HomeMy WebLinkAboutSeptic Repair 951 Main Street y
�IwDQp� ��S TOWN OF SOUTH WINDSOR
�t BUILDING DEPARTMENT
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South Windsor, Connecticqt
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Application for Permit to.lnstall or Repair Individual Sewage Disposal"System
Application No.
TO THE BUILDING DEPARTMENT: Date._
A permit is requested fo< r ct t uation of an in v d[ posal system concerning whi 1qike
following information is submitted:
1. Owner of Property Qoz Address�of er S/ /rIA/a/ 47*4 f T
2. Location of PropertyW 0AW J?'J
Lot. No.
3. Type of Structure No. of Bedrooms
(Dwelling,Commercial Building,Store,etc.)
4. Number of Families or Persons to Occupy-Premises k V Kwt C4 A 4o„fs
5. Plumbing Fixtures: Water Closets Urinals Lavatories Bathtubs
Showers Kitchen Sinks Laundry Tubs Garbage Grinder Other
6. Liquid Capacity of Septic Tank Material of Septic Tank
7. Soil Conditions: Type of Soil CAM-b 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(ater course drainage ditch, storm drain or embankment
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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 Length Width Total
Other as rtAw •F .S S A2 i Q tt.
Signature d.v�.
(Ucensrd Insta er))
(Sketch showing all minimum distances and othd i s reeq i �b��w)
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Permit Issued -V'Ltt-V 19 L9 y
Installation Completed, Inspected and Approved_ D/ HtlateS�f 19� B-' o*..b�
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