HomeMy WebLinkAboutDrain Layers Permit 123 Pine Knob Drive TOWN OF SOUTH WI N DSOR �.
BUILDING DEPARTMENT �/C. ✓ z"
South Windsor, Connecticut
Application for Permit to Install or Repair Individual Sewage Disposal Sy7�ezl
Application No.
TO THE BUILDING DEPARTMENT: Date i+.�,��r'�7 191216--
A permit is requested for repair or construction of an individual sewage disposal system concerning which the
following information is submitted: nd r e r M
1. Owner of Property Address of Owner '3y�s �C�,�.,a INr
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2. Location of Property le, Ic
Lot. No. 2 2
3. Type of Structure +�. G gw,J f W e J r r�A No. of Bedrooms__
(Dwellin Commercial Building,Store,etc.)
4. Number of Families or Persons to Occupy Premises_ t
5. Plumbing Fixtures: Water Closets�/ _ Urinals —' Lavatories_ Bathtubs
Showers _ Kitchen Sinks ` Laundry JTubs ——' Garbage Grinder '�^^' Other } ✓to
6. Liquid Capacity of Septic Tank '�� �>I• Material of Septic Tanker
7. Soil Conditions: Type of Soil�� 2.jc rt9 a►-' Maximum ground water table
(Sand,G vel,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- 9n
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 L 13C Total/3 C)
Other
Signature
(Licensed installer)
(Sketch showing all minimum distances and other details required below)
k x v I y y "
x x ��
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Permit Issued 19 13Y
Installation Completed, Inspected and Approved 19 By