HomeMy WebLinkAboutSeptic Repair 70 Chapel Road ,�✓� .c«,�r TOWN OF SOUTH WI N DSOR �pF
rAf PA to BUILDING DEPARTMENT D ,
South Windsor, Connecticut 46'
Application for Permit to Install or Repair Individual Sewage Disposal System
Application No.
TO THE BUILDING DEPARTMENT: Date. — /d 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�l/icri'oLn-f i37?A AAQaTl/ Address of Owner 7cJ
2. Location of Property S"°1~ Lot. No.
3. Type of Structure / 10-✓✓5 ni/L ��'o S No. of Bedrooms
(Dwelling,Commercial Building,Store,etc.)
4. Number of Families or Persons to Occupy Premises_ '6
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
7. Soil Conditions: Type of Soil S fin.n Maximum ground water table
(Sand,Gravel,Clay,etc.) ,t
8. If not served by public water supply: Distance from Owner's well >° from adjacent wells -2
9. Distance to nearest water course, drainage ditch, storm drain or embankment
10. Percolation Tests: Time for 1" drop in soil test f " -3 - H.Classi8cation of soil
11. Minimum square feet of effective seepage area required .ate l-r>o A.,,12-
1
12. Leaching System: Number of trenches 2- Length Width 2-e 5" Total
Other
Signatur ct-" �
(ldcensedInstaller)
(Sketch showing all minimum distances and other details required below)
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Permit Issued 19-2-,�, By LE
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Installation Completed, Inspected and Approved — /-7/ 19 2d By �