HomeMy WebLinkAboutSeptic Repair 330 Long Hill Road TOWN OF SOUTH WI N DSOR
I?e—1 4 BUILDING DEPARTMENT
' South Windsor, Connecticut
f:e�f ation for Permit to Install or Repair Individual Sewage Disposal System
Applicati n No.
TO THE BUILDING DEPARTMENT: Date 6 19 to
A permit is requested for repair or construction of an individual sewage disposal system concerning which the
following information is submitted: /- n
1. Owner of Property d� Address of Owner 4S? da-4 ��t'� �
2. Location of Property O Lot. No.
3. Type of Structure No. of Bedrooms
(Dwelling,Commer Building,Store,etc.)
4. Number of Families or Persons to Occupy Premises_ -�
5. Plumbing Fixtures: Water Closets Urinals 7/40--L4- Lavatori s Bathtubs -2.�
Showers ' Kitchen Sinks 2_ Laundry Tubs)kfll� Garbage Grinder Other `7'tVv^-L�
6. Liquid Capacity of Septic Tank Material of Septic Tank
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7. Soil Conditions: Type of Soil Maximum ground water table J
(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_
10. Percolation Tests: Time for 1" drop in soil test Classification of soil /7:
11. Minimum square feet of effective seepage area required
12. Leaching System: Number of trenches_ Length 4vZ6 Width Z;6 Total
Other
Signature />C% L)zll2) 7` 'n'l
(Licensed Installer)
(Sketch showing all minimum distances and other details required below) i
Permit Issued 19 By
Installation Completed, Inspected and Approved a9 nl-✓&-M/sf/ 19�.- By
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