HomeMy WebLinkAboutSeptic Repair 171 Woodland Drive (rG P,*It�,
TOWN OF SOUTH WINDSOR
BUILDING DEPARTMENT oilo. 0a
South Windsor, Connecticut
Application for Permit to Install or Repair Individual Sewage Disposal System
Application No._",v/?a--/
TO THE BUILDING DEPARTMENT: Date. 0/ /`Nf+V 19- at,
A permit is requested for repair or construction of an individual sewage disposal system concerning which the
following information is submitted:
1. Owner of Property Rie q AR D 1 kl k—w Address of Owner l7 t !c:�b 4-AN b bfd,ve
2. Location of Property 01 E Lot. No. 3(0
3. Type of Structure No. of Bedrooms
(Dwelling,Commercial BuildingZ".q
re,etc.)
4. Number of Families or Persons to Occupy Premises Gam'E C�) V
5. Plumbing Fixtures: Water Closets Urinals Lavatories Bathtubs
Showers Kitchen Sinks Laundry Tubs Garbage Grinder Other
6. Liquid Capacity of Septic Tank Material of Septic Tank
7. Soil Conditions: Type of Soil (Sand,Gravel,Clay,etc.) Maximum ground water table
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 test Classification of soil
11. Minimum square feet of effective seepage area required
12. Leaching System: Number of trenches Length Width Total
Other
Signature
(Licensed Installer)
(Sketch showing all minimum distances and other details required below)
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Permit Issued Cs/ HA!j 70 By ,
Installation Completed, Inspected and Approved 19 By