HomeMy WebLinkAboutSeptic Repair 492 Miller Road t�
Department of Pollution Control
SOUTH WINDSOR, CONNECTICUT`
DRAIN LAYER'S PERMIT
Application for Permit to Install or 6DIndividual Sewage Disposal System
Fee Paid $..�.�.......................... By .................. RI'K............... ............................... Permit No. .....749-1",.Z. .......................
Date ........��..-... ?�.Q...-. ...................
Pursuant to written application, permission is hereby granted to the Licensed Drain Layer named herein
for repair ...'14. or construction ......... of an individual sewage disposal system concerning which the following
information is submitted:
1. Owner of Property ..................................................��-! N. E. .... Address of Owner ..........." r...........olk
..... ..... 1�,.........
��.....
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 ..............................................................................................................................................................................
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 ...... �N!k.....'.. l...1 !M. �f.�1Rl......................................................................
V�" � ,
(Licensed Drain Layer)
Installation Completed, Inspected and Approved in accordance with State Public Health Cqde and Local Ordinances
.................................................................................................................................... 19.................. By ..........................................................................................
PollutionProblem abated Date .....................�o..: ..4.. �g...................... .............................. .1...:.... ..................................,.........................
Inspector
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NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATION lL&0t
OWNER Xe4ntdq
TYPE OF WORK eC Wail-
.DATE - d-? PERMIT PIPE
INSTALLER r n!i
INSPECTOR DRAWN BY