HomeMy WebLinkAboutSeptic Repair 209 Pleasant Valley Road 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_�c�` 19 6 7
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 Va Address of Owner.
2. Location of Property Q Lot. No.
3. Type of Structure No. of Bedrooms
(Dwelling,Commercial Building,Store,etc.)
4. Number of Families or Persons to 4cupy Premises_
5. Plumbing Fixtures: Water Closets Urinals Lavatories Bathtubs
Showers Kitchen Sinks Laundry Tubs Garbage Grinder Other
6. Liquid Capacity of Septic Tank Material of Septic Tank
7. Soil Conditions: Type of Soil (Sand,Gra ve lay,etc.) Maximum ground water table
8. If not served by public water supply: Dista a 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
J Signature
/ (Licensed Installer)
(Sketch showing all minimum distances and other details required below)
er
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Permit Issued 19 By Installation Completed, Inspected and Approved 0.1,AAVgr,Ia c2 19 n�7 By '/A7
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TOWN ` OF SOUTH WI N DSOR
BUILDING DEPARTMENT
South Windsor, Connecticut
Application for Permit to fiWWOw Repair Individual Sewage Disposal System
Application No.
TO THE BUILDING DEPARTMENT: Date-A(J Q t 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 8�c �ofOwner_Aa �Addrress d 9 //;
2. Location of Property Property-!::,
Lot. No.
3. Type of Structure .�us ///'yQ No. of Bedrooms_
T%-I(Dwelling,Commercial Building,Store,etc.)
4. Number of Families or Persons to Occupy Premises_ �t�.�c, h�i �o A4, A1/
5. Plumbing Fixtures: Water Closets Urinals P Lavatories Bathtubs 2—
Showers 0 Kitchen Sinks 2. Laundry Tubs_ Garbage? /Grinder�� Other y
6. Liquid Capacity of Septic Tank %Sy 6 Material of Septic Tank ���i�
7. Soil Conditions: Type of Soil_ cP 4 A- 6 Maximum ground water table---
(Sand,Gravel,Clay,etc.)
8. If not served by public water supply: Distance from Owner's well from adjacent wells--- d v 1
9. Distance to nearest water course, drainage ditch, storm drain or embankment_ _Y_ /56 /
10. Percolation Tests: Time for 1" drop in soil test /17 1/k- Classification of soil ZE
11. Minimum square feet of effective seepage area required
i
12. Leaching System: Number of trenches Length �ZD L Width Total
Other
Signature 4 4.1 f/ ,�, sl
(Licensed Installer)
(Sketch showing all minimum distances and other details required below)
T�arch
D ,
Permit Issued 19 By
Installation Completed, Inspected and Approved 19 By