HomeMy WebLinkAboutSeptic Repair 100 Scantic Meadow Road C, own of #11at4 ightboar
Department of Pollution Control
SOUTH WINDSOR, CONNECTICUT
DRAIN LAYER'S PERMIT
Application for Permit to Install or Repair Individual Sewage Disposal System
Fee Paid $: ..'... .................. 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 ..........::.. :{ ......... .......I.......................
2. Location of Property
P Y ............::.�:.�::,>:................................................................................................................................................................... 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 ..... :..........,.........E:.::::.
. ...............................................
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 ...: ......... .:...::.. ...............................................,
A�° ,; i (Licensed Drain Layer)
Installation Completed, Inspected and Approved in accordance with State Public Health Code and Local Ordinances
................... .....::. :.............................::. ......:..................................................... 19.... ..:::;:::... By ................................................................................................................................................
PollutionProblem abated Date .............................................................................. ¢....... ' ....:.............:.:...... .:..:...........................................
d. _.Inspector
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NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATION loo
OWNER a,v o
TYPE OF WORK , z pA7,,�.
DATE i PERMIT - .2 PIPE ag,
INSTA LE
INSPECTOR <J' DRAWN BY f