HomeMy WebLinkAboutSeptic Repair 199 Rye Street Zutun jot #v* Mitboar
Department of Pollution Control
SOUTH WINDSOR, CONNECTICUT'
DRAIN LAYER'S PERMIT
Application for Permit to Install or Repair Individual Sewage Disposal System
�. .1./...I4 .1.................................................... Permit No. . �./�
Fee Paid $..../�............................ By .......... .........................
....................
di-w q?�lo 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: f
1. Owner of Property `/ .. . ........Address of Owner .......................................... ..................................................
............ .
2. Location of Property .....J. ..... ... ............ .. .�e�(�........ ................................................ .................................................................. Lot No. ..............................
3. Type of Structure .................................... .....(................................................... if l......... ...........................................................................................................
(Dwelling, Commercial Buil ing, 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 ......................................................... Mate •al of Septic Tank ..........................................................................................
8. Soil Conditions: Type of Soil ............................................................................. ....at. ..0...................................................................................:...................................
(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 ..............2...................... Length ............�. .�.......... Width .. ........................................
Total .....,f � Via, .. Other ........................................................................................................ ..............................................................
14. Plot Plan Attached. .... .../V d........................................
15. Layout Approved. ...... . ....�1....C...........................
16. This, permit expires ............ ....................................................................................................
1
Vtion
ature (Licensed Drain Layer)
InstalCompleted, Inspected and Approved in accordance with State Public Health Code and Local Ordinances
..................................................................I 19.77.. By ..................... .....:..................................................................................................................
Pollution Problem abated Date ...
.............................:............................................. ............`....................................................�"�.� ......................�.........,.....
Inspector
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NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATION Of ecle-
OWNER if/Q o r�o
TYPE OF W RK
DATES Z -22 RMIT - -P'Ipr.4
INSTALLER
INSPECTOR DRAWN BY
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