HomeMy WebLinkAboutSeptic Repair 75 Petersen Way TOWN OF SOUTH WI N DSOR
BUILDING DEPARTMENT
South Windsor, Connecticut
Application for Permit to Install or Repair Individual Sewage Disposal System
ej 5,,7,Application No.
TO THE BUILDING DEPARTMENT: Date g r 19 (n f
A permit is requested f repair or ons uction of an individual se a disposal system concerning which the
following information i t d
1. Owner of Prope an
of Owne
2. Location of Propert�y ,
Lot. No.
3. Type of Structure No. of Bedrooms
(Dwelling,Comm al Building,Store,etc.)
4. Number of Families or Persons to Occupy Premises_
5. Plumbing Fixtures: Water Closets Z- Urinals LavatoriehL Bathtubs /
Showers Kitchen Sinks / Laundry Tubs Garbage Grinder Other
6. Liquid Capacity of Septic Tank OOyd Material of Septic Tank , A9 Aw_
7. Soil Conditions: Type of Soil e/�(,)el Maximum ground water table
(Sand,G avel,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 Width Total
Other
Signature
(Licensed Installer)
(Sketch showing all minimum distances and other details required below)
Permit Issued 19 By
Installation Completed, Inspected and Approved !I eet'ct67T 19 By
PROPERTY
SURVEYED FOR
MARION L. SNOW
n
4
ELLINGTQN ROAD
,o s�
SOUTH WINDSO.R, CONN.
SCALE: 1 INCH = 50FEE.T MAY01964
I HEREBY CERTIFY THAT THIS MAP IS SUBSTANTIALLY CORRECT.
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