HomeMy WebLinkAboutSeptic Repair 60 Willow Street A_ .. ,
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43z TOWN OF SOUTH WI N DSOR
BUILDING DEPARTMENT
South Win onnecticut
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Application for Permit to Install or epair; Individual Sewage Disposal System
. Applica 'on No. �+
TO THE BUILDING DEPARTMENT: Date 19
A permit is requested for repair or construction of an individual sewage dispos ystem concerning which the
following information is submitted: Ep,MR2D �tEPu�E
1. Owner of Proper _—Address of Owner �f� &(/i��OW . �(. �y
2. Location of Property � O �(/; //o S^� /,[�� p d G Lot. No.
3. Type of Structure pule No. of Bedrooms 3
—�
Dwelling,Commercial Building,Store,etc.)
4. Number of Families or Persons to Occupy Premises_ V e r So lit S
5. Plumbing Fixtures: Water Closets Urinals Lavatories— Q, Bathtubs_ /
Showers Kitchen Sinks / Laundry Tubs_L_ Garbage Grinder Otherle s`j_ �Y—
6. Liquid Capacity of Septic Tank_ 7.5-U Material of Septic Tank_ SEE L
7. Soil Conditions: Type of Soil Maximum ground water table
(Sand,Gravel,Clay,etc.)
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8. If not served'by public water supply: Distance from Owner's well adjacent wells f l
9. Distance to nearest water course, drainage ditch, storm d in or embankment
10. Percolation Tests: Time for 1" drop in soil test Classification of soil
11. Minimum square feet of effective seepage area require
12. Leaching System: Number of trenches Length Width Total
Other
Signature
( censedInstaller)
(Sketch showing all minimum distances and other details required below)
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��ti 'Cwinaeur �
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Permit Issued 19 By
Installation Completed, Inspected and Approved 19 By