HomeMy WebLinkAboutDocStar TOWN OF SOUTH WI N DSOR
BUILDING DEPARTMENT I,
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South Windsor, Connecticut � 35 40
Application for Permit to Install or Repair Individual Sewage Disposal Syste
Application No.
TO THE BUILDING DEPARTMENT: Date_ �.�..,;r - e 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 h i-t-y-P Address of Owner 4L ' 14
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2. Location of Property Lot. No.
3. Type of Structure
No. of Bedrooms
(Dwelling,Cow ercial Building,Store,etc.)
4. Number of Families or PQLWns to Occupy Premises_
5. Plumbing Fixtures: Water Closets d't Urinals Lavatories Bathtubs 2
Showers_ Kitchen Sinks,_ Laundry Tubs Garbage Grinder Other
6. Liquid Capacity of Septic Tank ojop Material of Septic Tank
7. Soil Conditions: Type of Soil—Ien� 17�- La-.Maximum ground water table
(Sand,Gravel,Clay,e!5�-
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
i
12. Leaching System: Number of trench ;� Length ✓r� Widt 2 a Total 7 S
Other
7
Signature
.Z--- I
(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 +Z/ A�I-Z 19� B y