HomeMy WebLinkAboutSeptic New 97 Pleasant Valley Road TOWN OF SOUTH WINDSOR
BUILDING DEPARTMENT
South Windsor, Connecticut
Application for Permit to Install or Repair Individual Sewage Disposal System
Application No.
TO THE BUILDING DEPARTMENT: Date �'--/,� _- 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 a 4 Address of Owner 2 9/
2. Location of Property ],. �+ -J Lot. No.
3. Type of Structure No. of Bedrooms
(Dwelling,co ercial Building,Store,etc.)
4. Number of Families or Persons to Occupy Premises
5. Plumbing Fixtures: Water Closets Z-- Urinals avatories y Bathtubs_
Showers Kitchen Sinks Laundry Tubs Garbage Grinder Other
6. Liquid Capacity of Septic Tank �' D 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 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
s�
12. Leaching System: Number of trenches_ Length Widthf Total
Other
Signature -
(LicensedI taller)
(Sketch showing all minimum distances and other details required �W)
Permit Issued 19 By
Installation Completed, Inspected and Approved __19,T By
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