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Department of Pollution Control... rttl
SOUTH WINDSOA CONNECTICUT
DRAIN LAYER'S PERMIT p
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q. Application for Permit to Install or Repair Individual Sewage Disposal System ' Y' a
Fee Paid $......1b.xo ......... By ........ ......:.ch��k... . .. �:6o1....
......... ........ ........ ...... Permit � r*z y
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Pursuant to written application, permission is hereby granted to the Licensed Drain Layer named bereiti r,''� '
for repair X.. or construction ......... of an individual sewage disposal system concerning, which` the follot #iig =
information is submitted:
R 1. Owner of Property} ..:.........Me ril .. Thama,a
Address of Owner Rba d h.V 7
I* 2. Location of Property .....:3ame
3. Type Litt No. " �x ,
of Structure , ,t
(Dwelling, Commercial Budding, Store, etc)
y., 4. Number of Families or Persons to Occupy Premises .... .....Q.k a (1..)....�f�az family x pie „�, .... .. ,
5. Number of Bedrooms
6. Average Daily Flow
....... ...... qq
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Manufacturer and ;
' 7. Liquid Capacity of Septic Tank(l..130 ....., Material of.Sep#g,Tank
8. Soil Conditions: Type of Soil ......... .........
(Sand, Gravel, Clay, etc.) a
9. If not served by p Maximum ground water table ..................
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blic water supply
Distance from Owner's well f
From adjacent wells ......... .:. . ...
10. Distance to nearest water course, drainage ditch, storm drain or embankment
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I.L. Percolation Tests: Time for 1" drop in soil test........................
Classification of soil ...
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12. Minimum square feet of effective seepage area re aired repair x }
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13. Leaching System: Number of trenches .:.. Four �4................. Length ...... BOO..:f t ,..,... , Width .....,..'3�.�}...feet
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Total 60o eq f t. Other .................................................
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14. Plot Plan Attached. ..No...................... . ..
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15. Layout Approved. Y. ,T
16. This permit expires .. ..:1.2...i%rokt,.t 19.7..E......................................................
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(Licensed Drain Layer)
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14 January1 2 # �- ��Pollution Problem abated Date ..... ld vim �� c
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MOTES - SOUTH WINDSOR POLLUTION CONTROL
LOCATION 579 Graham Road
OWNER Merrill Thomas
TYPE OF WORK Septic Repair
DATE 01 14 72 PERMIT 72-01 PIPE 4t1 O.B.
INSTALLER Boutin ,W9-205 25
INSPECTOR ME DRAWN BY ME