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HomeMy WebLinkAboutSeptic Repair 112 Gordon Drive Town of South Windsor - Health Department Subsurface Sewage Disposal System Inspection Report PROPERTY LOCATION: Q1 Gocc)wr\ BOTTOM OF EXCAVATION: DATE: 0 ( INITIAL PERCOLATION TEST "FILL CHECK": DATE: NT INITIAL DEPTH HOLE# DEPTH HOLE# TIME READING TIME READING PERC PERC FINAL INSPECTION: SANITARIAN DATE: I'L rL- 1. SEWER LINE: * `S�`�Q1� A. SEWER LINE CEMENT ED'AT FOUNDATION(Y/N) ................PIPE LENGTH B. PITCH(.25 inches per foot min)REQUIRED FT................PROVIDED FT D. PIPE TYPE&ASTM SPEC. .................................PIPE SIZE(INCHES) 2. SEPTIC TANK: A. MANUFACTURER DATE MFD SIZE. GALLONS B. TANK COMPARTMENTS PLACED PROPERLY(Y/N)................................................ C. INLET BAFFLE(not in middle of opening). ..........OBSERVATION OPENING(slag removal) D. OUTLET BAFFLE FILTER TYPE Zoe-\\-e_t i-7p-MlS RISERS NEEDED(Y/N) SIZE E. TYPE OF PIPE (approved by code) 3 PUMP CHAMBER/GREASE TRAP: �iI} A. PUMP CHAMBER MANUFACtU t ...SIZE GALLONS B. TYPE PUMP ............PUMP ALARM CHECKED (Y/N) C. FLOAT CONTROL ELEVATION VERIFIED(Y/N). .....TYPE OF PIPE D. GREASE INTERCEPTOR TANK SIZE GALLONS........MANUFACTURER 4. D BOXES: A. LEVEL(YIN) SERIAL DISTRIBUTION(High level overflow within top 3')...... ►�► C. LEVEL SYSTEM(Ends tied together)(Y/N)_\ 5. TRENCHES: A. LENGTH OF TRENCH............ 1._J 2. 3._ 4. 5. 6. B. GALLERIES(stone around all units).1. 2. - 3. 4. 5. 6. C. CENTER-TO-CENTER SPACING FILTER FABRIC PRESENT(Y/N) TYPE D. APPROVED AGGREGATE FREE OF SILT DIRT&DEBRIS(Y/N). F. AGGREGATE MEETS PHC SPECIFICATIONS(Y/N) TYPE OF PIPE G. LEACHING SYSTEM DESCRIPTION: 5\ 45' VM01.�11s 6. SEPARATION DISTANCES CONFORNMlTH APPROVED PLAN(Y/N) SEP,AATION DISTANCES FIELD VERIFIED (Y/N) PASS---\�=FAIL COMMENTS: k- e� WELL INSPECTION: SANITARIAN DATE: WELL LOCATION Sanitary Well Cap Rev.April 2012 FINAL INSPECTION ELEVATIONS PROPERTY LOCATION: kka C-zr n TOWN: Scx4 \jj 1y'Acor- PROPERTY OWNER: INSTALLER: SANITARIAN: \mu GC'y'r' DATE: LEVEL TO BENCHMARK(ROD READING) BENCHMARK ELEVATION HEIGHT OF LEVEL My - .r-Z �- .F .,. s s-_ v . eta, SEWER LINE AT FOUNDATION SEPTIC TANK INLET > � SEPTIC TANK OUTLET LA,M PUMP/GREASE TRAP INLET N PUMP/GREASE TRAP OUTLET N D-BOX# 1 INLET 3fo FLOWLINE RIGHT N A FLOWLINE LEFT -A OUTLET D-BOX#2 INLET FLOWLINE RIGHT FLOWLINE LEFT OUTLET D-BOX#3 INLET FLOWLINE RIGHT FLOWLINE LEFT OUTLET TRENCH # 1 -To oj�- ur"'* U"�v e u"�a ss o , RIGHT U b 'r LEFT 6 CN TRENCH # 2 RIGHT LEFT TRENCH # 3 RIGHT LEFT INVERT ELEVATION=Top of Pipe+Diameter of Pipe—Height of Level HEIGHT OF LEVEL=Benchmark+Rod Reading Reference: Page 2 rgfi 8� - Town of South Windsor — Health Department 1640 Sullivan Avenue, South Windsor, CT 06074 Phone: 860-644-2511 ext. 248 Fax: 860-644-7280 SITE INVESTIGATION FOR A SUBSURFACE SEWAGE DISPOSAL SYSTEM r_-Z;Z­' 0�- Application/Permit#: Property Owner ` \,N� Location__ DEEP TEST PIT DATA/SOIL DESCRIPTIONS DATE: a, (Record all Test Pits) TEST PIT: TEST PIT: TEST PIT: TEST PIT: s�- 1 3-1-10C& wtid -ccp rye- -dc I�,tog�;1 r�ohee- Mottles: "to Mottles: Mottles: Mottles: GW: N o GW: GW: GW: Ledge: t\jl o Ledge: Ledge: Ledge: Roots: -E-o y 1 r' Roots: Roots: Roots: Restrictive: N /k Restrictive: Restrictive: Restrictive: COMMENTS: GROUNDWATER TABLE(Near max.,below max.,etc.): �� SOIL MOISTURE(High,medium,low,etc.): V_g� PERCOLATION TEST DATA DATE: Z 3 Z (Record all Pere Tests) PERC: PERC: PERC: PERC: DEPTH: ,S DEPTH: DEPTH: DEPTH: PRESOAK: PRESOAK: PRESOAK: PRESOAK: TIME READING TIME READING TIME READING TIME READING 1 S2- 10.;5 PERC 33 PERC PERC PERC RATE: RATE: RATE: RATE: COMMENTS: � a y `' + 4 SITE INVESTIGATION FOR A SUBSURFACE SEWAGE DISPOSAL SYSTEM LOCATION DRAWING INCLUDING ALL TEST PITS AND PERCOLATION HOLES w fJ`-Ac2-4' �q$ SPECIAL CONDITIONS CONCLUSIONS Design Flow>2000 GPD Suitable for Sewage Disposal Public Water Supply Watershed Unsuitable for Sewage Disposal Probable High Groundwater Additional Investigation Req'd Slope>25 percent Wet Season Monitoring Req'd Perc Rate< 1 min/inch Retest During Wet Season Pere Rate>30 min/inch Licensed Engineer Plan Req'd Ledge<5 feet below grade Other: Limited Suitable Area Open Watercourse or Wetlands Flood Plain/Seasonal Flooding Max.G.W.<36 inches below grade DESIGN RECOMMENDATIONS/COMMENTS Form completed by: - �eSM � c4,-. , `LS . Certified Local Health Agent or P.E.) Accuracy assured by(If P.E.completed form): (Certified Local Health Agent) Others present for site investigation(Engineer,developer,installer etc.): Town of South Windsor — Health Department 1540 Sullivan Avenue, South Windsor, CT 06074-2786 Phone: 860-644-2511 ext. 248 Fax: 860-644-7280 DESIGN RECOMMENDATIONS FOR REPAIR OF SEWAGE DISPOSAL SYSTEM PROPERTY ONVNER(S): Executor of estate of Ruth Lieberg STREET ADDRESS: 112 Gordon Drive, South Windsor RESIDENTIAL(#of Bedrooms): 3 SEPTIC TANK: Install 1,000 gallon two-compartment septic tank with approved outlet filter. LEACHING SYSTEM: 495 square feet of effective leaching area required. Maximum depth into existing grade is sixty(60) inches. Minimum Leaching System Spread(MLSS)need not be addressed. SPECIFIC INSTRUCTIONS: I. Permit application to be completed and permit fees to be paid in full at time of application submission. 2. Installer's construction plot plan(drawn to scale) to be submitted and approved by this office prior to issuance of permit to construct. 3. Plot plan must indicate location of proposed structure, water supply, septic system, embankments, watercourses,property lines, and existing and proposed finished grades. Benchmark to be set and indicated on plan. Note on plan that existing Septic System is to be properly abandoned. SIGNATURE: �� DATE: I,�_l 13 I I' 11/30/2012 12:00 8602822684 JIM THROWE PAGE 02/03 R8C, . VFW G U �G 1540 SULLIVAN AVENUE a SOUTH WINDSOR, CT 06074 Nq�TN FpSOR ��OsoR•co TELEPHONE(860) 644-2611 T, Septic System As- Built Plan . .. . Street Address �.�� ��.c,�� �,r. Date n..4- l 2- Permit Number New Septic-System JC 'Repair of Septic System Alteration of System • . . Number.of Bedrooms^ or Design Flow of Building Type of system installed (e.g. stone trenches,iaa£iltxatoa�s,galleries) Square footage of system:'Total length � '� � Width Effective Area Capacity ofTa j G�+rr�� New _ —Existing Length of home.sewer pipe Minimum distance between septic tank and foundation Minimum distance between leaching field and foundation 'Minimum distance between sewage system and nearest well 04 z Public water supply Kuijaa=.dxstauce between leaching system and property boundary f J Cartaia drain required? Yes No Minimum distance from leaching field to drains (curtain drain,foundation;stormwater,etc.) YL : � 11/30/2012 12:00 8602822684 JIM THROWS 'V 3/03 Fp 12 HF,q TH INpSO& Se fie System ,As-B . oEpr Address Date D. 12- Location of System <,L' , ,(N, S,E,W, front,back side of house) Draft a substantially correct drawing showing separation distances of the septic system installation.Include ail of the following infonnation to provide an accurate record of the entire system location: At least two sides of the building nearest the system,septic tank house sewer,disbn'bution bores, trench ends,dry wells,curtain drain,potable water supply wells and any other features affecting the system and its location. �a►stalle�.s Naxuc—�rfvr- ��__��� �.�_.. ��` � -�' _ Installers Address ( a► ^M-, r t, - �1 (street,city,state and.zip code) . . � Distance from corner A Wt .17 i Am". s 3 !" a q-4 Y Distance from.corner ate If Distance from corner 1) Distance from corner I Town of South Windsor — Health Department 1540 Sullivan Avenue, South Windsor, CT 06074 1#sty Phone: 860-644-2611 ext. 248 Fax: 860-644-7280 PERMIT TO DISCHARGE Approval is hereby given to 12SXo.� s , in accordance with Public (Property Owner) Health Code Section 19-13-B103e(h)to discharge to a subsurface sewage disposal system located at VD, Golrkorl\ (Street Address) in the town of W r,&or- ,CT that will receive domestic sewage from a: Residential building containing 13 _bedrooms. Single family(Y/N).� Restaurant containing seats. Commercial/Office building providing square feet. Other structure as described: Design Flow= H SO _gallons per day. Permitted Flow= L S) gallons per day. The design flow shall equal the permitted flow,except for non-compliant repairs(See Section IV D). In order to provide a sufficient factor of safety it is recommended that the average daily discharge not exceed 2/3 of the permitted flow or 30p gallons per day. Operation and Maintenance: Septic tank shall be inspected regularly and pumped as needed but not less frequently than every five years. The septic tank has an effluent filter(Y/N)_k?_. Effluent filters require periodic cleaning. Failure to clean filters can result in sewage backup into the building or effluent breakout. Restaurants serviced by external grease interceptor tank(s)require quarterly inspections and cleaning as necessary. Tank pump-outs tracked by local health department(Y/N) 0 _. If yes, stipulate pump-out requirements: Special Requirements and Restrictions: 1 In the future if there is a septic system malfunction or failure it must be addressed. Exceptions(Repairs Only): ` iW File Information: Construction Permit No. Approved as-built on file(Y/N) L Date of Final Inspection: \2�kq,Ni— Inspected By: � Permit Issuance: Issued by: QA&:P V-1 Title: \n� _Ae )J N ©'�(_Lr (Director of Health o Registered Sanitarian) Signature: Date: a 12 DEC-17-2012 11:34 From:DESIATO SAND 8604295436 To:8602822694 P.3/4 1.4jubfu man 11,1111114antic 86ND-4438 P.03 M N 'w AT ER M- sTESTING, I C* 55'LAURA SIREET-NEW HAVEN,CONNECTICUIA651 2 4(207)468-5216 '800 .3 72 42 BOSTON POST ROAD WILLIMAI NIX,CONNECTIeVT 06126 42 - 9 ... ................ 1-3Q-12- REPORT', M--17-42- CLIENT: Desiato Saild &GraVel 999 Sims,OT 06268 PROJEOT, Client's Information SuOJECT: YSI ASTM Qjaj.-G-111) _11ASIU�P-SIEVI MA- Rec Material; Sand for Septic e/V ED souf'M oeslato Sand and Gravel,Storrs,CT DEC 19 20 1Z Sampled. and delivered to MITI by client on I 1122/12 So Cw sieve Size percent Passing ASTM-C-33 Modified (9.5mm) 100 100 N4 (4.76mm) 100 95-100 #8(2-36mm) 83 80-100 #16.(1,1 Brnm) 62 50.85 #30 (600pm) 37 2"0 #60(300,um) 14 10-30 #100 (115011in) 3 2-10 9200(7$ljn7) 0.4 0.6 Ttlis msterie�cis sampled and delivered meels the listed specification. Materials Testing. Inc. Bryan Kearns �MLjCY " I HIlsm J. 9 W Im w1b rtaf mw(b DEC=17-2012 11:34 From:DESIATO SAND 8604295436 To:8602822684 P.4/4 14}U4J1z .. UMM K11111111antle M-0-4436 p104 MATERIALs TESTING, INC. LAURA IJnpfa" it,NEW HAVEN,EN,,err T4 NNEC nLrUT 06512#(203)468-5216 Jrr. n tCO r : µ - 1972 DATE, 11- Q. 2 'i EPOR7:--kL-1-Z4—i- CLIENT: Desiato Sand& Gravel 999 SIafford Road Storrs,CT 062~�i '! PROJECT: Client's Information SU&JECT: _WA$HEV §l v �►LYSIS#ASTM C-136 GAIT Material Sand for Septic ••1141'I�A r.J•r,7•' •„ •.••�• ••,` "•14, Sourow Desioto Sand and Grave% Storrs, CT Sampled: and delivered to Wrl by client on 11;20i12 sleve Size percent Passing Mantis Wastewater Leaching System Specification. Sri'(9,5rsrrt;) 100 100 #4:(4.75min) 100 05-100 #8(2r86mrn) 83 80-1.00 #16(1,1$mr11) 62 60-85 #30(600itm) 37 25-60 060(30OPM) 14 5.30 9#100(150wm) 3 0-10 ff200(75gm) 0.4 0-5 T€ils mate-dal as sampled and delivered meets the listeol spocificatiort, Materials Testhig, Inc, Bryan K"rrm William J. Juely 1 w; wlb Yn,I(Igans rho f hst Vd,'V LVed V$ftll ft gN11 1gasparIMWA1 Of Mv M'd T_ssrg.Inc Rrtwla mOv elllm ig gemf wed DEC'17-2012 11:34 From:DESIATO SAND 8604295436 To:8602822684 P.2/4 UiMpa 660-423-4438 P.02 MATEMALsTnTING, INC. -45 LAURASTRIE ET-NEW HAW.N,CONNEMCUT W512-(203)468-9-216 "4k%wW0'F' 41-BOSTON POST ROAD.!WILLIMANTIC,CONK ECTICM.06226-(860)423-1972 DATE; REPORT:_,.M-.1gAj_,_ CLIENT, Desiato Sand&Gravel 909.Stafford Road Storrs,-CT 06268 PROJECT; Client's Information $USJECT:,.-w4wE-rL$lEVE ANKMIISL M*terial: Concreto Sand Source. DeslatQ Sand and Gravel, Storrs,CT Sampled,. and delivered by client to MT!on 1112SM2 Wove Size Percent Passing A31'M C-33 *,V(9.5mm) 100 100 #4(4.7517 m) 100 95-100 #8(2,36mm) 83 80.100 916(1,1 8mm) 62 50-65 #30(60opm) 37 26-60 #50(300pm) 14 #100(1 Wpm) 3- 2.10 0200(75pm) 0.4 0.3 Fineness ModulLis 3.0 2,3-3A This rnate al as sampled and delivered meets the listed specification.. Materials Tooting, Inc. Bryan Kearns Wlb Town of South Windsor - Health Department 4' 1540 Sullivan Avenue, South Windsor, CT 06074-2786 Phone: 860-644-2511 ext. 248 Fax: 860-644-7280 APPRnvAI Tn C01SICTRI ICT nR REPAIR SF;WAGF nISpnSAI cYSTF Approval is hereby granted for the construction/repair of a subsurface sewage disposal system at the property described below: PROPERTY OWNER(S): Estate of Ruth Lieberg STREET ADDRESS: 112 Gordon Drive TOWN:South Windsor INSTALLER: James Throwe CT. LIC# 5836 EXPIRES: 05/31/2013 RESIDENTIAL: #of Bedrooms-3 INSTRUCTIONS FOR INSTALLER 1. Construction plot plan submitted and approved by this office must be adhered to. 2. This office must be contacted for approval if any change is going to be made in the system location,size or design,or any changes in house,well or property line locations. 3. Any NEW sewage disposal system must conform to ALL requirements of Section 19-13-BI03 of the CT Public Health Code. 4. ALL new construction to be under DIRECT supervision of a CT licensed installer under Section 20-341 of the CT General Statutes. 5. The installer is RESPONSIBLE for VERIFYING LOCATIONS of PROPERTYLINES, WELLS, and BURIED UTILITYLINES prior to construction. 6. Installer to notify South Windsor Health Dept.24 hours prior to the start of construction. 7. Installer to have septic tank covers removed at the time of inspection. SPECIFIC INSTRUCTIONS: 1. Install per approved plan, (James Throwe, Dated: 12/17/2012). 2. Licensed Installer to field stake house, well(if applicable), permanent benchmark, and septic system. Offset stakes to include bottom of trench or flow line elevations. Health Dept. staff to conduct stake inspection prior to construction of system. 3. Permanent benchmark to be set within 50 feet horizontally and 12 feet vertically of septic system. 4. Existing 1,000 gallon one compartment septic tank of fair condition (per inspection conducted by Installer-as noted on plan) is to remain in place for use. 5. Install 495 square feet of effective leaching area, consisting of a single row 45 feet long, of Mantis 536-8 units, bedded on the bottom and sides with sand fill meeting both the manufacturer's and select fill specifications. System to be installed per manufacturer's specifications. Systems with total cover that exceeds eighteen (18) inches as measured from the top of the units to finished grade shall be vented at the distal (far)end of the system. 6. Current Sieve analysis(within 30 days)for sand fill must be submitted to the South Windsor Health Department 7. Max depth into existing grade is not to exceed sixty(60)inches. 8. Installer to schedule, and be present for final inspection with Health Dept. staff. Level to be set up for verification of elevations OR an engineer's/surveyor's as built will be required. 9. Installer to complete and submit septic system as built plan and drawing with ties to the house. SIGNATURE: DATE ISSUED: 12/17/2012 RENEWAL: APPROVED BY: Sherry ann,BS,REHS,HHS EXPIRES: 12/17I2013 EXPIRES:4j 1 1 THIS PERMIT IS VALID FOR A PERIOD OF ONE YEAR FROM DATE OF ISSUE. IN ACCORDANCE WITH THE CT PUBLIC HEALTH CODE SECTION 19-13-BI03e(F)(1). ONE RENEWAL IS POSSIBLE PROVIDED SOUTH WINDSOR HEALTH DEPARTMENT IS NOTIFIED PRIOR TO THE EXPIRATION DATE NOTED ABOVE. IF PERMIT EXPIRES, INSTALLERS ARE CHANGED, OR ANY OTHER DEVIATION FROM THE ORIGINAL PERMIT,A NEW APPLICATION MUST BE COMPLETED AND ALL APPLICABLE FEES MUST BE PAID. FEE PAID:10.00 CASH CHECK# NIA DATE PAID:1211712012 Town of South Windsor — Health Department _ 1640 Sullivan Avenue, South Windsor, CT 06074 Phone: 860-644-2611 ext. 248 Fax: 860-644-7280 APPLICATION FOR APPROVAL TO CONSTRUCT A SUBSURFACE SEWAGE DISPOSAL SYSTEM Application/Permit#: To the Director of Health,Town of I— Du.,w, W. ,r4 c Date: /7 0c,41/Z- Application is hereby made for an approval to construct a subsurface sewage disposal system for a: r�'S� �t't�►, 1 (Residential Building,Restaurant,Retail Building,etc.) located at: 11 e1 .-n d r (Street Address,Lot Number,Subdivision Name,Map,Block,Lot,etc.) New System j Addition Repair Other Owners 1 C Address &PtR,-. Tel.No. Installer,IMC, 7trt� Address` &,5,L Jf` ✓4.rIn Tel.No."o cd Installer License No. 3 RS-C ,. 5f 3t Izc�3 In accordance with detailed information stated below: Application fee paid Signed _ l,.— -7//74,- ­1 (Owner or duly authorized representative) GENERAL NFORIVIATION Soil Tests Conducted(Date):.. W ` ,^� Lot size y(.0v(.X , sq.8. Area of Special Concern(Y/N): If yes,Reason(s): Basis of Design(#of Bedrooms,Restaurant Seats,Building Size,etc.): Engineered Plan Required(Y/N): If yes,Name of Engineer: Address of Engineer: Design Plan Approved(Y/N):�_Date of Approved Plan: 11 Revision Date: Type of Water Supply qs,�'C_ If well,has location been approved(Y/N): Well Driller's Name: Address: OFFICE USE ONLY Approval to Construct issued by: _ J�v-,C\ A Date: "f--- (Director of Health o Registered Sanitarian) Signature: Title: Q\�J Vans Sewer & Septic Service, LLC 97 versa a unve Vernon,CT 06066 Phone(860)871-7968 .................Fax(860)282-2684 SOUTy �D�Z NF,q�TN EUSOR AV" Y,�t+'t w 41it, k +,, czrn� ion Wg 1` L nT7L. �LN �--Pdcx V.w,,,'ts 536-5 yvp `i lnc.✓� lDU �/►n�t� �j r�nC4� OMwh up �G, Town of South Windsor, CT Property Listing Report GIS PIN 36300112 Account 36300112 5 hON(IY.COc Property Information Droperty Location 112 GORDON DRIVE Sewer Service Owner LIEBERG RUTH M Census Tract 4871 Co-Owner Neighborhood 350 112 GORDON DRIVE Zoning Code A20 Mailing Address SOUTH WINDSOR CT 06074 Acreage 0.46 Land Use 101 Res Dwelling Book/Page 248/205 Land Class R Lot Setting/Desc Water Service CONNECTICUT WATER 860.623.3355 Trash Day WEDNESDAY Photo Sketch Primary Construction Details Year Built 1966 Bedrooms 3 Exterior Walls Vinyl Siding Stories 1.0 Full Bathrooms 2 Interior Walls Drywall Building Style Raised Ranch Half Bathrooms 1 Heating Type Hot Water Building Use Residential Bath Style Average Heating Fuel Oil Building Condition C Kitchen Style Average AC Type Floors Carpet Roof Style Gable Gross Bldg Area 2900 Total Rooms Roof Cover Arch Shingles Total Living Area 1340 Report Created On 12/4/2012 LS,o'D�d Jlill'J J.L1' 1 ll, 1AIV K NhKV IUE. .11V 6 Nutmeg Drive - P.O.Box 29 - Ellington,Connecticut,00029 (860) 875-2332 - www.skipsseptic.com / THIS IS NOT A REAL ESTATE INSPECTION ,e _2 3 reet �o1%y ©! - House(Lot)# Ala Owner r"�� G-'�"��✓� :wn Telephone 52$-3381 _ iilding Serviced: Li Residential ❑Apartment ❑Commercial Garbage Disposal Y ze of Tank: /!JU U Gal. Depth Below Grade: Separate Graywater System Y i ser(s): �� Water treatment discharge to septic Y :lids: Q• "_Liquid Depth -5 7 "_ % Distance from tank to truck when pumping:/3v )te:State Health Department recommends e250/.accumulation Approximate vertical(uphill)pull-if any: ft ink: ❑Good Acceptable '❑Poor Outlet Filter ,� Type of Tank:❑Steel *-Concrete et piper rM,!A-r ❑Multi Compa e ❑Other: tffles: Type ���! GU Conditioner - r---------- -- ----hut--------- ;Ids appear to be: : .nk at:Normal Level / Slightly above i es A Considerably aboverU° �A/ OWater running back st pumped:: Next pump: fps / -rd mac/ 3=6�r�-;s lit :ed to call office re: ��f� ��`"` �ys� w( ; h� a 7 cation of tank: Diagram w/dimensions.and locations of covers... .. �► ; i )t responsible for change or damage due to seasonal water table variations ; change in household use. If you have any further questions,please call our { ice or your-local or state health department._ t t n • a