HomeMy WebLinkAboutSeptic Repair 921 Foster Street w
Department of Pollution Control
SOUTH WINDSOR, CONNECTI CUT
DRAIN LAYER'S PERMIT
Application for Permit to Install o<��
dividual Sewage Disposal System
ndo
Fee Paid $..:........................ B ........ Permit No. .. .. ,7 ..
3p. ...............
Date ............. .....
................
Pursuant to written application, permission is hereby granted to the Licensed Drain Layer named herein
for repair X or construction ......... of an individual sewage disposal system concerning which the following
information is submitted:67/P) � �� Q.
�,,� 2o F. � �
1. Owner of Property . ... �.5.`..... ..G.... f�.�rr./.P... . .............. Address of Owner .. ........................ .................. ......................................
2. Location of Property ... z. ......... ...�..+............................................................................................................. 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 C �
7. Liquid Capacity of Septic Tank ... ..®... ..0.............................. aterial gz. ....
eptic T�a k . ...../....... ....................................�G...............
8. Soil Conditions: Type of Soil ........................................................... Q. .... ....... l..................................................................................................
(Sand, Gravel, Clay, etc.)
Maximumground water table ......., L?.. .......................................................................:..........................................................................
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 are required ...............................................
13. Leaching System: Number of trenches .............3.............................. Length .......f 2., ........................ Width ..... ......................................
Total ................................................ Other ........................................................................................................................................................................
14. Plot Plan Attached. ...............................................................
15. Layout Approved. ....................................................................
16. This permit expires ...................................................................................................................
Signature, '..... . . .. ........
/ JC-(Licensed Drain ayer
Installation Completed, Inspected and Approved in accordance with State Public Health Code and Local Ordinances
.........7
......................................... 19.................. By ............ ........ ........................................................................................................................
PollutionFro1 abated Date .............................................................................. ...................................
........................ . .......................................................... ...............
I ..
rmpector
92
fo,� r V
4 �
a
a
S \ v
i O
1
n
a
Y
22
� V
SOUTH W iNOSOrR POI_1_UTIO, CONTROL
LocATION 21 of ,
rovv.,,Jc p? ,� a, LIZZ
aE {i _
INS TALLE I :
IN PECT-'OR �Cj` __ OPAVVNOY ll=G
{
F h
4
� p
1
� '1►� a T;.� ,...+...».�+w�_ ___ --fi�'i-gin