HomeMy WebLinkAboutSeptic Repair 1124 Sullivan Avenue izututt lit #auto Ightbour
Department of Pollution Control
SOUTH WINDSOR, CONNECTICUT'
DRAIN LAYER'S PERMIT
Application for Permit to Install or epair Individual Sewage Disposal System
FeePaid $.. ...... By ...:.:.. .......:: .......:: ..'::...................................................................................... Permit No. c
Date . .'
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: l
1. Owner of Property ... t' , ti�E>..t........................................... Address of Owner ..{!IC„LL /: ...., ................
2. Location of Property1 '................................................................................................... Lot No.............................. ..............................
3. Type of Structure ............... '.......................
(Dwelling, Commercial Building, Store, etc.)
4. Number of Families or Persons to Occupy Premises ,'
5. Number of Bedrooms .z:—:.:..... . ).............
6. Average Daily Flow ...................................................
Manufacturer and #
7. Liquid Capacity of Septic Tank ''' Material of Septic Tank -U �a ..................................................
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 1,9?....::.! ,..., 7 . ; d
From adjacent wells ..................... ;.............................................
10. Distance to nearest water course, drainage ditch, s rm dram or embankment ...?�........±:....:...................................I.......................
11. Percolation Tests: Time for 1" drop in soil test .......
Classificationof soil ....................................................................................................................................................................................................
12. Minimum square feet of effective seepage area required "`.....:.'.....;:..�!..............................................................................................I...............
13. Leaching System: Number of trenches ................................................ Length ................................................... Width ...................................................
?..:.'..Total ................................................ Other ......... .......................................................................
14. Plot Plan Attached. ...............................................................
15. Layout Approved. .............!'..:A';.............................................
16. This permit expires :t::....:..;;.. .:.,.....
1 . / G p •�
Signature .... :..:: : ::.:>:... ` ......................................................................
(Licensed Drain Layer) ()
Installation Completed, Inspected and Approved in accordance with State Public Health Code and Local Ordinances
.................................................................................................................................... 19.................. By ................................................................................................................................................
Pollution Problem abated Date ...../.Q.... wa .../...9..?./.......... q ........................................................
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NOTES SOUTH WINDSOR POLLUTION CONTROL
td,r 7o SeAtE, LOCATION tal
OWNER Alowx a /Jq
TYPE OF WORK .S� .
DATEoa 9 -i PERMIT t-4S' PIPE
INSTALLER A -3s9"-A.)
INSPECTOR ME DRAWN BY 444C