HomeMy WebLinkAboutSeptic Repair 685 Governor's Highway SEE QA'� TOWN OF SOUTH
W I N DSOR P&&&%,r
BUILDING DEPARTMENT
South Windsor, Connecticut
.Application for Permit to Repair Individual Sewage Disposal System
Application No. oio C 7e-,
TO THE BUILDING DEPARTMENT: Date._ Of 94.yy 19 70
A permit is requested for repair of an individual sewage disposal system concerning which the
following information is submitted:
1. Owner of Property N�4rtoa� ST Cr,t Address of Owner Io13g' 6!o%WA#Vs e 4 /yrSn► f/
2. Location of Property - GAwG- Lot. No.
3. Type of Structure awi R, No. of Bedrooms 3
(Dwelling,Commercial Building,Store,etc.)
4. Number of Families or Persons to Occupy Premises QNi tf) 0;/AM4 L!J
5. Plumbing Fixtures: Water Closets Urinals Lavatories Bathtubs
Showers Kitchen Sinks Laundry Tubs Garbage Grinder Other
6. Liquid Capacity of Septic Tankd.eo 0046 Material of Septic Tank �BrdOR.Grir lnlEMl�
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
12. Leaching System: Number of trenches IV4F LB LengthM/6 ACT. Width Z. S FT. Total36
Other
Signature Cam--
Q ( ce se Installer)
90#SWAr !f"9-3s9 uaj
(Sketch showing all minimum distances and other*etaiis requiii&Row)
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Permit Issued aL J'"44ar 192A-_ By#AIfL IF4wAA.OS fa
Installation Completed, Inspected and Approved_.*a ZAAIN 19074 Bylftc p44.1"a. .r4
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