HomeMy WebLinkAboutSeptic Repair 00 John Fitch Boulevard Y.
TOWN OF SOUTH WI N DSOR
BUILDING DEPARTMENT
South Windsor, Connecticut
Application for Permit to Install or Repair Individual Sewage Disposal System
69 Application No.
TO THE BUILDING DEPARTMENT: Date. CV 19-6"Cl-
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 12 ddress of Owner
2. Location of Proper (/1sfIn tq,.� g Lot. No.
3. Type of Structure No. of Bedrooms
(Dwelling,Commercial Building,Store,etc.)
4. Number of Families or Persons to Occupy Premises_
5. Plumbing Fixtures: Water Closets Urinals ` Lavatories Bathtubs
Showers !�Kitchen Sinks ✓ Laundry Tubs — Garbage Grinder Other
6. Liquid Capacity of Septic Tank(r;e-) Material of Septic Tank
7. Soil Conditions: Type of Soil /¢- Maximum ground water table c1''
(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
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__11,4 Width Total 4 d
Other °. All
Signatu
( censed Installer)
(Sketch showing all minimum disc nc nd other details required below)
Permit Issued 19 By
Installation Completed, Inspected and Approved 19 By
444,'"J
70,a.
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