HomeMy WebLinkAboutSeptic Repair 640 Rye Street TOWN OF SOUTH WI N DSOR
BUILDING DEPARTMENT
South Windsor, Connecticut
Application for Permit to Install or Repair Individual Sewage Disposal System
Application No.
TO THE BUILDING DEPARTMENT: Date_
A permit is requested for repair or construction of an individual sewage disposal system concerning which the
following information is sub to �� 2
1. Owner of Property r Address of Owner 2
2. Location of Prope y3/ifi. Lot. No.
3. Type of Structure No. of Bedrooms
(Dwelling,Commercial Bui rg,Store,etc.)
4. Number of Families or Persons to Occupy Premises_ G
5. Plumbing Fixtures: Water Closets Urinals Lavatories `- Bathtubs
Showers e4 Kitchen Sinks,_ Laundry Tubs_ Garbage Grinder_ Other
6. Liquid Capacity of Septic Tank` ate ial of Septic Tank ��
7. Soil Conditions: Type of Soil Maximum ground water table-
(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 •�G�`
10. Percolation Tests: Time for 1" drop in soil test C-X— Classification of soil
11. Minimum square feet of effective seepage area required
12. Leaching System: Number of trenches — Length Width Total
Other /0.--
Signature
Licensed Installer)
(Sketch showing all minimum distances an other details required below)
Permit Issued 19 By
Installation Completed, Inspected and Approved 19 By
1 9
?LOT PLAN FOR
JOHN SAR"u
SOUTH -,VINDSOA, CONN.
Seals 1 ff-50 , Dos . 1 9b2
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< "r i HEREBY CERTIFY THAT THIS W
IS SU3�3TANTJALLY CORRECT