HomeMy WebLinkAboutSeptic New 16 Gulley Drive TOWN OF SOUTH WI N DSOR
BUILDING DEPARTMENT ����
South Windsor, Connecticut
Application for Permit to Install or Repair Individual Sewage ;Disposal S stem
Application No. //�®
TO THE BUILDING DEPARTMENT: Date 19 6
A permit is requested for repair or construction of an individual sewage disposal system concerning which the
following information is submitted: -Inctm
1. Owner of Property_ ®6! "'`' /
Address of Owner_/ u
2. Location of Property Lot. No.
3. Type of Structure_ �.Is �L j,(/ �, No. of Bedrooms(Dwelling,Commercial Building,Store,etc.)
4. Number of Families or Persons to OccupyPremises_V&E
' 5. Plumbing Fixtures: Water Closets Urinals Lavatories
/�. Bath u
Showers Kitchen Sinks ndry Tubs '�'^�' �DGarbage� rG-inde r � the
6. Liquid Capacity of Septic Tank Ei� �Jp� 4f L Material of Septic Tank
7. Soil Conditions: Type of Soil �� R'T Maximum ground water table_
(band,Urravel,Clay,etc.)
8. If not served by public water supply: Distance from Owner's well Pu 8L t
from adjacent wells
9. Distance to nearest water course, drainage ditch, storm drain or embankment�Q
10. Percolation Tests: Time for 1" drop in soil test CL�/ Classification of soil dj(�
11. Minimum square feet of effective seepage area required
12. Leaching System: Number of trenches_. Length 1 Width. aTotal
Other CIL �` r d"C_ C' C%`
Signature C
c nsed ns Ile
(Sketch showing all minimum distances and other details required below)
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Permit Issued 19 By
Installation Completed, Inspected and Approved a� By