HomeMy WebLinkAboutSeptic Repair 00 Windsorville Road (4) TOWN OF SOUTH WINDSOR
BUILDING DEPARTMENT
South Windsor, Connecticut
Application for Permit to Install or Repair Individual Sewage Disposal System
Application No. //�
TO THE BUILDING DEPARTMENT: Date. 19
A permit is req a ed for epair or construction of an individual sewage disposal system concerning which the
following information is s b itted:
1. Owner of Property
Address of Owner 11 J/
2. Location of Pr t �cc n/ �ittt,J Lot. No._ �"
3. Type of Struct r
7cupy
welling,Commercial Buildin Stork,etc.) NO. Of Bedrooms
4. Number of Families or Persons to �iPremises
5. Plumbing Fixtures: Water Closets/ x Urina Lavatories 1-`1-1 Bathtubs
Showers 1 Kitchen Sinks ( Laundry Tubs Garbage Grinder Other
6. Liquid Capacity of Septic Tank Z , Material of Septic Tank E-
7. Soil Conditions: Type of Soil a Maximum ground water table
(Sand,Gravel,Clay,etc.)
8. If not served by public water supply: Distance from Owner's well from adjacent wells
9. Distance to nearest water course, drainage ditch, storm drain or embankment
10. Percolation Tests: Time for 1" drop in soil testes Classification of soil
11. Minimum square feet of effective seepage area required �`�
12. Leaching System: Number of trenches_ Length Z Width, Z �L ' Total
Other
Signature—,:,"—' . / ���wc�z�i•
(Licensed Installer)
(Sketch showing all minimum distances and other details required below)
Permit Issued 19 By
Installation Completed, Inspected and Approved 19 By
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