HomeMy WebLinkAboutSeptic Repair 245 Main Street FeAF PAia TOWN OF SOUTH WINDSOR `
BUILDING DEPARTMENT Peam#T
64 a9-Cott.98- South Win , onnecticut f O.7J-6 2
Application for Permit to Install or epair Individual Sewage Disposal System
Application No. o#/3,7/-/
TO THE BUILDING DEPARTMENT: Date. /3 1-9,0 . 19 7/
A permit is requested for repair or construction of an individual sewage disposal system concerning which the
following information is submitted:
1. Owner of Proper t ))LWAIV OyrOc.A_ Address of Owner SAAhr'
2. Location of Property 2-45- IV QIAI-' T Lot. No.
3. Type of Structure .A c: 140 No. of Bedrooms
(Dwelling,Commercial Building,Store,etc.)
4. Number of Families or Persons to Occupy Premises. Obc- e-`) /at ,/y
5. Plumbing Fixtures: Water Closets Urinals Lavatories Bathtubs
Showers Kitchen Sinks Laundry Tubs Garbage Grinder Other
6. Liquid Capacity of Septic Tan s _ Material of Septic Tank caNr�aL�TF
7. Soil Conditions: Type of Soil 60AID It tv�r1 Maximum ground water table
mod,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
11. Minimum square feet of effective seepage area required
12. Leaching System: Number of trenches-rWe) c2-2 Length /40�'T Width 2g SFT Total 357p s4 =7-
Other
Signature
`(Lic&nssV Installer) 11
(Sketch showing all minimum distances and at& deta ow
Permit Issued 11 APA IA. 19 1/ By�'�----
Installation Completed, Inspected and Approved )I 19paiL 19,2! By 9 3
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SOUTH WINOSOP POLLUTION CONTROL
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