HomeMy WebLinkAboutSeptic Repair 60 Chapel Road A
(raE PAID 'ex TOWN OF SOUTH WI N DSOR p� �
y BUILDING DEPARTMENT
South Windsor, Connecticut /►�v,`71—/ 7
Application for Permit to Install or Repair Individual Sewage Disposal System
Application No. ®417 7/-/
TO THE BUILDING DEPARTMENT: Date_ y7 Av..,,s- 19 7/
A permit is requested fo(repair construction of an individual sewage disposal system concerning which the
following information is submitted:
1. Owner of PropertyA,414 /20 Address of Owner gQ CAV, �v ib
2. Location of Property �Aal6 Lot. No.
3. Type of Structure -1W E'-"'t G No. of Bedrooms
' (Dwelling,Commercial Building,Store,etc.)
4. Number of Families or Persons to Occupy Premises-r'wo C z) IGAMW C.S
5. Plumbing Fixtures: Water Closets Urinals Lavatories Bathtubs
Showers Kitchen Sinks Laundry Tubs Garbage Grinder Other
6. Liquid Capacity of Septic Tank G.1V,1r1A3 i, Material of Septic Tank C 6AC$2E74!!5-
7. Soil Conditions: Type of Soil !Znoa'D 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 System: Number of trenches_ uyaCt -- Length LSS FT Width X•SFT Total-3 . T
Other
Signature
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(L ricense n er) lC�
ere�beT 19-
(Sketch showing all minimum distances and other a ails ul ow
Permit Issued I7 AVA, 19 7/ By
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Installation Completed, Inspected and Approved ` 6 oe/L 19
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