HomeMy WebLinkAboutSeptic Repair 160 Long Hill Road Fz 1
TOWN OF SOUTH WI N DSOR /)/j
BUILDING DEPARTMENT
South Windsor, Connecticut "
Application for Permit 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 disposal system concerning which the
following information is submitted: n p
1. Owner of Property J r%r4 KA z-g Ila g� Address of Owner
2. Location of Property 16-0 Z Lot. No.
3. Type of Structure J4 "- I -
No. of Bedrooms 1�
wing,Commercial Building,Store,etc.)
4. Number of Families or Persons to Occupy Premises_ � ^ 1 4k,
5. Plumbing Fixtures: Water Closets _ Urinals _ Lavatories_ Bathtubs_
Showers_ Kitchen Sinks_ Laundry Tubs_ Garbage Grinder_ OtheQ
6. Liquid Capacity of Septic Tank _S4s e) ? Material of Septic Tank ,44-e�-
7. Soil Conditions: Type of 13 ho u rr Maximum ground water table �d
(Sand,Gravel,Clay,etc.)
8. If not served by public water supply: Distance from Owner's well t ?- —/ from adjacent wells f X S1J"',
9. Distance to nearest water course, drainage ditch, storm drain or embankment 4 'y
10. Percolation Tests: Time for 1" drop in soil test ;2 14i Classification of soil
11. Minimum square feet of effective seepage area required --3 7 c cal%
12. Leaching System: Number of trenches / Length _ DWidth, Total o
Other
Signatur � �
Licensed Installer
(Sketch showing all minimum distances and other details required below)
i�
1 Li h N
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33 `
ZdA/c <c aA D
Permit Issued 19 By
Installation Completed,Inspected and Approved o Z. 19 Ui 6 By