HomeMy WebLinkAboutSeptic Repair 156 Farnham Road p�
,?y,Z 93 O TOWN OF SOUTH WI N DSOR
al F fd BUILDING DEPARTMENT
Al 970 South Windsor, Connecticut
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 disposal system concerning which the
following information is submitted: /
1. Owner of Property — LL Address of Owner
2. Location of Property >.g-tt E Lot. No.
3. Type of Structure / Lf.��'GC,//r/� No. of Bedrooms
(Dwelling,Commercial Building,Store,etc.)
4. Number of Families or Persons to Occupy Premises_ A/r—
5. Plumbing Fixtures: Water Closets
,•' Urinals Lavatories / Bathtubs___L___
Showers�� Kitchen Sinks ! Laundry Tubs_Z Garbage Grinder Other
6. Liquid Capacity of Septic Tank_7 5 Cl Material of Septic Tank xJC
7. Soil Conditions: Type of Soil �/¢�/' 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
10. Percolation Tests: Time for 1" drop in soil test Classification of soil
11. Minimum square feet of effective seepage area required 70, ;r-
12. Leaching System: Number of trenches Length Width Total
Other
Signature
(Ed-myzised Installer)
(Sketch showing all minimum distances and other details required below)
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Permit Issued 19 By
Installation Completed, Inspected and Approved - 19 �33y