HomeMy WebLinkAboutSeptic New 388 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. TO
A permit is requested for repair or construction of an individual sewage disposal system concerning which the
following information is submitted: 11
1. Owner of Property. o Yn c eA Address of Owner ;g 2ke_asCn\V �)Prkte Re,fl
2. Location of Property g g Lot. No.
3. Type of Structure Q No. of Bedrooms
(Dwelling,Commercial Building,Store,etc.)
4. Number of Families or Persons to Occupy Premises,_ Al
5. Plumbing Fixtures: Water Closets Urinals Lavatories_ Bathtubs_
Showers_ Kitchen Sinks Laundry Tubs Garbage Grinder Other
6. Liquid Capacity of Septic Tank 100 0 !ao.,� Material of Septic Tank14 . (:eOhC_ (�_
7. Soil Conditions: Type of Soil CCsn X") Maximum ground water table
(Band,Gravel,Clay,etc.)
8. If not served by public water supply: Distance from Owner's well /l 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 s � Width Total
Other�o `y R Lt)eA1 (P 2.sl.e-R
Signature
(Licensed Installer)
(Sketch showing all minimum distances and other details required below)
a4 O
41,9So.J7 V14ttv-v LAD
Permit Issued 19 By
Installation Completed, Inspected and Approved 19 By