HomeMy WebLinkAboutSeptic New 170 Kelly Road TOWN OF SOUTH WI N DSOR
BUILDING DEPARTMENT n/
South Windsor, Connecticut
Application for Permit to Install or Repair Individual Sewage Disposal System
Application No.
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TO THE BUILDING DEPARTMENT: Date ALL 19
A permit is requested for repair or construction of an individual sewage disposal system concerning which the
following information is submitted:Qr{k�. rct N eew
1. Owner of Property 1'/ S✓ ��
� Address of Owner. `�i �-L.
f 2. Location of Property
Lot. No.
3. . Type of Structure SIC✓&L--&ZA-1 6 No. of Bedrooms_
� (Dwelling,Commercial Building,Store,etc.)
4. Number of Families or Persons to Occupy Premises/ 1!5_ &
5. Plumbing Fixtures: Water Closets Urinals M--- Lavatories v Bathtubs._
Showers Kitchen Sinks Laundry Tubs Garbage Grinder Other
6. Liquid Capacity of Septic Tan Material of Septic Tank—�.
7. Soil Conditions: Type of Soil L Maximum groundwater table
(Sand,Gralvel,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, stogy ai or embankment + _/
10. Percolation Tests: Time for 1" drop in soil test d/ Classification of soil �l
11. Minimum square feet of effective seepage area required
12. Leaching Spte5: Numper of trenches_ Length g � � Width—ET, Total
Other
Signatur ¢
�1 �r icensed Insta ler)
if (Sketch showing all minimum distances and other details required below)
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Permit Issued 19 By
Installation Completed, Inspected and Approved ?S 19�� By
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