HomeMy WebLinkAboutSeptic Repair 26 Thomas Street b y
�/ d TOWN OF SOUTH WI N DSOR
4 BUILDING DEPARTMENT
,69. South Windsor, Connecticut
Application for Permit to Install or Repair ndividual Sewage Disposal System
Application No. 7Y�e
TO THE BUILDING DEPARTMENT: Date_ JZS� 19�
A permit is requested fo repair r construction of an individual sewage disposal system concerning which the
following information is submitted:
1. Owner of Property Address of Owner T Li o 1.7 p J r;
2. Location of Property '0 ,b 1 I— Lot. No.
3. Type of Structure w Gt No. of Bedrooms
(Dwelling,Commercial Building,Store,etc.)
4. Number of Families or Persons to Occupy Premises_ !
5. Plumbing Fixtures: Water Closets > Urinals Lavatories / Bathtubs /
Showers_, Kitchen Sinks, L Laundry Tubs Garbage Grinder . Other
6. Liquid Capacity of Septic Tank / e—r--o Material of Septic
7. Soil Conditions: Type of Soil f1�7. _ l Maximum ground water table_ /i/v w/-
(Sand,GrlaVel,Clay,etc.
8. If not served by public water supply: Distance from Owner's well?0 from adjacent wells v y4 eg ><< .
9. Distance to nearest water course, drainage ditch, storm drain or embankment /lv o zr,z-
10. Percolation Tests: Time for.1" drop in soil test ~/, s Classification of soil
11. Minimum square feet of effective seepage area required
12. Leaching System: Number of trenches Length Width 3 s`= Total .
Other f
Signature l
(Licensed Installer)
(Sketch showing, all minimum distances and other details required below)
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Permit Issued 1 19 By ?
Installation Completed, Inspected and Approved os'dia..i now/ 19 By
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wiluwrt of J*vW4 18ittboar
Department of Pollution Control
SOUTH WINDSOR, CONNECTICUT
DRAIN LAYER'S PERMIT
Application for Permit to Install or Repair Individual Sewage Disposal System
FeePaid $ 7 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 ............::z. �t .:.'.... . .. t.a..: F :............................ Address of Owner ................ ..... .......................................................
2. Location of Property ......::. ::.... ..::.:.:...:..............
.:.::,........:.,. c:............................................................................................ Lot No. ..............................
3. Type of Structure ...............:.r.::'.;.....
(Dwelling, Commercial Building, Store, etc.)
4. Number of Families or Persons to Occupy Premises ...:::'.:: s:;.....( .. .....!.:;:;:..<1: .:::.........................................................................................................5. ..
Number of Bedrooms ...::..:.:.:.::.::::..... .....1.............
6. Average Daily Flow ...................................................
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 ......'75,..¢T...................
From adjacent wells ...........................?S...Fr...........................................
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 ...............................:::::..:!..:;...::..:....:...:....:,:::.:.:...:.1:......:..:...:...............................................................
14. Plot Plan Attached. ...............................................................
15. Layout Approved. .....................................................................
16. This permit expires
Signature .......::.....::. :..rx.4;��...� -....r; :: ' .C?.... ,, rz.:...i,..........................................................
(Licensed Drain Layer)
Installation Completed, Inspected and Approved in accordance with State Public Health Code and Local Ordinances
.....................................................................:...........................................I.................. 19.................. By ................................................................................................................................................
Pollution Problem abated Date ......;.
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NOTES SOUTH WINDSOR POLLUTION CONTROL
Q0TN sAnuc j2.�nFr��+�y mow LOCATION o T S of
tKac�r► �o F►.��p ����s OWNER T.
TYPE OF WORK �+�
Owr To DATE u.bi PERMIT -44 PIPE
INSTALLER- a hl9-aS9siZ _ __ __
INSPECTOR tie DRAWN BY me