HomeMy WebLinkAbout2019-9-9 - 242 Dart Hill Road - Septic ApplicationK prr�
n�,`s• Town of South Windsor — Health Department
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4 = + 4 - n 1540 Sullivan Ave., South Windsor, CT 06074 — Mailing Address
1530 Sullivan Ave., South Windsor, CT 06074 — Office Address
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Phone Number: (860) 337-6173, Fax Number: (860) 644-1930
APPLICATION FOR APPROVAL TO CONSTRUCT A SUBSURFACE SEWAGE DISPOSAL SYSTEM
Application/Permit #:
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To the Director of Health, Town of: 6KrW- W1"dFS0*-- Date: �] [
Application is hereby made for an approval to construct aLLsubsurface sewage disposal system for a:
ko l4 &Nr) A--s. 9K I L�Q /aLL
(Residential Building, Restaurant, Retail Building, etc.)
located at: 2`'(� � 'i' !'r , �� �10 J I-A-rw
(Street Address, Lot Number, Subdivision Name, Map, Block, Lot, etc.)
New System _ Addition Repair Other
Owner-4ft6,4L�4%46s� Address A,�Tel.No. ;u
_
Installer _Address (L Tel.No. % U SA LSD
Installer License No. 06Q3 a g
In accordance with detailed'nrormation stated below: -0
Application fee paid r104 Signed
Owner or duly authorized representative)
------------ — -- — --- - ---------------------- - -- - ------- - 0 -------------------------
GENERAL INFORMATION
Soil Tests Conducted (Date):
Area of Special Concern (Y/N): If yes, Reason(s):
Lot size
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):
Type of Water Supply
Well Driller's Name:
Date of Approved Plan
Revision Date:
If well, has location been approved (Y/N):
Address:
OFFICE USE ONLY
Approval to Construct issued by: _ Date:
(Director of Health or Registered Sanitarian)
Signature:
FEE PAID: CHECK #
DATE PAID:
Title:
sq.ft.
Rev.7/16/18
Town of South Windsor -- Health Department
a 1530 Sullivan Avenue, South Windsor, CT 06074
Phone Number: (860) 337-6173, Fax Number: (860) 644-1930
SITE INVESTIGATION FOR A SUBSURFACE SEWAGE DISPOSAL SYSTEM
Application/Permit #:
Property Owner: David Givens & Barbara Furnish Location: 242 Dart Hill Rd.
DEEP TEST PIT DATA/SOIL DESCRIPTIONS
DATE8/9/19 (Record all Test Pits)
TEST PIT: 1
TEST PIT: 2
TEST PIT:
TEST PIT:
0-8" Top soil
0-12" Top soil
9-24" Roots/Brown Sand
13-34" Light brown sand
25-29" Light brown sand
TO bottom — Brown sand
TO bottom — Light red sand
with pebbles
with pebbles
72" Deep
72" Dee
Mottles: N/A
Mottles: N/A
Mottles:
Mottles:
GW: N/A
GW: N/A
GW:
GW:
Ledge: N/A
Ledge: N/A
Ledge:
Ledge:
Roots: 24"
Roots: 44"
Roots:
Roots:
Restrictive: N/A
Restrictive: N/A
Restrictive:
Restrictive:
COMMENTS: Area between trenches seems suitable
GROUNDWATER TABLE (Near max., below max., etc.):.
SOIL MOISTURE (High, medium, low, etc.):
PERCOLATION TEST DATA
DATE:8/9/19 (Record all Perc Tests)
PERC:1
PERC:
PERC:
PERC:
DEPTH: 36 INCHES
DEPTH:
DEPTH:
DEPTH:
PRESOAK:9:20am
PRESOAK:
PRESOAK:
PRESOAK:
TIME
READING
TIME
READING
TIME
READING
TIME
READING
9:45am
24"
9:46am
26"
9:48am
27.5"
9:49am
29"
9"50am
29.5"
9:52am
30.5"
9:53am
30.5"
9:54am
31"
9:56am
32"
PERC
PERC
PERC
PERC
RATE 10 min/unch
RATE:
RATE:
RATE:
COMMENTS:
SITE INVESTIGATION FOR A SUBSURFACE SEWAGE DISPOSAL SYSTEM
LOCATION DRAWING INCLUDING ALL TEST PITS AND PERCOLATION HOLES
wul
SPECIAL CONDITIONS
CONCLUSIONS
Design Flow > 2000 GPD
Suitable for Sewage Disposal
X
Public Water Supply Watershed
Unsuitable for Sewage Disposal
Probable High Groundwater
Additional Investigation Req'd
Slope > 25 percent
Wet Season Monitoring Req'd
Pere Rate < I 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
Well exception will be required test pit 60' from well head
Form completed by: —Heather Oatis
(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.):
Melissa Pierce SW H jeff Poihenius Ski 's Wastewater Services homeowners
Health Department
Town of South Windsor —
1530 Sullivan Avenue, South Windsor, CT 06074
Phone Number: (860) 337-6173, Fax Number: (860) 644-1930
SITE INVESTIGATION FOR A SUBSURFACE SEWAGE DISPOSAL SYSTEM
Application/Pcrmit #:
Property Owner: David Givens & Barbara Furnish Location: 242 Dart Hill Rd.
DEEP TEST PIT DATA/SOIL DESCRIPTIONS
DATE8/9/19 (Record all Test Pits)
TEST PIT: 1
TEST PIT: 2
TEST PIT:
TEST PIT:
0-8" Top soil
0-12" Top soil
9-24" Roots/Brown Sand
13-34" Light brown sand
25-29" Light brown sand
TO bottom — Brown sand
TO bottom — Light red sand
with pebbles
with pebbles
72" Deep
72" Dee
Mottles: N/A
Mottles: N/A
Mottles:
Mottles:
GW: N/A
GW: N/A
GW:
GW:
Ledge: N/A
Ledge: N/A
Ledge:
Ledge:
Roots: 24"
Roots: 44"
Roots:
Roots:
Restrictive: N/A
Restrictive: N/A
I Restrictive:
I Restrictive:
COMMENTS: Area between trenches seems suitable
GROUNDWATER TABLE (Near max., below max., etc.):
SOIL MOISTURE (High, medium, low, etc.);
PERCOLATION TEST DATA
DATE:8/9/ 19 (Record all Perc Tests)
PERC: l
PERC:
PERC:
PERC:
DEPTH: 36 INCHES
DEPTH:
DEPTH:
DEPTH:
PRESOAK:9:20am
PRESOAK
PRESOAK:
PRESOAK:
TIME
READING
TIME
READING
TIME
READING
TIME
READING
9:45am
24"
9:46am
26"
9:48am
27.5"
9:49am
29"
9" 50am
29.5"
9:52am
30.5"
9:53am
30.5"
9:54am
31 "
9:56am
32"
PERC
PERC
PERC
PERC
RATE: < 10 min/unch
RATE:
RATE:
RATE:
COMMENTS:
SITE INVESTIGATION FOR A SUBSURFACE SEWAGE DISPOSAL SYSTEM
LOCATION DRAWING INCLUDING ALL TEST PITS AND PERCOLATION H LES
�rovj-IA-
lc .
x
y
r
SPECIAL CONDITIONS
CONCLUSIONS
Design Flow > 2000 GPD
Suitable for Sewage Disposal
X
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
Perc 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
Well exception will be required. test pit 60' from well hand
Form completed by: Heather Oatis
(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.):
Melissa Pierce, SW HD. Jeff Polhemus. Skid's Wastewater Services. homeowners
9/9/2019`` Print Lookup Details
State of Connecticut
Lookup Detail View
Name
Name
JONATHAN PIELA
i
License Information
lookup
License Expiration Granted License Licensure Actions or Pending
License Type Number Date Date License Name Status Charges +
Sub -Surface Sewage 6308 0913012011 03106/2018 JONATHAN ACTIVE CURRENT None
Installer I I PIELA
Generated on: 9/9/2019 9:14:06 AM
https://www.elicense.ct.gov/Lookup/PrintLicenseDetails.aspx?cred=1469357&contact=592437 1 /1
State of Connecticut, Department of Public Health
Well Separation Distance Exception Ap ication
To: Environmental Engineering Program Date: .. 1
Department of Public Health
410 Capitol Ave., MS# 51SEW Local Health Department: �oylgl LJOP-0s jet_—
P.O. Box 340308
Hartford, CT 06134-0308
Attn: &CG1n of IA- $ A
Subject Property
Address:�Z
Replacement of.
Septic Tank*
Leaching System**
Both
Exception for:
Septic Tank
SC1 Leaching System
Both
Mailing Address: I KD rj�u.►✓rhu A✓iE�,
Phone Number: S'Q 0 3 $ `1 — W } 3
Email Address:
Town: JNvt,r f( L.J/ n..!-SJ►2__
Wells affected:
—Owner's well
Neighbors' well
Both
Basis of Design:
# of Bedrooms:
or
Design Flow:
Affected
Properties
Lot Number or Address
Property Owner's Name
Well
Type
Distance from well to:
New Tank
New System
Subject Property
Front Adjacent
Rear Adjacent
Left Adjacent
Right Adjacent
Shallow well pump(s) with suction pipe(s)? YES / NO If yes, show on plan & note distance if <75 feet.
Building sewer or distribution piping <25 feet to well? YES t�_o )If yes, show on plan & note distance.
Potability testing of affected wells? YES 40 If yes, are results satisfactory? YES / NO
Is the replacement tank or leaching system located closer to well than the existing system? YES NO
Does the subject property have any compliance issues concerning PHC Section 19-13-13100a? YES &If yes, explain.
*Leaching system has been evaluated to confirm it is functioniizg satisfactorily? YES /0 ]f no, explain. 6epj(r �4"c,6i0
**Septic tank has been evaluated to confirm it is in satisfactory condition and properly baffled? ES NO If no, explain.
Comments:
Plan prepared by:
Professional Engineer
yLicensed Installer
Other:
Plan reviewed by: W44/%
(Print Name and Title)
Documentation Submitted:
Soil Test Data
Detailed Plan
A�"
Signature
Please note, in accordance with CT General Statutes Section 19a-209c, the a licam is required to notify owners of properties
with water supply wells a[Tecte y thi excepti equest. 1' piicabie, operty owner must sign below.
Applicant's Signature:
(Subject Property Owner) Date of Certified Mail Notification
12/2011
J oM 1 Itv5 TM PftOF^PTY
N S ` x Ik ` 1� 1 �-' 4.c.JT
A. J A M E S 1! I G G I N 'S
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SCALE: 1"-30'
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REMM "r:::ti;.:.a.RY ?, 1963
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NOTE: .D A f' T L i
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i HEALTH DEPARTMENT
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GARAuE SIDE YAnu NON -CO °Nti
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1JORTGA t'F. SURVEY FOR THE.
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Form # 3
4
-risok• NY'� y
Local Health Department:
Property Owner: l
Technical Standards for Subsurface Sewage Disposal Systems 1/l/11
Final Inspection Report
Application/Permit #:
Property Address: Town:
Licensed Installer:
License M
Approved Plan Information
Check one: New System Repair/Replacement System
Residential Building: bedrooms Large Tub: YES Aid Garbage Disposal: YES NQ
Non residential Building/Residential Institution: GPD
Plan Prepared by: Title:
Plan Approved by:
Date:
Approval to Construct
Date Permit Issued: Permit Issued
Registered Sanitarian or Director of Health
Inspection Information
Type
Date
Licensed Installer
Present? Yes/No
Comments
Field Stake Inspection (house,
well, property lines, system etc.)
Strip/Scarification
Select Fill Placement
Sieve required (Yes/No)
Other:
Final Inspection
t
Was 24 Hour (min) Installer Notice Given (Y/N) : I Date Final Inspection Requested: 'l 1 '� `-�
Date of As -Built
Final Inspection Completed by: A royal:
Permit to Discharge Issued by: Date:
Registered Sanitarian or Director of Health
FORM #3 (Cont'd) Technical Standards for Subsurface Sewage Disposal Systems 1/l/11
Final Inspection Report
House Sewer Information
Pipe Type and ASTM Specification: Pipe Size: in,.
Pipe Invert Elevations at:
Foundation Wall: �11\ �
Septic Tank: W . Z V
Pipe Length: JA , ft.
Pitch Required: (—, � 2 S �k
Pitch Provided:
Tank Information
Septic Tank Size: 'n(y) Gallons Tank Inlet Elevation: ,
Tank Manufacturer: u S-�f ( i! n\ ,; Tank Outlet Elevation:
Date Manufactured: Al Riser Needed (Y/N): E
Outlet Filter Type/Manufacturer: ra b
Size: Gallons Pump Alarm Checked Y
Pump Chamber
Manufacturer: Float Control Elevation Verified (ff[N): _
Grease Interceptor Grease Interceptor Tank
Tank Size: Gallons Manufacturer:
Leaching System Information
Approved Aggregate: Free of silt dirt and debris (Y/N):
Sieve Required (Y/N): \1
Filter Fabric Present (Y/N): Type: Aggregate Meets PHC Specifications (Y/N):
Select Fill (Y/N):y Meets PHC Specifications (Y/N):�_ Sieve Information on File (Y/N):
Leaching System Description raduct, size, length, number of rows, level or serial etc.):
Effective Leaching Area Required: sq. ft. Reserve Area Provided (N/A, Y/N): /V \�
Effective Leaching Area Provided:
System Installed Per Approved Plan Elevations (Y/N):
Elevation notes:
sq. ft. Center to Center Spacing: Aj P ft.
Elevations Field Verified (Y/N): (
Separation Distances
Separation Distances Conform with Approved Plan (YIN):
Separation Distances Field Verified (Y/N):