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HomeMy WebLinkAboutMisc Correspondence 606 King Street South Windsor Health Department B 100a application (for building conversion, change of use, building addition, accessory structure and lot line change) Address of proposed activity street number Owner Name Address telephone Applicant name &address if different from above telephone Describe the proposed structure or activity with dimensions (e.g. "addition with bedrooms, bathroom, family in ground/below ground pool, deck, winterizing porch) Residential V Number of existing bedrooms 3 Non-residential Please describe Property served br on-site well? Y N Prop E!rty served b ublic water? N Plot plan-attach a scaled drawing showing property lines and dimensions, location and size of existing and proposed structures, and site features such as driveways, wells and septic systems, drains and water courses. Building plan-attach a sketch/floor plan of the proposed structure, addition or renovation showing exist. and proposed rooms with door and window locations. Soil test data (deep test pits and percolation test) are required for the review of this application. If the data is not available, you will need to schedule an a ointment with the health department. As property owner or duly authorized representative of the property owner of the above referenced property, I agree to permit the health department staff to enter the above referenced property as part of this B100a application review process. I further agree that this authorization to enter the subject property may extend through a period of time ending with the final B 100a application approval and affirm such with My si nature below. Applicant Signature Date 7- 0 ICAIL USE ONLY _/7 PROPERTY OF' -DOUGLAS J. & MARILYN R. KING . . .506 KIN(, STREET SbUT 7IIu''?SOR . i COrNsECTICtlT �r SCALE:. l�? » 3.0 I Augus 31,' ?. . . .. ; J �o..,: .:,Y o• Q MO GE SURVEY FOR RTGA N 4 : W ford Federal Sa ii & Loan i NOTE: Buildings over buildin. line. 1 57v..� No. ExcGp 7— Douglas J•.& Marilyn R. Kiro fh i ittSr £2c�iS, Svii-:iR ..5:>'.s s'f�/�...,! Ca�:C i�Licins and that_-Oning vv, CLOSES �iti •R MILLER ..r r�....„ SKIPS SEPTIC TANK SERVICE, INC. PO Box 29 Ellington, CT 06029 CONNECTICUT RECOMMENDED MINIMUM EXISTING SEPTIC SYSTEM INSPECTION REPORT 1 PROPERTY INFORMATION: Address: 606 King St Town: South Windsor Inspection Date: 4/8/2008 Type of Dwelling or Use: Residential 2 CLIENT INFORMATION: Name: Gary DeGiacomo Phone#: 836-6650 Mailing Address: 10 Eleanor St Town: Vernon State: CT Agent Name: Zip: 06066 Fax Report To: 3 INSPECTOR INFORMATION: Name: Drew Gilbert Company: Skips Septic Service, Inc. Phone#: 860-875-2332 -Mailing Address: PO Box 29 Town: Ellington State: CT Zip: 06029 4 IMPORTANT NOTICE „ THIS INSPECTION REPORT INDICATES THE PRESENT CONDITION OF THE SYSTEM BASED ON RECOMMENDEb`iNSPECTIOt' PROCEDURES OUTLINED IN THIS REPORT. THE RESULTS OF THIS INSPECTION DOES-NOT GUARANTEE OR WARRANTY FUTURE PERFORMANCE. THE INSPECTION REPORT EXCLUDES AND DOES NOT INTEND TO COVER COMPONENTS THAT ARE INACCESSIBLE (BY REASONABLE HAND DIGGING) OR ARE OTHERWISE NOT OBSERVABLE. UPON COMPLETION OF INSPECTION, THIS REPORT BECOMES THE PROPERTY OF SKIPS SEPTIC TANK SERVICE, INC. 6 .RESULTS AND RECOMMENDATIONS INSPECTION REVEALED (INDICATE ONE OR MORE OF THE FOLLOWING) . O System functioned properly at time of inspection. ❑ System functioning but is not necessarily sized per today's standards, no upgrade required ❑ Plumbing lacks or wastewater routing problems in home. ❑ Need for component replacement and/or modification. ❑ System is currently malfunctioning ❑ Evidenee'ofpnorhigf liquid levels-in-system-components. ❑ System operating at capacity under current usage levels. '"❑ Sewage-overflow observed,-repair:required under permit of local health department. Soil testing recommended to determine expansion/repair area. COMMENTS AND RECOMMENDATIONS FOR ABOVE CHECKED ITEMS ON NEXT PAGE INSPECTION REPORT Page 2 Comments: The 4"sch 40 pvc sewer line from the house to the tank is clear and flowing properly. The 1000 gallon concrete septic tank appears structurally sound with functional baffles. The leach field consists of two precast drywells. The septic system is not original to the home. Exact age is unknown. The house has been vacant for 6 years. Staining indicates that all previous use has been absorbed properly. Recommendations: Read all of the literature provided in'the green folder. Conserve water and space out laundry. Pump out every 2 years. Call Skips to schedule. NOTE: The recipient of this report should discuss any deficiencies found by this inspection with the Inspector. INSPECTION PROCEDURES RECORDS AND DATA: (OBTAIN AS MUCH AS PRACTICAL PRIOR TO THE ACTUAL INSPECTION) NOTE: This information may be obtained through numerous sources, some of which is provided voluntarily, such as, through the property owner. The inspector assumes no responsibility for the accuracy of information provided in this manner. Attach copies of all available records and indicate the source of such records. 6 'RECORDS (INDICATE NUMBER OF EACH) Permit Applications: New System: 0 Date: Source: unknown Repair/Alter: 0 Date: Source: Permits to Construct: New System: 0 Date: Source: unknown Repair/Alter: 0 Date: Source: Permits to Discharge: New System: 0 Date: Source: unknown Repair/Alter:_ 0 Date: Source: NOTE: Lack of records or data on.file does not necessarily indicate that the existing subsurface sewage disposal system is_non-compliant with installation standards. MAINTENANCE RECORDS Last Two Septage Pumpout Dates: & Source: unknown Copies of Pumpout Reports Available: N Source: LOCATION DRAWING-(AS-BUILT) Is a Location Drawing Available?: N Source: none 606 King St INSPECTION REPORT Page 3 7 GENERAL INFORMATION Age of System: Tank: 15+/- Years Leaching Fields: 15+/-Years Number of People Occupying Dwelling: Currently 0 Anticipated 0 *If currently unoccupied how long has it been vacant?6 years Number of Bedrooms? 3 Water Supply to Building? ❑ Well V Public Water Supply 8 WASTEWATER ROUTING One Tank/One System: Yes Two or More Tanks/One System: No Separate Gray and Black Water Systems N Does more than one sewer line leave foundation? N (indicating possible two separate systems?) Is there an in-home ejector pump? N Water treatment system utilized? N If yes, does backwash discharge to septic system N If yes, recommend alternative Does kitchen sink have garbage disposal? N If yes, recommend cleaning the tank more often ---- Does basement have a sump pump? N If yes where it is discharged? Does the washing machine discharge to septic tank Y If no, dye test may be necessary If discharge to a separate drywell or separate leaching system,_is it functional? N If no,corrective action would be required Is there any indication that sewage bypasses the septic system? N If yes, dye test may be necessary NOTE: IF DYE TEST 1S NECESSARY, PERFORM IT PRIOR TO PUMPING TANK 9 SEPTIC TANK EVALUATION Type of Septic Tank: ❑ Single Compartment ❑ Multiple Tanks 0 Two Compartment ❑ Cesspool Depth of Tank below Grade 12" Riser: none Depth to Riser: 0 Tank Construction: Ev] Concrete ❑ Plastic ❑ Fiberglass ❑ Metal ❑ Other Volume of Tank: 1000 Gallons Is system served by a pump and pump chamber? ❑ Tank Components: Present Type Components Condition Is it functional? El General Tank Y O concrete acceptable Is there an alarm? ❑ Inlet Baffle Y ❑O pvc tee good Is there surface access? ❑ Outlet Baffle Y 0 pvc tee good If yes give details: Effluent Filter N ❑ Compartment Wall Y concrete acceptable Inlet Pipe Y 4"sch.40 clear Has there been any indication of previous higher than normal levels of septage in the tank N Depth to liquid from inside top of tank: 12 inches 606 King St INSPECTION REPORT Page 4 Was the tank pumped at the time of the inspection? N If pumped, did effluent flow back from the fields during pump out? N What was the amount of solid build up in tank: no pump 10 LEACHING SYSTEM EVALUATION Type of System: ❑ Trenches ❑ Galleries ❑ Pits ❑ Bed ❑� Other two precast drywells LEACHING AREA REQUIRED PER PRESENT STANDARDS (if perc. Test info. Is avail.) S.F. EFFECTIVE LEACHING AREA PROVIDED (if as-built drawing is available) S.F. Distance between septic tank/leaching fields and potable water wells: public FEET Are there any structures or impermeable surfaces located over or near the leaching area N Describe: -- Were one or more of the following signs of system malfunction present? N ❑ SEPTIC ODORS ❑ PONDING OR SEWAGE BREAKOUTS ❑ LUSH GREEN GRASS OVER PARTS OF SYSTEM ❑ ILLEGAL DISCHARGE Does surface water, roof drains, or sump pump runoff drain onto leaching area? N Were distribution boxes exposed? What was found: sm.4 hole concrete, 2 pipes exit Depth to distribution box(es): 36 inches Was leaching system probed? ❑ What were the results: unable to probed due to depth . Were there any leaching galleries or pits opened to observe present or past effluent levels? N What was found? Was a more in-depth investigation of leaching system conducted? Y What were the results: camera used to inspect and locate drywell, little to no ponding at this time Is there an expansion area available: Likely Were there any conditions observed which might limit a repair? (wetlands, ledge outcrops, streams, etc.) test holes would determine 606 King St } = 27 Muddy Brook Road r Nvo PO Bo`x.C77 y Elim ton �T 06029 (860)87&'2332_ ol septic tank pu►npirig repairs, installation •.excavation =sewer&drain line:instrxllation/cle ing _ NAME007 DAT JOB LOCATIQ PHONE BILI:ING=dDDRES3 V. LASH CHECK # HAR�a� ✓(�T ..; ASS ...IPTt� F:_IJ�Ff/l1�fA1i1{l AIuIOU,N ..,,_ PUniping _. �Dig�lhg/Loc�titag - \ vl�nual make 1 - . Ba'Ble's. Dram Cleaning Je ..g- ervice Call. of►> - Real Eslaw Inspection - Fiepair Test Hales TAX TOTAL SIGNE BALANCE DUE _ PLEASE P% FROM THIS IN-V©t E - A 111/2 °/;'service charge will be�ad&W if lio#paid Pn 10 days: - Ref.No:Q 012411403 INSPECTION REPORT Page 6 DIAGRAM OF TANK AND LEACHING SYSTEM LOCATION (ties from permanent structures): d v 1-AN t' t2 o 14 9!:( �. d��2(�tta�v Drew Gilbert \a1A Inspector's Name.(printed or typed) Preparers Signa e Profession: Inspector LIC No.: 0 This form is a result of a Connecticut Environmental Health Association Committee consisting of members of the State Dept. of Public Health., Local Sanitarians, Licensed Installers, CT Sewage Disposal Association, CT Association of Realtors, and the Home Inspection Industry. 606 King St