HomeMy WebLinkAboutSeptic Repair 1559 Sullivan Avenue TOWN OF SOUTH WINDSOR
BUILDING DEPARTMENT
Ca South W' onnecticut
Application for Permit to Install or`Repair Individual Sewage Disposal System
6 �'✓�/�.�A�r� -�27 APPlicatign N0.0109
TO THE BUILDING DEPARTMENT: p y
Date
A permit is requested for repair or construction of an individual sewage disposal system concerning which the
following information is submit d:
1. Owner of Property
Address of Owner �,rs �`s���,�✓� C�.� J`2. Location of Property
3. Type of Structure
�— :Z:: ' Lot.
Dwelling,Commercial Building,Store,etc.) No. of Bedrooms
4. Number of Families or Persons to Occupy Premises_
5. Plumbing Fixtures: Water Closets
Urinals Lavatories_! Bathtubs/Showers / Kitchen Sinks / LaundryTubs Garbage Grinder Other
6. Liquid Capacity of Septic Tank .5-0
Material of Septic Tank
7. Soil Conditions: Type of Soi1� 1/
Mana,Gravel,clay,etc.) Maximum ground water table k
8. If not served by public water supply: Distance from Owner's well
9. Distance to nearest water course, drainage ditch, storm drain or embankment from adjacent wells
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 tr riches
Length S_G Widt Total �CYJ
Other
Signatur �
(Licensed Installer)
(Sketch showing all minimum distances and other details required below) _ 3ss�a
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tT�I�1442 1970
1pleted, Inspected and Approved t— t:
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