HomeMy WebLinkAboutSeptic New 9 Lake Street TOWN OF SOUTH WINDSOR
BUILDING DEPARTMENT
South Windsor, Connecticut
Application for Permit to Install or Repair Individual Sewage Disposal System
Application No.
TO THE BUILDING DEPARTMENT: Date.. %r// 19 L s
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 X//c er a 114 -e d Address of Owner___
2. Location of Propertvlr •T t L V/!it -p Jr- Lot. No. I
3. Type of Structure D .,.r ,t//!L c No. of Bedrooms
(Dw ing,Commercial Building,Store,etc.)
4. Number of Families or Persons to Occupy Premises_
5. Plumbing Fixtures: Water Closets / Urinals f Lavatories / Bathtubs /
Showers,L Kitchen Sinks_[` Laundry Tubs_ Garbage Grinder Other
6. Liquid Capacity of Septic Tank Material of Septic Tank
7. Soil Conditions: Type of Soil GR-V v4'/ Maximum ground water table,_ Nu iv g"
(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 1 Classification of soil J YCArdv&./
11. Minimum square feet of effective seepage area required is%.u�O
12. Leaching System: Number of trenches Length if.7 Width r'T , Total
Other
Signature (5R2Z,
( AcensedInstaller)
(Sketch showing all mininium distances and other details required below)
Permit Issued 19 By
Installation Completed, Inspected and Approved 19 By
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