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TOWN OF SOUTH WINDSOR
BUILDING DEPARTMENT
South Windsor, Connecticut
Application for Permit to Install or Repair Individual Sewage Disposal System
Application No.
TO THE BUILDING DEPARTMENT: Date 19
A permit is requested for repair or construction of an individual sewage disposal system cf cerning which the
following information is submitted:
1. Owner of Property Address of Owner
2. Location of Property Lot. No.
e
3. Type of Structure .�
No. of Bedrooms
(Dwelling,Commerci ding,Store tc.)
4. Number of Families or Persons to Occupy Premises f_
5. Plumbing Fixtures: Water Closets z;;1— Urinals La ories—_,J--� Bathtubs �/
Showers_ Kitchen Sinks Laundry Tubs Garbage Grinder Other
6. Liquid Capacity of Septic Tank /ddD Material of Septic Tan' . ��,,
7. Soil Conditions: Type of Soil g:94 Y�-- Maximum ground water table
(Sand,Gravel,Clay,etc.)
8. If not served b supply:y public water su 1 Distance from Owners well ?c`J from adjacent wells
9. Distance to nearest water course, drainage ditch, storm drain or embankment -;21�5-�f
10. Percolation Tests: Time for 1" drop in soil test Classification of soil
11. Minimum square feet of effective seepage are required
12. Leaching System: Number of trenches Width Total
Other
Signature
(Lice Installer)
(Sketch showing all minimum distances and other details required I )
Permit Issued 19 By
Installation Completed, Inspected and Approved 19 By
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peal
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