HomeMy WebLinkAboutSeptic Repair 15 Niederwerfer Road 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-%<Ls." c. !-:�! 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 ®®� c.17 verr 1,V%C. Address of Ownerf
2. Location of Property G� I1�9r c -,W,9e r4tiV IC�• Lot. No.
3. Type of Structure ,
__ _A JlL2 No. of Bedrooms_
(Dwelling,Commercial Building,Store,etc.)
4. Number of Families or Persons to Occupy Premises-4/ �cyS� s
5. Plumbing Fixtures: Water Closets l Urinals Lavatories—_ Bathtubs_
Showers_ Kitchen Sinks_,` Laundry Tubs Garbage Grinder Other) (A 5 c.a
6. Liquid Capacity of Septic Tank G' Material of Septic Tank
7. Soil. Conditions: Type of Soil ? Maximum ground water table_
—13
(Band,Grave,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 System: Number of trenches Length b ;z Width -3 J Total 3 G c)'x j
Other
0 .Signature (Licensed Installer)
-gam (6k tcfi showinVall minimum distances and other details required below)
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Xn�it Issued19 0
44
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Installation Completed, Inspected and Approved 19
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