HomeMy WebLinkAboutSeptic Repair 31 Beldon Road ..E-. `.g{
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Department of Pollution Control
SOUTH WINDSOR, CONNECTICUT'
DRAIN LAYER'S PERMIT s
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Application for Permit to Install or Repair Individual Sewage Disposal System
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FeePaid $..............::.................... By ............................................... .::......................................................................................... Permit No ................... .
Date J.�.... ...............
Pursuant to written application, permission is hereby granted to the Licensed Drain Layer named herein
for repair .......:: or construction ......... of an individual sewage disposal system concerning which the following
information is submitted:
1. Owner of Property .. :....:.:.... :..::.:...:................................... Address of Owner ................ ......................................................................
2. Location of Property .....::.:..:.:..:........... ..... ..................................................................................................................................................... Lot No. ..............................
3. Type of Structure .................:.....:.....: ............................................................................................................................................................................................
(Dwelling, Commercial Building, Store, etc.)
4. Number of Families or Persons to Occupy Premises .............::,;..... ,
5. Number of Bedrooms ................................................
6. Average Daily Flow ...................................................
Manufacturer and
7. Liquid Capacity of Septic Tank .......... Material of Septic Tank ..........................................................................................
8. Soil Conditions: Type of Soil ................. ,t�
(Sand, Gravel, Clay, etc.)
Maximumground water table .............................................................................................................................................................................
9. If not served by public water supply:
Distance from Owner's well ..............
........'-5...
......................................
From adjacent wells ............................................................................................. r
10. Distance to nearest water course, drainage ditch, shorm drain or embankment ..07.................................................:
11. Percolation Tests: Time for 1" drop in soil test ....... .........................
Classificationof soil ....................................................................................................................................................................................................
12. Minimum square feet of effective seepage area required .......................................................f..................................................I..............!...I.................
13. Leaching System: Number of trenches ..............::................................ Length ...........1. xr ...........:............ Width ..........�_Q............................
Total ............................................... Other ..... :.:. .............::...................................... . .............. .........................................
14. Plot Plan Attached. ...............................................................
15. Layout Approved. ....................................................................
16. This permit expires ...................................................................................................................
Signature .
.................................................................................................................................................................................
(Licensed Drain Layer)
Installation Completed, Inspected and Approved in accordance with State Public Health Code and Local Ordinances
................................................................................................................................... 19.................. By ........................ .............................................. ............,.......................................
PollutionProblem abated Date ..........................................................:.................. ............................................................................................................................................
Inspector
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NOTES: Scale 40, in 1" approx. SOUTH WINDSOR POLLUTION CONTROL
S T D/B LOCATION 31 Beldon Road
A 15.9 25.8 OWNER Robert C. Steiger
B 23.0 33.0 TYPE OF WORK Septic Repair
DATE 4 PERMITa-z PIPE 4't O.B.
-- -- - - - INSTALLER Adam W9-20-559 -
INSPECTOR ME DRAWN BY ME