HomeMy WebLinkAboutSeptic Repair 205 Farnham Road Gown of Onu#4 Mubsor
Deparhnent of Pollution Control
1 SOUTH WINDSOI, CONNECTICUT'
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DRAIN LAYER'S PERMIT
Application for Permit to Install or Repair Individual Sewage Disposal System
FeePaid $..... ..A..OG:....... By ...Clff�ok.......... .......................................................................1...................... Permit No. -7.7'....... G........................
Date ....... ..........J...'Z.................I....................
Pursuant o written application, permission is hereby granted to the Licensed Drain Layer named herein
for re air or construction p of an individual sewage disposal system concerning which the following
information is submitted:
1. Owner of Property&.���� �/o 0p y ......... ......... ......... ...... ,�.... Address of Owner :............ ...... ...�.1.�,2........�1l2.�.. ..
2. Location of Property ............ ................................ . Q..L ..e. .. ... ........................................................................................... Lot No. .....b..j ..................
3. Type of Structure .........!•,5 . ........ .....................................................1V1k�Jfi. ................................ ..
(Dwelling, Cc erci . Building, Store, etc.)
4. Number of Families or P ons 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 ...................:,CjJ. .. .....................................................................................................................................................................................
(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 ............;-�T............................. Length . 7 .. .._. Width ...... ........:..............................
Total ...........I77 < ........ Other .........................................................................................................................................................................
14. Plot Plan Attached. .........et�p......."... :eArt''
15. Layout Approved. ................................................ ..................
16. This. permit expires ...................................................................................................................
Signature ../4 ........ . ........................................................................
(Licensed Drain Layer)
Installation Completed, Inspected and Approved in accordance with State Public Health Code and Local Ordinances
— --°°77
........................................................................... 19...1....7. By .................... .........................................................................................................................
PollutionProblem abated Date ................................;............................................. ...... ...................................
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Inspector
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NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATION 0' o-�-
OWNER / (2 GI
TYPE OF WORK
DATE —)Z— P IT — / PIPE
INSTALLER '
INSPECTOR DRAWN BY eEe
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