HomeMy WebLinkAboutSeptic New 490 Buckland Road TOWN OF SOUTH WI N DSOR
BUILDING DEPARTMENT
South Windsor, Connecticut
Q Application for Permit to Install or Repair Individual Sewage Disposal System
Application No
TO THE BUILDING DEPARTMENT:
A permit is requested for repair or construction of an individual sewage disposal system concerning which the
following information is subm ted:
1. Owner of Pro, Address of Owner
2. Location of Property � Lot. No.
r
3. Type of Structure No. of Bedrooms
(Dwelling,Co m rcial Building,Sto ,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 Tank Material of Septic Tank Lam. .
7. Soil Conditions: Type of Soil Maximum ground water table
(Sand,Gravel,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
12. Leaching Syst tuber of trenches Lengths JWidth, 11 _Total
Other P DD �drff TE' �L� Td� �� Q/l /.. •
Signature v�G�'—L•� i^
(Licensed Installer)
(Sketch showing all minimum distances and other details required below)
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Vie
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Permit Issued 19 By
Installation Completed, Inspected and Approved 19 By