HomeMy WebLinkAboutSeptic Repair 154 Hilton Drive Department of Pollution Control
SOUTH WINDSOR, CONNECTICUT'
DRAIN LAYER'S PERMIT
Application for Permit to Install or epa' dividual Sewage Disposal System
FeePaid $.. .0....................... By ........... 1n........... 15r..n.1.L°.1 S if.................................... Permit No. .. ....... ......................
Date .......,�'�... 1..2...:.... ......................
Pursuant to written application, permission is hereby granted to the Licensed Drain Layer named herein
for repair ...U% or construction ......... of an individual sewage disposal system concerning which the following
information is submitted: '
1. Owner of Property .4,H/ JI10e17. ..foo.0.....l.Y.PAPt Address of Owner ....../ter ........14216 -b ............wr,��R.1.Vr...
2. Location of Property �................4841�.......... .. . 1. .................................................................................. Lot No. ..............................
3. Type of Structure ......................... S..t,? .nr..T..i ................................................................................................................................................................
(Dwelling, Commercial Building, Store, etc.)
4. Number of Families or Persolis to Occupy Premises ...................ilM �...........................................................................................................................
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 .....................r .........................................................................................................................................................................
(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. ...............................................................
15. Layout Approved. ....................................................................
16. This permit expires ...................................................................................................................
Signature ..................................................................................................................................................................................
(Licensed Drain Layer)
r
Installation Completed, Inspected and Approved in accordance with State Public Health Code and Local Ordinances
.................................................................................................................................... 19.................. By ................................................................................................................................................
PollutionProblem abated Date ................................:...................................I......... ............................................................................................................................................
Inspector
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NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATION ILTO%l TRWE
OWNER CHAR#.ES $ RA&t4 7t�lp �lZ
TYPE OF WORK SCfrIc. F-/eLD RE?4.lZ-
DATE 5-12-78 PERMIT PIPE
INSTALLER w1s1v1cavS,C
INSPECTOR DRAWN BY