HomeMy WebLinkAboutSeptic New 96 Chapel Road TOWN OF SOUTH WI N DSOR
BUILDING DEPARTMENT
South Windsor, Connecticut
Application for Permit to Install or Repair Individual Sewage Disposal System
Application No.
TO THE BUILDING DEPARTMENT: Date. /Z 19 C 5—
A permit is requested for r pairr,�ns,tuction of an individual sewage disposal system concerning which the
following information is submitted:
1. Owner of Property Address of Owner__/. yil��,_!�_
2. Location of Property z Lot. No. 14,
3. Type of Structure No. of Bedrooms `J
(Dwelling, mercial Building,Store,etc.)
4. Number of Families or Persons to Occupy Premises_
5. Plumbing Fixtures: Water Closets y Urinals Lava ories Bathtubs _
Showers Kitchen Sinks� Laundry Tubs Garbage Grinder Other
6. Liquid Capacity of Septic Tank__ 0�O d Material of Septic Tank
7. Soil Conditions: Type of Soil 14 �/ Maximum ground water table��,,o
(Band,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 U Classification of soil
11. Minimum square feet of effective seepage area required
12. Leaching System: Number of trenches Length Width Total
Other
Signature
( icensed Installer)
(Sketch showing all minimum distances and her details required below)
Permit Issued 19 By
Installation Completed, Inspected and Approved —19— By
7A,01AA
C?e��6tA/� %✓ '1'Ly.�'/^ � '� ~,Vs'NO.. ON
r \
:. ' a ✓ram
' :Y-_ '�- �/ C`<7�✓',fir/c��s'ii
Y ei,/ 6'1 7C Z 0 7c
'oAv 107
a
y yr os
v
QD
h�� I
_ a
{7 1
i