HomeMy WebLinkAbout1965-11-23 - 15 Beelzebub Road - Septic Repair Permit ApplicationTOWN OF SOUTH WIN ❑SOR
J
-� BUILDING DEPARTMENT
{ South Windsor, Connecticut
Application for Permit to Install o Re c Individual Sewage Disposal System
Application No.
_--7�
TO THE BUILDING DEPARTMENT: Date - 10
A permit is requested for epair r construction of an individual sewage disposal system concerning which the
following information is submitted:
1. Owner of Property Address of Owner ,/ �S ,_;,���
2. Location of Property •, a r2 •t Lot. No.
3. Type of Structure , -(,c
c No. of Bedrooms
( Dwell g, ammercial 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 Al.. C _ .Material of Septic Tank
7. Soil Conditions: Type of Soil Maximum ground water table
(Sand, Gravel, Clay, c tc;. i
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 �? - f- r Total.,
Other
Signature ae,.--ti• =
�? &
(Urens d Installer)
(Sketch showingall minimum distances and other details required below)
(EC-f<' ovcA-J
NNED
Permit Issued
19 Sy
Installation Completed, Inspected and Approved -7r 9 /ir'pa��n�l3 _ 19 64- By