HomeMy WebLinkAboutSeptic Repair 145 Edwin Road F„yz. . . ..�'� ,'•ry,. bt �;. � $„ 1�4i`a.?:: �;a.��: NE�t�q?,} '8t !"w !� i;;:4 4 hh..;¢i�y.,'n.f'
Department of Pollution Control
SOUTH WINDSOR, CONNECTICUT
DRAIN LAYER'S PERMIT
Application for Permit to Install or Repair Individual Sewage Disposal System
FeePaid $. '..:........... 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 ...,:..:i...t: r.......................................................
From adjacent wells ............................f�.;..........................................................
10. Distance to nearest water course, drainage ditch, storm drain or embankment ...... ..::..........................................................................
11. Percolation Tests: Time for 1" drop in soil test ......:is. ..................................................................................................................................................................
Classificationof soil ......f.n: .;a................................................................................................................................................................................
12. Minimum square feet of effective seepage area required
13. Leaching System: Number of trenches ......r..a.... ............................ Length ................................................... Width ...................................................
Total ........... ::................................. Other ........................................................................................................................................................................
14. Plot Plan Attached. ..............:.::...........................................
15. Layout Approved. 3.
16. This permit expires .. '
Signature ..................................................................................................................................................................................
(Licensed Drain Layer)
Installation Completed, Inspected and Approved in accordance with State Public Health Code and Local Ordinances
...... ........................................................ 19..r �........ By ...... , ....::.., - --
Pollution Problem abated Date ................................:..................I.......................... ............................................................................................................................................
Inspector
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NOTES SOUTH WINDSOR POLLUTION CONTROL
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