HomeMy WebLinkAboutSeptic New 500 Sullivan Avenue TOWN OF SOUTH WINDSOR
BUILDING DEPARTMENT
South Windsor, Connecticut
Application for Permit to Install or Repair Individual Sewage Disposal System
Application N �
TO THE BUILDING DEPARTMENT: Date. 19 C3
A permit is requested for repair or construction of an individual sewage disposal system concerning which the
following information is subm'd:
1. Owner of Property Address of Owner .
2. Location of Property n O ezv J"
Lot. No.
3. Type of Structure
(Dwelling,Commercial Building,Store,etc.) No. of Bedrooms
4. Number of Families or Persons to Occupy Premises_ 3
5. Plumbing Fixtures: Water Closets _ Urinals 4/_ Lavatories Bathtubs
Showers Kitchen Sinks Laundry Tu s Garbage Grinder Other
6. Liquid Capacity of Septic Tan G O 0.
Material of Septic Tank
7. Soil Conditions: Type of Soil Maximum ground water table 4f,
(Sand,Gravel,Clay,etc.)
8. If not served by public water supply, Distance from Owner's well ys 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 % i4_k q Classification of soil
11. Minimum square feet of effective seepage area required
12. Leaching System: Number of trenches r Length QD o Width
.Total el!J U
Other
Signature
(Licensed Installer)
(Sketch showing all minimum distances and other details required below)
Permit Issued 19 By
Installation Completed, Inspected and Approved 19 By