HomeMy WebLinkAboutSeptic New 735 John Fitch Boulevard TOWN OF SOUTH WI N DSOR
BUILDING DEPARTMENT
South Windsor, Connecticut
Application for Permit to Install or Repair Individual Sewage Disposal System
Application No.
TO THE BUILDING DEPARTMENT: Date 19�
A permit is requested for repair or construction of an individual sewag disposal system concerning which the
following information is submitted: `7 3 Se
1. Owner of Property / -Address of Owner u fP W�
2. Location of Property ���� � �A2/t�g/ ,444T-o 14R7'5
Lot. No.
3. Type of Structure —5,ro No. of Bedrooms
(Dwelling,Commercial Building,Store,etc.)
4. Number of Families or Persons to Occupy Premises_ a
5. Plumbing Fixtures: Water Closets a-- Urinals_ Lavatories Bathtubs
Showers_/ Kitchen Sinks Laundry Tubs Garbage Grinder Other
6. Liquid Capacity of Septic Tank_ a d er 4 Material of Septic Tank L'd✓lam C �1°� fe
7. Soil Conditions: Type of Soil_ X4 A Maximum ground water table_
(Band,Gravel,Clay,etc.) /
8. If not served by public water supply: Distance from Owner's well Ud from adjacent wells
9. Distance to nearest water course, drainage ditch, storm drain or embankment /h 6 ?1
10. Percolation Tests: Time for 1" drop in soil test / m//w or Classification of soil 14-
11. Minimum square feet of effective seepage area required 3 O
12. Leaching System: Number of trenches 3 Length Width a Total
Other
Signaturez&.,, g dLR�L•
(Licensedinstaller)
(Sketch showing all minimum distances and other details required below)
Permit Issued 19 By
Installation Completed, Inspected and Approved 19T By
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