HomeMy WebLinkAboutSeptic Repair 184 Windsorville Road C, own nt #o ut4 39inboar
Department of Pollution Control
SOUTH WINDSOR, CONNECTICUT'
DRAIN LAYER'S PERMIT
Application for Permit to Install or Repair Individual Sewage Disposal System
FeePaid $ ....' .t.::`^. ...... 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 .......................................................
2. Location of Property .:. ..:,:. ,............ :.......................................................................................................... Lot No. ..............................
3. Type of Structure .... .. ...........................................................................................................................................................................................................
(Dwelling, Commercial Building, Store, etc.)
4. Number of Families or Persons to Occupy Premises .. „,.:;r; ..... �,... ............................................................................................
5. -Number of Bedrooms
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
From adjacent wells 4.......... <.....,
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 .. �..4:;.t .
........�. t. ..s.:a�.::�::,.�+:.t ,tvF... �r ..j.............................................
(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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NOTES SOUTH WINDSOR POLLUTION CONTROL
Drawixg xot to scale. LOCATION 184-185 Wixdsorville Road
S T No 1 No 2 OWNER J.E. Shepard Estate
A 29 33 52 TYPE OF WORK Septic Field Re air
B 48 39 30 DATE _ PERMIT PIPE 4', B
D 47 35 27 29 32 INSTALLER Adam (W9-20 559
INSPECTOR ME DRAWN BY ME