HomeMy WebLinkAbout1978-4-7 - 223 Carriage Drive - Septic ApplicationMitutt of #v* 18inbsor
Department of Pollution Control
SOUTH WINDSOR, CONNECTICUT
DRAIN LAYER'S PERMIT
Application for Permit to Install or Repair Individual Sewage Disposal System
FeePaid $....`�..:......IS,}�.........�.Q..........`............ ................................................................... 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 Property4Address of Owner ........
2. Location of Property ..........-r~lr...... ..--...._.........._................ Lot No. !
3. Type of Structure ... ................................ .... ................... ......................
(Dwelling, Commercial Building, Store, etc.)
4. Number of Families or Persons to Occupy Premises..............................................................................................................................................:.......
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 ......._ .................. .................... ............ .................................... ........... .... ........................ ..... w.............. ...... ........
(Sand, Gravel, Clay, etc.)
a]
10.
11.
12.
13.
14.
15.
16.
Maximum ground water table ..::.::.........
If not served by public water supply:
Distancefrom Owner's well ._ ...................................�
Fromadjacent wells ...... ..:.................... ::.......... :.............. ........................ ::..........
Distance to nearest water course, drainage ditch, storm drain or embankment ................ ...... .......... _............................... ................
Percolation Tests: Time for 1" drop in soil test ................... -.................
Classificationof soil ................................. ............ ._.................... _....--....,....... ...... .:ix €......... a... . ,; . ..._ ..............................
Minimum square feet of effective seepage area required . ........................... ........1................................
LeachingSystem: Number of trenches .........:...... .......:....................... Length.W................,:.......::.................. Width .,...,,....,.......,.............................
Total Other ....................... ...:.:................ ............ .......m.......................... ........................................ ............
.......................
Plot Plan Attached. ..:
LayoutApproved.................................�....................
This permit expires
Signature ..-.......:.....:. :......................
:..:::.............. .
Drain La;
Installation Completed, Inspected and Approved in accordance with State Public Health Code and Local Ordinances
...................... ........ ........................... ........... ..........:..,:.....:....:..... . By ...
Pollution Problem abated Date ........... ..........................................
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