HomeMy WebLinkAboutSeptic Repair 7 Deming Street �=At
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TOWN OF SOUTH WINDSOR
�CJ 7 g-:7 BUILDING DEPARTMENT
South Windsor, Connecticut
Application for Permit to Install or Repair Individual Sewage Disposal System
Application No.
TO THE BUILDING DEPARTMENT: Date-- L, T� 19
A permit is requested for repair or construction of an individual sewage disposal system concerning which the
following information is submitted: �j
1. Owner of Property, i�0 A/ /�l ��� � & Address of Owner /'�_ ' / bt &14 6 �T
2. Location of Property_ 1+/if 15— Lot. No. $�
3. Type of Structure WELL/ /1 No. of Bedrooms
(Dwelling,Commercial Building,Store,etc.)
4. Number of Families or Persons to Occupy Premises_l 1al NG— FA&/L T f�
5. Plumbing Fixtures: Water Closets Urinals Lavatories Bathtubs
Showers Kitchen Sinks Laundry Tubs Garbage Grinder Other
6. Liquid Capacity of Tank Material of Septic Tank L
7. Soil Conditions: Type of Soil r— TL LC ( 4Y Maximum ground water table
(Sand,Gravel,Cyay,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 4, eer AaAl Classification of soil C `
11. Minimum square feet of effective seepage area required C E ®Al
s� l
12. Leaching Sys em S Numb of trenches; Length d' . Width Total
Other KX X `� ���SOGGL �'D,� �Te�13L aC K—C'O'RW, Al qo .
Signature
(Licensed Installer)
(Sketch showing all minimum distances and other details required below)
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Permit Issued 19 By
Installation Completed, Inspected and Approved 19 By