7. Soil Conditions: Type of Soil Maximum ground water table_ �//
(Sand,Gravel,Clay,etc.) A�
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 V drop in soil test Classification of soil_ / +
11. Minimum square feet of effective seepage area required
12. Leaching System: Number of trenches_ Length "f(.f Width cad Total ��
Other
Signature
(L Ceriaed Inataller)
x
(Sketch showing all minimum distances and her details required below)
t
sly
y9'— ,
c�
L-------------
3q 9
Permit Issued 19 By
Installation Completed, Inspected and Approved 19� By