HomeMy WebLinkAboutSeptic New 105 Miller Road TOWN OF SOUTH WINDSOR
BUILDING DEPARTMENT
South Windsor, Connecticut
Application for Permit to Install or Repair Individual Sewage Disposal System
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Applic n No.
TO THE BUILDING DEPARTMENT: Date b 19 0
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 �� Address of Owner / L. /
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2. Location of Property__Jcf' & / is��+ Lot. No.
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3. Type of Structure D(,fit ELL
(Dwelling,Commercial Building,Store,etc.) No. of Bedrooms_
4. Number of Families or Persons to Occupy Premises_l�''ice �(
5. Plumbing Fi tures: Water Closets Urinals Lavatories__ Bathtubs_
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Showers Kitchen SinP
s 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
(Band, ravel,Clay,etc.)
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8. If not served by public water supply: Distance from Owner's well from adjacent wells
9. Distance to nearest water course, drainage ditch, s r d in embank4ment
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10. Percolation Tests: Time for 1" drop in soil test lassification of soil
11. Minimum square feet of effective seepage area required
12. Leaching System: Number of trenches�� Length _ Widt TotalC.�
Other
Signature
( censed Ins al er
(Sketch showing all minimum distances and other details required below) L�9-3�19
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Permit Issued 19 By -
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Installation Completed, Inspected and Approved o2S 19 `