HomeMy WebLinkAboutSeptic New 360 Beelzebub Road TOWN OF SOUTH WI N DSOR "
BUILDING DEPARTMENT
South Windsor, Connecticut
Application for Permit to Install or Repair Individual Sewage Disposal System
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-3 �, 6 Application No.
TO THE BUILDING DEPARTMENT: Date
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 OwnerJ'�m� �c� f��G' Qi'
2. Location of Property ��� r .rc u Lot. No.
3. Type of Structure No. of Bedrooms
(Dwelling, mercial Building,S re,etc.)
4. Number of Families or Persons to Occupy Premises_ c2.
5. Plumbing Fixtures: Water Closets — Urinals L atories a! Bathtubs /'
Showers_ Kitchen SinksL Laundry Tubs Garbage Grinder Other
6. Liquid Capacity of Septic Tank Material of Septic Tank OV� cf/ c�7�_
7. Soil Conditions: Type of Soil Maximum ground water table
(Sand,Grav ,Clay,etc.)
8. If not served by public water supply: Distance from Owner's well 1✓�� from adjacent wells 2✓ l�'z
9. Distance to nearest water course, drainage ditch, storm drain or embankment
10. Percolation Tests: Time for 1" 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
'027
Other
Signature `z' 7`5 4�z:Z„
(Licensed In taller)
(Sketch showing all minimum distances and other details required below)
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Permit Issued 19 By
Installation Completed, Inspected and Approved 19 By