HomeMy WebLinkAbout1976-5-6 - 1624 Main Street - Septic As Built@nmn nf $mtth minhanr
Department of Pollution Control
SOUTH WINDSOR,CONNECTICUT
DRAIN LAYER’S PERMIT
Application for Permit to Install or Repair 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 :(X of an individual sewage disposal system concerning which the following
information is submitted:
l.Owner of Property .....................................33..........................................................Address of Owner ...................................................................................................
Location of Property .............................................................................................................................................................................................Lot No...............................
3.Type of Structure ..............................................................................................................................................................................................................................................................
(Dwelling,Commercial Building,Store,etc.)
Number of Families or Persons to Occupy Premises we
2.
......................................................................
Number of Bedrooms ................................................
Average Daily Flow ...................................................ODOIkp
Manufacturer and
Liquid Capacity of Septic Tank .........................................................Material of Septic Tank Qa.kib".............................................................
Soil Conditions:Type of Soil .............................................................................................................................................................................................................................
(Sand,Gravel,Clay,etc.)
Maximum ground water table ...................................................................................................................................................................t ..........
If not served by public water supply:
Distance from Owner’s well ............................................................
10.11.
l2.
13.
14.
l5.
l6.
Signature ..................................................................................................................................................................................
(Licensed Drain Layer)
Installation Completed,Inspected and Approved in accordance with State Public Health Code and Local Ordinances
Pollution Problem abated Date ..........................................................................................................................................................................................................................
Inspector
.....................................................................IQ/VA)’........................19.19....3%géak‘e’gk ................................................................
From adjacent wells .........................................................................................
Distance to nearest water course,drainage ditch,storm drain or embankment
Percolation Tests:Time for 1"drop in soil test ...............................................................................................................................................................................
Classidcation of soil ....................................................................................................................................................................................................
Minimum square feet of effective seepag area required
Leaching System:Number of trenches ......i ¢.€5)...................Length z.b‘r ........................Width .‘..
Total M.$$.T .........Other .......r:
Plot Plan Attached................................................................
Layout Approved................E TS..............................................
This permit expires ..................................................................................................................
F""l
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NOTES
Drawing not to scale.
$/T DIB _
/9 52.0 3455‘
3 43.g 43»?
SOUTH WINDSOR POLLUTION CONIROL
LOCATION M 'Street Lo 1
OWNER Old Mgr:Street CompanyTYPEOFWORKSepticInstallationDATE9amPERMIT76-11 PIPE4”WC;INSTALLER Rossi (SJ.#000195)
INSPECTOR k,DRAWN BY g.