HomeMy WebLinkAboutSeptic Repair 155 Pine Tree Lane J �
TOWN OF SOUTH WI N DSOR
BUILDING Wi EPARTMENT ����� Dap
South sor, necticut a
Application for Permit to Install or epair Individual Sewage Disposal System
Application
TO THE BUILDING DEPARTMENT: Date 19
A permit is requested for repair or construction of an individual sewage dis osal system concerning which the
following information is submitted:
1. Owner of Propertya/J 4e4-S Address of Owner/ S'S �i„ �
2. Location of Property ) c c�r. a -.�• Lot. No.
LA-;,es 1
3. Type of Structure l i No. of Bedrooms_
(Dwplling,Commercial Building,Store,etc.)
4. Number of Families or Persons to Occupy Premises_ 4-1
5. Plumbing Fixtures: Water Closets Urinals Lavatories Bathtubs
Showers_ Kitchen Sinks __ Laundry Tubs Garbage Grinder — Other o -,r
6. Liquid Capacity of Septic Tank / a O d Go J� Material of Septic Tank ��G�
7. Soil Conditions: Type of Soil�7�-0�� c-,/sy Maximum ground water table J�
(Sand,ur vel,clay,et .)
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 &0 1
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 ,J �O� Width Z_ : Total
Other
Signature
(Licensed Installer)
(Sketch showing all minimum distances and other details required below)
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Permit Issued 19 By
Installation Completed, Inspected and Approved .3 A 1942 By
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