HomeMy WebLinkAboutSeptic Repair 223 Main Street '
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Department of Pollution Control
SOUTH WINDSOR, CONNECTICUT
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DR .~^, L4,YkR S PERMIT
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Application
for Permit to install r Repai Individual Sewage Disposal @vwtmom
Foe Paid By . ` ^r'..�, Permit No.
/ Date ''
Pursuant to written is hereby granted to the Licensed Drain Layer named herein
for repair or couubmzotixu --- of an individual umvvoge disposal system concerning which the following
information issubmitted:
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l. Owner of Address �vm --...-.......'.........L............-----'------
2. of Lot No
-. Type -- Structure '_'__--_--...............
(Dwelling, Cmmnexoial8nil6ino Store, etc.)
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4. Nood�orof %ruod�ea or Persons ouo to Occupy Prem
ises
5. Number ofBedrooms ---'.-----------.
G^ Average Daily Flow -----------------
Muoo{uohzner and �
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7. Liquid of Septic Tank ----.--------------' D�ute�ulof8ondo Tank ---'.-.-....----------------------
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0. SoilConditions: Tvoo of Soil __!?n`� ...__'-_-_----'-----_--,_-_---''------_---''_----------
(Sand, Gravel, Clay, etc.)
Maximum ground water table ----_--------------------------------'------------------.
9. If not served by public water supply:
Distance from Owner's well
From adjacent wells ____-_-,........................................................
Dl Distance to nearest water course, ditch,� storm drain or embankment ----------------------------.
ll. Percolation Tests: Time for l° drop bu soil test --------------------------------------------------_----'
Classification of soil ---------------------------.-------------------------------------
1lMinimum egnuro feet wf effective seepage area required ........... ,c-'-.,~--------------------------------.'
13. Leaching 8vmhno: Number of bmouhmu -----.---------. Length ----------------' Widtb -----------------
' Total ................................................ Other ........................................................................................................................................................................
14. Plot Plan Attached. .................................................
15. Layout ....................................................................
16. This permit expires .
Signature '_--_-'_-_------'------------'--'-'----------
(Lioensed Drain Layer)
Installation Completed, Inspected and Approved in accordance with State Public Health Code and Local Ordinances
'---'_--_'~i'=-���-�-�2-�'�--------'---_� ��'_--' By ----'_----_-----'_--.-----'-_____________
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Pollution Problem abated Date --___--------.-----'...- ....-_ ' -'------.---
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NOTES SOUTH WINDSOR POLLUTION CONT 0
LOCATION 94
w OWNER
n TYPE OF WORK `
DATMAZ142YTE T P E
INSTA
Q' INSPECTOR DRAWN BY