HomeMy WebLinkAbout1976-6-29 - 17 Carman Road - Septic Application(fatutt of IFPlatill Mubsor
Department of Pollution Control
SOUTH WINDSOR, CONNECTICUT
DRAIN LAYER'S PERMIT
Application for Permit to Install or Repair Individual Sewage Disposal System
Fee Paid $ .1.0.0..0.... By 1'10189.......- ..... Permit No...." ,
Date....J.uze......... ............................
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 S.G11111.]3F.,lt'.1'..,.....Allan ....2...... M.. Address of Owner 17 "—t%�+!� A n.... T'� � �.......
... ........................ ....... ..
2. Location of Property ....... S.amc..................................................................................................................................................................... Lot No............ '.................
3. Type of Structure .................tear.Pa..:i..:i.n................ ....................................... :......................................................................................................................................................
(Dwelling, Commercial Building, Store, etc.)
4. - Number of Families or Persons to Occupy Premises .............One f.ami? y.................................................................................................
5. Number of Bedrooms .................. _---- ...--.--.-.-
6. Average Daily Flow ...................................................
7. Liquid Capacity of Septic Tank ...............
8. Soil Conditions: Type of Soil ................................
9.
10.
11.
12.
13.
14.
15.
16.
Manufacturer and
Material of Septic Tank ........................................................
........................ „ ....................,......,...
(Sand, Gravel, Clay, etc.)
Maximumground water table ........ .............................................................. .......-...-.......-..-...........-.-........ ................ ................. ....... ..........
If not served by public water supply: t1� %��
Distance from Owner's well .....................]�h.Ite........................ . �7 � ■ NeD
From adjacent wells .......................................... ...
Distance to nearest water course, drainage ditch, storm drain or embankment.......................................................................................
PercolationTests: Time for 1" drop in soil test .......... Rr mA-;X...............................................................................................................................................
Classification of soil — ....... ...... .................... ...... ........ _........ ......... _..................... ...................
..w...._.__ .. ....._.......�....
Minimum square feet of effective seepage area required ...................'..''r 7�}.... e ". :............
LeachingSystem: Number of trenches .................................... ........... Length ................................................... Width ............. .,................ ... ..............
Total.. Other �................_....,.........................................._......,......,....................................
Plot Plan Attached. .. ... ..... .......
...._.....-
LayoutApproved. .....................................................
Thispermit expires .......... '.:1.............. ...... »........................... ......
1
r Signature ........ .......... ....-.../
......,,........-......_.................
i arr 'a. M cK inn c(J.icensed Drain Layer) ,
Installation Completed, Inspected and Approved in accordance with State Public Health Code and Local Ordinances
Pollution Problem abated Date......................................................................
By r� ......�.a rs �✓
_...........:....+r, ......-...-... ............ ............-............-....
Inspector
N
i
.p�
�l
i
1
i
i
1
NOTES SOUTH WINDSOR POLLUTION CONTROL
Drawing not to scale. LOCATION 1 Carman Road (Lot 2 )
OWNER ScHuBUT,, AjIgM Rx & MA= M.
TYPE OF WORK Septic Repair
DATE '1- - ? (.PERMIT PIPE
INSTALLER
INSPECTOR F J S DRAWN BY
7
���\A 7arq ?1�