HomeMy WebLinkAbout1978-9-13 - 164 Carriage Drive - Septic Applicationi1vtott of OvW4 19hibsor
Department of Pollution Control
SOUTH WINDSOR, CONNECTICUT
DRAIN LAYER'S PERMIT
Application for Permit to Listal r Repair Individual Sewage Disposal System /
Fee Paid $ Z �r� ` b` ( Permit No.
Date ..........
Pursuant to written applicatio 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:
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Owner of Property ....... Address of Owner ..............................,....,,,... ,,..... ......................
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Location of Property ...............L" 11,., r. Lot No, ,
Type of Structure................................................................................�.........�......,..... ............................................................ ........ ........ �.....
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(Dwelling, Commercial Building, Store, etc.) ,®
Number of Families or Persons to Occupy Premises ................................... ...... ...-......... ........................ ........... .. �1 .. :...........
Number of Bedrooms ................................................ ` t
Average Daily Flow ........... , _ , ... „..M............
Manufacturer and
Liquid Capacity of Septic Tank . ........... .......... ..,.............:..... ........ Material of Septic Tank......................................................................................
SoilConditions: Type of Soil . .......... ........ :._..... .... .................... ............... .............. .................. ...................................._......._..............................................................
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(Sand, Gravel, Clay, etc,)
Maximumground water table .... ............ ..................................... ........... ... .... ............................ .....................
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If not served by public water supply:
Distance from Owner's well ....................... .............. ............
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From adjacent wells ..,,::....;....::.. _._..::. :;..:.:
Distance to nearest water course, drainage ditch, storm drain or embankment........................................................................... ..........
Percolation Tests: Time for 1" drop in soil test ................................ .... .......
Classificationof soil ................................................. ._...._....,�..........-.....,�....... .............._..........:: r ,�-4 �. ................
Minimum square feet of effective seepage area required ' `' ..d ................
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Leaching System: Number of trenches ............... Length ................................................... Width -.. ...... ......... ....... ..........
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Total........... .:.........�.............,.... Other ............... ....... ........--.......... ........... .
Plot FIan Attached. L.---.........,............................
Layout Approved ....... �i..L.................................... ....,,.,.,
This. permit expires
Signature .................. ... ...................
Installation Completed, Inspected and Approved in accordance with State Public Health Code and Local Ordinances
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Pollution Problem abated Date ....................... ..,.... ............... ....... _........... ................
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Inspector
ale
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