HomeMy WebLinkAboutSeptic Repair 20 Kelly Road TOWN OF SOUTH WI N DSOR
BUILDING DEPARTMENT
South Windsor, Connecticut
Application for Permit to Install or Repair Individual Sewage Disposal System
Application No. 1l17469—/
TO THE BUILDING DEPARTMENT: Date_ 17 /yi�8�2 19 69
A permit is requested for repair or construction of an individual sewage disposal system concerning which the
following information is submitted: / i Kr' _ "
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1. Owner of Property AN, Duaw"' rile- C�. �. 2�ddress of Owner .0-0 Ftcy /Zti b
2. Location of Property 9A,✓14r Lot. No. Z+
3. Type of Structure 1WC--LL1 4 9 No. of Bedrooms
(Dwelling,Commercial Building,Store,etc.)
_4. Number of Families or Persons to Occupy Premises OWAI C or/
I, f A.n A t/
5. Plumbing Fixtures: Water Closets Urinals Lavatories Bathtubs
Showers Kitchen Sinks Laundry Tubs Garbage Grinder Other
6. Liquid Capacity of Septic Tank Material of Septic Tank
7. Soil Conditions: Type of Soil Maximum ground water table
(Sand,Gravel,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
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'THREE 12) Length SAD FAT Width A,S FT Total 37SR '
Other
Signature (Lice Installe
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Ir1 nw/1w[!Gr)
(Sketch showing all minimum distances and of er D4a ails requiredowl
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33,6+ 33,V
4er+.L eRoA
Permit Issued 17 A1cy4in6awt—
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Installation Completed, Inspected and Approved to 40i6i't"n— 19� B
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