HomeMy WebLinkAboutSeptic Repair 52 Willow Street TOWN OF SOUTH WI N DSOR --�
BUILDING DEPARTMENT e/C 'teZ?�
South Windsor Connecticut �V
Application for Permit to Install or` a air, Individual Sewage Disposal P g System
Application o.
TO THE BUILDING DEPARTMENT: Date 19�
A permit is requested for repair or construction of an individual sewage dis osal system concerning which the
following information is submitted:
1. Owner of Property \-- o . i4"'., Address of Owner-
2. Location of Property
�S Z �.����Jo c+,� �� Lot. No._
3. Type of Structure j I I n u No. of Bedrooms—
(Dwelling,Commercial Building,Store,etc.)
4. Number of Families or Persons to Occupy Premises_
5. Plumbing Fixtures: Water Closets C1:1-1 Urinals Lavatories` Bathtubs
Showers F
_ / Kitchen Sinks,_ Laundry Tubs • �Garbage Grinder Other—A tlTo eY
6. Liquid Capacity of Septic Tank �a : , Material of Septic Tank
7. Soil Conditions: Type of Soil Maximum ground water table_
(Sand,G avel,Clay,etc.)
8. If not served by public water supply: Distance from Owner's well 7s from adjacent wells_�7�
9. Distance to nearest water course, drainage ditch, storm drain or embankment_ 9 o "
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 trenches Length J f WWidth O "1 Total '
Other
Signatur
(L censedInstaller)
(Sketch showing all minimum distances and other details required below)
1-400
K-�(-yt
111
IT 0
d Ti J
X r Flj
/t Y ®� a j4.�,i'kti�✓t.
Permit Issued 19 By
Installation Completed, Inspected and Approved 19 By