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Cnnrn of OoW4 Vinbsor
Department of Pollution Control
SOUTH WINDSOR, CONNECTICUT
DRAIN LAYER'S PERMIT
Application for Permit to Install or Repair Individual Sewage Disposal System
Fee Paid $. ......:. ......... By ...:. ::. . ..:: `:.r..... 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. Owner of Property "
Yt a Address of Owner ,f r„ti K... ,
2. Location of Property S Q. .....e. ,.. je.......E fi.k.;:....,:; Lot No. .......................:......
3. Type of Structure ..... .,....:.. a..:...� t{. :.................................................................................................I........................
(Dwelling, Commercial Building, Store, etc.)
4. Number of Families or Persons to Occupy Premises ................................................................................................................................................................
5. Number of Bedrooms ................................................
6. Average Daily Flow ...................................................
Manufacturer and
7. Liquid Capacity of Septic Tank .r;.< t :.....t , : �:........... Material of Septic Tank S Y<tE •r.......,.>............................................................
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. .... ,:..:.,..I.,
16. This permit expires . .............
..x
Signature ....
....... ......... ......... ....................................................
(Licensed Drain Layer)
Installation Completed, Inspected and Approved in accordance with State Public Health Code and Local Ordinances
ByJuy ...................................... . 7 .#.................................................................
PollutionProblem abated Date ................................:......................................I...... ........................................................................................................................... .............,.
Inspector
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NOTES jj*,r to ScA E' SOUTH WINDSOR POLLUTION CONTROL
LOCATION �r loemr
1 OWNER
qc- ` TYPE OF WORK SE ec NDATE sa PERMIT - 3 PIPE4o,INSTALLER - 3s s!o
INSPECTOR E DRAWN BY Mac
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y c� der well XZt
O Q • . 2 ASPHALT,.. PA V/NG 1 'i
Ool
d /
0 0 0 9/. rook
SOL/D f
40.0
e 35 BLDG. L�/NE (Zons) ,
Id
145. 00 ► �'
of STRONG RA
ROAZ
39, /DENT
FOOT AREA AROUND DRY ,,m—�r unit DEEP A
#7/- 17
TOWN OF SOUTH WINDSOR
TOWN HALL
SOUTH WINDSOR, CONN. 06074
DEPARTMENT POLLUTION CONTROL
Date
The Sanitary Sewer . . . . e tic S stem . . .
at . .104W.r . A 3S. . . . .
or lot #. . . . . . . . . . . . . . . has been installed and completed
in accordance with the Town of-South Windsor ordinances
and regulations.
Accepted and Approved
By Date /�__971 _