HomeMy WebLinkAbout1973-6-23 - 1760 Ellington Road - Septic Application011iun of #114 19inboar
Department of Pollution Control
SOUTH WINDSOR, CONNECTICUT
DRAIN LAYER'S PERMIT
Application for Permit to Install orttepair Individual Sewage Disposal System
Fee Paid $ BY ..:::..........�::....--....... :.....:.._. G,l�.�C-Nra..-...2.4..4. Permit No...I..',i...................................-
Date ...Z..3......!-�y...l...? ..................
Pursuant to written application, permission is hereby granted to the Licensed Drain Layer named herein
for repair X, or construction ....... of an individual sewage disposal system concerning which the following
information is submitted:
1. Owner of Property N M. ... i,,-,-.::....... Address of Owner ...
2. Location of Property ...(76 ��r�l.G?...... ? l;i ..........„ ..„�................... _........................ ...:................. ,...,..... Lot No...............................
3. Type of Structure ........0"'.q'.1'-A04AA,+.,. 4t1�A.Lre., ...............................
(a.
Commercial Building, Store, etc.)
4. Number of Families or Persons to Occupy Premises ........................................................................................M..........................................
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.)
Maximum ground water table . ww......................... _........... .......... ..,........... ........................... ............................... ..........
...
9. If not served by public water supply:
Distance from Owner's well ....:.................. ...................
::............:.:.....
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 _„ ._................................................................................................
Classification of soil .. .................. ...................... :........
........,..,.........,.......,....................................................................
12. Minimum square feet of effective seepage area required ...:....................... ......... _........ ......._...........................................--- ............ ...........
.................
13. Leaching System: Number of trenches . ............................................... Length,..:::::....................................:.,... Width .......:..... ..............
....._...;;..:....:...
Total Other
14. Plot Plan Attached.!
15. Layout Approved. ..... ,lap. ..........._........... ........
16. This permit expires .....-. iE]u r�.�.hr...I.A"..........................................
I �
Signature........ ................. --- ..............................
(Licensed Drain Layer) 2
Installation Completed, Inspected and Approved in accordance with State Public Health Code and Local Ordinances
w.. :::.-.. ......_................................ ..... 19 .................. By
PollutionProblem abated Date ....... ..................... .........................................................................................._......................._...............
Inspector