HomeMy WebLinkAbout1973-7-16 - 115 Chapel Road - Septic Application01 own of Ovut4 10inbsor
Department of Pollution Control
SOUTH WINDSOR, CONNECTICUT
DRAIN LAYER'S PERMIT
Application for Permit to Install or Repair Individual Sewage Disposal System
FeePaid $... .... By ...............-.--... ........................ Permit No. ..-..................................... ....... .............
Date ..................
Pursuant to written application, permission is hereby granted to the Licensed Drain Layer named herein
for repair . or construction ........ of an individual sewage disposal system concerning which the following
information is submitted:
1. Owner of Property Address of Owner...1.....J............. ..... .....................................................
2. Location of Property......................................................................................................................... I-- ................ Lot No. ..............................
3. Type of Structure ....................... ... .. .. ........... I .......... .... ... ... ......... ....................... ..,....,........................
..............
(Dwelling, Commercial Building, Store, etc.)
4. Number of Families or Persons to Occupy Premises . ........................:......:„......................::...............................:.............
5. Number of Bedrooms .............. ......�...... .
6. Average Daily Flow .... .. ...... .......
-- .. ...
Manufacturer and
7. Liquid Capacity of Septic Tank ............. .......................... Material of Septic Tank .... ..................
8. Soil Conditions: Type of Soil ......... .............. ........................... --- ...... :....:,....,,,.... ........................ ............. .....
(Sand, Gravel, Clay, etc.)
Maximumground water table .........................................................................................:.....M.:::.:...............,.......................,.......
9. If not served by public water supply: .�
f
Distance from Owner's well 7$............ ....................... .......
From adjacent wells .............................. .
10. Distance to nearest water course, drainage ditch, storm drain or embankment .................. ....,,..............................
11. Percolation Tests: Time for 1" drop in soil test ..................... ..3.Q.-..-........_............... ::.....,.....:,.............,..... ,,.................
....... ,..,
Classification of soil ............................... M....
12. Minimum square feet of effective seepage area required,-J�! .' + �:..........I............ ,m. .1 %..................
13. Leaching System: Number of trenches .............. ......... :...... ::...... ......- Length ..................... ...,................ ...... . Width .-......_...... ................... ............
Total............. Other ...-- .................. ............. ............ .................
14. Plot Plan Attached. .-..
15. Layout Approved . ....................
16. This permit expires ................................:.................................................
Signature....... ............................................................
(Licensed Drain Layer)
Installation Completed, Inspected and Approved in accordance with State Public Health Code and Local Ordinances
................................. .................. ......,..................... ..,....- 19.. ..--.... By ............... ....... . .
PollutionProblem abated Date........................................................................................................... .................... ............ ........... ......... ..-. .............. .................
Inspector
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