HomeMy WebLinkAboutSeptic Repair 131 Ident Road i1vton of #v* 19inbsor
Department of Pollution Control
SOUTH WINDSOR, CONNECTICUT'
DRAIN LAYER'S PERMIT
plication for Permit to Install (;;Individual Sewage Disposal System
(67y
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Fee Paid $......./..d..'................. By ............................ C -1 - -
. .L.i. ..... -....................................................................... 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 . �►'1►IA'.S. ... ..SLO.Q.Y1 . Address of Owner ............. ...... d-ey
....... 1... ...1............... . . ........................... . ..
2. Location of Property ............ ............. -........1Q. ....i................................................................................................. Lot No. ..............................
3. Type of Structure ........................... Veal.(...n . .............................................................................................................................................................................................
(Dwelling, Commercial Building, Store, etc.)
4. Number of Families or Persons to Occupy Premises ...........................0 r.12 ...............................................................................................................
5. Number of Bedrooms ................................................
6. Average Daily Flow ...................................................
Manufacturer and
7. Liquid Capacity of Septic Tank ................./oP!2 . ..�� .i, Mate 'al of Septic Tank .............�'b. -!:. .............................................
8. Soil Conditions: Type of Soil ...........................................................,':p1,�...............................................................................................................................................
��(Sand, Gravel, Clay, etc.)
Maximumground water table ....................t A.................................................................................................................................................
9. If not served by public water supply:
Distance from Owner's well ...............�...`.��....................................
From adjacent wells .....................-.> 741................................................
10. Distance to nearest water course, drainage ditch, storm drain or embankment .................
11. Percolation Tests: Time for 1" drop in soil test ...........................C1::roca.t.14A.........t ..........L'. .
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 .... . ...... ... .... ...... ... .................. ................................................�................................................
icensed Drain Layer)
Installation Completed, Inspected and Appr a 'in accordance with State Public Health Code and Local Ordinances
.............................................................................3.......':..�,....g............................. 19.. ../�... By ................................................................................................................................................
Pollution Problem abated Date
.....: .-.124icto;.. ........................................_...............
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NOTES_ SOUTH WINDSOR POLLUTION CONTROL
LOCATION ,3 -T og4 R
OWNER
TYPE OF WORK
DATE 3-3 - PE IT - ^L PIPE
INSTALLER
INSPECTOR DRAWN BY R-(�