HomeMy WebLinkAboutSeptic Repair 1169 Main Street TOWN OF SOUTH WI N DSOR
BUILDING DEPARTMENT
South Windsor, Connecticut
Application for Permit to Install or Repair Individual Sewage Disposal System
Application No. /���
TO THE BUILDING DEPARTMENT: Date_-
A permit is requested for repair or construction of an individual sewage disposal system concerning which the
following information is submitted: /t^
1. Owner of Property. Address of Owner�� C1 �",I ,f S7-
2. Location of Property Lot. No.
3. Type of Structure_ - No. of Bedrooms?
(Dwelling,Commercial Building,Store,etc.)
4. Number of Families or Persons to Occupy Premises_ 1
5. Plumbing Fixtures: Water Closets Urinals Lavatories_` Bathtubs 1
Showers b Kitchen Sinks_ Laundry Tubs Garbage Grinder Q Other
6. Liquid Capacity of Septic Tank Material of Septic Tank�N 'APO.
7. Soil Conditions: Type of Soi1�l��Maximum ground water table
(Band, ravel,Clay,etc.)
8. If not served by public water supply: Distance from Owner's well f- 74 from adjacent wells r J D
9. Distance to nearest water course, drainage ditch, storm drain or embankment; -!�-o o
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 trenchess_ Length_d Width 7 Total
Other
Signatur !i7/
Lice d Installer)
(Sketch showing all minimum distances and other details required below)
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Permit Issued 19 By
Installation Completed, Inspected and Approved a 7 J VF- 19? By
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