HomeMy WebLinkAboutSeptic New 85 Birch Road TOWN OF SOUTH WI N DSOR
BUILDING DEPARTMENT
South Windsor, Connecticut
Application for Permit to Install or Repair Individual Sewage Disposal System tea.
Application. o.
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TO THE BUILDING DEPARTMENT: D 19 <<
A permit is requested for repair or construction of an individual sewage disposal system concerning which the
following information is submit d: ;`,*fW A-, �y�►i�'1�0�
1. Owner of Property Address of Owner__
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2. Location of Property Lot. No.
3. Type of Structure No. of Bedrooms 3
( ,Commercial Building,Store,etc.)
4. Number of Families or Pels'ons to Occupy Premises_ 41
5. Plumbing Fixtures: Water Closets / Urinals / Lavatories / Bathtubs
Showers Kitchen Sinks Laundry Tubs Garbage Grinder Other
6. Liquid Capacity of Septic Tank S-a Material of Septic Tank
7. Soil Conditions: Type of Soil T . Maximum ground water table
(Band,Gravel,Clay,et
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 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
Other 2 r� "f lb -F i o .f Fr
Signature Zl(//,
(Licensed Installer)
(Sketch showing all minimum distances and other details required below)
Permit Issued 19 By
Installation Completed, Inspected and Approved d/A1oV---1L1,l9L 1964, By
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