HomeMy WebLinkAboutSeptic Repair 00 Niederwerfer Road (7) TOWN OF SOUTH WINDSOR
BUILDING DEPARTMENT
South Windsor, Connecticut
Application for Permit to Install or Repair Individual Sewage Disposal System
Application No.
TO THE BUILDING DEPARTMENT: Date. 2-2 19
A permit is requested for repair or construction of an individual sewage disposal system concerning whit the
following information iesuitted:
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1. Owner of Propert ! _Address of Owner cy �
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2. Location of Property Lot. No.
T c
3. Type of Structure No. of Bedrooms c�
(D 11 ,C mercial Building,Store,etc.)
4. Number of Families or Persons to Occupy P.e ses_ e5 z-,Z --
5. Plumbing Fixtures: Water Closets Urinals Lavatories 2— 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 welly^�
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 3� Length Width_ Z Total 3_V Al
Other
Signature /
(Lice Installer)
/ _J
(Sketch showing all minimum distances and other details required low
Permit Issued 19 By
1 Installation Completed, Inspected and Approved 19 By