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HomeMy WebLinkAboutSeptic Repair 00 Mascola Road (3) • TOWN OF SQU'TH WI N DSOR BUILDING DEPARTMENT South Wins Connecticut Application for Permit to Install ors/kepair; Individual Sewage Disposal System Application No. TO THE BUILDING DEPARTMENT: Date 19S A permit is requested for repair or construction of an individual sewag disposal system concerning which the following information is submitted: 1. Owner of Property Address of Owner 2. Location of Property MASGb<© Ro.44 D Lot. No. 3. Type of Structure No. of Bedrooms (Dwelling,Com ercial Building,Store,e .) 4. Number of Families or Persons to Occupy Premises — 5. Plumbing Fixtures: Water Closets Urinals, vatories�_ Bathtubs_ Showers_ Kitchen SinksL(Laundry Tubs Garbage Grinder Other 6. Liquid Capacity of Septic Tank I/3 to Material of Septic Tank_ ' ..� 7. Soil Conditions: Type of Soil e / Maximum ground water table (SWd,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 14 11. Minimum square feet of effective seepage area required 12. Leaching System: Number of trenches Z— Lengthy_ Widt ��A L Total C3 Other Signature i ► Ai�-- icensed Installer) (Sketch showing all minimum distances and other details required below) %410 1�Rro►#� �y r C.Z', �� nWwtO t-.�s+�ti�- ww`Q.w+a�. Permit Issued 19 By Installation Completed, Inspected and Approved 19 By