HomeMy WebLinkAbout1977-6-21 - 105 Edgewood Drive - Septic Application��
���������#vtd4 Mitboar
Department of Pollution Control
SOUTH WDND8OR, CONNEC]ICUT
DRAIN LAYERS PERMIT
Application for Permit to Install mrRepair Individual Sewage Disposal System
Fee Paid By _........ ..- Permit
/ -
��u���owd�� application, permission ����v toU� Licensed Drain Layer namedherein
for repair 17X or construction of an individual sewage disposal system concerning which the following
informatioh is submitted:
(Dwellin� 9mmorcial Building, Store, etc.)
4. Number of Fuodbeo or Persons to Occupy Praod000 ..................... ...... ................................ ............ ...... ---- ........... --'-'................
-----
I Number of Bedrooms .
8. Average Daily Flow ..... .....
Manufacturer and
?. Iignbl Capacity of Septic Tank .........--....-.-.' Material ofSeptic Tank ..........
\���&/.�m.�-.-_.^^'°�._--_-.
8. Soil Conditions: Type of Soil -------....... ------------------------.......... -------------------------.................... ....
..
(Sand, Gravel, Clay, etc,)
Muxiozonu ground water table ............... __.............................................. ..... ---... ...... ........................ _---............. &. If not served 6vpublic water supply:
Distance from Ovvoor'e well ... ..... ... ...... .... ........... ~...................... ...........
'
From u6iucout neDo -._-.............. --_-----�
Dl Distance to owuzoot vvutar course, drainage dibh, storm drain or oobuokozeot ...................
ll. Pwronludoo Tests: Time for l~drop in soil test ............... ......... ....... -.................................. ............................ ---.-.........
_----.
Cluuoi8outiuzof soil .... ............... _.......... ........................ ...................................................... ........ ....................... .......,_-
l8. Mbuinunzu ogouro {oot of effoodvo seepage area
�� oono�ed �..'.
lO. Leaching 8vxheu Number .~.�9-�x-^----'-'-
I.000t6 Width
Total- -'_...... Other ~----_'.............................. .................... .-...... ................. .......................
11 Plot P}uo Attached ........... /Vo ....... _......
1i Luvuot Approved.~` ..... -_-�..........
_�~-
16. This, permit expires
Signature A�Z� ........ U) - L 4 .., w. -- ........ ................ ............
(Licensed Drain Layer)
41�L
Installation Completed, Inspected and Approved in accordance with State Public Health Code and Local Ordinances
--...... ..... ''--...... --'-'-----......... ....... .................... --_' l9............ By__-_ _~,~___,---~---------_-
I NOTES
C-olq a
Dr
"la
I OWNER A7jlj,c Ao-P�-,e a -
I TVPIF. nlF WnR]( A61,,j
I INSPECTOR DRAWN BY I
t I I
M