HomeMy WebLinkAboutSeptic Repair 168 Pine Tree Lane Ael 14' TOWN OF SOUTH WI N DSOR
BU I LDI.NG DEPARTMENT
10
South Windso Connecticut
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Application for Permit to Install or;,Repair }Individual Sewage Disposal System
l Application No.
.�,
TO THE BUILDING DEPARTMENT: Date
A permit is requested for repair or construction of an individual sewage disposal system concerning which the
following information is sub itteed: f!
1. Owner of Property s- 1` e t/� bW V L Address of Owner
2. Location of Property Lot. No.
3. Type of Structure No. of Bedrooms -�
(Dwelling,Commerc Buuding,Store,etc.) r
4. Number of Families or Persons to Occupy Premises,_
5. Plumbing Fixtures: Water Closets /� �7UUrrinals ""R' Lavatories Bathtubs
+ Showers Kitchen Sinks L u dryyTubs Y(/PY�Ga bage Grinder Other
6. Liquid Capacity of Septic Tan Material of Septic Tank_ !Z& ��
7. Soil Conditions: Type of Soil Maximum ground water table 1 / ' o�•
(Sand,Gravel Clay,etc.)
8. If not served by public water supply: Distance from Owner's well LIC from adjacent wells
9. Distance to nearest water course, drainage ditch, s orm drain or embankment '
10. Percolation Tests: Time for 1" drop in soil test O+f/_ Classification of soil d
11. Minimum square feet of effective seepage area required
12. Leaching ystem: Number of trenches Ee Length�4 Width
,j, -� Total
Other I o"
Signature
(Lleensed Installer)
(Sketch showing all minimum distances and other details rvuired below)
tit"lip, b
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Permit Issued 19 By
Installation Completed, Inspected and Approved -1VA otJ1;FA8F2. 19 6 r" By
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