HomeMy WebLinkAboutSeptic Repair 437 King Street ti
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Department of Pollution Control
SOUTH WINDSOR, CONNECTICUT
DRAIN LAYER'S PERMIT
Application for Permit to Install or Repair Individual Sewage Disposal System
FeePaid .............. By . ,:; .%.......................................:........................................................... 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 ...........s'�.jrk ...:.:; 'A , Address of Owner
... ........................................ ......
2. Location of Property .....?: ?`.ts.......................................................................................................................................................................... Lot No. ..............................
3. Type of Structure ............... ..................iJ.......................................................
(Dwelling, Commercial Building, Store, etc.)
4. Number of Families or Persons to Occupy Premises ..........rnc.....(.:)..?.....C°;ra: .q.. .......:.............................................................................................
5. Number of Bedrooms ..........................................:.....
6. Average Daily Flow ...................................................
Manufacturer and
7. Liquid Capacity of Septic Tank . ..g %{%l.l...: ........ Material 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 ... L:'....f:: '.a............................................
Fromadjacent wells .............................................................................................
10. Distance to nearest water course, drainage ditch, storm drain or embankment .......................................................................................
11. Percolation Tests: Time for 1" drop in soil test ...... ;;:,::i;#,;i,x:..................................................................................................................................................
Classificationof soil ....................................................................................................................................................................................................
12. Minimum square feet of effective seepage area required ................. �.?;; 'C:....';.{'F' ...........................................................I..................
13. Leaching System: Number of trenches ................................................ Length ................................................... Width ...................................................
Total ................................................ Other J 0 Y '�0 c.- �t .:�_,
..........................................................................................::................................................................
14. Plot Plan Attached. ......: ...................................................
15. Layout Approved. ....................................................................
16. This permit expires;}?....?::;; v k)�';.'.'. �::.s:......3..`%r:.........................................................
Signature.. r` ..,,....�' .::.... tw .... ............. ...............................
(Licensed Drain Layer)
Installation Completed, Inspected and Approved in accordance with State Public Health Code and Local Ordinances
.................................................................................................................................... 19.................. By ................................................................................................................................................
Pollution Problem abated Date ..... %. ....�.... .... :� ....................... /f�.%t. .;.::f' f\' '
%' Inspector
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1540 SULLIVAN AVENUE • SOUTH WINDSOR, CONN. 06074
�f�dsox•co AREA CODE 203/644-2511
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