HomeMy WebLinkAboutSeptic Repair 57 Hollis Road 46ar Alb TOWN OF SOUTH WI N DSOR
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e jofm BUILDING DEPARTMENT ,_y
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y South Windsor, Connecticut
Application for Permit to Install or Repair Individual Sewage Disposal System
Application No. &17 I i 76•I
TO THE BUILDING DEPARTMENT: Date_ /i ftssu 1970
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 JASP04 4 IUwT Address of Owner V7 OUIPS KoAa
2. Location of Property sA.AF Lot. No. 140
3. Type of Structure �wi�.tlwl No. of Bedrooms
(Dwelling,Commercial Building,Store,etc.)
4. Number of Families or Persons to Occupy Premises_ame co) FAMI0-3
5. Plumbing Fixtures: Water Closets Urinals Lavatories 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,Gravel,Clay,etc.)
8. If not served by public water supply: Distance from Owner's well P"A&IC- 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 Length Width Total
Other
Signature Ahk
ALicen�d Irw 'ler) �o f t9sI2)
(Sketch showing all minimum distances and other details requlr ow)
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Xa�rF
Peec,r
Permit Issued is X41f 1914 By Jok/ &Mmr4s dr
Installation Completed, Inspected and Approved 1.i fy_y 19L By fftI&M04 Jr.