HomeMy WebLinkAboutSeptic Repair 78 Main Street l
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Departinent of Pollution Control
SOUTH WINDSOR, CONNECTICUT'
DRAIN LAYER'S PERMIT
Application for Permit to Install or 10Individual Sewage Disposal System
Fee Paid $./.D.�°�..... By ......... .4"/.rK..............�°—1S-t 1J0-W-%. ................................ Permit No. 2 ....................
Date ......�, `�( y......... 7�.....19''7�
Pursuant to written application, permission is hereby granted to the Licensed Drain Layer named herein
for repair ....X or construction ......... of an individual sewage disposal system concerning which the following
information is submitted:
1. Owner of Property .................................................................................................. Address of Owner ...................................................................................................
2. Location of Property ................ ....... .t�?.......... .. ............................................................................................................. Lot No. ..............................
3. Type of Structure ....................... ?f .e-D ........
............................................................................................................................................
........................................
............
(Dwelling, Commercial Building, Store, etc.)
4. Number of Families or Persons to Occupy Premises ...........8��..................................................................................................................................
5. Number of Bedrooms ..............13..........................
6. Average Daily Flow ...................................................
Manufacturer and
7. Liquid Capacity of Septic Tank ......................................................... 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 ........................................................................
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 ...................................................................................................................
Signature ..... �/t'`N1.... .. . ..... i4i&L
...........................................................................
(LicensLayer)
Installation Completed, Inspected and Approved in accordance with State Public Health Code and Local Ordinances
.........................................................................................................1—..1 19:.7b....... By .............. ....
Pollution Problem abated Date ................................:..................
...........................
Inspector
Ny
a �AWS
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NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATION 76 MAN S*7066'r"
OWNER
TYPE OF WORK IG C)P l
DATE I- 7 -7f PERMIT PIPE " Ft�►
INSTALLER A64vo ' w i ejAh k{
INSPECTOR DRAWN BY _,^