HomeMy WebLinkAboutSeptic Repair 120 Robert Drive TOWN OF SOUTH WI N DSOR
BUILDING DEPARTMENT
South Windsor, Connecticut
Application for Permit to Repair Individual Sewage Disposal Syste
Application No.
TO THE BUILDING DEPARTMENT: Date. y g 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 t (j 4,;.,A4e. Address of Owner /2()_��p ,�j 2 r� [I I^ ✓C'
2. Location of Property Za D i& L �" -Lot. o.
3. Type of Structure uu P I �ez No. of Bedrooms_
welling,Commercial Building,Store,etc.)
4. Number of Families or Persons to Occupy Premises_
5. Plumbing Fixtures: Water Closets `r Urinals C) La atories .5— Bathtubs _
Showers__ Kitchen Sinks /� Laundry Tubs_ Garbage Grinder_—! Other
6. Liquid Capacity of Septic Tank ZS'f� Material of Septic Tank C e5 oY'c s�
i
7. Soil Conditions: Type of Soil %t Fcr VC,/ Maximum ground water table
Sand,Gravel,Clay,etc.)
8. If not served by public water supply: Distance from Owner's well 7t /d 4 from adjacent wells.! .&Q
9. Distance to nearest water course, drainage ditch, storm drain or embankment S'd
10. Percolation Tests: Time for 1" drop in soil test Classification of soil
11. Minimum square feet of effective seepage area required 7 :
12. Leaching System: Number of trenches J Length /e 2 Width ,1-6 Total
Other
Signature g2s "
(License staller)
(Sketch showing all minimum distances and other details required below)
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owl -11
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Permit Issued 19 By
Installation Completed, Inspected and Approved 19 By. `11Ar �