HomeMy WebLinkAboutSeptic Repair 214 Long Hill Road TOWN OF SOUTH WI N DSOR
BUILDING DEPARTMEN.T
South Windsor, Connecticut
Vication for Permit to Install or 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 ,Qiva E,46A AWddress of Owner. ¢ z o y
2. Location of Property Lot. No.
3. Type of Structure No. of Bedrooms--3--
(Dwelling,commercial Building,Store,etc.)
4. Number of Families or Persons to Occupy Premises�/�.�� t�i¢l?f/L �/� �'G'.Us
5. Plumbing Fixtures: Water Closets Urinals Lavatories Bathtubs _
Showers_ Kitchen Sinks Laundry Tubs Garbage Grinder_—" Other /
6. Liquid Capacity of Septic Tank D G B Material of Septic Tank G C' //
C 6; �f 7f o If ,
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 AQ !/C-
10. Percolation Tests: Time for 1" drop in soil test — /—Classification of soil 4' �l"7GEC/
11. Minimum square feet of effective seepage area required 4� e'1 ?- O OOV P
12. Leaching System: Number of trenches_ Length Width ' Total BJdC
Other G � C C e pcl ? 4 BLOCIt 6,-
s ♦ '
Signatur C
(Licensed Installer
(Sketch showing all minimum distances and other details required below)
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Permit Issued 19 By
Installation Completed, Inspected and Approved 19 By