HomeMy WebLinkAboutSeptic Repair 20 Pear Tree Lane aumn at #aan inboar
Department of Pollution Control
SOUTH WINDSOR, CONNECTICUT
DRAIN LAYER'S PERMIT
Application for Permit to Install o Repair dividual Sewage Disposal System
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Fee Paid $......,.l..o►..o.v By .................�..................... Permit No. ..
Date ............. .:.�6.'. { �.........................
Pursuant to written application, permission is hereby granted to the Licensed Drain Layer named herein
for repair A or construction ......... of an individual sewage disposal system concerning which the following
information is submitted:
1. Owner of Property ........ ....... .. ............. ... .............. o ........ . d ess f Owner ...................................................................................................
2. Location of Property ........... �.�.. . .......P- C. .........../(.bG......... �?. ........................................................................ Lot No. ..............................
3. Type of Structure ................................. .�11L'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 ................................................................................................................:...............................................I............
Classificationof soil .....................................................................................................:..............................................................................................
12. Minimum square feet of effective seepage area required ...................................................................................................................................................
13. Leaching System: Number of trenches .................:........................ ... Lens................ ,��/.............. Width ...................................................
Total ................................................ Other ........., � Q...4'.�� ..::....... ...., . .....'...........................................................
............................
14. Plot Plan Attached. ...............................................................
15. Layout Approved. ....................................................................
16. This permit expires ...................................................................................................................
Signature .............................. C
(Licensed Drain Layer) t
Installation Completed, Inspected and Approved in accordance with State Public Health Code and Local Ordinances
............
.......... ... ....... ....... ......................... -.I:z.....
............ 19.91.. B ........................ ............................................................................................... .................
Pollution Problem abated Date .
`...................... .or........................................ ...............
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