HomeMy WebLinkAboutSeptic Repair 610 Niederwerfer Road TOWN OF SOUTH WI N DSOR
BUILDING DEPARTMENT
SouthXWindso onnecticut
Application for Permit to installir Individual Sewage Disposal System
Application No.
TO THE BUILDING DEPARTMENT: Date. r 19
A permit is requested for repair or construction of an individual sewage disposal system concerning which the
following information is submitted: M41 DQ0
1. Owner of Property Address of Owner
2. Location of Property 6/o Lot. No.
3. Type of Structure No. of Bedrooms
(Dwe g,Commercial Building,Store,etc.)
4. Number of Families or Persons to Occupy Premises_
5. Plumbing Fixtures: Water Closets Urinals Lavatories Bathtubs
Showers Kitchen Sinks Laundry Tubs Garbage Grinder Other
6. Liquid Capacity of Septic Tank_ '-f .0 O Material of Septic Tank- z -
7. Soil Conditions: Type of Soil Maximum ground water table_ #! 2- ,_.
(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 -40-Mliy"T IS Classification of soil
11. Minimum square feet of effective seepage area required
12. Leaching System: Number of trenches Length Width, oZ Total (J d
Other
Signatur2er
(ZLicensed Installer)
(Sketch showing all minimum distances and details required elow)
Permit Issued 19 By
Installation Completed, Inspected and Approved 19 By
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