HomeMy WebLinkAboutSeptic Repair 137 Maskel Road TOWN OF SOUTH WI N DSOR
BUILDING DEPARTMENT
South Windsor, Connecticut
Application for Permit to Install or Repair Individual Sewage Disposal System
Applicati n No.
TO THE BUILDING DEPARTMENT: Date - z 19 4 /41
A permit is requested for repair or construction of an individual sewage disposal system concerning which the
following information is subrpit
1. Owner of Property JAddress of Owner k
2. Location of Property Lot. No. '
3. Type of Structure No. of Bedrooms
(Dwelling,Commercial ilding,Store,etc.)
4. Number of Families or Persons to Occupy Premises_ i f
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 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 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 S stem: Number of trenches Length Width Total
Signature 6
(Licensed Installers'
(Sketch showing all minimum distances and other details required below)
Permit Issued 19 By
Installation Completed,Inspected and Approved 19 1,V By
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