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Home My WebLink About1976-5-24 - 1330 Main Street - Septic Application@nmn nf $111M Minham‘ Department of Pollution Control SOUTH WINDSOR,CONNE-CTICI% DRAIN LAYER’S PERMIT Application for Permit to Install pai Individual Sewage Disposal System Fee Paid $...................................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: Owner of Property ..................................................................................................Address of Owner ...............‘.................................................................................... Location of Property .......................'L .....................................................................................................................................................................Lot No............................... Type of Structure ............................................................................................................................................................................................................................................................... (Dwelling,Commercial Building,Store,etc.) Number of Families or Persons to Occupy Premises ................................................................................................................................................................ Number of Bedrooms ................................................ Average Daily Flow .................................................. Manufacturer and Liquid Capacity 0f Septic Tank .........................................................Material of Septic Tank .......................................................................................... 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 ....................................................................................... ll.Percolation Tests:Time for 1"drop in soil test ............................................................................................................................................................................... Classihcation of soil .................................................................................................................................................................................................... 12.Minimum feet of edective area ...................................................-,............................................................................................... O>UI$ Signature .................................................................................................................................................................................. (Licensed Drain Layer) Installation Completed,Inspected and Approved in accordance with State Public Health Code and Local Ordinances ...............................................143$................3Q/4tq/..................19...2Z.¢.::.....By..”((1%........,................................................................ Pollution Problem abated Date ......................................................................................................................................................................................,................................... Inspector o e l3.Leaching System:Number of trenches ................................................Length ...................................................Width ................................................... Total Other cw w QwHMM 75w cam wi Mawve/{ywé‘w l4.Plot Plan Attached............................................................... 15.Layout Approved.................................................................... 16.This permit expires .................................................................................................................. 1A.“ CONDlTiONS 1.This pennit is is3ue<i under the express com§it£on that every persfm skating umiar tkesameshaiicanfermt0#:he reprasentations anzi canditims 0f the ay§iication £heref0r andshal}conform t0 anti he gavemed E3y tha aidimmees 33x3 reguiations yertaining ts indivi€iu&isewagedisposalsy$tems of the Town 0f Smith Wimisar mchuiing mentimeats,thereto,and ail ether pertinem laws,reso’iutiens ordixxanceg,mks,anci regulatiom 0f tize Town ofSouthWimisorand/0r its Sewer Commi’ssion. 2.This permit"may Em revakeci at any time. 3’This permii:shaH be maintainmi at the si£e 0f any wark being {iene umier itsauthorityamishallbeshownuponrequestofanyauthorizedyeman: 4.This permit <i<x~ts 31m authezke the (icing of :my acts in awn Gr i0 private pm ertvw£thoutwig}the the comiitiensGarment ofthereofthe:Omarresé;tiiereafsoleiy‘un Th6 the(int?airam0f o'ht'u‘nirggEagler ami suchthaw cementfer Whamam}compEie acts.ymg 5.This permit (ioes net authorizg any excavatian in any puhHc street,highway 0r grounas smchor (icingshaii any he workahtainéc-i therein fmm or thethe weperpiacing Ogiciaio§any hwmgo‘nstmctmn charge themin.thereof.Syeci§c yermission £9; 8.The Town of Smith Windmr am§its agems assmmg no resgwnsibility that any repw-S€ntat£<ms in the amslicatian fer this permit were correct am}assmne n9 resyonsibgity faranyinformationfurnishedor110%furnisheég. 7‘At least twe hows :mn‘oe must be given t9 ‘the Suwrintenéem of the Sawer $epartmen£befarehstween suchtha hmxrsInspector 0f 8:;30us needeé3m“t0 an4:30 the pm. work (a;Mon§ay3in anew}ta’FriIn aysectars inclusgvcz.wiii iae avaiiabk 8.The Drain Layer zigrees that he sha§1 at aH times inciemnify aad save harmless the issses,Tova}andiitigaztion,its o$cersaxgma’sas'agents ceunsei anal feesservants,and campensatian{m accolmz ofwagingany an<§(mt ofafk iaj1x):ies013mm, {malading damages, (feath)sustamezi b ,or ageged to have bean sustaixaa}by th?germnts,{Empfeyeas 92'agents0§the Town,or 0f the Drain Layer,my confractors empieyed by him or any suimom haw}£ractor hear;0r materialsustainmi men,by theam} {)ublic, fm‘m fm‘uriesany 0r 3i}(inciu&ingyersons death)on or swtainednear the hywork,0r orailegedIby anyto otherwhoEe oersonor in partor byom &e arty,acts reaEor omissionor personal of the (incl1:<iingDrain Layer propert an anyof contractorthe Town),emoloyeécat1sec¥byin him or any subcontraetor or mawriai man or anyone dir’ecti or indirectiy emphyec}bythemozanyofthemwhikengagedix:{"he performance 0 any work covemé by thispermitamioutinganymamtegnceperimiseeciiieximtheaforementione<§ordirxance.