HomeMy WebLinkAbout1978-7-11 - 191 Newberry Road - Septic Application and Plan@nmn nf §nmh minhanr
Department of Pollution Control
SOUTH WINDSOR,CONNECTICUT
DRAIN LAYER’S PERMIT
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Application for Permit to Installlor Repair Individual Sewage Disposal System
Pursuant to written application,permission is hereby granted to the Licensed Drain Layer named herein
for repair .........or construction )L of an individual sewage disposal system conceming which the following
information is submitted:
Installation Completed,Inspected and Approved in accordance with State Public Health Code and Local Ordinances
....................................................................................................................................19 ..................By ...............................................................................................................................................
Pollution Problem abated Date ..........................................................................................................................................................................................................................
Inspector
Owner of Property .......................................................................A..........................Address of Owner
Location of Propertly m .........kWVp5’?.é ......i ................................................................................................................Lot NO..
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.)
9.
Maximum ground water table ..............................................................................................................................................................................
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 l”drop in soil test ...............................................................................................................................................................................
Classihcation of soil ....................................................................................................................................................................................................
l2.Minimum square feet of eEective seepage area required ...................................................................................................................................................
13.Leaching System:Number of trenches ................................................Length ...................................................Width
Total ................................................Other .........................................................................................................................................................................
14.Plot Plan Attached...............................................................
l5.Layout Approved....................................................................
16.This permit expires ..................................................................................................................
Signature ...................................:tif ..........i .........................................................L................................................................
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NOTES SOUTH WINDSOR POLLUTION CONTROL
LOCATION
OWNER
TYPE OF WORK
DATE w.):gSq PERMIT PIPE K»;
INSTALLER ;<;'1:,"'y 7 -=.'
INSPECTOR L.B DRAWN BY ELL
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