HomeMy WebLinkAboutSeptic Repair 18 Edgewood Drive TOWN OF SOUTH WI N DSOR
BUILDING DEPARTMENT '
South Windsor, Connecticut 7
Application for Permit to Install or epai Individual Sewage Disposal System
Application No. f
TO THE BUILDING DEPARTMENT: Date_ zzz 7 19 C
A permit is requested fo repai r construction of an individual sewage disposal system concerning which the
following information is submitted: /
1. Owner of Property Y tr Address of Owner Afz d z 'e'd • ` S
2. Location of Property ----Lot. No. .ZS
3. Type of Structure No. of Bedrooms
(Dwelling,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 .&I C° _ Material of Septic Tank
7. Soil Conditions: Type of Soil Maximum ground water table
(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 / 1 1"d Width Total -d
Other
Signature
(Licensed-Installer)
(Sketch showing all minimum distances and other details required below)
Permit Issued 19 By
Installation Completed, Inspected and Approved 19(� By
J
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CHECKED
SCALE
CERTIFIED SUCST.ANTIA.-_Y CC