HomeMy WebLinkAboutSeptic Repair 82 Main Street ,
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Department of Pollution Control
SOUTH WINDSOR, CONNECTICUT
DRAIN LAYER'S PERMIT
Application for Permit to Install or 6epairdividual 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 :.. ............................ ........::...................................... Address of Owner ......... ........................................................................
2. Location of Property ................................................:: .::::::............................................................................................................................... Lot No. ..............................
3. Type of Structure .............................................................:...................................................................................................................................................................................................
(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 ..... ..... ........................ Material of Septic Tank .............................................: ................
8. Soil Conditions: Type of Soil ............................................................................................................................................................................::.:.:.............:.::..:,::.
(Sand, Gravel, Clay, etc.) t
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 .T 9..41)............. Length 4041 T....................... Width ..:.::.:...
TotalW X...4.$..ff.............. Other ...........................................:.................................................................................
14. Plot Plan Attached. ...............................................................
15. Layout Approved. ....................................................................
16. This permit expires ` 11
Signature ................ : .................................. ......... ...........................:.........................................
(Licensed Drain Layer)
Installation Completed, Inspected and Approved in accordance with State Public Health Code and Local O
.................................................................................................................................... 19.................. By ............................................................................................................................
PollutionProblem abated Date ....I.ti........ ►.iF.r...l,l!.7/...................... .......... ,,...............................................................................................
Inspector
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NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATION 932. MRtwI S-rQ.,-gr
OWNER as LAZK
TYPE OF WORK ric. P-j* &
DATEao o6 i PERMIT 1-*3 PIPE t
INSTALLER S�wsrf2 - "g3o
INSPECTOR M4 DRAWN BY M E
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