HomeMy WebLinkAboutSeptic Repair 00 Sullivan Avenue AWN OF SOUTH WI N DSOR
BUILDING DEPARTMENT
South Windsor, Connecticut
Application for Permit to Install or Repair Individual Sewage Disposal System
Application No.1240 69-S
TO THE BUILDING DEPARTMENT: Date y I A e-- >c L �-�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 PropertyJ#4," /iorasL 0,�e61 T Address of Owner_ &14-ciyAef .&QVg--A1 U 4C--
2. Location of Property Lot. No.
3. Type of Structure 06AsMAFA-a®A o. of Bedrooms °-=
(Dwelling,Commercial Building,Store,etc.)
4. Number of Families or Persons to Occupy Premises_
5. Plumbing Fixtures: Water Closets Urinals Lavatories Bathtubs
Showers Kitchen Sinks Laundry Tubs Garbage Grinder Other
5-0 Q
6. Liquid Capacity of Septic Tank Lt-g: b Material of Septic Tank
7. Soil Conditions: Type of Soil Maximum ground water table
(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 3 ,vti orJt Xr Classification of soil
11. Minimum square feet of effective seepage area required
12. Leaching System: Number of trenches Length . Width Total
Other N/L 01-41FRI<tr 2)cc l 'At a/,1T 'r_V�.'4p,.¢ f yh
Signature d 6-t—
,,�((jj (LicenyedInstaller)
(Sketch showing all minimum distances and otl�err etaillssreq ire-below) ", 3-,0
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Permit Issued L& o � fifL- 19 B
Installation Completed, Inspected and Approved !;b 3trefA-a-A 1949 B J„4,G OV
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