HomeMy WebLinkAboutSeptic New 35 Birch 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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Application No. V
TO THE BUILDING DEPARTMENT: Date._ . 19
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 a Address of Owner_
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2. Location of Property :A I Lot. No. a 04.
3. Type of Structure U it/&u,/ No. of Bedrooms
(Dwelling,commercial Building,Store,etc.)
4. Number of Families or Persons to Occupy Premises OU&
5. Plumbing Fixtures: Water Closets Urinals Lavatories_ Bathtubs
Showers Kitchen Sinks L ndry Tubs -� Garbage Grinder Other
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6. Liquid Capacity of Septic Tan O� b Material of Septic Tank
7. Soil Conditions: Type of Soil Maximum ground water table
(San ,Gravel,C y,etc.) MA� 6+�ItGtiC
8. If not served by public water supply: Distance from Owner's well Q from adjacent wells /'
9. Distance to nearest water course, drainage ditch, sto m rain or embankment
10. Percolation Tests: Time for 1" drop in soil te Classification of soil c G.0
11. Minimum square feet of effective seepage area required
12. Leaching System: Number of trenches / Length_ 10 Width Total
Other �� .Q r7 4 LinsedIr
_g Signaturf �edef (Licstaller)
32� (Sketch showing all minimum distances and other details required below) /
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4�
�Ld�ta.�. 14 i
Permit Issued 19 By
Installation Completed, Inspected and Approved 19 By