HomeMy WebLinkAboutSeptic Repair 473 Sullivan Avenue TOWN OF SOUTH WINDSOR
BUILDING DEPARTMENT
South Windsor, Connecticut
Application for Permit tom or Repair Individual Sewage Disposal System
TO THE BUILDING DEPARTMENT: Application No.
Date 19 �
A permit is requested for repair or construction of an individual sewage ispos system concerning which the
following information is submitted:
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1. Owner of Property Address of Owner A �/f _ Q., '
a-� sin (ILO
2. Location of Prope rty
3. Type of Structure Lot. No.______
(Dwelling,Commercial Building,Store,etc.) NO. of Bedrooms —5-
4. Number of Families or Persons to Occupy Premises .*
5. Plumbing Fixtures: Water Closets
Urinals---6 Lavatories_ � Bathtubs._
Showers_ Kitchen Sinks^'T f— Laundry Tubs_6_ Garbage Grinder
6. Liquid Capacity of Septic Tank �n C�I
Material of Septic Tank—6— Other
_ C �, .►ter C.�,�P (����)
7. Soil Conditions: Type of Soil_c�/y n
(Sand, ravel,Clay,etc.) Maximum ground water table
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_ /Q tj 6 -—
19. Percolation Tests: Time for 1" drop in soil test_ � /Jl//Y
Classification of soil_
11. Minimum square feet of effective seepage area required Q
12. Leaching System: Number of trenches_ 3 Length A a i"
-,-�_ Width_ Total d � .ff
Other /y'��
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Signatur9: tX _
(Licensed installer)
(Sketch showing all minimum distances and other details required below)
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Permit Issued 19 B
Y
Installation Completed, Inspected and Approved_
19 By