HomeMy WebLinkAboutSeptic New 0000 Chapel Road (2) -TOWN OF SOUTH WI N DSOR
BUILDING DEPARTMENT
South Windsor, Connecticut
Application for Permit to Install or Repair Individual Sewage Disposal System Y-!?S
�VO 4)b� e�5 Application No.
TO THE BUILDING DEPARTMENT: Date i z i q jgth�
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"N�1i fka- lZe'e 1 0 Address of Owner
2. Location of Property Clij,�e s�=C�'- Lot. No.
3. Type of StructureNo. of Bedrooms
(Dwelling,Commercial Building,Store,etc.)
4. Number of Families or Persons to Occupy Premises_
5. Plumbing Fixtures: Water Closets Urinals 1 Lavatories _ Bathtubs
Showers Kitchen Sinks Laundry Tubs Garbage Grinder Other
6. Liquid Capacity of Septic Tank Material of Septic Tank-C. ,x ,
7. Soil Conditions: Type of Soil S�wb/ Maximum ground water table
(Sand,Gravel,Clay,etc.)
8. If not served by public water supply: Distance from Owner's well from adjacent wells RWI,c
9. Distance to nearest water course, drainage ditch, storm drain or embankment
10. Percolation Tests: Time for V drop in soil test Classification of soil
11. Minimum square feet of effective seepage area required
12. Leaching System: Number of trenches L gt Width Total
Other r )
Signature
censed Installer)
(Sketch showing all minimum distances and other details required below)
\ 19 By
�pleted, Inspected and Approved 19 By