HomeMy WebLinkAboutSeptic Repair 380 Burnham Street T
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Department of Pollution Control
SOUTH WINDSOR, CONNECTICUT
DRAIN LAYER'S PERMIT
Application for Permit to Install or Repair Individual Sewage Disposal System
FeePaid $.............:1C3.. X)..... By ................................................................................................................................................. Permit No. ....................;71.-:1.ri......................
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Date .................20...:.:.a,v ..............
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 h 7S :;A. .` 'a�xc;r.................
j.....:..... :................. Address of Owner ................7�?0.... u f;aha±s1....S tr-:,cc .....:............
2. Location of Property lac.Kt :... z .<a:..x... ?. �"-:!t .....``�:!.in tc�n R, Lon r 11. ......................................... Lot No. ..............................
.. ........................................ ...
3. Type of Structure ................... l..:?.n1.7�..............................................................................................................................................................................................................
(Dwelling, Commercial Building, Store, etc.)
4. Number of Families or Persons to Occupy Premises ............Qnk.....C.I.).....f rn.:a7 y...................................................................................................
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 .............................................................................................................................................................................................................................
(Sand, Gravel, Clay, etc.)
Maximumground water table ..............,..............................................................................................................................................................
9. If not served by public water supply:
Distance from Owner's well ........................................................................
Fromadjacent wells .............................................................................................
10. Distance to nearest water course, drainage ditch, storm drain or embankment ............. .
11. Percolation Tests: Time for 1" drop in soil test ........Berpn�l. .....................................................................................................................I..........................
Classificationof soil ................................................................................:...................................................................................................................
12. Minimum square feet of effective seepage area required ..................`r`..... .....t' .......................................................................I.......................
13. Leaching System: Number of trenches -.rw.,Q...CZ CZ�.................. Length .....1..3.G?.... ::Y........................ Width .� ................
Total ....3a2p....:>.q C.7........... Other ..........................................................................
14. Plot Plan Attached. ...........?:;.�.............................................
15. Layout Approved. ............... ...........................................
16. This permit expires ...2t:1....Jya.'I y.......:?.;:7 .................................................................
Signature �ts' �r, ... r t,,.:�.-t�..�.�:' -f h...t`....................................................... .........
f,1 ,i r; W i r}cr,t,!k i. (Licensed Drain-Layer)
Installation Completed, Inspected and Approved in accordance with State Public Health Code and Local Ordinances
.................................................................................................................................... 19.................. By ................................................................................................................................................
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Pollution Problem abated Date .....?.:'...I�<�`� i v 7� .... ! ., , t l i •-s'
r/................................................ ,r ..... ..... r ................................................................�....
nspector
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NOTES SOUTH WINDSOR POLLUTION CONTROL
Drawing not to scale. LOCATION 380 Aurnham-Streitt
OWNER ROSS Vernon
TYPE OF WORK
DATES-2 7- -7<. PERMIT 7 -1 PIPE4"
INSTALLER Adam S.I. # 001 7
INSPECTOR DRAWN BY
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NOTES SOUTH WINDSOR POLLUTION CONTROL
Drawing not to scale. LOCATION 380 Run2ham Str
OWNER ROSS Vernon
TYPE OF WORK
DATE s-2 7 7g. PERMIT 76-12 PIPE 4"
INSTALLER Adam S.I. # 001 7
INSPECTOR DRAWN BY ,�