HomeMy WebLinkAboutSeptic Repair 636 Pleasant Valley Road ' TOWN OF SOUTH WI N DSOR
BUILDING DEPARTMENT
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South Windsor, Connecticut J(2,d i
Application for Permit to Inter Repair Individual Sewage Disposal System���
Application No.
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TO THE BUILDING DEPARTMENT: Date bg-c, /-�— 1'9/ 7 19
A permit is requested for repair or construction of an individual sewage disposal system concerning which the
following information is submitted:su l p
1. Owner of Property`� C 4 ��� J P n Address of Owner / fez
2. Location of Property (�<3 7 , GY Lot. No.
3. Type of Structure s No. of Bedrooms �-
(Dwelling,Commercial Building,Store,etc.)
4. Number of Families or Persons to Occupy Premises_
5. Plumbing Fixtures: Water Closets Urinals_ avatories Bathtubs_
Showers() Kitchen Sinks_ Laundry Tubs) Garbage Grinder 0 0thelC�/
6. Liquid Capacity of Septic Tan )6 n Material of Septic Tank
7. Soil Conditions: Type of Soil Maximum ground water table
(Band,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 f
10. Percolation Tests: Time for 1" drop in soil test 02!d rti.,. Classification of soil_
11. Minimum square feet of effective seepage area required a� /
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12. Leaching System: Number of trenches Lengthr/Z - a s_ Width �r9 Total /a,. Uy
Other
Signatur
( censed Installer
(Sketch showing all minimum distances and other details required below)
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ted, Inspected and Approved iy Pecenber- 19_ BY Ld,,1A