HomeMy WebLinkAboutSeptic Repair 348 Sullivan Avenue TOWN OF SOUTH WINDSOR
BUILDING DEPARTMENT
South Windsor, Connecticut 464 :24
Application for Permit to Install or Repair Individual Sewage Disposal System
Application
TO THE BUILDING DEPARTMENT:
Date 19�A permit is requested for repair or construction of an individual sewage disposal system concernin
following information is submitted: g which the
¢
I. Owner of Property �,,,,ri/1�
1� L Address of Owner
2. Location of Property �c o) y /j to
ii,,,�� r
Lot. No.�_
3. Type of Structure_ t/l�.C' �j�, G (�"�� vh
a y it—sr
Fj' ( b q, No. of Bedrooms 4. Number of Families or Persons to Occupy Premises_
5. Plumbing Fixtures: Water Closets z Urinals
Lavatories___ Bathtubs
Showers Kitchen Sinks Laundry Tubs Garbage Grinder
Other
6. Liquid Capacity of Septic Tanl�/ !0�d
Material of Septic Tank_
7. Soil Conditions: Type of Soil gz �^ Maximum ground water table
(Sand, rav ,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 V drop in soil test
Classification of soil_ y�
11. Minimum square feet of effective seepage area required
12. Leaching System: Number of trenches Length Width
O Total
Other
Signature
(Licensed Installer)
(Sketch showing all minimum distances and other details required below)
Permit Issued 19 By
Installation Completed, Inspected and Approved 19�6 By .S .
Vol '
t
�c<LL r✓Arl�il�,��z----
r