HomeMy WebLinkAbout1976-3-24 - 120 Farnham Road - Septic Applicationcanton of !-�uut4 18inboor
Department of Pollution Control
SOUTH WINDSOR, CONNECTICUT
DRAIN LAYER'S PERMIT
Application for Permit to Install or Repair Individual Sewage Disposal System
FeePaid $ ... By . ................................. ..... ............. ....... ............................ ..............,,..... .....,.,.............-... 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 A.N.................._..... Address of Owner .-.....:............................ .,-,..:....,.............................
2. Location of Property ... Lot No. ...........
3. Type of Structure ........................ :.............................. ................................................................. ..... .............-.-.....w....._................................ ............
_..........._..W.. w,........
(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 ........................ ............. .....m...................
�
8. Soil Conditions: Type of Soil ........ ....................
(Sand, Gravel, Clay, etc.)
Maximum ground 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 ......................................:...... Length ........................ Width ...................................................
Total Other ........_ .................. ................ ....... !.......r...............
......................... _ ..
14. Plot Plan Attached...............................................................
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
........................ .. 19..... By ...............:.....:_......„....:................ ...........;......... .................................... ..... ........
..........
Pollution Problem abated Date ............ .............................. .-........... ....... .......... ........... ...-....---.....--........... .........................................
........
Inspector
i
i
A
Q
C-'
N
W
3 A
K
do
�ae�NAy ilwoa
NOTES SOUTH WINDSOR POLLUTION CONTROL
Drawing not to scale. LOCATION 120 Farnham Road
0 OWNER VITIELLO Anthon A.
/.� 31.0 3/,o TYPE OF WORK Septic Repair
31, o — DATE ei2e,/76 PERMIT 76-02 PIPE4" A Ass.
INSTALLER P' rin 1061
INSPECTOR fr— DRAWN BY �,