HomeMy WebLinkAboutSeptic Repair 39 Long Hill Road TOWN OF SOUTH WI N DSOR ,>�
BUILDING DEPARTMENT
QNKa4 3(�F South Windsor, Connecticut
Application for Permit to Install or Repair Individual Sewage Disposal System
Applicatio Na-TO THE BUILDING DEPARTMENT: Date 19
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 LUC 'APO Ltt Address of Owner LWt�
2. Location of Property Lot. No.
3. Type of Structure ��'' - No. of Bedrooms
(Dwelling,Commercial Buildi�re,etc.)
4. Number of Families or Persons to Occupy Premises_
5. Plumbing Fixtures: Water Closets_._ Urinals ` Lavatories 1�7-- Bathtubs
Showers Kitchen Sinks L dry Tubs Garbage Grinder Other
6. Liquid Capacity of Septic Tan 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 JOB
ZJC from adjacent wells "
9. Distance to nearest water course, drainage ditch, storm draiSjK embankment Q
10. Percolation Tests: Time for 1" drop in soil test ssification of soilno
11. Minimum square feet of effective seepage rea required
12. Leaching System: Number of trenches 3 Len13*
gth Widt Total 374'
Other
Signature
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'MiLlensedInstaller)
(Sketch showing all minimum distances and other details required below)
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Permit Issued /O AJyXr 19 70 By
Installation Completed, Inspected and Approved /o By AAA 6 .Q
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