HomeMy WebLinkAboutSeptic Repair 99 Scantic Meadow Road 1 cc, q G f
TOWN OF SOUTH WI N DSOR � , Aev
BUILDING DEPARTMENT
South Windsor, Connecticut Ck,#✓�Z���
Application for Permit to Install or Repair Individual Sewage Disposal System �JOzo
Application No.TO THE BUILDING DEPARTMENT: Dat /M14/ /?,J 19
41/
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 ve Address of Owner
2. Location of Property Lot. No.
3. Type of Structure E— Al 6 No. of Bedrooms_
(Dwelling,Commercial Building,Store,etc.)
4. Number of Families or Persons to Occu y Premises_ 0//
5. Plumbing Fixtures: Water Closets Urinals ""'—"' Lavatories � Bathtubs _
Showers Kitchen Sinks_ La dry Tubs Garbage Grinder Other_ 1 A-I ffJ9-
6. Liquid Capacity of Septic Tankto C O 570 910 61-Material of Septic Tank C �.���' _
7. Soil Conditions: Type of Soil It T Maximum ground water table `f
(Band,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 ,L/ej// -1
10. Percolation Tests: Time for 1" drop in soil test A(Z !0 Classification of soil
i
11. Minimum square feet of effective seepage area required
12. Leaching System: Number of trenches Length t Width, Total
Other
2 Signature
(Licensed Installer)
3 (Sketch showing all minimum distances and other detail required below)
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Permit Issued 19 By
Installation Completed, Inspected and Approved b3 /a, lg Goo By �, /a