HomeMy WebLinkAboutSeptic Repair 36 Willow Street TOWN OF SOUTH WIND , L-t e��r
SOR � �ri
BUILDING DEPARTMENT ,&63
South Windsor, Connecticut Z
Application for Permit to Install or Repair Individual Sewage Disrs1� tem
Application No.4_194?
TO THE BUILDING DEPARTMENT: DateJ AL I
A permit is requested for repair or construction of an individual sewage disposal system concerning which the
following information is submitted: CMa/6f'-' / •/'1. Owner of Property LL� - Address of Owner -W t
2. Location of Property , Lot. No. 19
3. Type of Structure �� `
No. of Bedrooms
(Dwelling,Commercial Building,Store,etc.)
4. Number of Families or Persons to Occu Premises L-
5. Plumbing Fixtures: Water Closets Urinals Lavatories Bathtubs
Showers Kitchen Sinks aundry Tubs Garbage Grinder � Other
6. Liquid Capacity of Septic Tank I% gl � Material of Septic Tan le-.
7. Soil Conditions: Type of Soil kt
�. Maximum ground water table
(Sand,Gr el,Clay,etc.)
8. If not served by public water supply: Distance from Owner's well from adjacent wells / erGO
9. Distance to nearest water course, drainage ditch, st m 7,71410
in or embankment_ /Y(s'
10. Percolation Tests: Time for 1" drop in soil test Classifi6ca�tion of soil
11. Minimum square feet of effective seepage area required D N
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12. �e��ng System: Number of trenches Length 1A1.`A`-width_ _ Total
Other 1�C LaCIftM C O'SPOOL / , O D
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Signature G
Licensed Installer)
(Sketch showing all minimum distances and other details required below)
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Permit Issued 19 By
Installation Cgmpleted, Inspected and Approved 19 By