HomeMy WebLinkAboutSeptic New 20 Pam Lane TOWN OF SOUTH WI N DSOR
BUILDING DEPARTMENT
South Windsor, Connecticut
Application for Permit to Install or Repo Individual
PP p v ual Sewage Disposal Syste
Application No.
TO THE BUILDING DEPARTMENT: Date 19 /
A permit is requested for repair or construction of an individual sewage disposals stem concerning which the
following information is su mitt`ed:
1. Owner of Property �A�/l9L (VWIZAkAddress of Owner ;,
2. Location of Property - Lot. No.. (a
3. Type of Structure
No. of Bedrooms_
(Dwelling,Commerci B/ui�lding,Store,etc.)
4. Number\of Families or Persons to Oc py Premises_ !V L
5. Plumbing Fixtures: Water Closets Urinals `-- ' Lavatories Bathtubs I
Showers_ Kitchen Sinks} Laundry Tubs .-� Garbage Grinder ' Other &/��,_�/�
6. Liquid Capacity of Septic Tank / CAL ' Material of Septic Tank - C
7. Soil Conditions: T ,,//
Type of Soil ff Maximum ground water table
Sand,Gravel,clay,etc.)
'19
8. If not served by public water supply: Distance from Owner's well y &i L' fr7/12
adjacent wells ""' '`
9. Distance to nearest water course, drainage ditch, sto in in or embankment
10. Percolation Tests: Time for 1" drop in soil test Classification of soil f Ck)
11. Minimum square feet of effective seepage ea required I�.t
12. Leaching System: Number of trenches ` Length / Widt Total
!� 'l Other a 04 Q
Signatur
ylLee�,,,��1w L
r (Licensed Install ) �
t, T (Sketch slowing all minimum distances and other details required O.W)
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Permit Issued 19 By
Installation Completed, Inspected and Approved 19 By e`
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