HomeMy WebLinkAboutSeptic Repair 767 Pleasant Valley Road TOWN OF SOUTH WI N DSOR
/ BUILDING DEPARTMENT
/ South Windsor, Connecticut
Application for Permit to Install or eR Individual Sewage Disposal System
Application No.
TO THE BUILDING DEPARTMENT: Date /le 19-6.V
A permit is requested for repai or construction of an individual sewage disposal system concerning which the
following information is submitted: J� /
1. Owner of Property d�, /�?�P f- P c=Al Address of Owner
2. Location of Property Tr!g I,? Lot. No.
3. Type of Structure w aG!co- No. of Bedrooms
(Dwelling,Commercial Building,Store,etc.)
4. Number of Families or Persons to Occupy Premises_ r
5. Plumbing Fixtures: Water Closets Urinals Lavatories l Bathtubs /
Showers Kitchen Sinks _ Laundry Tubs_ Garbage Grinder Other
6. Liquid Capacity of Septic Tank 'Al o . Material of Septic Tank
7. Soil Conditions: Type of Soil S�f A"" Maximum ground water table A,< Rrrr
(Sand,Gravel;Clay,etc.)
8. If not served by public water supply: Distance from Owner's well 70� from adjacent wells 7�
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 Width Total 3$6
Other /'�
Signature -�,f z
(Licensed Installer)
(Sketch showing all minimum distances and other details required below)
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Permit Issued 19 By Q
\ Installation Completed, Inspected and Approved .19 By
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