HomeMy WebLinkAboutSeptic Repair 00 Oakland Road (2) -0 F E-F- TOWN OF SOUTH WI N DSOR
fl(d� �St���J BUILDING DEPARTMENT
T� South Win r, onnecticut
Application for Permit to Install or R pair ndividual Sewage Disposal System
Application No.
TO THE BUILDING DEPARTMENT: Date 7—U l-'r 2-, 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 O B RWQ 1«- Address of Owner_ �T �GC
2. Location of Property 6 &-KLL- 6 p a Lot. No.
3. Type of Structure r ® !` C 9 P 04 y� tow 1(/G(
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 �Laundryx Tubs Garbage Grinder Other
6. Liquid Capacity of Septic Tank !2S Q 19 Eta ' Material of Septic Tank
?. 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 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
Signature o
icensed Installer
(Sketch showing all minimum distances and other details required below)
16
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Permit Issued 19 By
Installation Completed, Inspected and Approved 19 By