HomeMy WebLinkAbout1972-10-30 - 1384 Ellington Road - Septic Application0ntun of Ovut4 18inboor
Department of Pollution Control
SOUTH WINDSOR, CONNECTICUT
DRAIN LAYER'S PERMIT
Application for Permit to Install or Repair Individual Sewage Disposal System
M-7&
Fee Paid B Permit No. . .....................................
Date ...........
Q..............��..70�
Pursuant to written application, permission is hereby granted to
for repair or construction ... of an individual sewage disposal
information is submitted:
Address of Owner...Z...1..4.............................................
.................... :.................................................. .. Lot No. ..............................
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
Owner of Property .
Locationof Property ....... ..... .......... '......................................... .............
Typeof Structure ........................................ ..... ......................
the Licensed Drain Layer named herein
system concerning which the following
(Dwelling, Commercial Building, Store, etc.)
Number of Families or Persons to Occupy Premises ......................._....... ............ ...........,..,..-........-...............................
Number of Bedrooms.......................3................
Average Daily Flow ..................
Manufacturer and
Liquid Capacity of Septic Tank-1...06 -ell ...... ...... Material of Septic Tank'.
.. ...................... -....... .- ......... ...............
SoilConditions: Type of Soil .... ... ...... .... .. .. .. .--.... ....... .......-1... ........,,_ ..........................................................
(Sand, Gravel, Clay, etc.)
Maximumground water table .-,--........ .................... _...'-......... ........ ._...... ..... _.............. ...............-..................................-......................
If not served by public water supply:
Distance from Owner's well ................... ............. ......--.............
Fromadjacent wells....................................................................,..-....-..........--..
Distance to nearest water course, drainage ditch, storm drain or embankment-1-6
Percolation Tests: Time for 1" drop in soil test ..................................................... ....._..._............._................ ......... ...........:............................. .......
.........,
Classification of soil .. ..............
Minimum square feet of effective seepage area required ............ .... ..................... ...............:.......:.................. .....................
......._....,
Leaching System: Number of trenches ............................ Lang ........... .......................... ....-....... Width ..................................................
Total ................................................ Other ............ ....................................... .............. ...........,.,....,.,....:..._,........
... .
Plot Plan Attached. . ........... .... --- ............ _........................
Layout Approved . ................................. .................
Thispermit expires ... .......... :.............:...:............................. :.".."...............................................
Signature
(Licensed Drain Layer)
Installation Completed, Inspected and Approved in accordance with State Public Health Code and Local Ordinances
ZIGA h 54 D
:�.
..... ,,.....w ............................. _....._....... w..._ ...w .._ ... 19,..- By .......................
Pollution Problem abated Date �' `
�"-
......................................................................................................,........ M......... ... Inspector
A
I
11
-Job-#r
j/ 6