HomeMy WebLinkAboutSeptic New 00 Pleasant Valley Road (3) TOWN OF SOUTH WI N DSOR
BUILDING DEPARTMENT
South Windsor, Connecticut
Application for Permit to Install or Repair Individual Sewage Disposal System
Application No. O O
TO THE BUILDING DEPARTMENT: Date y-12- -f*' 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 ,.�� Address of Owner
2. Location of Property Lot. No.
3. Type of Structure_ ._ ol�� No. of Bedrooms I?
(Dwelling,co
Immercial Building,Store,etc.)
4. Number of Families or Persons to Occupy Premises_
5. Plumbing Fixtures: Water Closets -Z Urinals La stories Z Bathtubs,_
Showers Kitchen Sinks / Laundry Tubs i Garbage Grinder Other
6. Liquid Capacity of Septic Tank Z4� Material of Septic Tank
7. Soil Conditions: Type of Soil Maximum ground water table
(Sand,Gravel,Clay,etc.)
r s/
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 O"dZ
11. Minimum square feet of effective seepage area required
12. Leaching System: Number of trenches Length OJ Width Total_1,6
-Other
Signature
(Licens d Installer)
(Sketch showing all minimum distances and other details required )
Permit Issued 19 By
Installation Completed, Inspected and Approved 19 By
.7O,y�l1/�"`f �7/�' WIZ lr Z--C'.Z PIP
ti
4
� N
fa iE
110-e eogrov ov i- v L c xf ,,fo.po
11. _fovTi4/ YsrsfvOJ'o%? C"oiv/V
00
WX
r
�9 a. ,CF191
1
.
- — ------
,—N
60�� 36 r
.z_ _
rrA
-� i/o 6, i3 r� ; �>,• c.
..�v/�T.' I'�.�'.!'Cv.c'.9'f'�«>/�- .t7,�a-,.%.9+ '�+s�'ti'F`�r�/�''--�.�.ie�`—•