HomeMy WebLinkAboutSeptic Repair 1503 Sullivan Avenue TOWN OF SOUTH WI N DSOR
BUILDING DEPARTMENT
South Windsor, Connecticut
Application for Permit to Install or Repair Individual Sewage Disposal System
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Application No.
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TO THE BUILDING DEPARTMENT: Date 19 �.S
A permit is requested for repair or construction of an individual sewag disp ol stem cncerni ong which the
following information is submitted:
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1. Owner of Property—til-4// M (n i 0 4A Address of Owner_
2. Location of PropertyZ�d y u 1 /4 v e Lot. No.
3. Type of Structur No. of Bedrooms 3
(Dwelling,Commercial Building,Store,etc.)
4. Number of Families or Persons to Occupy Premises_ �Otv�n�c
5. Plumbing Fixtures: Water Closets Urinals _ Lavatories 2-, Bathtubs
Showers 6 Kitchen SinksL Laundry Tubs_ Garbage Grinder_ Other y
6. Liquid Capacity of Septic Tank /a_Q 6 Material of Septic Tank C O
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7. Soil Conditions: Type of Soil S'/'}ND rceu±4 Maximum ground water table_.
(Sand,Gravel,Clay,etc.)
8. If not served by public water supply: Distance from Owner's well from adjacent wells -ITT' `
9. Distance to nearest water course, drainage ditch, storm drain or embankment "rd a f 'i<
10. Percolation Tests: Time for 1" drop in soil test ��-„ Classification of soil
11. Minimum square feet of effective seepage area required 0
12. Leaching System: Number of trenches_ Length Width_ ,I ) ' Total ardo
Other Z 33
SignatureC. �f G�i��.0 ft,�c
(Licensed Installer)
(Sketch showing all minimum distances and other details required below)
Permit Issued 19 By
Installation Completed, Inspected and Approved 1g By
FOR BUILDING PURP NLY
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