HomeMy WebLinkAboutSeptic New 1179 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 sewage di/stosal system concerning which t e
following information is submitted: 01
1. Owner of Propert ss of Owner —
2. Location of Property �j � �/ �ia& Lot. No.
3. Type of Structure L c r No. of Bedrooms
(Dwelling,Commercial Building,Store,etc.)
4. Number of Families or Persons to Occupy Premises_
5. Plumbing Fixtures: Water Closets OL Urinals Lavatories_ Bathtubs
Showers Kitchen Sinks Laundry Tubs Garbage Grinder Other
6 Liquid Capacity of Septic Tan / G`�°-'�� 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 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 ;71y' Classification of soil e'_l
11. Minimum square feet of effective seepage area required
eMl
12. Leaching System: Number of trenches Lengt Width - Total
Other
Signature
icensed staller
(Sketch showing all minimum distances and other detai s required below)
Permit Issued 19 By
Installation Completed, Inspected and Approved 19 By
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