HomeMy WebLinkAboutSeptic New 00 Clark Street (2) -�- ` 0 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 ,Jd / e 19 C Y,
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 r.� �i, �a i � � Address of Owner 4 yyzld - hm-
2. Location of Property —Lot. No.
3. Type of Structure ca Ham/ s No. of Bedrooms--,?—
(Divelling,Commercial Building,Store,etc.)
4. Number of Families or Persons to Occupy Premises_
5. Plumbing Fixtures: Water Closets Urinals Lavatories_ Bathtubs_
Showers Kitchen Sinks_ Laundry Tubs_ Garbage Grinder Other
6. Liquid Capacity of Septic Tank Material of Septic Tank
7. Soil Conditions: Type of Soil ri5?.6r cl A l/ Maximum ground water table
(Sand,Gravel,Clay,etc.)
8. If not served by public water supply: Distance from Owner's well 71J from adjacent wells 7-r�
9. Distance to nearest water course, drainage ditch, storm drain or embankment f 7 4 v zzu+ t 1.
10. Percolation Tests: Time for 1" drop in soil test / ea Classification of soil !!Ll _ a
11.- Minimum square feet of effective seepage area required ? 7U
12. Leaching System: Number of trenches o2 Length WidthiC/ Total
Other /
Signature 0, �- -�(
",7 ��r ✓
(Licensed Installer) /
(Sketch showing all minimum distances and other details required below)
I
Permit Issued 19 By
Installation Completed, Inspected and Approved 19 By
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