HomeMy WebLinkAboutSeptic Repair 63 Hollis Road iZount of OvW4 Ightboar
Department of Pollution Control
SOUTH WINDSOR, CONNECTICUT
DRAIN LAYER'S PERMIT
Application for Permit to Install or Repair dividua. Sewage Disposal System
Fee Paid By ...............Check N9.*.....1.1 5.7................................................................................. Permit No.
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:
1.
2. LOwner ofofrop ertL. c ......,. t�.�... r�. .............................Address...of Owner .....M1..r 1�..'.......... Lot.............................................
P riY � `
PY ......jai;:.;,............ No. ... .l'...................
3. Type of Structure
(Dwelling, Commercial Building, Store, etc.)
4. Number of Families or Persons to Occupy Premises ..........0Xi,o :...................................................................................................
5. Number of Bedrooms ................................................
6. Average Daily Flow ...................................................
Manufacturer and
7. Liquid Capacity of Septic Tank .Est.-.....750....gallonsMaterial 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 ...P.ubli"c...............................................
From adjacent 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 ...............3.7.5..........................................................................................................................
13. Leaching System: Number of trenches ................................................ Length ................................................... Width ...................................................
Total ................................................ Other Two....:7.50-.gal on....pxe.cap:t....dr"y..w.el.1.s.......................................................
14. Plot Plan Attached. ....... ...:...................................................
15. Layout Approved. ...........Yes.............................................
16. This permit expires . .t.:.... ,
Signature y' ; ,....
: :............................................................................
.... ... ....................:::........
(Licensed Drain Layer)
Installation Completed, Inspected and Approved in accordance with State Public Health Code and Local Ordinances
..........................................."......................................"................................................. 19.................. By ................................................................................................................................................
Pollution Problem abated Date .........20....S.ep.t.emb.er.,.....1.972 ....................................................
Inspector
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NOTES Scale = 4ot in 1" approx. SOUTH WINDSOR POLLUTION CONTROL
S T D B #1 #2 LOCATION 63 Hollis Road
A 29 52 �7 59 OWNER George J. J
B 29 51 56 48 TYPE OF WORK Septic Repair
DATE _ - PERMIT PIPE " 0 B
INSTALLER Ph 1' W - 6
INSPECTOR ME DRAWN BY ME