HomeMy WebLinkAboutSeptic New 54 Cliffwood Drive TOWN OF SOUTH WI N DSOR
BUILDING DEPARTMENT
South Windsor, Connecticut
Application for Permit to Install or Repair Individual Sewage Disposal System/
Application No. w
TO THE BUILDING DEPARTMENT: Date
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 Owneroe, �
2. Location of Property Lot. No. tl�
3. Type of Structure No. of Bedrooms
(Dwellin ommercial Building,Store,etc.)
4. Number of Families or Persons to Occupy Pre ises_
5. Plumbing Fixtures: Water Closets 7/ Urinals La tories Bathtubs
Showers t Kitchen Sinks Laundry Tubs Garbage Grinder Other
6. Liquid Capacity of Septic Tank /40 o O® Material of Septic Tank
7. Soil Conditions: Type of Soil Maximum ground water table
—T(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 Length Width Total �j+
Other Q� Z A. 0 mil/Q �C!
Signature
(Licensed Installer)
(Sketch showing all minimum distances and Cher details required low)
Permit Issued 19 By
Installation Completed, Inspected and Approved 19 By,
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