HomeMy WebLinkAboutSeptic New 00 Poplar Drive (3) Is
TOWN OF SOUTH WI N DSOR
BUILDING DEPARTMENT
South Windsor, Connecticut
Application for Permit to Install or Repair Individual Sewage Disposal System�f
Application No. /
TO THE BUILDING DEPARTMENT: Date //6� 19
A permit is requested for repair or construction of an individual sewage disposal system concerning which the
following information 's submitted:
1. Owner of Pr(perty` Address of Owner
2. Location of Property Lot. No.
3. Type of Structure
No. of Bedrooms
(Dwelling,Comme i Building, tore,etc.)
4. Number of Families or Persons to Occupy Premises
Y
5. Plumbing Fixtures: Water Closets Z' Urinals Lavatories Bathtubs
Showers_ Kitchen Sinks r Laundry Tubs Garbage Grinder Other
6. Liquid Capacity of Septic Tank—_Z44D Material of Septic TankC�6,Y
` - 4ta- =� )
7. Soil Conditions: Type of Soil + Maximum ground water table
(Band,GraveY,Clay,e .)
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 Classification of soil
11. Minimum square feet of effective seepage area required
12. Leaching System: Number of trenches` Length / Widt ;-�J � Total .�CoC1
Other
Signature �77 "
(Licensed Installer)
(Sketch showing all minimum distances and other details required below)
Permit Issued 19 By
Installation Completed, Inspected and Approved 19 - By
0-T 36
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