HomeMy WebLinkAboutSeptic Repair 617 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_ . 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 T 1 ✓ u�o-►t_ Address of Owner
!Q/ �
2. Location of Proper?ty �JJ - Lot. No.
3. Type of Structure No. of Bedrooms_
(Dwellin �y re,etc.)
4. Number of Families or Persons to Occupy Premises_ /
Of,
5. Plumbing Fixtures: Water Closets Urinals Lavatories Bathtubs
Showers Kitchen Sinks__ Laundry Tubs Garbage Grinder Other
6. Liquid Capacity of Septic Tank a S-0 Material of Septic Tank Co IV o�"�1-f-
7. Soil Conditions: Type of Soil �A iV d Maximum ground water table L%�o n/G.
(Sand,Gravel,Clay,etc.)
8. If not served by public water supply: Distance from Owner's well from adjacent wells 7
s'
9. Distance to nearest water course, drainage ditch, storm drain or embankment
10. Percolation Tests: Time for 1" drop in soil test f 4 ��� ,Classification of soil SfL n/
11. Minimum square feet of effective seepage area required ^°
12. Leaching System: Number of trenches_ Length Width -Z, Total
Other Z/d Z
Signature /4'
(Licensed Install )
(Sketch showing all minimum distances and other details require elow)
Permit Issued 19 By
Installation Completed, Inspected and Approved 19 By
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FOR BUILDING PURPOSES ONLY
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