HomeMy WebLinkAboutSeptic New 72 Brook Street TOWN OF SOUTH WINDSOR /C
�LC"e, jao BUILDING DEPARTMENT
C h p. South Windsor, Connecticut
Application for Permit to Install or Repair Individual Sewage Disposal System /i
Application No.
TO THE BUILDING DEPARTMENT: Date. �` G 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 Address of Owner 2- A,e.io a k x
2. Location of Property AV
Lot. No.
3. Type of Structure No. of Bedrooms
(Dwe ng, mmercial Building,Store,etc.)
4. Number of Families or Persons to Occupy Pr ices_��a'E�,1K�
5. Plumbing Fixtures: Water Closets Urinals_/' Lavatories / Bathtubs /
Showers - Kitchen Sinks Laundry Tubs Garbage Grinder Other
6. Liquid Capacity of Septic Tank �c��® Material of Septic Tank
,
7. Soil Conditions: Type of Soils ' Maximum ground water table
(Sand,Gravel,Clay,etc.)
8. If not served by public water supply: Distance from Owner's wel 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
Signature
(Licensed Installer
(Sketch showing all minimum distances and other details required below)
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Permit Issued 19 By
Installation Completed, Inspected and Approved 'Zo Z:!A9ec N 1966 By
s
/�'W OF dSD IJTh` �'t� i1/®5�1f
To help locate your sewer, connection on-the main line, please show .
Where you would like the connection by drawing:a line from the house or,
the septic tank to the main line in the street. Also, install stake in yard
to indicate line= as.showri-on sketch. IF you have,any_doubt please=:contact
the Town E rig inee'b ng7Department.
Please draw important information such as driveways, Large.trees
and other obstructions-
PLEASE MAIL THIS FORM IMMEDIATELY_TO.
- - DAMES S. MINGES & ASSOC., INC.
e Exchange
Farmington Avenue
Farrnington, Connecticut 06032
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