HomeMy WebLinkAboutSeptic Repair 119 Troy Road TOWN OF SOUTH WI N DSOR
BUILDING DEPARTMERT
South Windsor, Connecticut
Application for Permit to Install or Repair Individual Sewage Disposal System
Application No.
TO THE BUILDING DEPARTMENT: Date. r'i 19 i� S/
A permit is requested for repair or construction of an individual sewage disposal system concerning which the
following information is submitted:
1. Owner of Property_A 7V X,A :SOS Address of Owner�/�
2. Location of Property_ Lot. No.
3. Type of Structure_ b fJ S e No. of Bedrooms
(Dwelling,Commercial Building,Store,etc.)
4. Number of Families or Persons to Occupy Premises_ A A f—d J0/e
5. Plumbing Fixtures: Water Closets Urinals__ Lavatories_ Bathtubs_
Showers Kitchen Sinks, Laundry Tubs__ Garbage Grinder ( Other
6. Liquid Capacity of Septic Tank ,/d [� Material of Septic Tank C D 4 (f
7. Soil Conditions: Type of Soil / Maximum ground water table
(Sated,GraVel,Clay,etc.)
8. If not served by public water supply: Distance from Owner's well 7 f from adjacent wells `X4 L 7'L-
9. Distance to nearest water course, drainage ditch, storm drain or embankment /2.d n
10. Percolation Tests: Time for 1" drop in soil test Y �,.. Classification of soil
11. Minimum square feet of effective seepage area required .3(m ,
12. Leaching System: Number of trenches Length SLd Width— L- L-- Total z&-V �.
Other /� /
Signature - G� 1 i (,�,s,.. Q 0 ��tC
T(Licensed In ler) `
(Sketch showing all minimum distances and other details required below)
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Permit Issued 19 By
Installation Completed,Inspected and Approved.-3/6A2C'# 19—±� By
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