HomeMy WebLinkAboutSeptic Repair 16 Scantic Meadow Road x�, TOWN OF SOUTH WI N DSOR
,�� BUILDING DEPARTMENT
J�,�`� South Windsor, Connecticut
Application for Permit to Install or Repair Individual Sewage Disposal Syst m
Application No. .
TO THE BUILDING DEPARTMENT: Date / 19
A permit is requested for repair or construction of an individual sewage d' sal system concerning which the
following information is submitted:
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1. Owner of Property _ /Taxi, Address of Owner- ll
2. Location of Property = �
Lot. No.
3. Type of Structure No. of Bedrooms
elling,Commercial Building,Store,etc.)
4. Number of Families or Persons to Occupy Premises_
5. Plumbing Fixtures: Water Closets Z— Urinals L Lavatories C- Bathtubs ",-
Showers_1, Kitchen Sinks 4- Laundry ubs e__ Garbage Grinder Other
6. Liquid Capacity of Septic Tank_ Material of Septic Tank
7. Soil Conditions: Type of Soil Maximum ground water table C
(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
10. Percolation Tests: Time for 1" drop in soil test 2 ) Classification of soil
11. Minimum square feet of effective seepage area required
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12. Leaching System: Number of trenc es Length d Width Z Total �40
Other
Signature (Licensed Installer)
(Sketch showing all minimum distances and other details required below)
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Permit Issued 19 By
Installation Completed, Inspected and Approved_ i_6 �A/ 1g By