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Home My WebLink About2013-12 - 210 Diane Drive - Septic Application¢f �� Town of South Windsor — Health Department �. 1540 Sullivan Avenue, South Windsor, CT 06074-2786 Phone: 860-644-2511 ext. 248 Fax: 860-644-7280 APPLICATION FOR APPROVAL TO CONSTRUCT A SUBSURFACE SEWAGE DISPOSAL SYSTEM // /� // Application/Permit #: el r�To the Director of Health, Town vf: ✓ o � 41s ••, Date: � Z 1 `' � 3 Application is hereby /made for any{/approval to construct a subsurface sewage /`disposal system for a: (Residential Building, Restaurant, Retail Building, etc.) located at: Z (J 01�.n e_ 01 (Street Address, Lot Number, Subdivision Name, Map, Block, Lot, etc.) New System— / f Addit Owner /� ` k � z ti Sr L 4 Tel.No. 0 — L 9 l W fr v'h Installer, r^ s t.� � � '- s Address Zr � - �� I ..� �� Te].Nn. �7j •-U" 5 7 s- C, Installer License No. In accordance with detailed information stated below: Application fee paid Signed (Owner or duly authorized presentative) __...._....-------•---------------------------------------------------------------------------------------------_-- ---------------- GENERAL INFORMATION Soil Tests Conducted (Date): G � 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 Fngineer: Design Plan Approved (Y/N): Date of Approved Plan: Revision Date. - Type of Water Supply If well, has location been approved (Y/N): Well Driller's Name: Address: Approval to Construct issued by: OFFICE USE ONLY (Director of Health or Registered Sanitarian) Signature: T i t ic: Town of South Windsor — Health Department 1540 Sullivan Avenue, South Windsor, CT 06074 " 4~ Phone: 860-644-2511 ext. 248 Fax: 860-644-7280 PERMIT TO DISCHARGE Approval is hereby given to C-o-c r-<_kVa` V\6�c ��, , in accordance with Public (Property Owner) Health Code Section 19-13-13103e (h) to discharge to a subsurface sewage disposal system located at (Street Address) in the town of VJ:4x r , CT that will receive domestic sewage from a: Residential building containing Restaurant containing Commercial/Office building providing Other structure as described: -bedrooms. Single family (Y/N): L seats. square feet. Design Flow = gallons per day. Permitted Flow = ysb 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 ' _ _ 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) Y . 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) rJ 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 (Rep File Information: Construction Permit No. — . Approved as -built on file (Y/N) Date of Final Inspection: �`Z-�'2_� l Inspected By: IN s�C [x"" Permit Issuance: Issued by: Sit rv� V�_..�, Title: _ (DirectorofHealth r Registered Sanitarian) Signature: <'v _ " 1 V l�/ _1 _ Date: age�7 town r< ° = Town of South Windsor — Health Department S Subsurface Sewage Disposal System Inspection Report PROPERTY LOCATION: BOTTOM OF EXCAVATION: DATE: n y INITIAL PERCOLATION TEST "FILL CHECK": DATE: INITIAL DEPTH HOLE # DEPTH HOLE # TIME READING TIME READING PERC PERC L� --rc v— FINAL INSPECTION: SANITARIAN rnA V-�l;�tns , DATE: 1. SEWER LINE: A. SEWER LINE CEMENTED AT FOUNDATION (Y/N) ................PIPE LENGTH I I ' B. PITCH (.25 inches per foot min) REQUIRED a ,7S '' FT ................ PROVIDED 3-' FT D. PIPE TYPE & ASTM SPEC. 7. �„�l� ii�...A:?!! i . ......... PIPE SIZE (INCHES) - 2. SEPTIC TANK: A. _ MANUFACTURER DATE MFD ► SIZE. I om, GALLONS B. TANK COMPARTMENTS PLALVED PROPERLY(Y/N)............................................... . C. INLET BAFFLE (not in middle of opening). .......... OBSERVATION OPENING (slag removal) D. OUTLET BAFFLE FILTER TYPE ,�,� - �, � L y RISERS NEEDED (Y/N)�( SIZE b E. TYPE OF PIPE •:,I F-,6-(w. 3u3N (approved by code) 3 PUMP CHAMBER/GREASE TRAP: A. PUMP CHAMBER MANUFACTURER SIZE GALLONS B. TYPE PUMP ............PUMP ALARM CHECKED (YIN) C. FLOAT CONTROL ELEVATION VERIFIED (Y/N). .....TYPE OF PIPE D. GREASE INTERCEPTOR TANK SIZE GALLONS ........ MANUFACTURER 4. D BOXES: A. LEVEL (Y/N) SERIAL DISTRIBUTION (High level overflow within top 3")....... C. LEVEL SYSTEM (Ends tied together) (YIN) 5. TRENCHES: A. LENGTH OF TRENCH ............ 1. 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: 6. SEPARATION DISTANCES CONFORM WITH APPROVED PLAN (Y/N) SEPARATION DISTANCES FIELD VERIFIED (Y/N) PASS FAIL COMMENTS: WELL INSPECTION: SANITARIAN WELL LOCATION DATE: Sanitary Well Cap Rev. April 2012 FINAL INSPECTION ELEVATIONS PROPERTY LOCATION: Z i h p;'� ,� ;.� _ TOWN:k� 1n PROPERTY OWNER: C INSTALLER: L��O.b�L w t� �,. �t SANITARIAN: DATE: LEVEL TO BENCHMARK (ROD READING) BENCHMARK ELEVATION HEIGHT OF LEVEL ROD READINGS TOP OF PIPE DISTANCE TO INVERT (Top of pipe & diameter of pipe) INVERT ELEVATION SEWER LINE AT FOUNDATION SEPTIC TANK INLET SEPTIC TANK OUTLET ; ' S PUMP/GREASE TRAP INLET PUMP/GREASE TRAP OUTLET D-BOX # 1 INLET (� , FLOWLINE RIGHT 7 ,p FLOWLINE LEFT , p OUTLET D-BOX # 2 INLET FLOWLINE RIGHT FLOWLINE LEFT OUTLET D-BOX # 3 INLET FLOWLINE RIGHT FLOWLINE LEFT OUTLET TRENCH # 1 RIGHT LEFT 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 soon aE, RECFi 70- Wn 0 '?013 �}y4�ox G�N2fS 1540 SULLIVAN AVENUE • SOUTH WINDSOR, CT 06074 � 7 6�0 TELEPHONE (860) 644-2511 Septic System As- Built Plan Street Address Z 1 i p Aj c -D rz- Date ! Z- 2--7 - ( -� Permit Number New Septic System t o "i L-y epw Of Septic System Alteration of System Number of Bedrooms v or Design Flow of Building Type of system "I p t c." 4` �, ., . i "e (8.& tamche3, infLitr$torS, galleries) Square footage of system: Total length �%' k° Width Effective Area `e ,,, 5 l Capacity of Tank tC� New `k Existing Length of house sewer pipe i Minimum distance between septic tank and foundation Minimum distance between leaching field and foundation 2-v Minimum distance between sewage system and nearest well Public water supply _ )C Minimum distance between leaching system and property boundary �ly Curtain drain required? Yes No Minimum distance from leaching field to drains ke;te' (curtain drain, foundation, stormwater, etc.) Septic System As- Built Plan Address O l Tic _ 44 w►� d� Date \2-a7-�3 Location of System��i I� (N, S, E, W, front, back side of house) Draft a substantially correct drawing showing separation distances of the septic system installation. Include all of the following information to provide an accurate record of the entire system location: At least two sides of the building nearest the system, septic tank, house sewer, distribution boxes, trench ends, dry wells, curtain drain, potable water supply wells and any other features affecting the system and its location. r Installers Name "`SA - � �-z, , Y�� «5 License Number Installers Address L T street, ci y, stateland zip code) i) rN-je- N,'Y 1 411, v i �`G,u�� l � 13 �I N � � will T°� a1 to le I--e Poi ` OVr z r4 pt j., d brit: td ,$ �� 36 3 Ex15rij1if- Q6. fi�—Y'-O jv icii�5 3 Distance from comer A Distance from comer B 3, q L41+ 4 q,-4 Distance from comer C Distance from comer D j oocv. .l0lley ` -n � �F '1 i ,,4Ti+e�r Tuf -' T IV � b,,� 2- b 1Ql+: �Y CSC Fe-1,YlGc Cc,,•t AtA 6n5 fn Oran. 7NF� K d7� 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): Carmella Rojecki STREET ADDRESS: 210 Diane Drive TOWN: South Windsor INSTALLER: Andrew Coleman CT. LIC # 5839 EXPIRES: 03/31/2014 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: SEPTIC TANK AND SEWER LINE REPLACEMENT ONLY 1. Install per approved plan, (Andrew Coleman, Dated: 12/19/2013). 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 approved building sewer pipe. Sewer line pitch to be at least % 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: (r I w DATE ISSUED: 12/1912013 RENEWAL: _I_I APPROVED BY: Sherry Mann, REHS/RS EXPIRES: 12/19/2014 EXPIRES: _1_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 CHECK # 1008 DATE PAID:12/19/2013 Septic Repair For: Al Cavicchi 210 Diane Dr -South Windsor Design Criteria: Tank replacement only, 3 bedroom house, public water Proposed: Install a new 1000 gallon 2 compartment concrete septic tank with an outlet filter and risers to grade. Pump, crush, and fill the existing septic tank. Connect the house to the tank using 4" sch40 pvc. Connect the new tank to the existing leaching system. Install a new pvc distribution box. There are no wells within 75' of the system. Drabek, Bernard From: CaliCenter@CBYD2.com Sent: Thursday, December 19, 2013 2:33 PM To: CBYD Subject: Locate Request - 20135101331 (CALL BEFORE YOU DIG - CT) 12/19/2013 14:32:25 -5G -AH -Cl -CW -G5 -OT 2-SW SWINDS -T5 *** REMOTE BATCH ENTRY *** ***** ROUTINE ***** TIME..14:32 DATE..12/19/2013 REQUEST NO...20135101331 LATITUDE..41.8216645 LONGITUDE..-72.5108674 TOWN...... SOUTH WINDSOR ADDRESS ... 210 STREET .... DIANE DR NEAREST CROSS STREET..BRENT DR TYPE OF WORK..... INSTALLING A SEPTIC TANK AREA IS MARKED ... YES REMARKS: WORKING ALL OVER THE PROPERTY --------------------------------------------- START DATE ...... 12/26/2013 START TIME..08:00 CALLER .......... ANDREW COLEMAN CALL BACK....... PHONE #......... 860-871-2616 FAX #........... 860-871-1587 ALT. PHONE #..- EMAIL ADDRESS.... CONTRACTOR ...... WASTE WATER SERVICES ADDRESS ......... 100 WINDERMERE AVE CITY ............ ELLINGTON STATE ........... CT ZIP.............06029 EXCAVATOR DOING WORK..WASTEWATER SERVICES ISSUED TO: DATE/TIME ARRIVED: CALL BACK: 1) DATE: PERSON CONTACTED: DATE: TIME: BY: TIME LEFT: TIME: BY: 2) DATE: PERSON CONTACTED: COMPLETED BY: TIME: BY: 1 Town of South Windsor, CT Property Listing Report GIS PIN 28200210 Account 28200210 Property Information roperty Location 210 DIANE DRIVE Owner ROJECKI CARMELLA Co -Owner Mailing Address Land Use 101 Res Dwelling Land Class R Water Service TCONNECTICUT WATER 860.623.3356 Photo Primary Construction Details Year Built 1965 Stories 1.0 Building Style Ranch Building Use Residential Building Condition C Floors Carpet Total Rooms Sewer Service Census Tract 4872 Neighborhood Zoning Code A20 Acreage 0.64 Book/Page Lot Setting/Desc Trash Day FRIDAY Sketch Bedrooms 3 Full Bathrooms 1 Half Bathrooms 0 Bath Style Average Kitchen Style Average Roof Style Gable Roof Cover Asphalt Exterior Walls Vinyl Siding Interior Walls Drywall Heating Type Hot Water Heating Fuel Gas AC Type Gross Bldg Area 2772 Total Living Area 1236 ReportCreated On 12/19/2013 Town of South Windsor, CT Property Listing Report GIS PIN 28200210 Valuation Summary (Assessed value = 70% of Appraised Value) Item Appraised Assessed Buildings Outbuildings Improvements Extras Land Total 0 Sub Areas Sales History Owner of Record Account 28200210 Outbuilding and Extra Items Book/ Page Sale Date Sale Price Report Created On 12/19/2013 ] w l9 lfl M r• '�' y � GLORIA W a -lode W000 o oze� O a � s S� OOA V r 4/ fr 0 3AIao lie 0 ry Cp 3 r in �4 L � o � _ N p W > It 4� 0 ME �v k --AQO W r • h o> z 0 �r4Ni Z ❑ 0 3AI»Q'11el �+ L &0 o w O -- -- c '� N $4 - o 2oz `/ — c no 3AIE10 '.Lle Ii W