HomeMy WebLinkAboutSeptic Repair 110 Robert Drive < ti , a.7
Department of Pollution Control
SOUTH WINDSOR, CONNECTICUT`
DRAIN LAYER'S PERMIT
Application for Permit to Install or Repair Individual Sewage Disposal System
FeePaid $. '........................ 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 ................::::..::.:'.::.:...........................................................................................................................................................................................................................
(Dwelling, Commercial Building, Store, etc.)
4. Number of Families or Persons to Occupy Prem .:ises ................::..:::.:.... ,.1................................................................................................................
..........
5. Number of Bedrooms ..................:......t.:::.%.............
6. Average Daily Flow ...................................................
Manufacturer and
7. Liquid Capacity of Septic Tank ..:..:.: ......i....::............................... 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 ...`1' tG...:(2).................... Length f01:t.................. Width .............................:.:..:...............
Total .....25..8 sq....fee.t... Other .....P.hus....old....£ieId ...............................................................................................................
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 ...............................................................................................................................................
Pollution Problem abated Date .......27...August......1.97..1................. ..........Melvin...Edwards,..Jr...+.......................................................... .
Inspector
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NnTF.S: Not drawn to scale. SOUTH WINDSOR POLLUTION CONTROL
A B LOCATION 110 Robert Drive
S/'P 975 73 OWNER Thomas D e
#1 36 47.5 TYPE OF WORK Se tic Re air
#2 42.5 50 DATE o8 2 71 PERMIT 71- 0 PIPE4" O.B.
INSTALLER P
INSPECTOR ME DRAWN BY ME