HomeMy WebLinkAboutSeptic Repair 644 Main Street pppppp,
Mitutt of On*
Department of Pollution Control
SOUTH WINDSOR, CONNECTICUT
DRAIN LAYERS PERMIT
Application for Permit to Install or Repair Individual Sewage Disposal System
FeePaid $Jk..0 0.............. B a0.. .V09 .. . . .................................................................................................. m76 -33
.. . . .. . P .Date Z51
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 Aj�!T- '.;2
Vn 0 Address of Owner .(244
0.
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.)
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 ...............................................................................................................................
Classification of soil
12. Minimum square feet of effective seepage area required ...................................................................................................................................................
13. Leaching System: Number of trenches Length ................................................... Width ..............................................
Total 17 7.
Other
14. Plot Plan Attached. .......................................................
15. Layout Approved. ....................................................................
16. This permit expires ........................................................................................................... .....
Signature ..................................................................... ...................................................................................
(Licensed rain rain Layer)
Installation Completed, Inspected and Approved in accordance with State Pub ic Health Code and Local Ordinances
........................................................................................................................I........... 19.................. By ................................................................................................................................................
Pollution Problem abated Date ................................
M(77Y.............
Inspector