HomeMy WebLinkAboutDrain Layers Permit 99 Pine Knob Drive (2) TOWN OF SOUTH WI N DSOR
BUILDING DEPARTMENT Qa
South Windsor, Connecticut 's�yg
Application for Permit to Install or Repair Individual Sewage Disposal System
Application No. /
TO THE BUILDING DEPARTMENT: Date.-V�,.,�
A permit is requested for repair or construction of an individual sewage disposal system concerning which the
following information is submitted:
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1. Owner of Prope � _��/ Address of Owner '
2. Location of Property �K, Lot. No.
3. Type of Structures /. !, No. of Bedrooms_
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Commercial u ding Store,etc.)
4. Number of Families or Persons to Occupy Premises-_ G
5. Plumbing Fixtures: Water Closets 571 Urinals Lavatories— B�athtubs t _
Showers_ Kitchen Sinks._ Laundry Tubs— Garbage Grinder-- Other 1 a�Te,.W&-"%
6. Liquid Capacity of Septic Tank Z QQ 0 C �r I Material of Septic Tank—Co"e-r ,41Z. ))
7. Soil Conditions: Type of Soil Maximum ground water tablef'
(Sand,Iravel,Clay,etc.)
8. If not served by public water supply: Distance from Owner's well T from adjacent
)J wells�—'
9. Distance to nearest water course, drainage ditch, storm drain or embankment 'grc'e'T
10. Percolation Tests: Time for V 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
k&,� a �z �A
(Licensed Installer)
(Sketch showing all minimum distances and other details required below)
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81
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Permit Issued 19 By
Installation Completed, Inspected and Approved z ,✓r 19�� By 4����