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TOWN 0 SOUTH WI N DSOR �?, •
BUILDING DEPARTMENT
South Windsor, Connecticut
Application for Permit to Install or Repair Individual Sewage Disposal System-*//�.
7
Application No.
TO THE BUILDING DEPARTMENT: Date -1 ^ Z7 19 4y
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 �L" Address of Owner
2. Location of Property LC[f .2/A Lot. No. 5�
3. Type of Structure- �� G�� _ No. of Bedrooms
welling,Commercial Building,Store,etc.)
4. Number of Families or Persons to Occupy Premises_
5. Plumbing Fixtures: Water Closets � Urinals Lavatories Bathtubs
Showers_ Kitchen Sinks/ Laundry Tubs Garbage Grinder Other
6. Liquid Capacity of Septic Tan Material of Septic Tank �-
7. Soil Conditions: Type of Soil Maximum ground water table
(Sand, ravel,Clay,etc.)
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 p G
12. Leaching System: Number of trenches Length Zr Width Total O
Other
Signature
(Licensed Installer)
(Sketch showing all minimum distances and other details required below)
Permit Issued 19 By
Installation Completed, Inspected and Approved 19 By
I` 151
/501
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LOT #151, "BIRCH HILL ESTATES", SECTION #7
TOWN OF SOUTH WINDSOR, CONNECTICUT ®�
SCALE: 1" 4o'
;�' ., �,; � `' -: . . .r•. . L.S. # 4395 :#
Rockville, Conn .
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