HomeMy WebLinkAboutSeptic New 00 John Fitch Boulevard (6) TOWN OF SOUTH WI N DSOR
BUILDING DEPARTMENT
South Windsor, Connecticut
Application for Permit to Install or Repair Individual Sewage Disposal System
Application No. d
'TO THE BUILDING DEPARTMENT: Date. ,/ 1a3►� 19 ,E
t A permit is requested for repair or construction of an individual sewage disposal system concerning which the
following information is submitted: A c evc P-
1. Owner of Property C ( LLIP 0 rrsd ae,—Address of Owner d,,; = , _ w'e/
2. Location of Property ll f r :s.� �T Nn/ AlroN '84✓1] Lot. No.
3. Type of Structure ' fN1- No. of Bedrooms
(Dwelling,Commercial Building,Store,etc.)
4. Number of Families or Persons to Occupy Premises_ 41 , •1 f
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 j
7. Soil Conditions: T ?"
Type of Soil ,G a e Maximum ground water table_ r ��
(Sand,Gravel, etc.)
8. If not served by public water supply: Distance from Owner's well I-J from adjacent wells J _
9. Distance to nearest water course, drainage ditch, storm drain or embankment zze- ' _��* :A0,
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 .a Width Total 1,A d A
Other
Signature
(Licgnsed Installer)
(Sketch showing all minimum distances and other details required-below)
a
Ott•
ermit Issued = _ 19 4, i By
stallation Completed, Inspected and Approved 19 By
ucr, -• .w
,--
��� r-Yr
_?s:J �
�'�
�`
e
s � �J
C_
ti.�
n1 � i ,...�..
` '`'�
t\ f
�~ t t
,�.� j
� I
�, �)
�' ---- �. �„a.-•���
I �
�`� - �
i!
i
i
� r %
q �
� �
�� ��
c�
!� �
/`''��"�
n