HomeMy WebLinkAboutSeptic New 175 Clark Street TOWN OF SOUTH
. W NDSOR �
BUILDING DEPARTMENT ��
South Windsor, Connecticut Gx v0
Application for Permit to Install or Repair Individual Sewage Disposal Syste
ip
Application No.
TO THE BUILDING DEPARTMENT: Date 9r
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 Address of Owner �_,��� �1�
2. Location of Property \_; /v1 !7S (,t,DrPi{ . `c7' Lot. No.
3. Type of Structure All e- !✓ram No. of Bedrooms_
(Dwelling, oinmerc ial Building,Store,etc.)
4. Number of Families or Persons to Occupy Premises
5. Plumbing Fixt-res: Water Closets � Urinals l Bathtubs
A Lavatories
Showers_Q_ Kitchen Sinks/ Laundry Tubs 4arbage Grinder !
--,� �_ Other
6. Liquid Capacity of Septic Tank f Z O d Material'of Septic Tank C: ��_� L �
7. Soil Conditions: Type of Soil -U.1 A(Q Ma�im�}m -ground water table "-
(Sand;Gravel,C1ay,etc.)
8. If not served by public water supply: Distance from Owner's wel_}L7 from adjacent well f Sy y
9. Distance to nearest wafer course, drainage ditch, storm drain or embankment
10. Percolation Tests': Time for V drop in soil test 3 i4 , /Y Classification of soil
11. Minimum square feet of effective seepage area required_
12. Leaching System: Number of trenches_ Length/,rj_ � 3 8 Width_ s9 'r Total
Other
Signature
(Licensed Installer)
(Sketch showing/all minimum distances and other details.required below)
Permit Issued 19 By
Installation Completed,Inspected and Approved a/ _19 By,
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