HomeMy WebLinkAboutSeptic Repair 535 Main Street AWN° � Town of South Windsor — Health Department
1540 Sullivan Avenue, South Windsor, CT 06074
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Phone: 860-644-2511 ext. 250 Fax: 860-644-7280
APPLICATION FOR APPROVAL TO CONSTRUCT A SUBSURFACE SEWAGE DISPOSAL SYSTEM
Application/Permit#:
✓��7� �I cSy1 r �r
To the Director of Health,Town of:�ci. � Date:
Application is hereby rnal de for an approval io construct a subsurface sewage disposal sysiem for a:
r.� Jtz
(Residential Building,Restaurant,Retail Building,etc.)
located at: 3� MCX I r� ST'
(Street Address,Lot Number,Subdivision Name,Map,Block,Lot,etc.)
New System Addition Repair Other
Owner Address_ri n o-YE1 Tel.No.
InstalletVC'nL y i f'Cd �h1JIL1ddress w c� r j A' Tel.N'o..Wo i7/ �X
Installer License No. ✓(�
In accordance with detailed information stated below:
Application fee paid Signed
(Owner or duly authorized representative)
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GENERAL INFORMATION
n/ �]
Soil Tests Conducted(Date): J"�/ ` Lot size sq.ft.
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:_ Revision Date:
Type of Water Supply W'Z)L If well,has location been approved(Y/N):
Well Driller's Name: Address:
OFFICE USE ONLY L }
Approval to Construct issued by: keg v�C/ A. , (LC„�3J Date:
(Director of Health or Registered Sanitarian)
Signature: A�" a 61 T J Title: G Au, 0KJ,4 Lj✓
Town of South Windsor - Health Department
1540 Sullivan Avenue, South Windsor, CT 06074-2786
Phone: 860-644-2511 ext. 248 Fax: 860-644-7280
APPROVAL TO CONSTRUCT OR REPAIR SEWAGE DISPOSAL SYSTEM
Approval is hereby granted for the construction/repair of a subsurface sewage disposal system
at the property described below:
PROPERTY OWNER(S): Merril&Sara Bowman STREET ADDRESS: 535 Main Street
LICENSED INSTALLER: Jim Throwe CT.LIC#3856 EXPIRES: 05/31/2017
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 PROPERTY LINES, WELLS,
and BURIED UTILITY LINES 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:
SEPTIC TANK AND SEINER LINE REPLACEMENT ONLY
1. Install per approved plan, (James Throwe, Dated: 7/6/16).
2. Install a 1,000 gallon two-compartment septic tank, with an approved outlet filter. Risers are to be installed if there
is to be more than 12"cover over septic tank cleanouts.
3. Replace existing sewer line with schedule 40 piping. Sewer line pitch to be at least 1/4 inch per foot.
4. 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.
5. Installer to complete and submit septic system as built plan and drawing with ties to the house.
6. Existing septic tank to be properly abandoned.
SIGNATURE:`ll- 0aar- DATE ISSUED: 7/7/16 RENEWAL: 1 1
APPROVED BY: Heather Oatis, REHS/RS EXPIRES: 7/7/17 EXPIRES:_I /
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 WINDOR 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:7/6/16
2f Town of South Windsor — Health Department
R 1540 Sullivan Avenue South Windsor CT 06074
Phone: 860-644-2611 ext. 248 Fax: 860-644-7280
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Subsurface Sewage Disposal System Final Inspection Report
Property Owner: Appl/Permit#
Property Address: n Town: 2, C (1
Licensed Installer: .� �>�/� License#:
Approved Plan Informations
Check one: New System ❑ Repair/Replacement Systems d�
Residential Building: bedrooms Large Tub: YES NO Garbage Disposal: YES N
Non residential Building/Residential Institution: GPD
PIan Prepared by: Title:
Plan Approved by: \ A D(LS Date: Gl l` L
4�- _..
Approval to Construct
Date Permit Issued: IONIP Permit Issued by: LggL� olo_
Registered Sanitarian or erector o Health
Inspection Information
Licensed Installer
Type Date Present? Yes/No Comments
Field Stake Inspection(house,
well,property lines,system etc.)
Strip/Scarification
Sieve required(Yes/No)
Select Fill Placement
Other:
Final Inspection
Was 24 Hour(min)Installer Notice Given(Y/N) : Date Final Inspection Requested: l�
11 ,, Date of As-Built
Final Inspection Completed by: �YCP mg �.� S Ap roval: t �,
Permit to Discharge Issued b : I S Ry S Date: 1 ( 3
egistered Sanitarian or Director of Health)
Subsurface Sewage Disposal System Final Inspection Report
House SewerInformation
Pipe Type and ASTM Specification: (� _. L _ _ Pipe Size: in.
Pipe Invert Elevations at: JAW C �_O` �� �' Pipe Length: ft.
Foundation Wall: �j , Pitch Required:
Septic Tank: l� Pitch Provided:
Tank Information
Septic Tank Size: (oo b Gallons Tank Inlet Elevation:
Tank Manufacturer: CAL j�A �A Tank Outlet Elevation: � � o
Date Manufactured: (j^l (b �� __ Riser Needed(YIN):
Outlet Filter Type/Manufacturer: X 1i� T
Pump Chamber k)U I
Size: Gallons Pump Alarm Checked(Y/N):
Pump Chamber
Manufacturer: Float Control Elevation Verified
Grease Interceptor Grease Interceptor Tank
Tank Size: Gallons Manufacturer:
Leaching System Information
Approved Aggregate: Free of silt dirt and\ebfiis(Y/N): Sieve Required(Y/N):Filter Fabric Present(Y/N): Typ Aggregate Meets PHC Specifications(Y/N):
Select Fill(Y/N): Meets PHC Speci tions(Y/N): Sieve Information on File(Y/N):
Leaching System Description(prod et,size,length,number of rows,level or serial etc.):
Effective Leaching Area Required: sq.ft. Reserve Area Provided(NIA,Y/N):
Effective Leaching Area Provided: sq.ft. Center to Center Spacing: ft,
System Installed Per Approved Plan Elevations(Y/N): Elevations Field Verified(YIN):
Elevation notes:
Separation Distances
Separation Distances Conform with Approved Plan(Y/N):
Separation Distances Field Verified(Y/N):_ _
0
- Town of South Windsor — Health Department
1540 Sullivan Avenue, South Windsor,CT 06074
Phone: 860-644-2511 ext. 250 Fax: 860-644-7280
SEPTIC SYSTEM AS-BUILT PLAN
Date ��� I Permit Number
Street Address
New Septic System A Repair of Septic System Alteration of System
Number of Bedrooms �3 __ OR Design Flow of Building
Type of System
Installed_
(e.g, stone trenches,i trators,galleries etc.)
Square Footage of System: Total Length Width .
Effective Leaching
Area
Capacity of Tank �''t'��1� _ Tank: Newer_ Existing
Length of Mouse Sewer Pipe
Minimum Distance Between Septic Tank &Foundation i Q
Minimum Distance Between Leaching Field &.Foundation
Minimum Distance Between Sewage System&Nearest Well
Public Water Supply
Minimum Distance Between Leaching System and Property Boundary
7
Curtain Drain Required? f�
Minimum Distance From Leaching System to drains
(curtain,foundation,storm water,etc.)
***DRAFT DRAWING ON REVERSE SIDE OF FORM
. SEPTIC SYSTEM AS-BUILT PLAN (Continued)
Address �,�5 rfi q i r Date f O��C,�I r
Location of System Crk _,..,. side of house
(N.S.E.W.,Front,Back)
Draft a substantially correct drawing showing separation distances of septic system insallation.
Include all of the following information to provide an accurate record of the entire system
location:
At least two sides of the building nearest the system,septic tank,house sewer,
distribution boxes,trench ends,dry wells,curtain drain,potable water supply wells,and any
other features affecting the system and its location.
Installer's Name ra License# A a
Installer's Address J11% V V-1
(street,city,state,zip code)
Installer's Email
1 �
i
1 '
0
t`
Point #1. #2 #3 #4 #5 #6 #7 #8
Distance from corner"A"
Distance from corner°B"
Distance from corner"C" +l
Avf
Distance fkom corner"D" /
Ire Town of South Windsor — Health Department
_Qy IP r'rl f'rY
'O 1540 Sullivan Avenue, South Windsor, CT 06074
52• �`` Phone: 860-644-2511 ext. 250 Fax: 860-644-7280
'�'OgOR.COi+
PERMIT TO DISCHARGE
Approval is hereby given to y--�� l & Spa.. t 0w in accordance with Public
(Property Owner)
Health Code Section 19-13-B103e(h)to discharge to a subsurface sewage disposal system located at
f rna: r s *.
(Street Address)
in the town of S. by )L �o U , CT that will receive domestic sewage from a:
Residential building containing bedrooms. Single family(Y/N):
Restaurant containing seats.
Commercial/Office building providing square feet.
Other structure as described:
Design Flow= L� fb gallons per day. Permitted Flow= L\S__k3 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 3 0 b 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) "i . 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) Al 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):
File Information: Construction Permit No. Approved as-built on file(Y/N)
Date of Final Inspection: Inspected By: O t)\�J
Permit Issuance: Issued by: �-L� S Title: L Y1 V• l�' U 1�ri�-@►�
(Direc r of Health or Registered Sanitarian)
Signature: C kkS Date: 1 3 I l