HomeMy WebLinkAboutSeptic Repair 00 Windsorville Road TOWN OF SOUTH WI N DSOR
BUILDING DEPARTMENT
South Windsor, Connecticut
Application for Permit to Install or Repair Individual Sewage Disposal stem
Application No.
TO THE BUILDING DEPARTMENT: Date -/�z " ,,,-eg 1963
A permit is requested for repair or construction of an individual sewage disposal system concerning which the
following information is submitted: �fA
1. Owner of Property %//iA4-1y� Address of Owner
2. Location of Property Lot. No.
3. Type of Structure No. of Bedrooms- �1.3
(Dwelling,Commercial Building,Store,etc.)
4. Number of Families or Persons to Occupy Premises_ /
5. Plumbing Fixtures: Water Closets _ Urinals Lavatories Bathtubs_
Showers / Kitchen Sinks,` Laundry Tubs_ Garbage Grinder Other
6. Liquid Capacity of Septic Tank �� 00® Material of Septic Tank 65,VO S T 1-
7. Soil Conditions: Type of Soil Maximum ground water table
(Sand,Gravel,Clay,etc.) /'
8. If not served by public water supply: Distance from Owner's well �/ from adjacent wells C��
9. Distance to nearest water course, drainage ditch, storm drain or embankment
10. Percolation Tests: Time for 1" drop in soil test./%� Classification of soil
r 11. Minimum square feet of effective seepage area required f�1
12. Leaching System: Number of trenches Length Width
Other O
Signature
(L tensed Installer) A
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(Sketch showing all minimum distances and er details required below)
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Permit Issued 19 By
Installation Completed, Inspected and Approved 19 By