HomeMy WebLinkAboutSeptic Repair 1511 Sullilvan Avenue TOWN OF SOUTH WIN DSO
ad° BUILDING DEPARTMENT
�•it`�' South Windsor, Connecticut
Application for Permit to Install or a ai Individual Sewage Disposal System
Application No.
TO THE BUILDING DEPARTMENT:
Date__ ...,pL 19�—
A permit is requested fo
following information is submitted:r a ai or construction of an individual sewage disposal system concerning which the
I. Owner of Property C
2. Location of Property /S// tL A Address of Owner ...$
i.,t 1 V/1N Qv>I Me.�.L
3. Type of Structure 7:bi„a t=LL I A t. Lot. No.
D mg,Commercial Building,S/tore,etc.) NO. Of Bedrooms
4. Number of Families or Persons to Occupy Premises_d�11
5. Plumbing Fixtures: Water Closets Urinals
Lavatories_ Bathtubs__
Showers Kitchen Sinks Laundry Tubs Garbage Grinder
Other
6. Liquid Capacity of Septic Tank Material of Septic Tank
7. Soil Conditions: Type of Soil Maximum ground water table
(Sand,Gravel,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 1" drop in soil test
Classification of soil
11. Minimum square feet of effective seepage area required
12. Leaching System: Number of trenchesl"&F A
Length! S r Widt �; Total_. MA
Other
Signature
(Licensed Installer)
(Sketch showing all minimum distances and aaer a ails reru h 1" r98/a,
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A
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Permit Issued__ ® SEiATF/»�OZ 19499
Installation Completed, Inspected and Approve d�a�f�� �8�2 19_� B
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