HomeMy WebLinkAboutSeptic Repair 630 Governor's Highway TOWN OF SOUTH WI N DSOR
BUILDING DEPARTMENT
e South Windsor, Connecticut
Application for Permit to Install or Repair Individual Sewage Disposal System
Application No.
TO THE BUILDING DEPARTMENT: Date ;,_ ;5// y`Z
A permit is requested for repair or construction of an individual sewage disposal system concerning which the
following information is submitted: In, 14cw, A
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1. Owner of Property Address of Owner_ sd
2. Location of Property 041 /Ln/ZVZ' i ✓.9Y
Lot. No.
3. Type of Structure No. of Bedrooms o2
05 ing,Commercial Building,
Store,etc.)
4. Number of Families or Persons to Occupy Premises_
5. Plumbing Fixtures: Water Closets Urinals Lavatories „Z Bathtubs__,
Showers Kitchen Sinks Laundry Tubs Garbage Grinder Other
6. Liquid Capacity of Septic Tank Material of Septic Tank
7. Soil Conditions: Type of Soil Maximum ground water table
(Sand,Gi avel,Clay,etc.)
8. If not served by public water supply: Distance from Owner's well from adjacent wells /lam
9. Distance to nearest water course, drainage ditch, storm drain or embankment 07/'4— d
10. Percolation Tests: Time for 1" drop in soil test Classification of soil
11. Minimum square feet of effective seepage area required >
12. Leaching System: Number of trenches Length Width Total
Other
Signatur/er
(Licensed Installer)
4
(Sketch showing all minimum distances and details required below)
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Permit Issued 19 By
Installation Completed, Inspected and Approved 0 lg G5/ By