HomeMy WebLinkAboutSeptic Repair 1135 Sullivan Avenue • i
Department of Pollution Control
SOUTH WINDSOR, CONNECTICUT'
DRAIN LAYER'S PERMIT
Application for Permit to Install r epair Individual Sewage Disposal System
Fee Paid $..' .:....::: ° ........... By ....... ........................... ....± ..::' ....:......................................... Permit 1�Jo,
..... ....... 73 -�5 .....................
Date ..'IV�Y...../ 9 . .. . �....
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 ........f. 'p rty .............:....:..... � .�.:.
2. Location of Property ..::::::.::.:°;............................................................................................................................................................................ Lot No. ..............................
3. Type of Structure ....::.:::::: ..:.:
(Dwelling, Commercial Building, Store, etc.)
4. Number of Families or Persons to Occupy Premises ...................i.;.r'....::.. ..............................................................................................................I.............
Number of Bedrooms ................'...............................
6. Average Daily Flow ...................................................
p Manufacturer and
7. Liquid Capacity of Septic Tank `"......... 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 ........:':::.:-..::...:: '............................................
From adjacent 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 required ...................................................................................................................................................
13. Leaching System: Number of trenches ................................................ Length .....................,.............................. Width ...................................................
Total ................................................ Other ........_...................................::........................................................................................................................
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 ....... ............................ :...................................................
PollutionProblem abated Date .............................................................................. ...........................................................................................................................�........:......
Inspector
s
N
3
70 Gq
Cot,
NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATION / ,r— &V,
OWNER
TYPE OF WORK .S'FpTsc- ,PlfP414
DATE PERMIT PIPE
INSTALIER
INSPECTOR DRAWN BY