HomeMy WebLinkAboutSeptic Repair 479 Pleasant Valley Road v
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 r l Z 19 la 6
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//P i�/�J aJ ti// Address of Owner -e
2. Location of Property P L Ie1�761 Lot. No.
3. Type of Structure //y u C C No. of Bedrooms �
(Dwelling,Commercial Building,Store,etc.)
4. Number of Families or Persons to Occupy Premises—/
5. Plumbing Fixtures: Water Closets / Urinals C) Lavatories _ Bathtubs_
Showers_ Kitchen Sinks Laundry Tubs Garbage Grinder O Other d
6. Liquid Capacity of Septic Tank --4 D 0 Material of Septic Tank COycr
7. Soil Conditions: Type of Soil -TA I ro Maximum ground water table
(Sand Gravel,Clay,etc.)
8. If not served by
public water supply: Distance from Owner's well f2.S'- from adjacent wells 74-
9. Distance to nearest water course, drainage ditch, storm drain or embankment ),- J d y
10. Percolation Tests: Time for 1" drop in soil test ) M// Classification of soil A
11. Minimum square feet of effective seepage area required
12. Leaching System: Number of trenches / Length Sy Width J—' Total Yd y
Other
n
Signature aX_a,,.,..
(Licensed Installer)
(Sketch showing all minimum distances and other details required below)
Permit Issued 19 By/ /
Installation Completed, Inspected and Approved If IV 11odC�/3&YL 19 &6 By �'1,
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