HomeMy WebLinkAboutSeptic Repair 44 Willow Street TOWN OF SOUTH WINDSOR
BUILDING DEPARTMENT ,41
South W' 7Cb necticut 5 �!
Application for Permit to Install or a ..Individual Sewage Disposal System
Application No.
TO THE BUILDING DEPARTMENT: Date. {/(1 G of& /f—19 6�j
A permit is requested for repair or construction of an individual sewage disposal system concerning which the
following information is submitted: R-11 ,,,� W. 1 p_p ^
1. Owner of Property A �.��'/"!� ILA Address of Owner_ 1 L L.cI ctl >/
2. Location of Property �f/ C Lot. No.
3. Type of Structure_ ul&;[ No. of Bedrooms(Dwelling,Commercial Building,Store,etc.)
4. Number of Families or Persons to Occupy Premises 7,.G'�
5. Plumbing Fixtures: Water Closets 1k Urinals Lavatories 0� Bathtubs _
Showers Kitchen Sinks _ Laundry Tubs' Garbage Grinder ^ Other (
6. Liquid Capacity of Septic Tank 1.S 0' 61jf.+ Material of Septic Tan !!
?. Soil Conditions: Ty
pe of Soil r� ,fd.) -�- Maximum ground water table
( an ravel,Clay,etc.) ���' ���
8. If not served by public water supply: Distance from Owner's well*L1-_from adjacent wells- Ir7`
9. Distance to nearest water course, drainage ditch, stor drain or embankment �Q
10. Percolation Tests: Time for 1" drop in soil test 4rAl Classification of soil C'�✓
11. Minimum square feet of effective seepage area required Q
12. Leaching System: Number of trenches-3— Length Width , _
Other
Signature G
icensed Installer)
(Sketch showing all minimum distances and other details required below)
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o �.D F
Permit Issued 19 By
Installation Completed, Inspected and Approved 19 By