HomeMy WebLinkAboutSeptic Repair 176 Pine Tree Lane a
WN OF SOUTH WI N DSOR
BUILDING DEPARTMENT
South Windsor, Connecticut
A lication for Permit to- fior Repair Individual Sewage Disposal System/-,-
/ /. L CC c — !)� / Application No.
TO THE BUILDING DEPARTMENT: Date tom&l t i 19
A permit is requested for repair or construction of an individual sewage disposal system concerning which the
following information is submitted: /�//��,,,,''
1. Owner of Property C e 0 � ,/1/�WfOV Address of Owner
2. Location of Property / "AJ�1� Lot. No.
3. Type of Structure W 6^1—Z. No. of Bedrooms
(Dwelling,Commerc
ial Building,Store,etc.)
4. Number of Families or Persons to Occupy Premises (.'�`' 2"`-&, IL.
5. Plumbing Fixtures: Water Closets Urinals ""'" Lavatories 0_ Bathtubs /
Showers Kitchen Sinks,_ L undry Tubs Garbage Grinder Other 4—/&/91�5 t
6. Liquid Capacity of Septic Tan + ,V Material of Septic Tank �4 /'C;7
7. Soil Conditions: Type of Soil�r�c-LJ—A Maximum ground water tabl
(Band,Grav ki Clay,etc.)
8. If not served by public water supply: Distance from Owner's well L/C from adjacent wells
9. Distance to nearest water course, drainage ditch, s or ain or embankment_��
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10. Percolation Tests: Time for 1" drop in soil test Classification of soil
11. Minimum square feet of eff ctive 4eepage area required
, /t�� .�_
12. Leaching Syst m: u ber of trenches* Q Length ` Width��� Total
Other a g �� CD 7- lew f 7-- c
Signature C
Li ensed Installer)
(Sketch showing all m' im,um di antes and other details required below)
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6A1 YLMIAle C&-u-kA
to 140
Permit Issued 19 By
Installation Completed, Inspected and Approved./6 By
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