HomeMy WebLinkAbout1977-9-21 - 160 Chapel Road - Septic ApplicationC, Own of *VUt4 Mubsor
Department of Pollution Control
SOUTH WINDSOR, CONNECTICUT
DRAIN LAYER'S PERMIT
Application for Permit toImtallrRepair Individual Sewage Disposal System
f
Fee Paid . �.' ......... By ..1....... ..................._.._....
FiC % � � C / t � ...-..-. Permit No.. � !
Date ............... �1..�.�1.'"..,r.................-.......
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!�itt �: P d � fef�o
Co
1. Owner of Property..................................:....:.......,......,-,.....................(..�.` ... Address of Owner ...... ....... ............. .......... ...................................................
2. Location of Property .,,....?........... r! .._.� r.w........ ...... Lot No........... .........
3. Type of Structure ............ ... ., .............................., ...�'...... ..4i,.... ........._ „_...._............ ........... .............. ............
..............
(Dwelling, Commercial Building, Store, etc.)
4. Number of Families or Persons to Occupy Premises.................................................!....................... .......::.....:....::......:..:............:.:.....................,..::..... .
5. Number of Bedrooms-,...m �� ...................
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: 1
Distance from Owner's well ......................:........:........................
Fromadjacent wells ........................................... .......:... ................ .......::...:..:.-.
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. y '
15. Layout Approved. ................... -• ..........................
16. This permit ex it ............................ .......
'U ov 1� 1�tlrU ✓ -
Signature..........
all 0 kl, �� J (Licensed Drain Layer)
d -,f S& 2
tallation Completed, Inspected and Approved in accordance with State Public Health Code and Local Ordinances
7
................. ..................... �...-.,...............,......,......,.,. la 13y ....................... ....._......... ...... .... h................... ....,................ .................
Pollution Problem abated Date ........... ....... ..._..... ..... ................,.... 1........-.............................. t :.
Inspector
fr r
SOUTH W INiSOO POLLUTION CONTROL
1_ p C AT 1TL-fz�o
T Y I'C _pr' VvOPK �, J
OA C �-73.7 'PERMIT 7 ' Plat Of'161C
TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL B/P No.:
• South Windsor, Connecticut
List No.. )5� }C
DRAIN LAYER'S PERMIT No 1315
Pursuant to written applicatior, permission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at on the
side, between
at premises owned by
whose address is
and to Lay House Drain, Repair House Drain,
for
Lay Main, Other
with Family Units, with,
Type of Sewage to be connected under this permit:
SANITARY SEWAGE ( ), INDUSTRIAL WASTES ( ), OR ( )
Connection will be made with
occupancy or use,
acres.
Permit to be issued to
the holder of Drain Layer's License No. Permit will expire on 19
The undersigned Drain Layer hereby agrees to all the terms and conditions set forth on the permit and the reverse side
thereof. Applicant has received Town Permit No. and/or C H D Permit No.
for street excavation.
SPECIAL CONDITIONS .
Signed
Connection Charge Paid Licensed Drain Layer
Tax Collector
Issued by
Permit Fee: Paid $
INSPECTION: Check Number:
INITIAL (Sig)
FINAL (Sig)
APPROVED (Date)
(Sig)
INSPECTOR
TOWN OF SOUTH WI N DSOR
DEPARTMENT OF POLLUTION CONTROL B/P No.:
t South Windsor, Connecticut
List.No.: )e
DRAIN LAYER' S PERMIT N? 1315
' 19
Pursuant to written applicatior, permission is hereby granted to the Licensed Drain Layer named herein to perform
the work indicated below at on the
side, between
at premises owned by -{_ .-.
whose address is Z
and to Lay House Drain, Repair House Drain, Lay Main, Other ,
for occupancy or use,
with Family Units, with acres.
Type of Sewage to be connected under this permit:
SANITARY SEWAGE ( ), INDUSTRI W STES ( ), OR ( )
Connection will be made with
I L
Permit to be issued to
the holder of Drain Layer's License No. Permit will expire on 19
The undersigned Drain Layer hereby agrees to all the terms and conditions set forth on the permit and the reverse side
thereof. Applicant has received Town Permit No. and/or C H D Permit No.
for street excavation.
SPECIAL CONDITIONS
tillo
Signed
Connection Charge Paid Licensed Drain Layer
s
Issued by
Tax Collector
Permit Fee: Paid $
INSPECTION: Check Number:
INITIAL (Sig)
FINAL (Sig)
APPROVED (Date)
(Sig)
INSPECTOR
CONDITIONS
1. This permit is issued under the express condition that every person acting under the same shall
conform to the representations and conditions of the application therefor and shall conform to and
be governed by the ordinances and regulations pertaining to sewers of the Town of South Windsor
including amendments,thereto, and all other pertinent laws, resolutions, ordinances, rules, and
regulations of the Town of South Windsor and/or its Sewer Commission.
2. This permit may be revoked at any time.
3. This permit shall be maintained at the site of any work being done under its authority and shall
be shown upon request of any authorized person.
4. This permit does not authorize the doing of any acts in, upon or to private property without the
consent of the owner thereof. The duty of obtaining such consent and complying with the condi-
tions thereof rests soley on the drain layer and those for whom he acts.
5. This permit does not authorize any excavation in any public street, highway or grounds, or doing
any work therein or the placing of any obstruction therein. Specific permission for such shall be
obtained from the proper official having charge thereof.
6. The Town of South Windsor and its agents assume no responsibility that any representations in
the application for this permit were correct and assume no responsibility for any information
furnished or not furnished.
7. No sewer or appurtenance thereof may be cut into or connection made therewith, or any pipe laid,
except in the presence of or under the direction of an Inspector from the Sewer Department. At
least two hours notice must be given to the Superintendent of the Sewer Department before such
Inspector is needed on the work. In general, Inspectors will be available between the hours of
8:30 a.m. to 4:30 p.m. on Mondays to Fridays inclusive.
S. The Drain Layer agrees that he shall at all time indemnify and save harmless the Town and its
officers, agents and servants, on account of any and all claims, damages, losses, litigation, ex-
penses, counsel fees and compensation arising out of injuries (including death) sustained by, or
alleged to have been sustained by the servants, employees or agents of the Town, or of the Drain
Layer, any contractors employed by him or any subcontractor or material men, and from injuries
(including death) sustained by or alleged to have been sustained by the public, any or all persons
on or near the work, or by any other person or property,real or personal (including property of the
Town), caused in whole or in part by the acts or omissions of the Drain Layer, any contractor
employed by him or any subcontractor or material man or anyone directly or indirectly employed
by them or any of them while engaged in the performance of any work covered by this permit and
during any maintenance period specified in the aforementioned ordinance.
9. The Drain Layer and owner shall be responsible to see that only the type of wastes specifi-
cally permitted by this permit are allowed into the public sewer as a result of this permit.
SURVEY OF LOT NO.
PROPERTY OF
Z-USZ-QID SIL VI4 �` IL DA MI)10. 119 CQ�PI�EIRO
AND LOCATED AT
NO. CL/AF�EL .E�Di9'.D SOIJTiS� W/n/L1S0� CONN.
SCALE " = 4 O DATE:- M,4)� /9 7 7
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Jee�Qa� iE'atc Lcsr T�icr •Zof Frvnfa9e /S"4 {eef.
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Building to be constructed.
I hereby certify that this map is substantiallycor=`.,1�+'2� f s,,<<'!�>,. ,ee✓-'s >/ Ma y /B, /9 77
rect and that the zoning ordinances of the town 1977
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Building completed as shown on sketch and
of So Conn., have not been violated. ' ;` osurvey is hereby re-certified as correct and
zoning regulations not violated.
"�' ' 11C. LAND SURVEYOR ' ' •
a r'i LIC. LAND SURVEYOR
E
SURVEY OF LOT NO.
PROPERTY OF
EU s�&'70 S.IL V-4 5 ` IL D'1-) M/)Rm CO.e'ozrzl'O
AND LOCATED AT
NO. CIIAoc�E L ,E'ofI b SOUTf/ v1//NdSO�C'� CONN.
SCALE 1 = 4 O DATE:- 9 7 7
S 6S�o0-ao-OV -}-
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See a.y �'a _' L�-ss Tcr., LO,� Fi�vnfc►s7e /s'¢ {e:7t
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Building to be constructed. �/.�.r F ��+�` r_o n,�y o.�
a, I hereby certify that this map is substantially cog-t;� , <<
1977
rect and that the zoning ordinances of the tovvh, z, y_Building completed as shown on sketch and
of So.W.:,r./r Conn., have not been violated.'-, survey is hereby re-certified as correct and
Z. «gyp°` zoning regulations not violated.
.LIC. LAND SURVEYOR LIC. LAND SURVEYOR
(}1
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SURVEY OF LOT NO.
PROPERTY OF
�`U SEQIf SIL V,4 5 ` IL D-4 /YARI,4
AND LOCATED AT
NO. CIMAE-L- /e0,oq Z> SOUTi�i/ !if///�/�SOh'� CONN.
SCALE 1" = 40 DATE:- 9 7 7
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q� /^i�ati J'" q.�9/�,r• �o side �'�e'.s
Building to be constructed. �/o vs F+_. Re y:se sip fe.M 6 e.- 2 /9 77
I hereby certify that this map is substantiallyc 'c /8�, 19177
��': : Pe Z 977I 9
rest and that the zoning ordinances of the to*" .Building completed as shown on sketch and
of So.W,ix-roo-,Conn.,have not been violated. `` �`* osurvey is hereby re-certified as correct and
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zoning_ regulations no IS
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