HomeMy WebLinkAboutSeptic Repair 213 Long Hill Road' TOWN OF SOUTH WI N DSOR
BUILDING DEPARTMENT
South Windsor, Connecticut
Application for Permit to 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:
1. Owner of Property, A ar f Q(t 11 4e.Q Address of Owner Q A,
Z. Location of Property Lot. No.
3. Type of Structure f y N 11/' No. of Bedrooms_
ling,Commercial Building,Store,etc.)
4. Number of Families or Persons to Occupy Premises_ a av i ,�e4l
5. Plumbing Fixtures: Water Closets_L_ Urinals_ Lavatories_ Bathtubs
Showers Kitchen Sinks` Laundry Tubs_ Garbage Grinder_____ Other 6
6. Liquid Capacity of Septic Tank DIP Material of Septic Tank_' n A- E le
7. Soil Conditions: Type of Soil_ y 8 I Maximum ground water table_
(Sand,Gravel,Clay,etc.)
8. If not served by public water supply: Distance from Owner's well from adjacent wells 7� oe�QD
9. Distance to nearest water course, drainage ditch, storm drain or embankment f 119 6
10. Percolation Tests: Time for 1" drop in soil test .� ,[h / /Y,��Classification of soil
11. Minimum square feet of effective seepage area required 37
r
12. Leaching System: Number of trenches �. Length &S,1� �,d_ Width / Total— ��' —ff
Other
Signature
A-Licensed Installer)
(Sketch showing all minimum distances and other details required below)
I
8
30�
Z 13
Permit Issued 19 By
Installation Completed, Inspected and Approved 19 By