HomeMy WebLinkAboutSeptic Repair 83 Mark Drive Hoorn of #oW4 10inboar
Department of Pollution Control
SOUTH WINDSOR, CONNECTICUT
DRAIN LAYER'S PERMIT
Application for Permit to Install or Repai Individual Sewage Disposal System
FeePaid $.............p....'::''...: B ........................................................................................ 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 ...............:.:.::....:.::.:::.,:..........................................................................................................................................................................................................I...........
(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 ............... ..:..:....................................................................................................................................................
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 ...........::::...............................::.:................................................................
Signature ......................................:......................:........,,::::,.....................................................................................................
(Licensed Drain Layer)
Installation Completed, Inspected and Approved in accordance with State Public Health Code and Local Ordinances
.................................................................................................................................... 19.................. By ..........................................................................................................................•.....................
PollutionProblem abated Date ..:........................................................................... ..........................................................................................................................._...............
Inspector
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Catutt at OvW4 18inboar
Department of Pollution Control
SOUTH WINDSOR, CONNECTICUT
DRAIN LAYER'S PERMIT
Application for Permit to Install or Repair Individual Sewage Disposal System
FeePaid $.. ...t................. 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 ............................:::: a.. .....::....................................................................................................................................................................................I.....................
(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 ................::.......;...............
....................
..........
From adjacent 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 ........:':....::::......:.:...,::..:...................:.::,....:................................................
Signature ................:::::. ..... : -:..::.... :..:..... .......... .........::.........................................
(Licensed Drain Layer)
Installation Completed, Inspected and Approved in accordance with.State Public Health Code and Local Ordinances
.................................................................................................................................... 19.................. By ......................................................................................................,,........................................
r
Pollution Problem abated Date .08.,,Septgmber, 1971.......... war '
Irnpector
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NOTES: Septic system not drawn to SOUTH WINDSOR POLLUTION CONTROL
scale• A B LOCATION
D 5- OWNER HenryHalenski
S/T 30.5 25.2 TYPE OF WORK
DATE 09 08 '71 PERMIT 71- 3 PIPE
INSTALLER P• •n W _ 48
INSPECTOR ME DRAWN BY ME