HomeMy WebLinkAboutSeptic Repair 64 Saginaw Street Pa,(,'W-16 —j1--(,FTOWN OF SOUTH WINDSOR
BUILDING DEPARTMENT 54� J l
South Windsor, Connecticut
Application for Permit to Install or Repair Individual Sewage Disposal System
Application No.
TO THE BUILDING DEPARTMENT: Date 19 6 O
A permit is requested for repair or construction of an individual sewage disposal system concerning which the
following information is submitted: / ` ,s
1. Owner of Property le,C Nt'/'C L�►'�e✓' l E Address of Owner
2. Location of Property Lot. No.
3. Type of Structure �- No. of Bedrooms_
(Dwelling,Commerc lBuuilding,Store,etc.)-
4. Number of Families or Persons to Occu y Premises- 16k&I
5. Plumbing Fixtures: Water Closets Urinals Lavatories_/Bathtubs--)
Showers Kitchen Sinks Laundry Tubs Garbage Grinder Otherf� /l
6. Liquid Capacity of Septic Tank L141 Material of Septic Tankf/ C'
7. Soil Conditions: Type of Soil _Maximum ground water table
(S d,Gr vel,Clay,etc.) fir•
8. If not served by public water supply: Distance from Owner's well from adjacent wells '1-
9. Distance to nearest water course, drainage ditch, storm r 'n 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 3 Width �- Total 1fi� 411-IZ-)
Other 4z'C17CN-Tripa G t
Signature C•
(Licensed Installer)
(Sketch showing all minimum distances and other details required below)
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Permit Issued 19 By
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Installation Completed, Inspected and Approved 19 By ` /9 T