HomeMy WebLinkAboutSeptic Repair 600 Ellington Road TOWN OF SOUTH WI N DSOR
BUILDING DEPARTMENT
(111 South Windsor, Connecticut
Application for Permit to Install o Re air Individual Sewage Disposal System
Application No.
TO THE BUILDING DEPARTMENT: Date 19 -&,Ors-,VA Q 19_�L
A permit is requested for re air r construction of an individual sewage disposal system concerning which the
following information is submitted:
1. Owner of Property R, Address of Owner 6tT-* ��tjsvlc�s./ cvg�
2. Location of Property Lot. No.
3. Type of Structure No. of Bedrooms
(Dwelling,Commercial Building,Store,etc.)
4. Number of Families or Persons to Occupy Premises_ (!VEcq)
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 SA ri b 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
i
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
Other_ Dp r"oK OF N1 w A44 wte t
Si nature
g
(Licensed Faller)
(Sketch showingall minimum distances and other �/C re o- eo 3Sy �v
ai s required below)
i
to�
9'
Permit Issued 19-4;iA1£"ASS-e- 1969 By
Installation Completed, Inspected and Approved_ 19 siodwovog&