HomeMy WebLinkAbout1971-7-9 - 2249 Ellington Road - Septic Application01oton of OoW4 Vinbsor
Department of Pollution Control
SOUTH WINDSOR, CONNECTICUT
DRAIN LAYER'S PERMIT
Application for Permit to Install or Repair Individual Sewage Disposal System
FeePaid $ . By ,...: V.................:............................................... ..... .... CI.'/.OTM S -..... 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 .....:....... . ..................... ................... ................... Address of Owner ..................-.....................-.......... .... ..............
......
2. Location of Property...... .......................... ................................... ............................. ...................................... Lot No, .....................,......,.
3. Type of Structure.................................................... ............................................ �............_......,.._....
(Dwelling, Commercial Building, Store, etc.)
4. Number of Families or Persons to Occupy Premises .............:.,.:..--..:,...-.:,.............................................. ...........................
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.)
Maximumground water table ... ....... .-:............. ....................................................................................................................,...
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 _
Classificationof soil ................. ....................-.......................... ---- ....... .-...........--...-................................................ ................. .......................
.........
12. Minimum square feet of effective seepage area required...................................................................................................................................................
13. Leaching System: Number of trenches-.-..-.-.-0t4JF....!0..1............ Length .......1.T..- ................. Width ..............
Total .............. g*�. FT Other ..... .......:...::......................._...........
14. Plot Plan Attached. . 144...................................
15. Layout Approved. ... .- „. -..
16. This permit expires ... ............. ........ ..... ......... . .....
Signature.......................................................... .
(Licensed Drain Layer)
Installation Completed, Inspected and Approved in accordance with State Public Health Code and Local Ordinances
........... m................................................................ 19.... By ......... .... ............... ......._............... .......,......--,-,................. .................... ............... ............
PollutionProblem abated Date .-................... ....................... ..................... ..........................._................................ ........ .......
Inspector
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NOTES SOUTH WINDSOR POLLUTION CONTROL
NIT to scQc.E. LOCATION f .r oA
OWNER Gj &&g/3 RQ
TYPE OF WORK SwoAl R
DATE -xa PERMIT -34,PIPE4"
INSTALLER -r&a - ss9 s
INSPECTOR 14w L DRAWN BY M C