HomeMy WebLinkAboutSeptic New 177 Laurel Street TOWN OF SOUTH WI N DSOR �'
BUILDING DEPARTMENT
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South Windsor, Connecticut ~
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Application for Permit to Install or Repair Individual Sewage Disp aI System �3
Application No.
TO THE BUILDING DEPARTMENT: Date 19
A permit is requested for repair or construction of an individual sewage dispos 1 system concerning which the
following information is submitted: /�
1. Owner of Property p ,�P_,r4 !"1 sp/)u,, Address of Owner�7 7
2. Location of Property`7 7 ) ;,r Lot. No. S4
3. Type of Structure 1 i y 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 1 a .�
6. Liquid Capacity of Septic Tank C51 Material of Septic Tank_( 1
7. Soil Conditions: Type of So' 2-v, Maximum ground water table c
(4nd,Gravel,ClOy,etc.)
8. If not served by public water sl}pply: Distance from Owner's well from adjacent wells �---"
9. Distance to nearest water course, drainage ditch, storm drain or embankment O
10. Percolation Tests: Time for 1" drop in soil test Classification of soil
11. Minimum square feet of effective seepage area required
i
12. Leaching System: Number of trenches Length Width Total 100
Other srxc-e,a ,4
SignaturJ2�,D V( a,
(Licensed Installer)
(Sketch showing all minimum distances and other details required below)
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