HomeMy WebLinkAboutSeptic Repair 135 Hillside Drive '
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Department of Pollution Control
SOoTuWINDSOR, CONNECTICUT
DRAIN LAYEWS PERMIT `
Application for Permit to Install or Repair Individual Sewage Disposal System
Fee Paid ` By Permit No. `
Date `
Pursuant to written application, permission is hereby granted to the Licensed Drain Layer named herein
for repair .--' or ouuobuntinu --- of an individual sewage dimmuoul oymbeou concerning which the following
information is submitted:
1. Owner ofProperty ..............:-i.^.--;........ ''c'"....................................... Address of Ovvoar ---.....--'i---^i.-------------------'
2. Location wf Property -�,-�z/..---------------------------------------------------------. Lot No. ----------
3~ Type ofStructure ............... --------------------------------------------------__-------------------'
(DwoDuno Commercial. Building, Store, etc.)
4. Number of Families or Persons to Occupy Premises
---`-'���..............................................................................................................................................
0. Number of Bedrooms ................................................
6. Average Daily Flow -----------------
Muoofuohzzor and
7. Liquid Capacity of Septic Tank ------------------- Material of Septic Tank sttM��----------------------.
0^ Soil Conditions: Type uf Soil ............................................................................................................................................................................................................................
(Suud Gravel, Clay, etc.)
Muzimozo ground water table -----------------------.---------------------------------
9. If not served by public water supply:
Distance from Owner's well .......................................................................
From adjacent vvwDu ------------------------------'
10 Distance to nearest water uoozom dru6zugm ditch' otomzu drain or embankment ----------------------------.
ll. Percolation Tests: Time for l" 6znm in soil test '-----i---_-__-'__'-------_-__--'_------------
0laooificatimm of soil --.--------'--'__---__--__--_-_-_-'_'_-----_-----'
12. Minimum ognure feet wfeffective seepage area required .............................................L_--........................................................................................
%l Leaching System: Number of trmoc6mo TPAK (A)------ Length ---1.25'ft,..----- width ----------------
Totul -,375-4M'tt°--' Other --___-'_--_-------__-_'_-__--'-'--'_----'-
1& Plot Plan Attached. ........................................... -'__
15. -------
16. This permit expires ........................
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Signature
(Licensed Drain Layer)
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Installation Completed, Inspected and Approved in accordance with State Public Health Code and Local Ozdloazcmo
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'-----------'----'--------'—'--_'_ 19.................. By __.....................................................................................................................................
Pollution Problem abated Date ....... .........��±.
'�^^�=`---' -` ^ ....-----------------.
CONDITIONS
I. This permit is issued under the express condition that every person acting under the
same shall conform to the representations and conditions of the application therefor and
shall conform to and be governed by the ordinances and regulations pertaining to individual
sewage disposal systems of the Town of South Windsor including amendments, thereto,
and all other pertinent laws, resolutions, ordinances, rules, and regulations of the Town of
South Windsor and/or its Sewer Commission.
2. This permit may be revoked at any time.
3. This permit shall be maintained at the site of any work being done under its
authority and shall be shown upon request of any authorized person.
4. This permit does not authorize the doing of any acts in, upon or to private property
without the consent of the owner thereof. The duty of obtaining such consent and complying
with the conditions thereof rests solely on the drain layer and those for whom he acts.
5. This permit does not authorize any excavation in any public street, highway or grounds,
or doing any work therein or the placing of any obstruction therein. Specific permission for
such shall be obtained from the proper official having charge thereof.
S. The Town of South Windsor and its agents assume no responsibility that any repre-
sentations in the application for this permit were correct and assume no responsibility for
any information furnished or not furnished.
7. At least two hours notice must be given to the Superintendent of the Sewer Department
before such Inspector is needed on the work. In general, Inspectors will be available
between the hours of 8:30 a.m. to 4:30 p.m. on Mondays to Fridays inclusive.
8. The Drain Layer agrees that he shall at all times indemnify and save harmless the
Town and its officers, agents and servants,
on account of any and all claims, damages,
losses, litigation, expenses counsel fees and compensation arising out of injuries (including
death) sustained by, or alleged to have been sustained by the servants, employees or agents
of the Town, or of the Drain Layer, any contractors employed by him or any subcon-
tractor or material men, and from injuries (including death) sustained by or alleged to
have been sustained by the public, any or all _persons on or near the work, or by any
other person or property, real or personal (including property of the Town), caused in
whole or in part by the acts or omission of the Drain Layer, and any contractor employed by
him or any subcontractor or material man or anyone directly or indirectly employyed by
them or any of them while engaged in the performance of any work covered by this
permit and during any maintenance period specified in the aforementioned ordinance.
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NOTES SOUTH WINDSOR POLLUTION CONTROL
Scale = 40, in 1" approx. LOCATION 135 Hillside Drive
S T D OWNER AnthonyFor hetti
A 29 5' TYPE OF WORK Septic Repair
B 27 54 DATE 01-0 -73 PERMIT .72-104 PIPE4" O.B.
INSTALLER Adam W9-20
INSPECTOR ME DRAWN BY ME