HomeMy WebLinkAboutSeptic New 292 Kelly Road AV A
TOWN OF SOUTH WI N DSOR
BUILDING DEPARTMENT �SZ,
South Windsor, Connecticut
Application for Permit to Install or Repair Individual Sewage Disposal Syste
Application No.
TO THE BUILDING DEPARTMENT:
A permit is requested for repair or construction of an individual sewage disposal system concerning which the
following information is submitted: 04.4,tet14.
1. Owner of Propert Address of Owner-a*of f*t di, Rd y1irlNe N
IF
2. Location of Property 1 Lot. No.
3. Type of Structur & d ��%� No. of Bedrooms
(DWellfhg,Commercial Build flag,Store,etc.)
4. Number of Families or Persons to Occupy Premises_
5. Plumbing Fixtures: Water Closets Urinals Lavatories__ Bathtubs
Showers_ Kitchen Sinks / Laundry Tubs I Garbage Grinder Other a
6. Liquid Capacity of Septic Tank d Material of Septic Tank t->
7. Soil Conditions: Type of Soil �TlMaximum ground water table_
(Band,Gravel,Clay,etc.)
8. If not served by public water supply: Distance from Owner's well 4 from adjacent wells
9. Distance to nearest water course, drainage ditch, storm drain or embankment / 1 J
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 . C)�� Total
Other
S2-,Qignatur
(Licensed Installer)
(Sketch showing all minimum distances and other details required below)
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Permit Issued 19 By
Installation Completed, Inspected and Approved 19 By