HomeMy WebLinkAboutSeptic New 871 Strong Road c�n�rrt �f �nr in��lax
Department of Pollution Control
SOUTH WINDSOR, CONNECTICUT`
DRAIN LAYER'S PERMIT
Apph ation for Permit t Install r Repair Individual Sewage Disposal System
3� 77
FeePaid $1a.0......... By .........�-'..�............w....,.../..................................................................................................... Permit No. .. ..... �..�b...................
�l^e �Date ........................r�..l...... .................
Pursuant to written applica 'o permission is hereby granted to the Licensed Drain Layer named herein
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for repair ......... or construction/I . of an individual sewage disposal system concerning which the following
information is submitted:
1. Owner of Property ....... .!. .....!� '�� Address of Owner ...................................................................................................
YP ........... ....... .............. ..............
.. .............
rl�..�?�......... .d................................................................................................ Lot No. .......................,......
2. Location of Property �./ .........
3. Type of Structure ..................................................w. .. ..........................................................................................................................................;..................................
welling, Commercial Building, Store, etc.)
4. Number of Families or PersonVo Occupy Premises ................................................................................................................................................................
5. Number of Bedrooms ................................................
6. Average Daily Flow ...................................................
Manufacturer and
7. Liquid Capacity of Septic Tank ....................
.............J atexialof S tic Tank....... ......rlG,....... ... 0...��: ..�..'.........
8. Soil Conditions: Type of Soil ....................... (.b.?.CJ.....-.........�4`7.r�t / GG
..... . e.............................................................................
(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 ..............................................................................................................................................................................
Classification of soil ..................................... . .
12. Minimum square feet of effective seepage area re tired .................................. :................. ......... ...................................................................
13. Leaching System: Number 9f ch�s .................:..... Len ����f. � ..3. ......Width ...... .....................................
Total ......lgr�r..f......... Other ...............1� ..1..................................... ...................................................:...........................
14. Plot Plan Attached. ...............................................................
15. Layout Approved. ....................................................................
16. This permit expires ...................................................................................................................
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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
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