HomeMy WebLinkAboutSeptic New 71 High View Road Vo-
TOWN OF SOUTH WI N DSOR
BUILDING DEPARTMENT
South Windsor, Connecticut 4�—Lo,off
Application for Permit to Install or Repair Individual Sewage Disposal System
Application No.
TO THE BUILDING DEPARTMENT: Date.
A permit is requested for repair or construction of an individual sewage disposal system concerning which the
following information is submitted:
1. Owner of Property I,a1� d e. Jf Address of Owner�(J
�A--X�- ,-- Lot.
2. Location of PropertyNo. ��8
3. Type of Structure No. of Bedrooms
(Dwelling,C )
4. Number of Families or Persons to Occupy Premises_
5. Plumbing Fixtures: Water Closets Urinals" Lavatories Aathtubs �-
Showers o`Z- Kitchen Sinks_ Laundry Tubs Garbage Grinder Other
6. Liquid Capacity of Septic Tank 1 o _Material of Septic Tank CE-,-r
7. Soil Conditions: Type of Soil g t^C 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_ �rY✓,
10. Percolation Tests: Time for 11, drop in soil test Classification of soil
11. Minimum square feet of effective seepage area required
12. Leaching System: Number of trenches 112 t h./i Length Width, Total
Other
'
Signature :J'� � U r`
(Licensed Installer)
(Sketch showing all minimum distances and oth detoo required below)
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Permit Issued 19 By
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Installation Completed, Inspected and Approved 19(0 6 By
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