HomeMy WebLinkAboutSeptic Repair 383 Smith Street Towit jot On*
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 ................ -27
... ..... ......
....... ............................................................ Permit No .7
'42.
Date VAY =..//....................
Pursua t 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 X. Owner
pertyv .. ............... . ......... X''-./")/, Address of .......................................................
2. Location of Property ...........
................. Lot No. ..............................
3. Type of Structure .........................
.......................... . ...........
B ui li g* .......
(Dwelling, Commercial
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 ...............................
M te,no of Sep ic Sep ..... ............................ ........... �p.�t...
8. Soil Conditions: Type of Soil ...................................saF . . .. . .... ......... ... .
(Sand, Grav 10
.. . , etc,"Y
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 I" drop in soil test ...
...........................
Classification of soil
12. Minimum square feet of effective seepage area required .........................................
13. Leaching System: Number of trenches ..............3......................... Length ............ Width"', '"'
Total . Other
,**...........
14. Plot Plan Attached. ........ *00 1*.......
15. Layout Approved. .................... .... ........I..........................
16. This permit expires .........................................................
Signature ................A
(Licensed Drain Layer)
Installation Completed, Inspected and Approved in accordance with State Public Health Code and Local Ordinances
. .
.....................................I.............................................................................................. 19.................. By
............... .......................
........ ...........
PollutionProblem abated Date ............................................................................. ... ............ ............t.... ...................................
...................Ps
Inspector
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