HomeMy WebLinkAboutSeptic Repair 450 Burnham Street dawn of OvW4 18inboar
Department of Pollution Control
SOUTH WINDSOR, CONNECTICUT
DRAIN LAYER'S PERMIT
Application for Permit to Install or Repair Individual Sewage Disposal System
Fee Paid $...........:...::.:...::.::........ By ................
................................................................................................................................. Permit No. ....... .....::..::........................................
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 .......::..............:......:..::::..:......:::................................................. 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 .............................................................................................................................................................................................................................
(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 ................................................ 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
M FEE
TO THE BUILDING DEPARTMENT Application No. �d
TOWN OF SOUTH WINDSOR Date P-/. z---
I hereby apply for permit to build a sewage disposal system for a
Residence , boarding house , hotel , etc.)
Owned by
And located at
To be built by_��� /��%�z�C_��--of
in accordance with detailed information stated below.
Signed
(Applicant)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
GENERAL INFORMATION
1 . Estimated population of premises (present) ! (future)
2. Description of premises (including number of bedrooms)
No. Fixtures
(Above basement): Water Closets Urinals Lavatories
Bath tubs Showers Kitchen Sinks Laundry Tubs
Garbage Grinder List basement fixtures
3. Water Supply Kind of Well
(Public, well, spring , cistern)
Location of well and underground water piping l aLa-c
.Method of obtaining or storing supply
(Pumps , tank , etc.)
4. Character of soil at proposed location of leaching system, including depths of
various_ strata_ e A"Iti,
(sand, loam, clay, hardpan, rock, etc. --Use test pits.)
5. Elevation of highest ground water
(with reference to both present & future grade)
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