HomeMy WebLinkAboutSeptic Repair 660 Main Street dawn of #i=4 ( 10ittboar
Department of Pollution Control
SOUTH WINDSOR, CONNECTICUT
DRAIN LAYER'S PERMIT
Application for Permit to Install or Repair Individual Sewage Disposal System
Fee Paid $.......10.00........... By ................IIARM LEVACK......eN.i....99�.......................................... Permit No. ............ ........
.......... . ...............................
12/1 75
Date .........................................................................
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 .................Fr.i.tz..Mahx............................................. Address of Owner .........bfiO...main...Stree.t...................................
2. Location of Property ............................................................................................................................................................................................. Lot No. ..............................
3. Type of Structure Dwelling............................................................................................................................................................................................................................
(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 ...........1.QQ.Q................................ Material of Septic Tank ..........................................................................................
8. Soil Conditions: Type of Soil .................Sandy......... clay..........................................................................................................................................................
(Sand, Gravel, Clay, etc.)
Maximumground water table ..............................................................................................................................................................................
9. If not served by public water supply:
Distance from Owner's well .........7.5.E C..:....................................
From adjacent wells .............................................................................................
10. Distance to nearest water course, drainage ditch, storm drain or embankment ............75tPm.......+..............................................
11. Percolation Tests: Time for 1" drop in soil test ..............................................................................................................................................................................
Classificationof soil .........................................................................................................:..........................................................................................
12. Minimum square feet of effective seepage area required ..............375..........................................................................................................................
13. Leaching System: Number of trenches ................................................ Length ................................................... Width ...................................................
Total ................................................ Other ..................7..?Q........gal.....4uy!P l..........................................................................................
14. Plot Plan Attached. ...............................................................
15. Layout Approved. ....................................................................
16. This permit expires ...................................................................................................................
Signature "
(Licensed Drain l
Installation Completed, Inspected and Approved in accordance with State Public Health Code and Local Ordinances
.................................................................................................................................... 19.................. By ........................................................................................................,.......................................
PollutionProblem abated Date ................................:............................................. ............................................................................................................................................
Inspector
TOWN OF SOUTH WINDSOR
HEALTH DEPARTMENT
Application for permit to install a newt epai subsurface sewage disposal system. To the Health Department,
Town of South Windsor. 37
Fee Paid 1(2 0--- Date 1°Z —� Permit Number 29—'Ag
As a subsurface sewa a disposal system installer licensed in the State of Connecticut, I
Name, Address, Telephone Number, License Number
hereby apply for a permit to constru /repair a subsurface sewage disposal system located at
66C) _;k,,e2 and owned by IWALIR
Street, Address, Lot Number Name
l r,el .�,�n� s
Address
Information to be supplied by Applicant:
Type of dwelling 2? If non-residential, estimated daily flow
Residential,Commercial,Etc.
Number of bedrooms Size of lot
Number of fixtures above basement
Tubs,Sinks,Toilets,Etc.
Number of fixtures in basement, if any ,
Pumped or gravity flow,
Type of water supply If private,type of well
Public-Private
Information to be supplied by Health Department:
Soil type at various levels &.,Cl
Percolation rate Square feet of effective leaching area required Qs Mocl as .06ss1bte fog aee4_
Size of septic tank sdf�_, Type of system Trenches,Dr ywells,Etc.
Number of dry wells, trenches, etc. 3 Distance between individual leaching
units. Distance from well on same property on adjoining property
Curtain drain required --
Yes,No
!
Height of system above ground water maximum ground water
ledge impervious soil layer
If automatic closing is required,description
A PLOT PLAN INDICATING LOCATION OF PROPOSED STRUCTURE, WATER SUPPLY, SEPTIC SYSTEM, EM-
BANKMENTS, WATERCOURSES, PROPERTY LINES AND ALSO INDICATING EXISTING AND PROPOSED
FINISHED GRADES MUST BE SUBMITTED BEFORE THIS PERMIT CAN BE ISSUED.
THIS PERMIT IS NOT TRANSFERRABLE FROM PERSON TO PERSON OR FROM PLACE TO PLACE.
NO PART OF THE SYSTEM SHALL BE BACKFILLED UNTIL IT HAS BEEN INSPECTED AND APPROVED BY THE
SANITARIAN.
SPECIFICATION AND REQUIREMENTS AS STATED IN THIS PERMIT MUST BE MET AND ANY CHANGES MUST
BE APPROVED BY THE TOWN SANITARIAN BEFORE FINAL APPROVAL WILL BE GIVEN.
THIS PERMIT SHALL NOT BE CONSTRUED AS PERMISSION TO CREATE A NUISANCE CONDITION NOR IS
THIS SYSTEM GUARANTEED BY THE HEALTH DEPARTMENT.
Permit Received by2'4�,JeDate
�7 7
Signs ure of Applig4nt& icense Number
For Office Use Only n
Permit issued by Date
System installed by r�/d
Final Inspection Approval Date
a a
N
n
I
I� @XI;S'�!Lt�_ 11 �—U-I U�_Il
�o
7 5'
r
60'
NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATION D �1u_`�
hiyi, 1���1 DU�v�lbw F' OWNER
rJ -aoy exrs1 r�� al rY too-i TYPE OF WORK e u
DATE PERMIT PIPE
INSTALLER -Lev a-
INSPECTOR DRAWN BY OP-