HomeMy WebLinkAboutSeptic Repair 00Sullivan Avenue Sullivan «i
TOWN OF SOUTH WI N DSOR
BUILDING DEPARTMENT
South Windsor, Connecticut
Application for Permit to Install or Repair Individual Sewage Disposal Systemz11 74
Application No.
TO THE BUILDING DEPARTMENT: Date 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, � st do--,s4 Address of Owner„6//yam
2. Location of Property SL i 2 aL A. 1�y-F Lot. No.
3. Type of Structure CIA M 41 e No. of Bedrooms
(Dwelling,Uoininercial Building,Store,etc.)
4. Number of Families or Persons to Occupy Premises_
5. Plumbing Fixtures: Water Closets_ Urinals d Lavatories T Bathtubs y
Showers_ Kitchen Sinks,` Laundry Tubs_ Garbage Grinder Q Othef�
6. Liquid Capacity of Septic Tank. &e aI a o/ Material of Septic Tank�y
7. Soil Conditions: Type of Soil .Sg ll"D Maximum ground water table_
(Sand,Gravel,Clay,etc.)
8. If not served by public water supply: Distance from Owner's well T /S —from adjacent wells ±�Dd /
9. Distance to nearest water course, drainage ditch, storm drain or embankment S
10. Percolation Tests: Time for 1" drop in soil test .3 4114" Classification of soi1�7�"
11. Minimum square feet of effective seepage area required
12. Leaching System: Number of trenches Length S11 Width J Total 1d d J1-3
Other
Signatur
License Installer)
(Sketch showing all minimum distances and other details required below)
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Permit Issued 19 By
Installation Completed, Inspected and Approved 19 By