HomeMy WebLinkAboutSeptic New 626 Ellington Road 4r''
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C, otatt of Ovut4 10inbsor
Department of Pollution Control
SOUTH WINDSOR, CONNECTICUT'
DRAIN LAYER'S PERMIT
Application for Permit t JInstall r Repair Individual Sewage Disposal System
...... B ........................ Permit No. ...�,'.�.............77�
Fee Paid $ ` ..............
....................... y ......................................................................................................................... Date ...� ..-.2..`...-..77..................................
Pursuant to written applicatio 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 ................................ 1 ..� 6. ........�,...... Address of Owner ...................................................................................................
2. Location of Property -6.f*......... .. rJ.... ... n!................................................................................................ Lot No. ........�..................
3. Type of Structure ....................................................... /.r:I...... ...........................................................................................................................................................
(Dwellini, Commercial Building, Store, etc.)
4. Number of Families or Persons4o Occupy Premises .............t..............................................................................................................................I..................
5. Number of Bedrooms ...................... ...................
6. Average Daily Flow ..................................... /
� Manufacturer and
L............ Materi o Se:tc Tank ..... ....7. Liquid Capacity of Septic Tank .J... .................C1......................
8. Soil Conditions: Type of Soil ................................................................................. ...............................................................................................................................
(Sand, Gravel, Clay, etc.)
Maximumground water table ..............................................................................................................................................................................
9. If not served by public water supply: �� (i
Distance from Owner's well .......................................................................
From adjacent 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 Tuired ................................ .. ..................................................................... ......
13. Leaching System: Number of trenchgs ��......................................... Len th ..........�.....�.......................... Width .....................................:.............
Total . ..... AZ A.......:.�. Other ....................1-}...'S o...............................................................................................................................
14. Plot Plan Attached. ....... .. .. ....................................
15. Layout Approved. ................ ..... .-...%....................................
16. This permit expires .........................................................:.............................................. ........
V/
I� Signature .......................... .. ...... ........ .. .................................................. ......
icensed Drain Layer)
i
Installation Completed, Inspected and Approved in accordance with State Public Health Code and Local Ordinances
.................................................................................................................................... 19.................. By ..................... ... ......... .........................................................................................................
PollutionProblem abated Date .................................. ..................... .:............. ..:.... ...............................................Insp ctor
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