HomeMy WebLinkAboutSeptic Repair 685 Rye Street fro Q'S—
TOWN OF SOUTH WINDSOR Z-,` 4e
BUILDING DEPARTMENT 672
South Windsor, Connecticut
Application for Permit to Install or Repair Individual Sewage Disposal System
Application No. ��
TO THE BUILDING DEPARTMENT: Date. T " 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 h 14�� Nati/SK1 Address of Owner ��J �/ 5 /7
2. Location of Property �S-n� Lf/1 Mdsem! Lot. No. �s
3. Type of Structure L/ w C-I I 44 41 No. of Bedrooms
(Dw ling,Commercial Building,Store,etc.)
4. Number of Families or Persons to Occupy Premises__- /
5. Plumbing Fixtures: Water Closets/ Urinals-�iC�it a Lavatories _ Bathtubs_
Showers Kitchen Sinks Laundry TubsA02-M Garbage Grinder NQQ if Other—N-O
6 Liquid Capacity of Septic Tank TT d G G Material of Septic Tank C
7. Soil Conditions: Type of Soil 5.)At _ Maximum ground water table
(band,Gravel,Clay,etc.)
8. If not served by public water supply: Distance from Owner's well J 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 Width Total
Other Adk Ala -/d �y
G
Signature � �� r i y2
J Licensed Installer) /
(Sketch showing all minimum distances and,' her details required below)
6'00
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d4D FIELD
VF race-7-
Permit Issued 19 By
Installation Completed, Inspected and Approved 196 L— By