HomeMy WebLinkAboutSeptic Repair 155 Laurel Street TOWN OF SOUTH WI N DSOR
� 34f BUILDING DEPARTMENT
South Windsor, Connecticut
Application for Permit to Install or Repair Individual Sewage Disposal System
Application No.
TO THE BUILDIN DEPART NT: Date 19
A permit is requested for repair or construction of an individual sewage disposal system concerning which the
following information is s mitted:
1. Owner of Property Address of Owner
2. Location of Property Lot. No. .Sro
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 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 Classification of soil
11. Minimum square feet of effective seepage area required
12. Leaching System: Number of trenches Length Width s Total lelz—
Other
Signature 'y
(License ler) �-
- J
showing all inimum distances and other details required below)
L11,TKerch
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Permit Issued 19 By
Installation Completed, Inspected and Approved 19 By
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