HomeMy WebLinkAbout1977-4-12 - 205 Farnham Road - Septic Application0ntutt of #11* 10inboor
Department of Pollution Control
SOUTH WINDSOR, CONNECTICUT
DRAIN LAYER'S PERMIT
Application for Permit to Install or Repair Individual Sewage Disposal System
Fee Paid $....h�.,.. qC::.-..... By ..L. r11,...,..._. ............................... .. .......... Permit No. ,.7.1.......E /FN .........
Date ................ ,1.z .............. ...........
... ...
Pursuant o 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 PropertyQU/Qr........k. �... Address of Owner .b �1......�t!lJ...f17./�C.......,....
/.??..�.... .
2. Location o£ Property ...:...::...:. ...............................,....._........... Lot No......
3. Type of Structure ........ ,5 .......... _...................... ........ ���i ,........................................................ ............................-.....��.......................
(Dwelling, Co erciyl Building, Store, etc.)
4. Number of Families or P ans 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 .................. _.............,..... ...............
................ .
Fromadjacent 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 ........ _....M................
13. Leaching System: Number of trenches Length 2T.
...,. .�..................... ,...... ., .. .-....... Width- ......... �..
Total ...
....�•. .,+.... Other.,.......,.._........_............................................................................ ............................. ....
14. Plot Plan Attached . ..............Q........ -` .,, : ....-�t� 4
15. Layout Approved.
16. This, permit expires ......................................................................................
Signature .. cl' ....... ..- ...............................
(Licensed Drain Layer)
Installation Completed, Inspected and Approved in accordance with State Public Health Code and Local Ordinances
_......, ... �............ .... ... ..�.. l- ................ ..-'........_..... 1977— By
Pollution Problem abated Date....................:........................_.........................:,.:.
............. --- .... ......
Mi m of #v* Mitboor
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.. ............... . Address of Owner .. ........... >.......... .........:..,.,..... .......,............ .............
2. Location of Property ...................
:.....:r,........... .............. ... ........ ..... ................................. ............................................. Lot No. .................
,,..w,.....
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 .-.-...........,......... m................ ................. .........................
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 ......................................................... ............... ........... ....... ,....,..................... ............. ...................... ....... :...........
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 . ........................-.................. ...................
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
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NOTES
SOUTH WINDSOR
POLLUTION CONTROL
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INSPECTOR 14:E?� DRAWN BY
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