HomeMy WebLinkAboutSeptic New 160 Chapel Road vomit of Outer 11inbsor
Department of Pollution Control
SOUTH WINDSOR, CONNECTICUT'
DRAIN LAYER'S PERMIT
Application for Permit t Install r Repair Individual Sewage Disposal System
FeePaid $... D,�D By ....................J./�1 ..............:.................................................. Permit No. . .� ........................................
Date .............��...... .... ..7 ......................
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 vj isysnbmitt 10 P /T. _ 1e
1. Owner of Property .........................................:..... ..................................... ...... Address of Owner ...................................................................................................
2. Location of Property ..... �i.. ?............. ....... ......... ......... Lot No. ..............................
3. Type of Structure ..................................................................................................................... ..�Il..l.}.:"
(Dwelling, Commercial Buil Store, etc.)
4. Number of Families or Persons to Occupy Premises ..............................................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 :..............7-T
.........................................
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 ex ir ..... ...............................................................................................
0-0
Signature ... . ......... ........Ol �0;
h (Licensed Drain Layer) �J
nstallati n a # �Z 16 . G v
o Completed, Inspected and Approved in accordance with State Public Health Code and Local Ordinances
................
.............................................................. .................................... 19. By .......................
Pollution Problem abated Date
Inspto ... ......... ..........� ..... ...............
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DEPARTMENT OF POLLUTION CONTROL gip No.:
a South Windsor, Connecticut
List No.:
DRAIN LAYER'S PERMIT NO 1315
19
Pursuant to written application, permission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at on the
side, between
at premises owned by
whose address is
and to Lay House Drain, Repair House Drain, Lay Main, Other
for occupancy or use,
with Family Units, with acres.
Type of Sewage to be connected under this permit:
SANITARY SEWAGE ( ), INDUSTRI L W STES ( ), OR ( )
Connection will be made with
i
Permit to be issued to
the holder of Drain Layer's License No. Permit will expire on 19
The undersigned Drain Layer hereby agrees to all the terms and conditions set forth on the permit and the reverse side
thereof. Applicant has received Town Permit No. and/or C H D Permit No.
for street excavation.
SPECIAL CONDITIONS
J y
Signed
Connection Charge Paid Licensed Drain Layer
3;
- Issued by
Tax Collector
Permit Fee: Paid $
INSPECTION: Check Number:
INITIAL (Sig)
FINAL (Sig)
APPROVED (Date)
INSPECTOR (Sig)
SURVEY OF LOT NO.
PROPERTY OF
AND LOCATED AT
NO. C lq.404'EL ,e0,4.0 Z 0C17W CONN.
SCALE 1" = 4 0 DATE:- A44 Y, 1977
1
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LA
24-%441 I
/ro.. ,,•e hptC� 40.1
37
37 � NF.f'Ay
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E`XiS�.tr� Co.��ov►r ave>.ri4.sy �--'34 i(in`o
Pro/v�.re�/ G o..�o�r- act/ .r-,��• /
a d =8�-30-OOS3, /
A
\Z =4 3.2.0
c ,Da hum i ,E Al 6S oo-oo W /38- 9
CAA PP"L. AF OA 1)
Se eP a� k'Q f e Lc ss T/i ca„ •�a f �rv.o f"a 9 e /S4 lee f
S /r�ir,/i"c/S q¢ i'�y/f' e7n�e /�,r A& tlt�ie �'�►CS
e®���turnop�ry0
Building to. be constructed. //ooxe �d°'®F�coly Ith�,
I hereby certify that this map is substantially cof"`,,,�"5 J' S&Z,�'x�'•.. .Pe v'r e�/ N1 a y /B, 19177
rect and that the zoning ordinances of the to : Buildi
wyfj, '` rs yz:e: Y
T, \ + ng completed as shown on sketch and
of So-W,,i,a ror;,Conn., have not been violated..; ,{ 14,�' 4 survey is hereby re-certified as correct and
zoning regulations not violated.
041. gy
sub ,.
IC. LAND SURVEYOR -'�"'��� •
LIC. LAND SURVEYOR