HomeMy WebLinkAboutSeptic New 2249 Ellington Road t�lanrn n� �nnt� ind��n�
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 .............................................. ::::: e(a/, .�'K'K...s .. ------- Permit No ,�'.'...::.. .................
Date .....::'..::r.'. .....
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 ..s .::: is`........f "`v{..� . !: ........................... Address of Owner ..:�::.% :, ...... `.::.:.. F ................
2. Location of Property .. ..
r : :":................................................................................................................................ Lot No.
...................
3. Type of Structure
„ -
(Dwelling, Commercial Building, Store, etc.)
4. Number of Families or Persons to Occupy Premises ..................:'F.j.. .:...........
..c::``.:...
.................................................................................................
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 ........W40....!0)............. Length .......V.4....A.T...................... Width ...: .:::.:
Total ..........................?..> . TOther .............................................:.:.:......................
...........................:,.....:::..:::........ l.S.�P..4A4.Z,
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
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NOTES SOUTH WINDSOR POLLUTION CONTROL
N+r Ta scAe.E LOCATION E „i A
OWNER &,rajLeC isQ
TYPE OF WORK PAI A
DATE r
d2::!;j-7jPERMIT i-3(o PIPE 4" 0 6
INSTALLER
INSPECTOR µ W L DRAWN BY - M