HomeMy WebLinkAboutDaycare New 2273 Ellington Road "i TOWN OF SOUTH WINDSOR
BUILDING DEPARTMENT
South Windsor, Connecticut 's
Application for Permit to Install or Repair Individual Sewage Disposal System
Application No
TO THE BUILDING DEPARTMENT: Date 19
A permit is requested for repair or construction of an individual sewage
following information is submitted: disposal system concerning which the
1. Owner of Property L � Address of Owner t-
2. Location of Property Lot. No.
3. Type of Structure
(Dwelling,Commercial Building,Store,etc.) NO. Of Bedrooms
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 C4Maximum ground water table
(sand,Gravel, 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
r� 10. Percolation Tests: Time for 1" drop in soil test Classification of soil
11. Minimum square feet of effective seepage area required
� l
12. Leaching System: Number of trenches Length Width_ Total_ 3
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