HomeMy WebLinkAboutSeptic Repair 00 George Road ♦ � w
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TOWN OF SOUTH WI N DSOR
BUILDING DEPARTMENT
South Windsor, Connecticut
Application for Permit to Install or Repair Individual Sewage Disposal System /<:I,-3f
Application No.
TO THE BUILDING DEPARTMENT: Date. Z4 -:�' 19<o 0
A permit is requeste for repair or const tion of an individual sewage disposal system concerning which the
following information is subm' J/DQ ?VS -
1. Owner of Property Address of Owner 26a /��
2. Location of Property ee /Ct�1c Lot. No. �
3. Type of Structure No. of Bedrooms
welling,COmmercial Building,Stor ,etc.)
4. Number of Families or Persons to Occupy Premises_ /a - —
5. Plumbing Fixtures: Water Closets 2— Urinals .-- Lavatories L Bathtubs
Showers Kitchen Sinks Laundry Tubs Garbage Grinder Other
6. Liquid Capacity of Septic Tank /o o en Material of Septic Tank
7. Soil Conditions: Type of Soil Maximum ground water table
(Sand,Gravel,Clay,etc.)
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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 Z�`
10. Percolation Tests: Time for 1" drop in soil test s�'zsv 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)
i `Permit Issued 19 By
Installation Completed, Inspected and Approved 19 By
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