HomeMy WebLinkAboutSeptic Repair 5 Pine Knob Circle TOWN OF SOUTH WI N DSOR
BUILDING DEPARTMENT
South Wind onnecticut
Application for Permit to Install or epai Individual Sewage Disposal System
Appli tion No.
TO THE BUILDING DEPARTMENT: Date ' 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 -- .-Address of Owner
1
2. Location of Property A< l �,� i , ✓'L-+y v 12 �,�=�� � Lot. No. S-S-
3. Type of Structure W f. , � No. of Bedrooms
(Dwelling,Commercial Building,Store,etc.)
4. Number of Families or Persons to Occupy Premises_
5. Plumbing Fixtures: Water Closets _ Urinals """'° Lavatories ` Bathtubs
Showers_ Kitchen Sinks Laundry Tubs Garbage Grinder Other A Ai
6. Liquid Capacity of Septic Tank Cj Q C. 2 Material of Septic Tank
7. Soil Conditions: Type of Soil t��2R A fi!C'Y*r1:)*� Maximum ground water table
( an,d; ravel,Clair,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 700
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 / C Width 3. Total
Other Y
Signatur
"( 6censed Installer)
(Sketch showing all minimum distances and other details required below)
Permit Issued 19,d. By
Installation Completed, Inspected and Approved 19 By
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TOWN OF SOUTH WINDSOR A
BUILDING DEPARTMENT
South Windsor, Connecticut
Application for Permit to Install or Repair Individual Sewage Disposal System
Application No.
TO THE BUILDING DEPARTMENT: Date_M,,.r e c5 19,46
A permit is requested for repair or construction of an individual sewage disposal system concerning'which the
following information is submitted: 99
1. Owner of Property �i et 7At_Ae,r Address of Own l
2. Location of Property Lot. No.
3. Type of Structure/ a 'cu 1�. �.>> M No. of Bedrooms
Tom_ (Dw in ommercial Build ,Store,etc.)
4. Number of Families or Persons to Occupy Premises_
5. Plumbing Fixtures: Water Closets_ Urinals Lavatories _ Bathtubs
Showers_ _ Kitchen Sinks Laundry Tubs Garbage Grinder OtherA i4e.--UDp
6. Liquid Capacity of Septic Tank f nn c2 Material of Septic Tank_(:�c,,,,C c ��
7. Soil Conditions: Type of Soi Maximum ground water table ��
(Sa d,Gravel,Clay,etc.) CP .4
rn+�+�y y
8. If not served by public water supply: Distance from Owner's well ' from afljaccent wells
9. Distance to nearest water course, drainage ditch, storm drain or embankment A !T 4.
10. Percolation Tests: Time for V drop in soil test Classification of soil
11. Minimum square feet of effective seepage area required
12. Leaching System: Number of trenches Length Width, '" Total 70-k-
Other
Signature
(Licensed Ins er)
(Sketch showing all minimum distances and other details required below)
�ossa �-�r,1 afi
max, x x � T
owt. )(
1[ �r y X X 1
)( k x '` 1
Permit Issued 19 By
Installation Completed, Inspected and Approved 19 By