HomeMy WebLinkAboutSeptic New 00 Ellington Road (2) j TOWN OF SOUTH WI N DSOR
BUILDING DEPARTMENT
South Windsor, Connecticut
Application for Permit to Install or Repair Individual Sewage Disposal System
Application No. Q l0
TO THE BUILDING DEPARTMENT: Date Id- ` 7 -6 19
A permit is requested for repair or construction of an individual sewage disposal system concerning which the
following information is submitted:
1. Owner of Property Address of Owner,
2. Location of Property Lot. No. �
3. Type of Structure -��� No. of Bedrooms 1
(Dwelling,commoccial Building,Store,etc.)
4. Number of Families or Persons to Occupy Premises_
5. Plumbing Fixtures: Water Closets Urinals La stories -7 Bathtubs._
Showers / Kitchen Sinks, Laundry Tubs Garbage Grinder Other
6. Liquid Capacity of Septic Tank ->c� Material of Septic Tank &n�
7. Soil Conditions: Type of Soil -----Maximum ground water table
and,Gr el,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 �'S � Classification of soil
11. Minimum square feet of effective seepage area required
12. Leaching System: Number of trenches Length A_::�d - Width _ Total d0
Other
Signature
(License In8 er)
(Sketch showing all minimum distances and other details uired below)
Permit Issued 19 By
Installation Completed, Inspected and Approved 19 By
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