HomeMy WebLinkAboutSeptic Repair 585 Main Street r
c�n�rrt �� �zr ind�nx �
Department of Pollution Control `
SOUTH WINDSOR, CONNECTICUT \
DRAIN LAYER'S PERMIT
i
Application for Permit to Install or Repair Individual Sewage Disposal System
FeePaid $...........::1.:"'....;l ...... By Che.clt...No......2.4.53................................................................................................ Permit No. ...................r .............................................................
Date .
Pursuant to written application, permission is hereby granted to the Licensed Drain Layer named herein
for repair ;:`E... 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 o Structure ...............:.:.::s .:...:..::.: ;.....................................................................................................................................................................................................................
�. (Dwelling, Commercial Building, Store, etc.)
4. Number of Families or Persons to Occupy Premises ..........::: ..........(:'.
f........:,x::i.?_ ..................................................................................................
5. Number of Bedrooms ..w.:.....(::;..r.................
6. Average Daily Flow ...................................................
Manufacturer and
7. Liquid Capacity of Septic ............ Material of Septic Tank .....Richards....-....coxtare.te.................
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 .. ''3 .
Signature .........................................................::.................:....:...............................:::....:::......................................................
(Licensed Drain Layer) "_.
Installation Completed, Inspected and Approved in accordance with State Public Health Code and Local Ordinances
.................................................................................................................................... 19.................. By ................................................................................................................................................
Pollution Problem abated Date ......o .:.'ll�. .. ... '.....................� ..... .................. ,....... . ..or. ,....__....................:............