HomeMy WebLinkAboutSeptic Repair 79 Pine Tree Lane TOWN OF SOUTH WINDSOR
, t BUILDING DEPARTMENT
—�o T South Wind , onnecticut
ep ppIication for Permit to Install or:Rpair Individual
Sewage Disposal System
c e Application No. ��
TO THE BUILDING DEPARTMENT: Date_�GL Y &2 1 19
A permit is'requested for repair or construction of an individual sewage disposal system concerning which the
following information is submitted: i b-S
1. Owner of Property dress of Owner.
2. Location of Property Lot. No. G 9 ?1
3. Type of Structure DWELL/ N C No. of Bedrooms,_
(Dwelling,Commercial Building,Store,etc.)
4. Number of Families or Persons to Occupy Premises 0N E I7A M IL
il
5. Plumbing Fixtures: Water Closets_ Urinals Lavatories_ Bathhttub$
Showers_ Kitchen Sinks Laundry Tubs Garbage Grinder Other /�A"
6 Liquid Capacity of Septic Tank r co cftL Material of Septic Tank ("�12L �
7. Soil Conditions: Type of Soil Ci I Alll&L, Maximum ground water table '
(Send,Uravel,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 ' /V a Alp- ,/ �j
10. Percolation Tests: Time for 1" drop in soil test d 17- t Q Al —Classificationof soil ,17� , p —
11. Minimum square feet of effective seepage rea required
12. Leaching System: Number of trenches Length Width Total ` r
Other La 5',P o,L
,�Ak
13 • Or .iC�1�'��'�` � Si nature
D p ul 6/ (Licensed Installer)
(Sketch showing allorni ' um distances d other details required below)
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Permit Issued 19 By
Installation Completed, Inspected and Approved 19 By