HomeMy WebLinkAboutSeptic New 00 Pleasant Valley Road (2) TOWN OF SOUTH WI N DSOR
BUILDING DEPARTMENT
South Windsor, Connecticut
4 Application for Permit to Install or Repair Individual Sewage Disposal System
Application No.
TO THE BUILDING DEPARTMENT: Date__ %- Af-
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 Q/ Address of Owner
2. Location of Property �.� y�i ���: ,T ,,(�' Lot. No. Z�—
3. Type of Structure No. of Bedrooms
(Dwelling,Comm al Building,Store,etc.)
4. Number of Families or Persons to Occupy Premises_
5. Plumbing Fixtures: Water Closets Z Urinals vatories Bathtubs
Showers Kitchen Sinks Laundry Tubs_ Garbage Grinder Other
6. Liquid Capacity of Septic Tank Ild6 Material of Septic Tank �D7it
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 wells
9. Distance to nearest water course, drainage ditch, storm drain or embankment
10. Percolation Tests: Time for 1" drop in soil test /-�J�J-,Ogr Classification of soil
11. Minimum square feet of effective seepage area required
Y Length—
12. Leaching System: Number of trenches Len th � Widt Z Total
Other
Signature
ry
(License Installer)
(Sketch showing all minimum distances and other details required I )
Permit Issued 19 By
Installation Completed, Inspected and Approved 19_ By
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