HomeMy WebLinkAboutSeptic New 733 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._ J`S9
TO THE BUILDING DEPARTMENT: Date_ ,�`19<,,a
A permit is requested for repair or construction of an individual sewage disposal system concerning which the
following information is subm' ted
1. Owner of Prone tty, Address of Owner,
2. Location of Propert ez Lot. No.
3. Type of Structure No. of`Bedrooms 3
(Dwping,Commercial Building,Store,etc.)
4. Number of Families or Persons to Occupy Premises_ 1
5. Plumbing Fixtures: Water Closets Urinals Lavatories / Bathtubs 1/
Showers_ Kitchen Sinks_ Laundry Tubs Garbage Grinder D, e Other.
6. Liquid Capacity of Septic Tank -Material of Septic Tank 6�' ,
7. Soil Conditions: Type of Soil 5/O Maximum ground water table �o /
(Sand,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
10. Percolation Tests: Time for 1" drop in soil test Classificaaati`on of soil
11. Minimum square feet of effective seepage area required � os4� TT-
� d
12. Leaching System: Number of trenches Lengt .A / Width Total
Other J�
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Signatur r
censed Installer)
(Sketch showing all minimum distances and other details required below)
Permit Issued 19 By
Installation Completed, Inspected and Approved 19 By
1 1
FOR BUILDING PURPOSES ONLYPOO
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