HomeMy WebLinkAboutSeptic Repair 269 Griffin Road • c�n�art �f ���� i�td���ax�
Department of Pollution Control
SOUTH WINDSOR, CONNECTICUT'
DRAIN LAYER'S PERMIT
Application for Permit to Install or Repair Individual Sewage Disposal System
1
FeePaid $.... .. ...C!..'.......................................................................................................................... Permit No. ...7-J 'y 2.� ................
Date ................�� � .. ... .j,, ................
Pursuant to written applicktio , 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 .................. � r .. .............. dr ss of Owner ...: .................................................................
....
2. Location of Property �? _%......../.P1......... � ....(............ Lot No. ...................:p ty ................. ... ..........�.. . ..........f... .........
3. Type of Structure ......................................................................................................„ .lf'. Z,jfil
.................................................................................................................
(Dwelling, Commercial Boding, 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 required ...................................................................................................................................................
13. Leaching System: Number of trenches ................................................ Length ................................................... Width .....:..............................................
Total .............. ..... Other ........................................................................................................................................................................
14. Plot Plan Attached. ... .................................
a
15. Layout Approved. .................. ..... ................................
16. This, permit expires r ?
A
`lp7C l� (.f/ Signature ..... '� ...... ...:.................... ....... ...............,. :.:..... ..............................................
(Licens4br Lay r
G/ InstalW ion Completed, Inspected and Approved in accordance with State Public Health Code and Local Ord
inances
.................................................................................................................................... 19.................. By ................................................................................................................................................
Pollution Problem abated Date ................................:............................................. _.............,.
Inspector