HomeMy WebLinkAbout1972-6-6 - 1104 Ellington Road - Septic Applicationaawn of it)n* l.Vinbo ar
Department of Pollution Control
SOUTH WINDSOR, CONNECTICUT
DRAIN LAYER'S PERMIT
Application for Permit to Install or Repair Individual Sewage Disposal System
Fee Paid $Rv ...... ..... .. .. .. .. .. .. 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 ... r..:....'........................................... . Address of Owner ......
2. Location of Property ............................. ...... ................................................... .... .... _ _............ .................... ---- ........... Lot No. ..............................
3. Type of Structure ................. ..... .... ....... g.......................................................... :...... :.......................................... ....:............::.......:.:.......................................................................
(Dwelling, Commercial Building, Store, etc.)
4. Number of Families or Persons to Occupy Premises .......... Q,xs N.....(A)..... s`.:M11.1....................................................................................................
5. Number of Bedrooms ................................................
6. Average Daily Flow ...................................................
Manufacturer and
7. Liquid Capacity of Septic Tank ......................................................... Material of Septic Tank .....tx,_t,ai,,,,,.-,,;,S.teel.
8. Soil Conditions: Type of Soil.......................................................................................................................................................................................
(Sand, Gravel, Clay, etc.)
Maximumground water table ................. ....... ------
....... ...............................................................................................................
9.
If not served by public water supply:
Distance from Owner's well ...................................................................
Fromadjacent wells .................... ................... :.............. ............................
...... .
10.
Distance to nearest water course, drainage ditch, storm drain or embankment .25.....t......
xora...inground....po.ol
11.
Percolation Tests: Time for 1" drop in soil test
.............................................................................................................................................
Classificationof soil .......... .......................................................................................................................................
.,.......................................
12.
Minimum square feet of effective seepage area required .................r
'..r... c. i. a........t..............................................
..................................
13.
Leaching System: Number of trenches One„(1„ bed„
Length........40...ft.- ....................
Width ........10 ft.
DepthY .............04...f t...Other........_...............................
..... .............................. ........................................................................
:....::......: �...
14.
Plot Plan Attached. ..................................................
15.
Layout Approved. .........Yes ...............................................
16.
This permit expires ........ .(a...c)f1 t xi:H..
Signature ..........�:.::'fi
rN D
z........;i..,:.:i.:.. .r:.....�. J.�:'a ..`.:zr1....
(Licensed Drain Layer)
*
Installation Completed, Inspected and Approved in accordance with State Public Health Code and Local Ordinances
............................................................................ 19..... By .............., _...M.......... ..... M..............
.. �.�__....M.................._...
Pollution Problem abated Date 07 June, 1972 Melvin Edwards , Jr.
Inspector