HomeMy WebLinkAboutSeptic Repair 42 Robert Drive Ar y,
4* pA,n TOWN OF SOUTH WI N DSOR
-at, 3 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 Address of Owner
.rl2. Location of Property Lot. No.
t n
3. Type of Structure ,!� No. of Bedrooms
Dwelling,Commercial Building,Store,etc.)
4. Number of Families or Persons to Occupy Premises_
5. Plumbing ixtures: Water Closets Urinals0" Lavatories Bathtubs _
Showers Kitchen Sinks d/r�y Tubs Garbage Grinder" Other
6. Liquid Capacity of Septic Tank /� p�� o 1 t;? , Material of Septic Tank ��'
7. Soil Conditions: Type of Soil (�/ L Maximum ground water table t '
( n , ravel,Clay,etc.) w 9r�
8. If not served by public water supply: Distance from Owner's well J ` ' from adjacent wells S 4_
9. Distance to nearest water course, drainage ditch, st In dr_in nbankment IF
10. Percolation Tests: Time for 1" drop in soil test Cl ' cation of soil
t
11. Minimum square feet of effective seepage area required
12. Leaching System: Number of enches_ Lengt /25 FT Width Tota
Other T 0 --
Signatur �JeiJ t`
c nse Installer)
(Sketch showing all minimum distances and other details required below)
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Permit Issued *ul A�R/L 1921 By
Installation Completed, Inspected and Approved 21 jP21L 19--LL— By U.VJ, L,
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