HomeMy WebLinkAboutSeptic Repair 00 Windsorville Road (3) TOWN OF SOUTH WI N DSOR
BUILDING DEPARTMENT
South Windsor, Connecticut
Application for Permit to Install or Repair Individual Sewage Disposal System
Application No.
TO THE BUILDING DEPARTMENT: Date.
A permit is requested for repair or construction of an individual sewage disposal system concerning which the
following information is su itted:
1. Owner of Property Address of Owner
2. Location of Prope Lot. No. �Q
3. Type of Structure No. of Bedrooms
welling,Commercial Building,store,etc.)
4. Number of Families or Persons to Occupy Premises_
5. Plumbing /Fixtures: Water Closets/ Urin Lavatories Bathtubs _
Showers C Kitchen Sinks l Laundry Tubs Garbage Grinder Other
6. Liquid Capacity of Septic Tank 9,19 ---Material of Septic Tank
7. Soil Conditions: Type of Soil Maximum ground water table�rar1
(Sand7GrAvel,Clay,etc.)
8. If not served by public water supply: Distance from Owner's wel 4rom adjacent wells
9. Distance to nearest water course, drainage ditch, storm drain o embankment
10. Percolation Tests: Time for 1" drop in soil test Classification of soil
11. Minimum square feet of effective seepage area required C.1�1-1�-
12. Leaching System: Number of trenches I? Length Widt !� Total
Other l /�
Signature✓ - , /a
(Licensed Installer)
(Sketch showing all minimum distances and other details required below)
Permit Issued 19 By
Installation Completed, Inspected and Approved ig By
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` PROPERTY OF
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NO. , WINDSORVILLE ROAD SOUTH WINDSOR, CONN,
'Being Lot No. $0 on map entitled "Property of Rolling Park
Howes, Inc. South Windsor, Conn. Scale 1 " 60' January LC�,
1957"
scete 1� 40,
1
HAYDEN L: GRI$WOLD C.E .