HomeMy WebLinkAboutSeptic New 395 Smith Street OWN kOF SOUTH WINDSOR
BUILDING DEPARTMENT
South .Windsor, Connecticut
Application for Permit to Install or Repair Individual Sewage Disposal System `
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Application No, �O
TO THE BUILDING DEPARTMENT: Date / f� 7 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 , Q
`/ A�"1XcT�ress of Owne�9 �
2. Location of Property - -
Lot. No.
3. Type of Structure /i�., rL, �ti No. of Bedrooms 3
(Dweinng,Commercial Building,Store,etc.)
4. Number.of Families or Persons to Occupy Premises_ J
5. Plumbing Fixtures: Water Closets Urinals Lavatories
S0htgbs. f
Showers Kitchen Sinks_,,_ Laundry Tubs Garbage Grinder Other ^.
6. Liquid Capacity of Septic Tank_ : .� Material of Septic Tank /Y C
7. Soil Conditions: Type of Soil Maximum ground water table
(Sand,Gravel,Clay,etc.)
8. If not served by public water supply: Distance from Owners well.
pp y' t ' 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` 4 `!
11. Minimum square feet of effective seepage area required `' r
12. Leaching System: Number of trenches` Length Width - - 1
Other r' . ` TotLr �/.'�
T h
Signature r
(Licens nstaller)
(Sketch showing all minimum distances and other details required
Permit Issued 19 By
Installation Completed, Inspec `and Approved 19 By
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FOR BUILDING PURPOSLS ONLY
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