HomeMy WebLinkAboutSeptic Repair 00 Gerber Road c�la�un n�f �n�� ind��ax�
Department of Pollution Control
SOUTH WINDSOR, CONNECTICUT
DRAIN LAYER'S PERMIT
Application for Permit to Install or Repair dividual Sewage Disposal System
FeePaid $..ic (�......... .... By! y .................................... P% ................... ..................................................... Permit No. .,/ ..... .... .,.....................
Date ..........JG....'1 ...-.....2........................
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: "
��/ rI'/� CC/—GO C
1. Owner of Property ..................... ... ..........//..................9-5*
�................... Address of Owner ...................................................................................................
2. Location of Property ............. Lot No. ..............................
3. Type of Structure .................... 122175.......... .... ... ...................................................................................................................................................................
( elling, 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 ........................................................................
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 equired ................................. .............
.................. ,, ..........................
13. LeachingSystem: Number tr n s ................. ........................... Len th .......... ... ............I................ Width ............ .,�..........I...................
............
Y Total .... � .P.. Other .................................
....................................................................................................................................
14. Plot Plan Attached. ..�.*. ...........
15. Layout Approved. ........ ......................................
16. This permit expires ...................................................................................................................
o U v o p ✓,— c.'t
Sigma ,e .................... .................................4icensed
...........................................................................................................
Drain Layer)
Installation Completed, Inspected`"--- pproved in acco ce with State Public Health Code and Local Ordinances
.................................................................................................................................... 19.................. By ................................................................................................................................................
PollutionProblem abated Date .............................................................................. ........................................................................................................................... ...............
Inspector
L' Eti,P-)•4Y."i if 1:VL: P.r,•,
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Tel. 566--3110
Mr. melvir-
public 4iorka
1540 c,xtllivan Avenuc!
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,�wa:;� cii:; )o:a,1 c/c for -
hllve revie'.recl. p1:::i:, for a sub:,ux t•: e .,c _ Ic 1 )
We
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