HomeMy WebLinkAboutSeptic Repair 922 Pleasant Valley Road 1.01
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. h — � 19��
A permit is requested for repair or construction of an individual sewage disposal system concerning which the
following information is 7submited:
1-14
1. Owner of Property &,,�, ,Afdress of Owner �,2
2. Location of Property Lot. No.
3. Type of Structure No. of Bedrooms
welling,Commercial Budding,Store,etc.)
4. Number of Families or Persons to Occupy Premises49
5. Plumbing Fixtures: Water Closets Urinals L atories l Bathtubs L
Showers L Kitchen Sinks Laundry Tubs Garbage Grinder Other
6. Liquid Capacity of Septic Tank Z6 b 0Material of Septic Tank C
7. Soil Conditions: Type of Soil C'IM Y Maximum ground water table_,?
(Sand,Gra el,Clay,etc.)
� f
8. If not served by public water supply: Distance from Owner's well from adjacent wells 5
9. Distance to nearest water course, drainage ditch, storm drain or embankment 6 0 I
10. Percolation Tests: Time for 1" drop in soil test Classification of soil
11. Minimum square feet of effective seepage area required
12. Leaching stem: Number of trenches LengtWQ /7 Width_ 30 Total 0 h Z-
Other 4 - .--c
Signature
(Licen a Installer)
(Sketch showing all minimum distances and ether details require low)
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Permit Issued 19 By
Installation Completed, Inspected and Approved ,Z-3 NF 19 By