HomeMy WebLinkAboutSeptic New 20 Imperial Drive Cek,c 3 o 7
TOWN OF SOUTH WINDSOR
BUILDING DEPARTMENT �'�13d,
South Windsor, Connecticut /14
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Application for Permit to Install or Repair Individual Sewage Disposal System D.
Application No.
TO THE BUILDING DEPARTMENT: Date
A permit is requested for repair or const uct, of an individual sewage disposal system concerning which the
following information is submitted- �!
1. Owner of Property� LL— �L A/V Address of Owner ,9`( AE-"4!� l)
2. Location of Property-... �� Lot. No.
3. Type of Structure No. of Bedrooms_
(Dwelling,Commercial Building,Store,etc.)
4. Number of Families or Persons to OccupyPremises_ 0j6 705;?4f 14
5. Plumbing F' tures: Water Closets Urinals `'„' Lavatories _ Bathtubs
Showers Kitchen Sinks La ndr ubs Garbage Grinder Other
6. Liquid Capacity of Septic IA Tankp `O L Material of Septic Tank
7. Soil Conditions: Type of Soil �j &4- _ MAC OR AA Maximum ground water table
(band,Grave Clay,etc.)
8. If not served by public water supply: Distance from Owner's well'79r /'` from adjacent
^wells_/ __/C_�'
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 ! l
11. Minimum square feet of effective seepage area required
12. Leaching System: Number of tre ch s _ Length h Widt Total
* Other r L�t'�✓�(/G &1 C
Signature s t
icense ataller)
(Sketch showing all minimum distances and other details required below)
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Permit Issued 19 By
Installation Completed, Inspected and Approved 19 By
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