HomeMy WebLinkAboutSeptic Repair 520 Burnham Street Department of Pollution Control
SOUTH WINDSOR, CONNECTI CUT
DRAIN LAYER'S PERMIT
Application for Permit to Install or Repair Individual Sewage Disposal System
FeePaid $....................U........ y��................. ......................................................................................................................... Permit Np. ..
Date ..... ..`.. .. ........ ., ......................
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 .l•C/1 GTQ�....... ..0 : lz....:....... ..;................. Address of Owner ...................................................................................................
2. Location of Pro a �.....".'. ';';f p rty ..........:... ::. �, Lot No. ..............................
3. Type of Structure ........................................... 1�. �1 /.Qf.................................................................................................... ..................................................
(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. Sofl,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 ..............................................................................................................................................................................
Classificationof soil ....................................................................................................................................................................................................
12. Minimum square feet of effective seepage area required ...................................................................................................................................................
13. Leaching System: Number of trenches ................................................ Length ................................................... Width ................,..,...............................
Total ......... ............ .............. O,ther ........................................................................................................................................................................
14. Plot Plan Attached. ..yL .—..... Put.. .....
15. Layout Approved. ....................................................I............
...
16. This, permit expires ...................................................................................................................
Signature ............ ............ .. �............................................................ .................. .............................
(Licensed Dr ' Layer)
Installation Completed, Inspected and Approved in accordance with State Public Health Code and Local Ordinances
..................................................................... ... 19.
Pollution Problem abated Date ............................ �+
d .............................I o.....,.....................................................
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