HomeMy WebLinkAboutSeptic Repair 115 71000115 TOWN OF SOUTH WI N DSOR
BUILDING DEPARTMENT
South Windsor, Connecticut
Application for Permit to 4410MW Repair Individual Sewage Disposal System
�14 Application No.
TO THE BUILDING DEPARTMENT: Date 19
A permit is requested for repair or construction of an individual sewage dispo 1 system concerning which the
following information is submitted: l
1. Owner of Property a Address of Owner�f�/ ����y�f AV rm,,r d J
2. Location of Property Lot. No.
3. Type of Structure i." IZ4 '6/' No. of Bedrooms_
(Dwelling,Commercial Building,Store,/etc.)
4. Number of Families or Persons to Occupy Premises_
5. Plumbing Fixtures: Water Closets Urinals0_ Lavatories 2 Bathtubs /
Showers _' _ Kitchen Sinks Laundry Tubs C-�' Garbage Grinder !')_ Other__ ,d
6. Liquid Capacity of Septic Tank Material of Septic Tan ,C
7. Soil Conditions: Type of Soil Maximum ground water table_ .-
(Azand,Gravel, lay,etc.) -Tc
8. If not served by public water supply: Distance from Owner's well f— from adjacent wells/
9. Distance to nearest water course, drainage ditch, storm drain or embankment__ /7 f-
10. Percolation Tests: Time for 1" drop in soil test A'l I4n Classification of soil
11. Minimum square feet of effective seepage area required
12. Leaching System: Number of trenches Length k e f Width Z 4L� _ Total a?)n �ZR
Other
Signature
(Licensed Installer)
(Sketch showing all minimum distances and other details required below)
AM, tr=t
1•c�ce Gr4 ce
-�{vL)s e
Permit Issued 19 y
Installation Completed, Inspected and Approved 19 By