HomeMy WebLinkAboutSeptic New 10 Governor's Highway g _ i
TOWN OF SOUTH WINDSOR
BUILDING DEPARTMENT
South Windsor, Connecticut
Application for Permit to Install or Repair Individual Sewage Disposal System
Application No. (�
TO THE BUILDING DEPARTMENT: Date—--I �— 19 �
A permit is requested for repair or construction of an individual sewage disposal system concerning which the
following information is submitted:
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1. Owner of Property ,� d�1" Address of Owner
2. Location of Property Lot. No.
3. Type of Structure r r�' No. of Bedrooms_
(Dwellifig,Commercial Building,Store etc.)
4. Number of Families or Persons to Occupy Premises— 42ZVI #
5. Plumbing Fixtures: Water Closets Urinals Lavatories 12— Bathtubs l
Showers_ Kitchen Sinks Laundry Tubs Garbage Grinder Other
6. Liquid Capacity of Septic Tank 6) 6'!" Material of Septic Tank
7. Soil Conditions: Type of Soil Maximum ground water table 0
(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
O
11. Minimum square feet of effective seepage area required 7 )
12. Leaching System: Number of trenches Length .5 6 fWidth /'2 Total �J
Other /S.3.1 a77 p'
Signature ',' s-."
(Licensed Installer)
(Sketch showing all minimum distances and other details required below)
Permit Issued 19 By
Installation Completed, Inspected and Approved 19 By
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