HomeMy WebLinkAboutSeptic Repair 271 Hilton Drive vomit of Onto Ightboor
Department of Pollution Control
SOUTH WINDSOR, CONNECTICUT
DRAIN LAYER'S PERMIT
Apn1ication for Permit to Install or Repair Individual Sewage Disposal System
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FeePaid $...IUl..!.. ..v.... By ..................................1....... ............... .................................................................................. Permit No. ... 7... 0.....................
Date ...........................................................................
Pursua t 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:
1. Owner of Property ...G ...�/.-QZ---2-&V /l Address of Owner .........`"'..................................
l. ....... .................. ................
2. Location of Property .........2.7�..........�77.� QC.1......... �'1..'0:°.�................................................................................................. Lot No. ..............................
3. Type of Structure ...............................................................................................................................................................................................................................................................
(Dwelling, Commercial. Buildin Store, etc.)
4. Number of Families or Pe rso s to Occupy Premises .........................4..dl':6. //.1... :..........................................................................................
5. Number of Bedrooms ...............�.........................
6. Average Daily Flow ...................................................
Manufacturer and
7. Liquid Capacity of Septic Tank ............{.3............ .......................... Material of Septic/Tank ........ .r .i.......... .� .. ................
8. Soil Conditions: Type of Soil ....+ ....t/ 1� . .... '?.0.. ..�...... /`PG ...C°6 :�. ......................................................................... ....................
(Sand, Gravel, (1ay, 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 .........................................................:.........................................................
/iQ nX<V11j cc 46/r
/ 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 .................. .................... ....................................:...dl.i.:...�' ! ........ .............,.
Inspector 7
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NOTES SOUTH WINDSOR POLLUTION CONTROL
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LOCATION
OWNER
TYPE OF WORK 2 rr- crj1
' DATE - - PE IT — PIP l/G
INSTALLER
INSPECTOR - DRAWN BY f`71rY