HomeMy WebLinkAboutSeptic Repair 00 Nutmeg Road (2) TOWN OF SOUTH WI N DSOR
BUILDING DEPARTMENT
South Windsor, Connecticut
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Application for Permit to Install or Repair Individual Sewage Disposal System
Application No. O?$070-/
TO THE BUILDING DEPARTMENT: Dat 1910 _
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 40 A&Z -7A--k PU I J a Address of Owner
2. Location of Property
//�yy 4dT . p.4D Lot. No.
3. Type of Structure C_..QA4^4 6 o&o2/Atr No. of Bedrooms
(Dwelling,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 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_AcLAA te- 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 Width Total
Other 4%1 7V-* ,Q -P q
Signature e0-,— U J L- Ins
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(Sketch showing all minimum distances and othe��jr��e cifs'requir=e� owJW1 1-W9-8S9r/z)
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Permit Issued .Io VtJ�I/ 19�Q B --�-
Installation Completed, Inspected and Approved .��__duA.0 19_� By.