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198 SMITH ST
6/15/2021 t0*jH $f�< et of South Windsor Building Department OR-00�[l Plumbing Permit: PLMB-21-94 APPLICANT NAME: Gerald Savage EMAIL ADDRESS: savracing88@hotmail.com ADDRESS: 7 Rosehaven Rd Somers , CT 06071 LOCATION ADDRESS: 198 SMITH ST South Windsor CT 6074 OWNER: REDDY MADHU 5-Oct ARTHUR DRIVE SOUTH WINDSOR CT 6074 DESCRIPTION OF WORK: Rough plumb 1 Kichen sink, dishwasher,Washing machine on 1 st floor, 1 and 1 /2 bthrooms on first floor.Washing machine on 2nd floor,2 full baths on 2 nd floor May 13, 2021 BUILDING OFFICIAL DATE SIGNED —ALL WORK TO BE DONE IN ACCORDANCE WITH THE APPLICATION AND PLANS APPROVED BY THE BUILDING DEPARTMENT— PERMIT ONLY VALID IF SIGNED BY BUILDING OFFICIAL— 1 '. ElccrAc # APPLICATION FOR BUILDING PERMIT Plumbing# ,, HVAC# I01 Z �f 1�yA _ii+me - Date: r6 Sprinkler# 0 23 Estimated Cost $ 0160 FINAL APPROVM S Permit Fee $ �� Buildin / J COMPLETE RED BOXED AREAS Occupancy Fee $ Engineering Affidavit TYPE OR PRINT ONLY Eng. Insp. Fee $ Appr.forCO. SIGN ON REVERSE SIDE Total Fee $ G0 TO THE BUILDING DEPARTMENT, TOWN OF SOUTH WINDSOR, CT (Additional Cost) $ ��-� Cj The undersigned hereby applies to do work according to the following: Applicant F F 7 + Location of Work M Lot No. Applicant's Address L✓h ! Tel # 960- 7 Town So , (.4�to A-sac G1— Zip 06o2v Lic.# Owner K f= 1-4L, Architect Owner's Address — Architect's Address N Zip Zip Sq. Ft. New Area: 1 st Ff. 2nd Fl. 3rd FI. Total New AreaIVIV Purpose of this permit City Water J Well '_1 Septic System J Sewer J ,2�(zo o t-3' Ins: HO SP Cert. Area Base ent Garage Approved by Date L Use Grou Construction Type_t Revised 1108 I hereby agree to conform to all the requirements of the Laws of the State of Connecticut and the Ordinances of the Town of South Windsor and to notify the Building Inspector of any alteration in the plans or specifications of the Building for which this permit is asked,and agree that this building is to be located the proper distance from all street lines,side yard lines,and required distances from all other zones and is located in which this building an is uses owed. Signed I hereby apply for a Certificate of Occupancy for the work described in this application for the permit. Signed !V 'aT DO NOT WRITE BELOW THIS LINE INSPECTION COMMENTS tO�N S� 1540 SULLIVAN AVENUE• SOUTH WINDSOR, CT 06074 SOR-CO TELEPHONE(860) 644-2511 June 3, 2016 RFCF I ,'�NQ82016 KF Realty sc 175 Wheeler Road , --=-- South Windsor, CT 06074 Dear KF Realty, It is the decision of the Demolition Delay Committee that the house located at 198 Smith Street is not a significant structure per the Demolition Delay Ordinance. The DDC has no objections to the South Windsor Building Department granting a demolition permit. Sincerely, (4ffU.'L' 0 Y "Fol Arthur W. Utay Chairman, Demolition Delay Committee cc: Chris Dougan, Town of South Windsor ✓ �8 S �-�!Location rvl���" ermi p • t # .DEMOLITION PERMIT- REQUIREMENTS • Hazardous material survey: Asbestos d - JCL Lead paint do&e,* Lea 4U,0_8 e Letters/confirmation of utility disconnect: Electricity 1UC/,0) Gas Water: public XV=* abw.W= Well X*=* WWmdm* Sewer: public .: Drain layer permit# (if abandons Septic Z*=e sbandan* AE *These require procedures approved by Health Department� `� Historic District/Commission 1� roval Certificate S Demolition License S-w, AyA (Single. family house exempted if'. .owner is present for demolitiop, and assumes all liability, 29-402(a) ) l.) ,ce ocate of insurance.d emonstaWng the prescribed coverage,and which names the Municipality issuing the demolition permit as an additional insureds and 2) A sepamte declaration from.tiie contractor,on company leitrhoad signed by an officer of company,with the following,save harmless statement: 'In accordance with-Connecticut General'Statute l 2�406,.we 1contraet9d hereby agree to save'harm less the town or city!and its Rents from any claim or claims arisen out oMe negligence oftle applicant,or his agents or employees in the course of thedemolition operations associated with[project title,addressl, SOON s��. � 7-0-w;n o-S vz' �C, 1540 SULLIVAN AVENUE• SOUTH WINDSOR, CT 06074 f�OsoR•co TELEPHONE (860) 644-2511 June 3, 2016 KF Realty 175 Wheeler Road South Windsor, CT 06074 Dear KF Realty, It is the decision of the Demolition Delay Committee that the house located at 198 Smith Street is not a significant structure per the Demolition Delay Ordinance. The DDC has no objections to the South Windsor Building Department granting a!— r 'demolition Permit.I Sincerely, Arthur W. Way Chairman, Demolition Delay Committee cc: Chris Dougan, Town of South Windsor A INSPECTION FIELD SHEET O1/26/18 Printed by Foreshaw, Dayshell it 13 28 INSPECTION: 85364 miyo—N PERMIT: STATUS APPLICATION: 201600563 LOC: 198 SMITH STREET SOUTH WINDSOR PROPERTY ID: 83700198 OWNER-: KF REALTY LLC CONTRACTOR: REQUEST BY: PROJ DESC: DEMOLISH HOUSE. WORK ORDER: INSPECTOR: r5bb-`0""'"� RESULT: PASS REQUESTED: Vo8/08/17 PRIORITY ' SCHEDULED: 08/10/17 AM COMPLETED 08 10 17 UNPAID FEES: 00 l�--Date _�. _ Time MILEAGE: 00 TIME: TRAVEL ONSITE COMMENTS 6/15/2021 `0 Sf9 C Town of South Windsor Building Department USOR `O _ Plumbing Permit: PLMB-21-94 APPLICANT NAME: Gerald Savage EMAIL ADDRESS: savracing88@hotmail.com ADDRESS: 7 Rosehaven Rd Somers , CT 06071 LOCATION ADDRESS: 198 SMITH ST South Windsor CT 6074 OWNER: REDDY MADHU 5-Oct ARTHUR DRIVE SOUTH WINDSOR CT 6074 DESCRIPTION OF WORK: Rough plumb 1 Kichen sink,dishwasher, Washing machine on 1 st floor, 1 and 1 /2 bthrooms on first floor. Washing machine on 2nd floor, 2 full baths on 2 nd floor May 13, 2021 BUILDING OFFICIAL DATE SIGNED -ALL WORK TO BE DONE IN ACCORDANCE WITH THE APPLICATION AND PLANS APPROVED BY THE BUILDING DEPARTMENT- -PERMIT ONLY VALID IF SIGNED BY BUILDING OFFICIAL- Connecticut Water Company 93 West Main Street a n Clinton, CT 06413-1600 �aaaactiaa� atar Office:860.669.8636 Customer Service:800.286.5700 August 17, 2016 Margaret French Account Number 198 Smith St 00066989 South Windsor, CT 06074-3618 Service Adtt Smith St South Windsor, CT Dear Margaret French, This is to verify that the Connecticut Water CompanyTdoes serve the above location. The hieter:was.removed and tumed.off at The Connecticut Water Company Valve at the street on August 17,2016 On July 29,2016 a serviceman of The Connecticut Water Company verified that the service line was disconnected from the main. Sincerely, The Connecticut Water Company Customer Service Department Printed on recycled paper i CTNewService@eversouree.com via nuxom May 10 (2 days ago) to ASK From:CLP New Service Clearing Desk/NUS@NU Date:09-MAY-16 To: KF REALTY Subject: Removal of Service Completed(2728570) Dear Customer, Your CL&P Demolition/Construction Service Removal Request:2728570 for Job Location: 198 SMITH ST, SOUTH WINDSOR, CT has been completed. Service Removal Date:09-MAY-16 This letter Is to confirm the removal of the existing Connecticut Light&Power(CL&P)electric service, ,and meter($)at the above address for the purpose of demolition/constructiortof the building: ' If you have any questions,please contact the CL&P Clearing Desk: Phone: 1-888-544-4826 Fax 1-877-285-4448 EV E RS=U RC E Eas Prospect Hill Road East Windsor,CT 06088 ENERGY May 9, 2016 KF Realty 175 Wheeler Rd. South Windsor, CT 06074 RE: Demolition of property at 198 Smith Street, South Windsor, CT 06074 To Whom It May Concern: This letter is in reference to the above mentioned address. Please be advised that there is;no. JEversource-gas-at this location. Please note that Call Before You Dig (1-800-922-4455) must be contacted prior to the start of any work. If you have further questions or concerns you may contact me at (860) 292-2248. Sincerely, Martin Baker Supervisor Gas Distribution 4818 REV 2-15 05/10/2016 TUE 8: 12 FAX 860 292 2202 _ 00.02/002 Removal of Service EVERS=URCE 'Building Demolition or Construction As the owner of this pwperty,I am requesting the removal of the existing Eversource gas service and meters)to allow for the demolition/construction of the building in accordance with all applicable Connecticut General Statutes. 1 certify that the building Is vacant. REMOVAL DATE NEEDP` STREETADDRESS WHERE GAS SqVIFE IS TO BE REMOVED NEARESTCR SS 5TRE6T 1 g.C9 St".' S4. L TOWN STATE ZIP CODE S6 . W , ACCOUNTNUMBER J 14 METER NUMBERS) i�I�v�IA THE REASON FORTH(S REQUEST? j i r �'DdMOLITION IF OTHER,EXPLAIN `_ L�il�/�Q.. C;L?tI #J ❑CONSTRUCTION 4•Y — ❑OTHER 'T"(J -1,- PRINT NAME OF P R SIGNATURE PRO TY KE MAILING ADDRESS 7 gee TOVVN w STATE ZIP CODE SO. t,J► 7 TELEPHONE NUM B ER �OtF PROPERTY OWNER FAX�jN/W3ER � VERIFICATION OF REMOVAL LFiITER c w! 6% ,7'^Sl—z (SO) .6'1(�—27^77 I�TAXEO 0 MAILED � NO 3194� c NOTARY PUBLIC DATE NOTARIZED Notrequiried tarsingWamily,owner-occupied dwellings. To avoid Delays Please Complete All Wormation On This Form U.S.Postal: Overnight Express: Mail To: Customer Service Mail To: Customer Service i Eversoume Eversource j PO Box 2919 1985 Blue Hills Ave. Extension ( Hartford,CT 06104-2919 Windsor,CT 06095 Fax: (860)607-6156 Customer Billing Services: 1-800-989-0900 -EVEITSOURCE JNTERNAL USE ONLY- Date faxed to AWC Dale service removed: File this form with completed demolition letters. PRINT NAME OF EVERSOURCE REPRESENTATIVE I SIGNATURE OF-EVERSOURCE REPRESENTATIVE DATE oroees•+n�v t•,s 05/10/2016 TUE 8: 11 FAX 860 292 2202 0001/002 112 EVE RS"U RC E EastWrindso Her Road 06088 ENERGY May 9, 2016 KF Realty 175 Wheeler Rd. South Windsor, CT 06074 RE: Demolition of property at 198 Smith Street, South Windsor, CT 06074 To Whom It May Concern: This letter is in reference to the above mentioned address. Please be advised that there is no Eversource gas at this location. Please note that Call Before You Dig (1-800-922-4455) must be contacted prior to the start of any work. If you have further questions or concerns you may contact me at (860) 292-2248. Sincerely, Martin Baker Supervisor Gas Distribution 4010 REV.2-1E � A SUPERIOR INDUSTRIES L.L.C. CorrvnttlRd In a clean Envhonment 342-CARTER LANE• S0111THINGTON. CT 06489 Attn: KF Realty 175 Wheeler Road South Windsor, CT 06074 Phone: Project Order#: 21454 Fax: Received Date: 1/17/2017 Project: 198 Smith Street, South Windsor, CT Analysis Date: 1/18/2017 Asbestos Analysis of Bulk Materials via EPA 6001R-931116 Method using Polarized Light Microscopy Non-Asbestos Asbestos Sample Description Appearance %Fibrous %Non-Fibrous %Type 1 PLASTER GREY 6%CELLULOSE 94%OTHER NONE FIRST FLOOR KITCHEN DETECTED 21454-0001 2 PLASTER GREY 8%CELLULOSE 92%OTHER NONE REAR STAIRS DETECTED 21454-0002 3 PLASTER GREY 6%CELLULOSE 94%OTHER NONE SECOND FLOOR DETECTED 21454-0003 4 PLASTER GREY 9%CELLULOSE 91%OTHER NONE SECOND FLOOR DETECTED 21454-0004 5 12X12 CEIILNG TILES BROWN 65%CELLULOSE 35%OTHER NONE FIRST FLOOR DETECTED 21454-0005 6 12X12 CEILING TILES BROWN 70%CELLULOSE 30%OTHER NONE FIRST FLOOR DETECTED 21454-0006 7 12X12 CEILING TILES BROWN 65%CELLULOSE 35%OTHER NONE FIRST FLOOR DETECTED 21454-0007 8 DUCT PAPER WHITE 60%OTHER 40% CHRYSOTILE 21454-0008 9 PANELS TAN 75%CELLULOSE 25%OTHER NONE SECOND FLOOR DETECTED 21454-0009 10 PANELS TAN 70%CELLULOSE 30%OTHER NONE SECOND FLOOR DETECTED 21454-0010 11 PANELS TAN 75%CELLULOSE 25%OTHER NONE SECOND FLOOR DETECTED 21454-0011 12 FLEX CONNECTOR WHITE 30%OTHER 10%AMOSITE SECOND FLOOR 60% 21454-0012 CHRYS011LE Analyst(s)Eaxe ela4k Ea)d X eta4k John Coleman,Quality Control Earl R Clark, Lab Director Due to magnification limitations Inherent in PLM,asbestos fibers in dimensions below the resolution capacity of PLM may not be detected. Samples reported as 41%or none detected may require additional testing by TEM to confirm asbestos quantities. The above test report relates only to the items tested and maybe reproduced in any form without the express written approval of Superior Industries LLC. Superior's liability Is limited to the cost of the analysis. Superior Industries bears no responsibility for sample collection activities or analytical methods limitations Interpretation and use of test results are the responsibility of the client samples received in good condition unless otherwise noted.AIHA Lab No.187297 State of Connecticut Laboratory Registration Number PH-0129 Kebalo Electric Company Inc:198 Smith Street, South Windsor,CT-20170124 Printed 1/30/201711:26 AM R SUPERIOR INDUSTRIES L.L.C. Cwranttt.d to a Clean Envkont.m 342-CARTER LANE• SOUTHINGTON. CT 06489 Attn: KF Realty 175 Wheeler Road South Windsor, CT 06074 Phone: Project Order#: 21454 Fax: Received Date: 1/17/2017 Project: 198 Smith Street, South Windsor, CT Analysis Date: 1/18/2017 Asbestos Analysis of Bulk Materials via EPA 600/R-93/116 Method using Polarized Light Microscopy Non-Asbestos Asbestos Sample Description Appearance %Fibrous %Non-Fibrous %Type 13 PLASTER GREY 9%CELLULOSE 91%OTHER NONE BASEMENT AT CHIMNEY DETECTED 21454-0013 14 CHIMNEY FLUE CEMENT LIGHT GREY 70%OTHER 30% BASEMENT AT CHIMNEY CHRYSOTILE 21454-0014 15 TEXUTED CEILING WHITE SAND 100%NON NONE FIRST FLOOR KITCHEN FIBROUS DETECTED 21454-0015 16 TEXTURED CEILING WHITE SAND 100%NON NONE BASEMENT RIGHT FIBROUS DETECTED 21454-0016 ROOM 17 TEXTURED CEILING WHITE SAND 100%NON NONE FIRST FLOOR FIBROUS DETECTED 21454-0017 BATHROOM 18 SHEETROCK TAN-WHTIE 9%CELLULOSE 91%OTHER NONE FIRST FLOOR KITCHEN DETECTED 21454-0018 CEILING 19 SHEETROCK TAN WHITE 9%CELLULOSE 91%OTHER NONE BASEMENT RIGHT DETECTED 21454-0019 ROOM 20 SHEETROCK TAN-WHITE 7%CELLULOSE 93%OTHER NONE BASEMENT RIGHT DETECTED 21454-0020 ROOM 21 JOINT COMPOUND WHITE 100%NON NONE SECOND FLOOR RIGHT FIBROUS DETECTED 21454-0021 BEDROOM 22 JOINT COMPOUND WHITE 100%NON NONE BASEMENT RIGHT FIBROUS DETECTED 21454-0022 ROOM 23 JOINT COMPOUND WHITE 100%NON NONE BASEMENT RIGHT FIBROUS DETECTED 21454-0023 ROOM 24 FIBERGLASS BACKING BLACK 750/6 CELLULOSE 25%OTHER NONE (TAR PAPER) DETECTED 21454-0024 WALLS AND CEILINGS Analyst(s)fmt e1a4 &%t a CEa 4 John Coleman,Quality Control Earl R Clark, Lab Director Due to magnification limitations Inherent in PLM,asbestos fibers In dimensions below the resolution capacity of PLM may not be detected. Samples reported as <1%or none detected may require additional testing by TEM to confine asbestos quantities.The above best report relates only to the Items tested and may be reproduced in any form without the express written approval of Superior Industries L LC. Superiors liability Is limited to the cost of the analysts. Superior Industries bears no responsibility for sample collection activities or analytical methods limitations Interpretation and use of test results are the responsibility of the client samples received In good condition unless otherwise noted.AIHA Lab No.187297 State of Connecticut Laboratory Registration Number PH-0129 Kebalo Electric Company Inc.-198 Smith Street,South Windsor,CT-20170124 Printed 1/30/201711:26 AM SUPERIOR INDUSTRIES L.L.C. Catanflbed to s Clem FirAun..M 342-CARTER LAME• SOUTHINGTON. CT 06489 Attn: KF Realty 175 Wheeler Road South Windsor, CT 06074 Phone: Project Order#: 21454 Fax: Received Date: 1/17/2017 Project: 198 Smith Street, South Windsor, CT Analysis Date: 1/18/2017 Asbestos Analysis of Bulk Materials via EPA 600/11-93/116 Method using Polarized Light Microscopy Non-Asbestos Asbestos Sample Description Appearance %Fibrous %Non-Fibrous %Type 25 FIBERGLASS BACKING BLACK 70%CELLULOSE 30%OTHER NONE (TAR PAPER) DETECTED 21454-0025 WALLS AND CEILINGS 26 FIBERGLASS BACKING BLACK 70%CELLULOSE 30%OTHER NONE (TAR PAPER) DETECTED 21454-0026 WALLS AND CEILINGS 27 WINDOW GLAZE OFF WHITE 100%NON NONE BASEMENT FIBROUS DETECTED 21454-0027 28 WINDOW GLAZE OFF WHITE 100%NON NONE FIRST FLOOR FIBROUS DETECTED 21454-0028 29 WINDOW GLAZE OFF WHITE 100%NON NONE SECOND FLOOR FIBROUS DETECTED 21454-0029 30 CERAMIC WALL TILE BROWN 100%NON NONE ADHESIVE FIBROUS DETECTED 21454-0030 FIRST FLOOR BATHROOM 31 CERAMIC WALL TILE BROWN 100%NON NONE ADHESIVE FIBROUS DETECTED 21464-0031 FIRST FLOOR BATHROOM 32 CERAMIC WALL TILE WHITE 100%NON NONE GROUT FIBROUS DETECTED 21454-0032 FIRST FLOOR BATHROOM 33 CERAMIC WALL TILE WHITE 100%NON NONE GROUT FIBROUS DETECTED 21454-0033 FIRST FLOOR BATHROOM 34 LINOLEUM RED-WHITE 12%CELLULOSE 88%OTHER NONE SECOND FLOOR FRONT DETECTED 21454-0034 RIGHT BEDROOM CLOSET Analyst(s)C"ela4k &jd a C'&)& John Coleman,Quality Control Earl R Clark,Lab Director Due to magnification limitations Inherent H PLM,asbestos fibers In dimensions below the resolution capacity of PLM may not be detected. Samples reported as <1%or none detected may require additional testing by TEM to confirm asbestos quantities. The above test report relates only to the items tested and maybe reproduced in any forth without the express written approval of Superior Industries I.I.C. Superiors 6abirty Is limited to the cost of the analysis. Superior Industries bears no responsibility for sample collection activities or analytical methods limitations interpretation and use of test results are the responsibility of the c ient samples received In good condition unless otherwise noted.AIHA Lab No.187297 State of Connecticut Laboratory Registration Number PH-0129 Kebalo Electric Company Inc.-198 Smith Street,South Windsor,CT 20170124 Printed 1/30/201711:26 AM c - SUPERIOR INDUSTRIES L.L.C. c«nr.�fa.a 1v s Civet,E„vikonr�c 342-CARTER LANE• SOUTHINGTON, CT 06489 Attn: KF Realty 175 Wheeler Road South Windsor, CT 06074 Phone: Project Order#: 21454 Fax: Received Date: 1/17/2017 Project: 198 Smith Street, South Windsor, CT Analysis Date: 1/18/2017 Asbestos Analysis of Bulk Materials via EPA 600/11-93/116 Method using Polarized Light Microscopy Non-Asbestos Asbestos Sample Description Appearance %.Fibrous %Non-Fibrous %.Type 35 LINOLEUM RED-WHITE 14%CELLULOSE 86%OTHER NONE SECOND FLOOR FRONT DETECTED 21454-0035 RIGHT BEDROOM CLOSET 36 LINOLEUM GREEN-WHITE-YELLOW 11%CELLULOSE 89%OTHER NONE SECOND FLOOR FRONT DETECTED 21454-0036 RIGHT BEDROOM 37 LINOLEUM GREEN-WHITE-YELLOW 13%CELLULOSE 87%OTHER NONE SECOND FLOOR FRONT DETECTED 21454-0037 RIGHT BEDROOM 38 LINOLEUM LIGHT BLUE-BLACK 12%CELLULOSE 88%OTHER NONE SECOND FLOOR LEFT DETECTED 21454-0038 BEDROOM 39 LINOLEUM LIGHT BLUE-BLACK 13%CELLULOSE 87%OTHER NONE SECOND FLOOR LEFT DETECTED 21454-0039 BEDROOM 40 LINOLEUM RED-WHITE-GREEN 11%CELLULOSE 89%OTHER NONE SECOND FLOOR ROOM DETECTED 21454-0040 AT STAIRS 41 LINOLEUM RED-WHITE-GREEN 12%CELLULOSE 88%OTHER NONE SECOND FLOOR ROOM DETECTED 21454-0041 AT STAIRS 42 LINOLEUM RED-BLACK 91%OTHER 9%CHRYSOTILE FIRST FLOOR REAR 21454-0042 ENTRY 43 LINOLEUM RED-BLACK STOP POSITIVE (NOT 21454-0043 ANALYZED) 44 LINOLEUM ORANGE STONE 11%CELLULOSE 89%OTHER NONE FIRST FLOOR REAR DETECTED 21454-0044 ENTRY 45 LINOLEUM ORANGE STONE 13%CELLULOSE 87%OTHER NONE FIRST FLOOR REAR DETECTED 21454-0045 ENTRY Analyst(s)Cart C'.Qaulfi; Eald a e&v& John Coleman,Quality Control Earl R Clark, Lab Director Due to magnification limitations Inherent In PLM,asbestos fibers In dimensions below the resolution capacity of PLM may not be detected. Samples reported as <1%or none detected may require additional testing by TEM to confirm asbestos quantities. The above test report relates only to the items tested and maybe reproduced In any form without the express written approval of Superior Industries LLC.Superior's Uability is limited to the cost of the analysis. Superior Industries bears no responsibility for sample collection activltles or analytical methods limitations Interpretation and use of test results are the responsibility of the client samples received in good condition unless otherwise noted AIHA Lab No.187297 State of Connecticut Laboratory Registration Number PH-0129 Kebalo Electric Company Inc.-198 Smith Street,South Windsor,CT 20170124 Printed 1/30/201711:26 AM SUPERIOR INDUSTRIES L.L.C. C x=nl tsd to a Ctaan F.nviv unesA 342-CARTER LANE• SOUTHINGTON. CT D6489 Attn: KF Realty 175 Wheeler Road South Windsor, CT 06074 Phone: Project Order#: 21454 Fax: Received Date: 1/17/2017 Project: 198 Smith Street, South Windsor, CT Analysis Date: 1/18/2017 Asbestos Analysis of Bulk Materials via EPA 6001R-931116 Method using Polarized Light Microscopy Non-Asbestos Asbestos _Sample Description Appearance %Fibrous %Non-Fibrous %Type 46 LINOLEUM GREEN STONE 89%OTHER 11% FIRST FLOOR REAR CHRYSOTILE 21454-0046 WASH ROOM-BACK SPLASH 47 LINOLEUM GREEN STONE STOP POSITIVE (NOT _21454-0047 ANALYZED) 48 LINOLEUM TAN-BROWN 9%CELLULOSE 91%OTHER NONE FIRST FLOOR REAR DETECTED 21454-0048 WASHROOM-TOP LAYER 49 LINOLEUM TAN-BROWN 11%CELLULOSE 89%OTHER NONE FIRST FLOOR REAR DETECTED 21454-0049 WASHROOM-TOP LAYER 50 LINOLEUM FLOWER PATTERN 93%OTHER 7%CHRYSOTILE FIRST FLOOR REAR 21454-0050 WASHROOM-BOTTOM LAYER 51 LINOLEUM FLOWER PATTERN STOP POSITIVE (NOT 21454-0051 ANALYZED) 52 LINOLEUM BROWN BRICK PATTERN 12%CELLULOSE 88%OTHER NONE FIRST FLOOR REAR DETECTED 21454-0052 WASH ROOM 53 LINOLEUM BROWN BRICK PATTERN 14%CELLULOSE 86%OTHER NONE FIRST FLOOR REAR DETECTED 21454-0053 WASHROOM 54 LINOLEUM TAN SQUARE PATTERN 16%CELLULOSE 84%NON- NONE FIRST FLOOR KITCHEN- FIBROUS DETECTED 21454-0054 TOP LAYER 55 LINOLEUM TAN SQUARE PATTERN 18%CELLULOSE 82%OTHER NONE FIRST FLOOR KITCHEN- DETECTED 21454-0055 TOP LAYER 56 LINOLEUM RED-BLACK 11%CELLULOSE 89%OTHER NONE FIRST FLOOR KITCHEN- DETECTED 21454-0056 BOTTOM LAYER Analyst(s)F.aue eta)& &vd a C&,A John Coleman,Quality Control Earl R Clark, Lab Director Due to magnification limitations Inherent in PLM,asbestos fibers in dimensions below the resolution capacity of PLM may not be detected. Samples reported as <t%or none detected may require additional testing by TEM to confirm asbestos quantities. The above test report relates only to the items tested and may be reproduced in any forth without the express written approval of Superior Industries LLC. Superiors liability Is limited to the cost of the analysis. Superior Industries bears no responsibility for sample collection activities or analytical methods limitations Interpretation and use of test results are the responsibility of the client samples received In good condition unless otherwise noted.AIHA Lab No.187297 State of Connecticut Laboratory Registration Number PH4129 Kebalo Electric Company lnc.-198 Smith Street,South Windsor, CT 20170124 Printed 1/301201711:26 AM SUPERIOR INDUSTRIES L.L.C. Corruntt,6od!o a Clown Enviwvnont 842-CARTER LINE o SOWMINGTON. CT 06489 Attn: KF Realty 176 Wheeler Road South Windsor, CT 06074 Phone: Project Order#: 21454 Fax: Received Date: 1/17/2017 Project: 198 Smith Street, South Windsor, CT Analysis Date: 1/18/2017 Asbestos Analysis of Bulk Materials via EPA 600/R-931116 Method using Polarized Light Microscopy Non-Asbestos Asbestos Sample Description Appearance %Fibrous %Non-Fibrous %Type 57 LINOLEUM RED-BLACK 9%CELLULOSE 91%OTHER NONE FIRST FLOOR KITCHEN- DETECTED 21454-0057 BOTTOM LAYER 58 LINOLEUM RED-GREEN 13%CELLULOSE 87%OTHER NONE FIRST FLOOR REAR DETECTED 21454-0058 SMALL HALL 59 LINOLEUM RED-GREEN 11%CELLULOSE 89%OTHER NONE FIRST FLOOR REAR DETECTED 21454-0059 SMALL HALL 60 ROOF SHINGLES GREEN STONE 19%CELLULOSE 81%OTHER NONE TOPLAYER DETECTED 21454-0060 61 ROOF SHINGLES GREEN STONE 17%CELLULOSE 81%OTHER NONE TOP LAYER DETECTED 21454-0061 62 ROOF SHINGLES GREEN STONE 19%CELLULOSE 81%OTHER NONE TOP LAYER DETECTED 21454-0062 63 ROOF SHINGLES BLACK STONE 17%CELLULOSE 83%OTHER NONE BOTTOM LAYER DETECTED 21454-0063 64 ROOF SHINGLES BLACK STONE 19%CELLULOSE MOTHER OTHER NONE BOTTOM LAYER DETECTED 21454-0064 65 ROOF SHINGLES BLACK STONE 19%CELLULOSE 81%OTHER NONE BOTTOM LAYER DETECTED 21454-0065 66 TAR PAPER BLACK 78%CELLULOSE 22%OTHER NONE ROOFS DETECTED 21454-0066 67 TAR PAPER BLACK 75%CELLULOSE 25%OTHER NONE ROOF DETECTED 21454-0067 68 TAR PAPER BLACK 78%CELLULOSE 22%OTHER NONE ROOF DETECTED 21454-0068 Analyst(s)Eg)d eta)Prr &d a John Coleman, Quality Control Earl R Clark, Lab Director Due to magnification limitations inherent In PLM.asbestos fibers In dimensions below the resolution capacity of PLM may not be detected. Samples reported as <1%or none detected may require additional testing by TEM to confirm asbestos quantities. The above test report relates only to the items tested and may be reproduced In any torn without the express written approval of Superior Industries U.C. Superior's liability is limited to the cost of the analysis. Superior Industries bears no responsibility for sample collection activities or analytical methods limitations interpretation and use of test results are the responsibility of the client samples received in good condition unless otherwise noted.AIHA Lab No.187297 State of Connecticut Laboratory Registration Number PH4129 Kebalo Electric Company Inc.-198 Smith Street,South Windsor,CT 20170124 Printed 1/30/201711:26 AM c • SUPERIOR INDUSTRIES L.L.C. CvrrmritZtad!v a C1eon L'nviw�ment 342-CARTER LANE • SOUTHINGTON: CT 08489 Attn: KF Realty 175 Wheeler Road South Windsor, CT 06074 Phone: Project Order#: 21454 Fax: Received Date: 1/17/2017 Project: 198 Smith Street, South Windsor, CT Analysis Date: 1/18/2017 Asbestos Analysis of Bulk Materials via EPA 600/R-93/116 Method using Polarized Light Microscopy Non-Asbestos Asbestos Sample Description Appearance %Fibrous %Non-Fibrous %Type 69 WINDOW CAULK OFF WHITE 100%NON NONE FIBROUS DETECTED 21454-0069 70 WINDOW CAULK OFF WHITE 100%NON NONE FIBROUS DETECTED 21454-0070 71 WINDOW CAULK OFF WHITE 100%NON NONE FIBROUS DETECTED 21454-0071 72 CERAMIC FLOOR TILE BEIGE 100%NON NONE ADHESIVE FIBROUS DETECTED 21454-0072 FIRST FLOOR BATHROOM 73 CERAMIC FLOOR TILE BEIGE 100%NON NONE ADHESIVE FIBROUS DETECTED 21454-0073 FIRST FLOOR BATHROOM 74 CERAMIC FLOOR TILE BEIGE 100%NON NONE ADHESIVE FIBROUS DETECTED 21454-0074 FIRST FLOOR BATHROOM 75 CERAMIC FLOOR TILE BROWN 100%NON NONE GROUT FIBROUS DETECTED 21454-0075 FIRST FLOOR BATHROOM 76 VAPOR BARRIER PAPER TAN-SILVER 80%CELLULOSE 20%OTHER NONE UNDER SIDING DETECTED 21454-0076 77 VAPOR BARRIER PAPER TAN-SILVER 80%CELLULOSE 20%OTHER NONE UNDER SIDING DETECTED 21454-0077 78 VAPOR BARRIER PAPER TAN-SILVER 85%CELLULOSE 15%NON NONE UNDER SIDING FIBROUS DETECTED 21454-0078 79 COVE BASE BROWN 100%NON NONE KITCHEN FIBROUS DETECTED 21454-0079 Analyst(s)faid C'.&j& &d a eia4A John Coleman,Quality Control Earl R Clark,Lab Director Due to magnification limitations Inherent In PI M,asbestos fibers In dimensions below the resolution capaaly of PLM may not be detected. Samples reported as <t%or none detected may require additional testing by TEM to confirm asbestos quantities. The above test report relates only to the items tested and may be reproduced in any forth without the express written approval of Superior Industries I.I.C. Superior's liability Is limited to the cost of the analysis. Superior Industries bears no responsibility for sample collection activities or analytical methods limitations Interpretation and use of test results are the responsibility of the client samples received in good condition unless otherwise noted AIHA Lab No.187297 State of Connecticut Laboratory Registration Number PH-0129 Kebalo Electric Company Inc.-198 Smith Street, South Windsor,CT-20170124 Printed 1/30/201711:26 AM SUPERIOR INDUSTRIES L.L.C. AmPkim- CortmNttsd a.Glean en,*onment 342-CARTER LANE* 801 THINGTON. CT 06489 Attn: KF Realty 176 Wheeler Road South Windsor, CT 06074 Phone: Project Order#: 21454 Fax: Received Date: 1/17/2017 Project: 198 Smith Street, South Windsor, CT Analysis Date: 1/18/2017 Asbestos Analysis of Bulk Materials via EPA 6001R-931116 Method using Polarized Light Microscopy Non-Asbestos Asbestos Sample Description Appearance %Fibrous %Non-Fibrous %Type 80 COVE BASE BROWN 100%NON NONE KITCHEN FIBROUS DETECTED 21454-0080 81 ADHESIVE BROWN 100%.NON NONE ASSOCIATED WITH FIBROUS DETECTED 21454-0081 COVE BASE 82 ADHESIVE BROWN 100%NON NONE ASSOCIATED WITH FIBROUS DETECTED 21454-0082 COVE BASE Analyst(s)Eaxe My& &d✓2.CQag John Coleman,Quality Control Earl R Clark, Lab Director Due to magnification limitations inherent in PLM,asbestos fibers in dimensions below the resolution capacityar PI.M may not be detected. Samples reported as <1%or none detected may require additional testing by TEM to confirm asbestos quantities.The above test report relates only to the Hems tested and may be reproduced in any forth without the express written approval of Superior Industries L.L.C. Superior's liability Is limited to the cost of the analysis. Superior Industries bears no responsibility for sample collection activities or analytical methods limitations interpretation and use of test results are the responsibility of the client samples received in good condition unless otherwise noted.AIHA Lab No.187297 State of Connecticut Laboratory Registration Number PH-0129 Kebalo Electric Company Inc.-198 Smith Street, South Windsor,CT 20170124 Printed 1/30/201711:26 AM c � SUPERIOR L.L.C. Committed to a Clean Environment 342-CARTER LANE a SOUTHINGTON,CT 06489 QSF-09 rev E PLM Cover Sheet January 20,2015 CLIENT INFORMATION Client Name: I Contact: Client Address: ('j-C(,Jn`�Ln. Phone Number. City: Fax Number: State: ��� �i a Gr- Email Address: Zip: 0r,0-j'14 PROJECT INFORMATION Project Location i 9r,� 5,.1,. .Sl Client Job# Condition of Samples Date Collected Total Number of Samples Z_ Date Submitted [YAccepted(#: [ 1 Rejected(#: Date Required CHAIN OF CUSTODY CHECK BOXES BELOW AS APPR LATE EPA 600/R-93/118 PLM Bulk Analysis EPA Point Count PLM Gravimetric NYS 198.1 NIOSH 9002 3 Hours(Advance Notice Required) 6 Hours(Advance Notice Required) Same Day or 12 Hours(Must arrive by 1 Iam M-F Turnaround Time 24 Hours(1 Day) (S Day if gone selected) 48 Hours(2 Day) Based on standard work day of Monday to Friday; 72 Hours(3 Day) 8:00 AM to 5:00 PM. If results are required after hours or on weekends, please contact our office 96 Hours(4 Day) ahead of time for custom scheduling and pricing. 120 Hours(5 Day) Special Instructions Stop First Positive Analyze all Layers Superior Project Number: G Starting Number: Ending Number: S-.7 Total Samples: Relinquished by: �,. Date: Time: Received by: Date: � Time: Phone:860-620-1133 Email:Earl—Clark@Superior-Industries.net Fax:860-620-1134 r SUPERIOR INDUSTRIES L.L.C. CkKwitted lo a Clean Ernrhonment V 342-CARTER LINE•SOUTHINGTON,CT 06489 Field Collection Sheet e 1/ Client: Superior Job#: Address: safL� City: Date: Sample Material Quantity in Number see back Location Color Location l/ y 'X ,ram ,.r Vdv<z 1 fi r ST Ftsr•.- �i•�'L' `LX'��2'atts �G�- ?�•,SF'ism Rt a �S 6c.t�/•� L3.�c�5 e,✓ .t � / T !co✓�[ �'a /mac" r�tic,� Page_of Phone!I60-620.t 133 Email'Fad C1wk@Supo ior-Ioduar;moal Fa c I6P620-I134 4 SUPERIOR AV INDUSTRIES L.L.C. o�rr.,rin.a to,CWa,ErrAm,mint 342-CARTER LANE•SOUTHINGTON,CT 06469 QsFaa,e.c Ma a.w�s Field Collection Sheet Client: Superior Job#: Address: City: Date: Material Sample Location Color Quantity in Number see back Location y ssd +"Wz' Z� 7�G Tim t�• b �/ el L E'fhlt�u c r rrJ t+.goy... 01, sic La 3/ �, <lcc 'rtc L�-<- /ate ��,� �✓��G/� .....�c�•1� 9 �. Phone:M0420.1137 awl Earl CWkWu"d-4m&AS ies eel Fa�c f60.620-I I31 INDUSTRIE S S L.L.C. Cotrrnllied to■dean FtMm"ent 342-CARTER LANE•SOUTHINGTON,CT 06489 ArMe.A15 Q6F-N rn C Field Collection Sheet Client: Superior Job#: Address: City: Date: Sample Material Quantity in Number see back Location Color Location zee/ 3�v�:.� Gly,,w �.Ltcv sT �-"w-- /'�.k►oL �i-Ce..ii jSs- /�t.tll:5��5 '4—4-A S '7 1 C 15-r Page—of Flan:90420.1133 Fu:/60420-1134 AV NDUSTRIES L.L.C. 1;&Commlttad to a Glean EWmnment + 342•CARTER LANE•SOUTHINGTON,CT 00409 W-N—C ApN a,auis Field Collection Sheet Client: Superior Job#: Address: City: Date: Sample Material Quantity in Number see back Location Color Location e, / Y .�o Q.1-� f of=ClK }�j1-vcc3� �. Pa e of Piave 860-620-1 I33 Email:Earl Ct&tt@3upew-I*&atr=ea Fax:awi-e20.1134 a SUPERIOR INDUSTRIES L.L.C. IQ,; �� Comrtdttea to.dean E„virw,m«u 342-CARTER LANE•SOUTHINGTON.CT 06489 Appendix 2 Inspector Qualifications Phone: 860-620-1133 Email:Earl—Clark@Superior-Industries.net Fax: 860-620-1134 11 SUPERIOR INDUSTRIES L.L.C. 342-CARTER LANE-SOUTHINGTON,CT 06489 Superior Industries LLC Asbestos Qualifications To AMICAWZ FROMMON Up TRX Mwic Stumn COM"0 OWMA STATVI=OF dc"CM,Too ILUMO TEX X%AWXATMM r4-M-%"4TWKM 0K=.rWWtMpo*V Wn" SUPERIOR INDUSTRIF-S. LLC 1,4CATSX,AT C-wrter ftnthtoon.CT 06489 am pj,=rXMW m"nM XAIWV.Dy L---LC-I.rk Tfox CEWTtrSrA-m z aM=M TRE XAMt OF Ewi cl�k VMO HAS 92"L"tG"Tr�� NY�"M x8Cwr==ov*Sw'AvMoY=r'"Rx?TO Ba 3w CRAM"or"M 4rosrr WOM aT'4itea NY I eys C�Trrw-lkm Of AMOVAL AA FOL-LoW& 499MULMATMAUG 1=81400A F K; &gbratot Fiber*-PCM A.b.zt�in uWk-MM MIS MMMATC EXPII= 31,2017 x"19 v"OCkXL%rt*�CAMS RV lUr R7ATW 0"ARTIV�-'Of P"UC HKAL t 111111M XT RAITFO".CV*1AC-'%M-r-tM:8 21. DAr or 20-15 US,HPIT CaMr,MIROX)ONTALMAUTH STXTION Superior Industries Laboratory License Phone: 860-620-1133 Email: Earl—Clark@Superior-Industries.net Fax: 860-620-1134 12 SUPERIOR INDUSTRIES L.L.C. dw Conaniaod to a Clwn EnvYomn.nt 342-CARTER LANE-SOUTHINGTON,CT 06489 Superior Industries Inspectors' Licenses STATE OF CONNECTICUT, ,: anu:wxrorrwu�cwua. RAS VAfR to n n►llbv0»;•'s Q nqy G5t+6AAl iTATI.'Te7 or CONNSLT{LLT 11frASDWMtTWf-WTASA:. - _ASBESTOS CONSULTANT INSPIMGMT PLANNER CVVO Tt YO EARL R CLAW 000214 C{.AMTHROUT0 12131/17 - .. •VAOMTYJMIR '03.560427 , r Dora. otis. STATE OF CONNEMCUT:- .urAe►siwTosrcauc�auaa . w.awANr To T1i►RovLt�Y of nm OL?FR+Y.sT�tlm's a oorrtscrxur • THE MVX)UAL NA&M MOW 0 CBN WUW iY TM•06YAATMrMN A ASBESTOS CONSULTANT-INSPECTOR ==wATENO SMOH HOEY 0000l� CU UMTHROUCH 11/30/17 VAL MTMNO 03.560421 arse $TXM( C0N.l Z A•w, \.V• e- ` ti•,-•'S £.- '�4bRAq'iQN'tOfl4.i7JCQY.Yt�„r_t _ - ,�•YURMlANY7U1}E MbNtSiULgdYtl Ahl+rRASYtATVR!OiIMAaBCflC(1f :., : 3^ ;t�...itt MCIWRgA1.NA1AiDBItlAiv q'Cilt?6st7 ..1, . �' :��wf« _ •� T.TlYSt7rtARTli{'K AS A'. �'x- - "ASBEBfiO$CON&UJ.tAtgT-IySQECTQR — Ss{ .'.f.YI',':'r -.:•i - q.001NYATLNt3• AL1dti0CtM1C{t t4:s''ws r,. _ 000835 (�.N.s t'`Y;i i+•^. _ •4; 'YS'v_ u�1�y'�.;•!��•n-_ '.t "• f•-�t:flY O3.540032.5- _•s: Phone: 860-620-1133 Email:Earl—Clark@Superior-Industries.net Fax: 860-620-1134 13 p,1R Qli Mystic Air Quality Consultants, Inc. 1204 North Road, Groton, Connecticut 06340 6 www.nrysticaincotn ntagc2� 1987 ot.cont 800?r17-7746 C� �`� ULT P+� February 28,2017 Mr.Chris Maahs Environmental Group Inc. 18 Roberts Street Middletown,CT 06457 Re: Post Abatement Inspection Pre-Demolition Review 198 Smith Street South Windsor,CT Dear Mr.Maahs: On February 28'",2017,our asbestos abatement project monitor,Mark Trotochaud(monitor license#000351)completed visual inspection at the location above for fulfillment of criteria for inspection prior to demolition.This site review was for the purpose of determining whether the asbestos-containing materials sited in the asbestos inspection were completely removed in order to allow for demolition to go forward,with regard to asbestos issues. These services were rendered in full accordance with the State of Connecticut Department of Health Services Standards for Asbestos Abatement,as found in the Regulations for Connecticut State Agencies Section 19a-332a-I to 16. As required in section 19a-332a-12 the applicable post abatement procedures to ascertain satisfaction of re-occupancy criteria were performed. Specifically,a visual inspection of the containment work areas revealed no visible asbestos dust or debris residue apparent in the contained areas,as required by subsection 19a-332a-12(b). Subsequently,a round of aggressive clearance air samples was performed and analyzed by phase contrast microscopy at the site,in accordance with subsection 19a-332a-12(g).The analytical results of the clearance samples were all below the concentration of 0.010 fibers per cubic centimeter of air allowed to permit re-occupancy. ACM Materials At this time,all of the stipulated asbestos-containing materials are completely removed from the structure and property.There is no visible asbestos related dust or debris remaining from these materials in the building,as required by US EPA NESHAPS and the State of Connecticut regulations to allow demolition to proceed. Thank you for selecting Mystic Air Quality,Inc.for these services. Si ely, C pher J.Eident CIH,CSP,RS C O Mystic Air Quality is an AIHA-LAP, LLC Accredited Lab FAX.- 860 449 8860 tic��L Mysfic Air Quality Consultants, Inc. 1204 North Road, Groton Connecticut 0 a � 6340 1987 wlan.at}sticaircont magc2 a�aoLcotn 800 247--7746 Report of Inspection of Asbestos Removal, [ ] FI\AL Renovation,and/or Demolition Project [ ] INTERBI Date: D Site Location: J�j$' 5xh))-k dll- Building Identification: Containment Location: G 0 06mo [FINAL INSPECTION PASSED [ ] INSPECTION INDICATES MORE WORK TO BE DONE CHECKLIST: Residual Dust On: a.Floor YES NO YES NO b.Horizontal Surfaces _s� g.Ducts !, c.Pipes ✓ h.Register AZ d.Ventilation Equipment i.Lights e.Vertical Surfaces FIELD NOTES: rc l,,/� r lil�ti9� `t�✓P C d- ..�'� ( c-Ir/ -1 d�s� l�s.i[t�iti►. J Ft-AL AIR SA.NiPLE RESULTS: [ ] TEM—to be Anal)7ed [ PCM—Analyzed on Site Sample# <6•mv9 Sample # S Sample# 6-GOYS Sample # S .cpy Sample# 7 0-awl-- L\SPECTOR: 77CO-7ormAy? ENCLOSURE l PAGE ( OF 3 Mystic Air Quality is an AIIIA-LAP, LLCAccredited Lab FAX. 860 449 8860 A I It Qat s .MYSTIC AIR QUALITY CONSULTANTS TELECOMMUNICATIONS DmCe: - •°o fU tic~ 1204 North Road (Rt. 117), Groton, Connecticut 06340 Www.mysticair.com O4408003 Nights!L Weekends: as ee0 448 8003 FAX: 860-440-88e0 Toll Free: 1-800-247-7746 CLIENT: SITE LOCATION: l 9$ S rr►,•1h S� Sol�h 1/v'i��tc� PURPOSE FOR MONITORING: TEMPERATURE: ��� C'1e�r/n,)/e CONTAINMENT LOCATION: C � RELATIVE HUMIDITY: >20°k ACM MATERIAL ABATEQ: ------------ CASSETTE SIZE:25 FILTER AREA:380 MM2 ofe�r� ROTOMETER#: SAMPLED BY: ANALYSIS METHOD: PCM-NIOSH 7400 A-RULES MICROSCOPE FIELD AREA; 5'0.0N. 5 MICROSCOPE FACTOR:48.4 LOG SAMPLE SAMP TIME (minutes) PUMP SAMPLE ANAL- NUMBER NUMBER DATE SAMPLE LOCATION FLOW LAB FINAL VOLUME RESULTS RESULTS YST Start Slop Total ATE Liters Fibero/Fields Fibers/CC Print ITI Min Liters/Min Initials o `l1`1350`� I �•iss•n c�an�-5)'»)►•ttn�' SGy iG;} �y � j�dSf � � 7 1 �W .ua ys ►�? m 5ay 1033 �y a, l4� 06 "'o �0'00415 �R� 1H355 ?j a- -n cM44inYnM,� 9aY IG33 8 � 3 3 m 9 �3 1IS7 w �d coy YhR� oyl�/3 5 y a• 'n pan�-si»m m� �� -n 9oy /o33 67 1 a °6g �w Q,dot15 rJef yl'l356 S �� n 90Y la33 gf i3 11�7 c1o�I�.. Mk 6 7 -�$'17 BLANK(s) 2/sat min G C y3 5 ,/w /u 9 ��`d 19 REPLICATE SAMPLE# 3 OC DATA: Book �f f Page/O? Logged by:vW SIGNATURES: REMARKS: 19455EG Samples Collected B4!E Samples Analyzed B Calculation QC'd B Sam les received in ood condition Date of Sample AnalAIHA CERTIFICATION:100129 LebCertlfledTorCTendRI LOD 10fibers/100field Data Review: _ Mystic Air Quality Lab meets AHERA 40 CFR 763.80(I)(2)(II)requirements Replicate acceptable? Yes NO Reference sample within aceptable limits(2 SD)7 Yes i No c _ (If no repeat analysis) Data acceptable for release? Yes=No_•__ Lab Director Christopher Eldent.CIH CSP x��'�:, Mystic Air Quality Consultants, Inc. 1204 North Road, Groton, Connecticut 06340 np 1987 ivwruuryeticair com niagc2@.)aol.com 800 247-7746 860 449-8903 �SrulVr DAILY JOB LOG page: ( of Client7 Site Supervisor: 1,A 141 lxkv Site Location: l9g �-lh Containment Location:_ �,.2 GENERAL OBSERVATIONS: z fiAa c R%A4 t r / 6- QX �Ohnr�-lN Cc.C! DoJD�I i lam! �ih Gi»� n 1 �- � r �el�ui.�d mC� C �Ph.�,� l�,.x� �}� ! Ij, ►Lt1'�'j c,� ar�, �it� �t I�PYL(� �,olu �rng�vL t� cl,, _Pncd m W 0 n W HYGENIST'S HYGENIST'S TIME ON SITE: NAME: SIGNATURE: TIME OFF SITE: Mystic Air Quality is an AIHA-LA P, LL C A ccrcditcd Lab FAX- 860 449 8860 PERT R SU 0 INDUSTRIES L.L.C. K'inq. 342-CARTER LANE•SOUTHINGTON,CT 06469 February 16,2017 Project#21576 KF Realty LLC 175 Wheeler Road South Windsor,CT 06074 RE: 198 Smith Street,South Windsor,CT 06074 Dear Andy: At your request, on February 6, 2017, Simon Hoey (State of Connecticut Lead Inspector/Risk Assessor License 000146)visited the above referenced site and performed Toxicity Characteristic Leaching Procedure (TCLP) sampling of the house structure and detached shed at 198 Smith Street,South Windsor,CT. As we understand it,the structures will be demolished. Representative building components were collected and composited into one TCLP sample.This sample was submitted to Connecticut Testing Laboratories, Inc. in Meriden, Connecticut for subsequent TCLP analysis. Results indicate that the resulting demolition debris may be disposed of as regular C&D_debrit. (0.082 mg/L)' The EPA regulatory limit for lead demolition debris is 5.0 mg/L. Sincerely, Simon oey d Inspec r/Ri sessor#000146 Phone: 860-620-1133 Email:Earl—Clark@Superior-Industries.net Fax: 860-620-1134 February 15, 2017 Superior Industries, LLC 342 Carter Lane Southington, CT 06489 Attn: Mr.Simon Hoey Please find attached laboratory report(s)for the samples submitted on: February 08, 2017. All pertinent information for this analysis is located on the report. Should it be necessary to contact us regarding billing or the test results, please have the following information readily available: Lab No. 0217131 PO/Job No. KF REALTY S. WINDSOR Invoice No. 202256 Customer No. 1448 Please contact us if you have any questions. Very�y,yo?T Stephen JyFranco Laboratory Director PH-0547 connecticut STEPHEN J. FRANCO testing Laboratory Director PHONE 11203/634-3731 h laboratories ;,, . www.ctl-web.com WATER 13 SOIL 12 AIR 165 GRACEY AVENUE 13 MERIDEN, CT 1306451 Page 1 Date Samples Received:02/08/17 Client Name Superior Industries CTL Lab No. 0217131 Report Date 02/14/17 PO/Job No. KF Realty 198 Smith St. South Windsor RESULTS OF ANALYSIS TCLP EPA 1311 Matrix Type: S CTL Sample No.: 1607 Field ID: TCLP-1 Parameters RL Method No. Lead-m L 10.005 1 0.082 3111 B RL=Reporting Limit ND=Not Detected Matrix Type:W=Water/Aqueous S=Soil/Solid O=OiVHydrocarbon Connecticut Testing Laboratories,Inc. 165 Gracey Avenue/Meriden,CT 06451 (203)634-3731 (Fax)630-1336 Certification CT-PHO5471 MA-CT035 '1 CHAIN OF CUSTODY RECORD gab Lab Trackin #: V J Requested Analyses Client: aeGY�!/�GaG�•i���1�' , ProjecNPO# t Sampler(s): (signature) I Ouote ID /ilLa/V �7 (print) RSR Lab Use Field ID leaseprint) Date Time 0 of Bottles Criteria Notes Relinquished By:(Signature) Date / Time Received By:(Signature) Date I Time By Laboratory:(Sign lure) Dale--t Time Relinquished By:(Slgnature) Date / Time Received By:(Signature) Date I Time furn Around Time 24 HR'E] 3 Day E] 5 Day Relinquished By:(Signature) Date / Time Received By:(Signature) Date I Time 48 HR• 4 Day 10 Day 'Turnaround times less than'S Days"may be subject to priority fee charges. CTL YAH not be held liable for incorrectly filled out Chain of Custody Record: Samples held for 45 days from receipt. c Connecticut Testing Laboratories,Inc. 165 Grecay Ave./Meriden,CT 06451 Tel.(203y634-3731/Fax(203)630-1336 SUPERIOR INDUSTRIES L.L.C. commfa.a to a clean EnvkaranwA 342-CARTER LANE•SOUTHINGTON,CT 06489 ASBESTOS INSPECTION REPORT 198 Smith Street South Windsor, CT Prepared for: KF Realty 175 Wheeler Road South Windsor CT 06074 Prepared by: Superior Industries LLC 342 Carter Lane Southington,CT 06489 January 27,2017 Project#21454 Phone: 860-620-1133 Email:Earl—Clark@Superior-Industries.net Fax: 860-620-1134 1 r � SUPERIOR INDUSTRIES L.L.C. oa„dn.a m.cw■.I„wonm.�e 942-CARTER LANE•SOUTHINGTON,CT 00489 Table of Contents 1.0 Introduction 2.0 Asbestos Containing Material Inspection 2.1 Introduction 2.2 Asbestos Survey Results 3.0 Summary and Conclusion Appendices Appendix 1 Asbestos Sample Analyses, Laboratory Reports and Chains of Custody Appendix 2 Inspector Credentials Phone: 860-620-1133 Email:Earl—Clark@Superior-Industries.net Fax: 860-620-1134 2 w -.► .r SUPERIOR INDUSTRIES L.L.C. _ i Contlnitted b�Chen Envkorxn•nt V 342-CARTER LANE•SOUTHINGTON,CT 08482 1.0 Introduction On January 17, 2017 Superior Industries LLC's (Superior) Mr. Simon Hoey (License Number 000090) performed an assessment of suspect asbestos containing materials to be impacted by planned demolition of 198 Smith Street in South Windsor, CT. At the request of KF Realty LLC, a full pre-demolition survey was perfomed. If any additional materials are discovered that are not addressed in this survey, those materials shall be assumed to be asbestos containing, until proven otherwise by a licensed asbestos inspector. A licensed Connecticut Asbestos Contractor must remove any identified asbestos containing building materials. 2.0 Asbestos Containing Material Inspection 2.1 Introduction During the inspection, suspect ACM was separated into three United States Environmental Protection Agency (USEPA) categories. These categories are: thermal system insulation (TSI), surfacing ACM, and miscellaneous ACM. TSI includes all materials used to prevent heat loss or gain or water condensation on mechanical systems. Examples of TSI are pipe insulation, boiler insulation, duct insulation, and mudded insulation on pipefittings. Surfacing ACM includes all ACM that is sprayed, trowelled, or otherwise applied to an existing surface. Surfacing ACM is commonly used for fireproofing, decorative, and acoustical applications. Miscellaneous materials include all ACM not listed in thermal or surfacing, such as linoleum, vinyl asbestos flooring, and ceiling tiles. Superior seeks to sample all suspect ACM. Polarized Light Microscopy (PLM) is initially utilized to analyze materials that are sampled. If a suspect ACM is not sampled, it is assumed to contain asbestos. Finally, all ACM is quantified in linear or square footage, depending on the nature of the material. 2.2 Results Utilizing the USEPA protocol and criteria, materials determined to be ACM are listed in Table 1 •Asbestos Containing Materialsw including their location and estimated quantities. Table II 'Laboratory Results' contains all'materials sampled at the site. Table I-Asbestos Containing Materials Location a Material Quantity Various Locations within Wall Chases Duct Insulation Paper 40 ft2 Second Floor Flex Connector —2 ft2 Basement Chimney Flue Cement --2 ft2 First Floor Rear Entry Red-Black Linoleum(Bottom Layer -�20 ft2 Phone: 860-620-1133 Email:Earl—Clark@Superior-Industries.net Fax: 860-620-1134 3 AAAkd SUPERIOR INDUSTRIES L.L.C. qp==to x Cason mnvkonrrwk 342 CARTER LANE e SOUTHINGTON.CT 06489 Materials' "%i�j.-tTablel�;AsEestcis Containin Location; -material": First Floor Rear Wash Room Green Stone Linoleum Back Splash -15 fe Flower Pattern Linoleum (Bottom -15 fe First Floor Rear Wash Room Laver) Appendix 1, *Asbestos Sample Analyses and Chains of Custody," provides a list of suspect materials, both ACM and non-ACM, and also the laboratory reports and the chains of Custody. Quantities are supplied as an estimate for guidance only. No abatement cost estimates or abatement notifications should be made using these quantities. Abatement contractors conducting abatement must verify all quantities In field. Utilizing the USEPA criteria,the following is a summary of all sampling conducted at the site: Table 11 Laboratory Results Non-Asbestos Asbestos Sample Description Appearance % Fibrous % Non- %Type Fibrous 1 PLASTER GREY 6% 94%OTHER NONE DETECTED FIRST FLOOR CELLULOSE 21454-0001 KITCHEN NONE DETECTED 2 PLASTER GREY 0921/6 OTHER REAR STAIRS CELLULOSE 2145"002 3 PLASTER GREY 6% 94%OTHER NONE DETECTED SECOND FLOOR CELLULOSE 21454-0003 91%OTHER 4 PLASTER GREY 9% NONE DETECTED SECOND FLOOR CELLULOSE 21454-0004 NONE DETECTED 5 12X12 CEIILNG BROWN 65% 35%OTHER TILES CELLULOSE 21454-0005 FIRST FLOOR -NONE DETECTED 6 12X12 CEILING BROWN 70% 30%OTHER TILES CELLULOSE 21454-0006 FIRST FLOOR 7 12X12 CEILING BROWN 65% 35%OTHER NONE DETECTED TILES CELLULOSE 21454-0007 FIRST FLOOR 8 DUCT PAPER WHITE 600%OTHER 40%CHRYSOTILE 21454-=8 9 PANELS TAN 75% 25%OUTHER NONE DETECTED SECOND FLOOR CELLULOSE 21454-0009 10 PANELS TAN 70% 30%OTHER NONE DETECTED SECOND FLOOR CELLULOSE 21454-0010 11 PANELS TAN 75% 25%OTHER NONE DETECTED SECOND FLOOR CELLULOSE 21454-0011 Phone: 860-620-1133 Email:Earl-Clark@Superior-Industries.net Fax: 860-620-1134 4 � -s. AAAid SUPERIOR INDUSTRIES L.L.C. CommNted M a Clean Emlydvnent 342-CARTER LANE•SOUTHINGTON,CT 05489 i Non-Asbestos Asbestos Sample Description Appearance % Fibrous % Non- %Type Fibrous 12 FLEX CONNECTOR WHITE 30%OTHER 10%AMOSITE SECOND FLOOR 60%CHRYSOTILE 21454-0012 13 PLASTER GREY 9% 91%OTHER NONE DETECTED BASEMENT AT CELLULOSE 21454-0013 CHIMNEY 14 CHIMNEY FLUE LIGHT GREY 70%OTHER 30%CHRYSOTILE CEMENT 21454-0014 BASEMENTAT CHIMNEY 15 TEXUTED CEILING WHITE SAND 100%NON NONE DETECTED FIRST FLOOR FIBROUS 21454-0015 KITCHEN 16 TEXTURED CEILING WHITE SAND 100%NON NONE DETECTED BASEMENT RIGHT FIBROUS 21454-0016 ROOM 17 TEXTURED CEILING WHITE SAND 100%NON NONE DETECTED FIRST FLOOR FIBROUS 21454-0017 BATHROOM 18 SHEETROCK TAN-WHTIE 9% 91%OTHER NONE DETECTED FIRST FLOOR CELLULOSE 21454-0018 KITCHEN CEILING 19 SHEETROCK TAN-WHITE 9% 91%OTHER NONE DETECTED BASEMENT RIGHT CELLULOSE 21454-0019 ROOM 20 SHEETROCK TAN-WHITE 7% 93%OTHER NONE DETECTED BASEMENT RIGHT CELLULOSE 21454-0020 ROOM 21 JOINT COMPOUND WHITE 100%NON NONE DETECTED SECOND FLOOR FIBROUS 21454-0021 RIGHT BEDROOM 22 JOINT COMPOUND WHITE 100%NON NONE DETECTED BASEMENT RIGHT FIBROUS 21454-0022 ROOM 23 JOINT COMPOUND WHITE 100%NON NONE DETECTED BASEMENT RIGHT FIBROUS 21454-0023 ROOM 24 FIBERGLASS BLACK 75% 25%OTHER NONE DETECTED BACKING(TAR CELLULOSE 21454-0024 PAPER) WALLS AND CEILINGS 25 FIBERGLASS BLACK 70% 30%OTHER NONE DETECTED BACKING(TAR CELLULOSE 21454-0025 PAPER) WALLS AND CEILINGS 26 FIBERGLASS BLACK 70% 30%OTHER NONE DETECTED BACKING(TAR CELLULOSE 21454-0026 PAPER) WALLS AND CEILINGS 27 WINDOW GLAZE OFF WHITE 100%NON NONE DETECTED BASEMENT FIBROUS 21454-0027 28 WINDOW GLAZE OFF WHITE 100%NON NONE DETECTED FIRST FLOOR FIBROUS 21454-0028 Phone: 860-620-1133 Email:Earl Clark@Superior-Industries.nct Fax: 860-620-1134 5 i SUPERIOR INDUSTRIES L.L.C. ,= ComrMKed b s Clean EnNronment 342-CARTER LANE•SOUTHINGTON,CT 08489 Non-Asbestos Asbestos Sample Description Appearance % Fibrous % Non- %Type Fibrous 29 WINDOW GLAZE OFF WHITE 100%NON NONE DETECTED SECOND FLOOR FIBROUS 21454-0029 30 CERAMIC WALL BROWN 100%NON NONE DETECTED TILE ADHESIVE FIBROUS 21454-0030 FIRST FLOOR BATHROOM 31 CERAMIC WALL BROWN 100%.NON NONE DETECTED TILE ADHESIVE FIBROUS 21454-0031 FIRST FLOOR BATHROOM 32 CERAMIC WALL WHITE 100%NON NONE DETECTED TILE GROUT FIBROUS 21454-0032 FIRST FLOOR BATHROOM 33 CERAMIC WALL WHITE 100%NON NONE DETECTED TILE GROUT FIBROUS 21454-0033 FIRST FLOOR BATHROOM 34 LINOLEUM RED-WHITE 12% 88%OTHER NONE DETECTED SECOND FLOOR CELLULOSE 21454-0034 FRONT RIGHT BEDROOM CLOSET 35 LINOLEUM RED-WHITE 14% 86%OTHER NONE DETECTED SECOND FLOOR CELLULOSE 21454-0035 FRONT RIGHT BEDROOM CLOSET 36 LINOLEUM GREEN-WHITE- 11% 89%OTHER NONE DETECTED SECOND FLOOR YELLOW CELLULOSE 21454-0036 FRONT RIGHT BEDROOM 37 LINOLEUM GREEN-WHITE- 13% 87%OTHER NONE DETECTED SECOND FLOOR YELLOW CELLULOSE 21454-0037 FRONT RIGHT BEDROOM 38 LINOLEUM LIGHT BLUE- 12%. 88%OTHER NONE DETECTED SECOND FLOOR BLACK CELLULOSE 21454-0038 LEFT BEDROOM 39 LINOLEUM LIGHT BLUE- 13% 87%OTHER NONE DETECTED SECOND FLOOR BLACK CELLULOSE 21454-0039 LEFT BEDROOM 40 LINOLEUM RED-WHITE- 11% 89%OTHER NONE DETECTED SECOND FLOOR GREEN CELLULOSE 21454-0040 ROOM AT STAIRS 41 LINOLEUM RED-WHITE- 12% 88%OTHER NONE DETECTED SECOND FLOOR GREEN CELLULOSE 21454-0041 ROOM AT STAIRS 42 LINOLEUM RED-BLACK 91%OTHER 9%CHRYSOTILE FIRST FLOOR REAR 21454-0042 ENTRY 43 LINOLEUM RED-BLACK STOP POSITIVE (NOT ANALYZED) 21454-0043 44 LINOLEUM ORANGE STONE 11% 89%OTHER NONE DETECTED FIRST FLOOR REAR CELLULOSE 21454-0044 ENTRY Phone: 860-620-1133 Email:Earl—Clark@Superior-Industries.net Fax: 860-620-1134 6 SUPERIOR INDUSTRIES L.L.C. - 342-CARTER LANE-SOUTHINGTON,CT 06489 Non-Asbestos Asbestos Sample Description Appearance % Fibrous %Non- %Type Fibrous 45 LINOLEUM ORANGE STONE 13% 87%OTHER NONE DETECTED FIRST FLOOR REAR CELLULOSE 21454-0045 ENTRY 46 LINOLEUM GREEN STONE 89%OTHER 11%CHRYSOTILE FIRST FLOOR REAR 21454-0046 WASH ROOM- BACK SPLASH 47 LINOLEUM GREEN STONE STOP POSITIVE (NOT ANALYZED) 21454-0047 48 LINOLEUM TAN-BROWN 9% 91%OTHER NONE DETECTED FIRST FLOOR REAR CELLULOSE 21454-0048 WASHROOM-TOP LAYER 49 LINOLEUM TAN-BROWN 11% 89%OTHER NONE DETECTED FIRST FLOOR REAR CELLULOSE 21454-0049 WASHROOM-TOP LAYER 50 LINOLEUM FLOWER PATTERN 93%OTHER 7%CHRYSOTILE FIRST FLOOR REAR 21454-0050 WASHROOM- BOTTOM LAYER 51 LINOLEUM FLOWER PATTERN STOP POSITIVE (NOT ANALYZED) 21454-0051 52 LINOLEUM BROWN BRICK 12% 88%OTHER NONE DETECTED FIRST FLOOR REAR PATTERN CELLULOSE 21454-0052 WASH ROOM 53 LINOLEUM BROWN BRICK 14% 86%OTHER NONE DETECTED FIRST FLOOR REAR PATTERN CELLULOSE 21454-0053 WASHROOM 54 LINOLEUM TAN SQUARE 16% 84%NOW NONE DETECTED FIRST FLOOR PATTERN CELLULOSE FIBROUS 21454-0054 KITCHEN-TOP LAYER 55 LINOLEUM TAN SQUARE 18% 82%OTHER NONE DETECTED FIRST FLOOR PATTERN CELLULOSE 21454-0055 KITCHEN-TOP LAYER 56 LINOLEUM RED-BLACK 11% 89%OTHER NONE DETECTED FIRST FLOOR CELLULOSE 21454-0056 KITCHEN-BOTTOM LAYER 57 LINOLEUM RED-BLACK 9% 91%OTHER NONE DETECTED FIRST FLOOR CELLULOSE 21454-0057 KITCHEN-BOTTOM LAYER 58 LINOLEUM RED-GREEN 13% 87%OTHER NONE DETECTED FIRST FLOOR REAR CELLULOSE 21454-0058 SMALL HALL 59 LINOLEUM RED-GREEN 11% 89%OTHER NONE DETECTED FIRST FLOOR REAR CELLULOSE 21454-0059 SMALL HALL 60 ROOF SHINGLES GREEN STONE 19% 81%OTHER NONE DETECTED TOP LAYER CELLULOSE 21454-0060 Phone: 860-620-1133 Email:Earl—Clark@Superior-Industries.net Fax: 860-620-1134 7 Y � III I SUPERIOR INDUSTRIES L.L.C.�*wt, r CortMnNied b a Clan Ern4onment 342-CARTER LANE-SOUTHINGTON.CT 06480 Non-Asbestos Asbestos Sample Description Appearance % Fibrous % Non- %Type Fibrous 61 ROOF SHINGLES GREEN STONE 17%. 81%.OTHER NONE DETECTED TOP LAYER CELLULOSE 21454-0061 62 ROOF SHINGLES GREEN STONE 19% 81%OTHER NONE DETECTED TOP LAYER CELLULOSE 21454-0062 63 ROOF SHINGLES BLACK STONE 17%. 83%.OTHER NONE DETECTED BOTTOM LAYER CELLULOSE 21454-0063 64 ROOF SHINGLES BLACK STONE 19% 81%OTHER NONE DETECTED BOTTOM LAYER CELLULOSE 21454-0064 65 ROOF SHINGLES BLACK STONE 19% 81%OTHER NONE DETECTED BOTTOM LAYER CELLULOSE 21454-0065 66 TAR PAPER BLACK 78% 22%OTHER NONE DETECTED ROOFS CELLULOSE 21454-0066 67 TAR PAPER BLACK 75% 25%OTHER NONE DETECTED ROOF CELLULOSE 21454-0067 68 TAR PAPER BLACK 78% 22%OTHER NONE DETECTED ROOF CELLULOSE 21454-0068 69 WINDOW CAULK OFF WHITE 100%NON NONE DETECTED FIBROUS 21454-0069 70 WINDOW CAULK OFF WHITE 100%NON NONE DETECTED FIBROUS 21454-0070 71 WINDOW CAULK OFF WHITE 100%NON NONE DETECTED FIBROUS 21454-0071 72 CERAMIC FLOOR BEIGE 100%NON NONE DETECTED TILE ADHESIVE FIBROUS 21454-0072 FIRST FLOOR BATHROOM 73 CERAMIC FLOOR BEIGE 100%NON NONE DETECTED TILE ADHESIVE FIBROUS 21454-0073 FIRST FLOOR BATHROOM 74 CERAMIC FLOOR BEIGE 100%NON NONE DETECTED TILE ADHESIVE FIBROUS 21454-0074 FIRST FLOOR BATHROOM 75 CERAMIC FLOOR BROWN 100%NON NONE DETECTED TILE GROUT FIBROUS 21454-0075 FIRST FLOOR BATHROOM 76 VAPOR BARRIER TAN-SILVER 80% 201/9 OTHER NONE DETECTED PAPER CELLULOSE 21454-0076 UNDER SIDING 77 VAPOR BARRIER TAN-SILVER 80% 20%OTHER NONE DETECTED PAPER CELLULOSE 21454-0077 UNDER SIDING 78 VAPOR BARRIER TAN-SILVER 85% 15%NON NONE DETECTED PAPER CELLULOSE FIBROUS 21454-0078 UNDER SIDING Phone: 860-620-1133 Email:Earl—Clark@Superior-Industries.net Fax: 860-620-1134 8 SUPERIOR 010 INDUSTRIES L.L.C. +- .•. Conwntttad to a clean Envkanment 342-CARTER LANE•SOUTHINGTON.CT 06489 Non-Asbestos Asbestos Sample Description Appearance % Fibrous % Non- %Type Fibrous 79 COVE BASE BROWN 100%NON NONE DETECTED KITCHEN FIBROUS 21454-0079 80 COVE BASE BROWN 100%NON NONE DETECTED KITCHEN FIBROUS 21454-0080 81 ADHESIVE BROWN 100%NON NONE DETECTED ASSOCIATED WITH FIBROUS 21454-0081 COVE BASE 82 ADHESIVE BROWN 100%NON NONE DETECTED ASSOCIATED WITH FIBROUS 21454-0082 COVE BASE 3.0 Summary and Conclusion Asbestos was detected in some materials. These materials must be abated by an asbestos abatement contractor licensed in the State of Connecticut prior to demolition. If materials not addressed by this report are identified during demolition, those materials must either be presumed to contain asbestos or be assessed by a licensed Asbestos Inspector. Phone: 860-620-1133 Email:Earl—Clark@Superior-Industries.net Fax: 860-620-1134 9 AAAW SUPERIOR INDUSTRIES L.L.C. ' 77 a ' ' c«nnrnw+o.p..n Fsv4onmanc V 342-CARTER LANE•SOUTHINGTON,CT 06489 Appendix 1 Asbestos Sample Analyses,Laboratory Reports and Chains of Custody Phone: 860-620-1133 Email:Earl_Clark@Superior-Industries.net Fax: 860-620-1134 10 KEBAL-1 OP ID:CS CERTIFICATE OF LIABILITY INSURANCE °A03/16/TE °017 03/16/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s) PRODUCER CONTACT Bouvier Insurance NAME: 29 North Main Street PAH1 N .860-623-8207NE Ac N,:860-623-0815 West Hartford,CT 06107 EMAIL Central Valley ADDRESS: INSURERS AFFORDING COVERAGE NAIC i INSURER A:Selective Ins Co of South INSURED Kebalo Electric Co Inc INSURER 8:Progressive Insurance 42919 175 Wheeler Rd South Windsor,CT 06074 INSURERC: INSURER D: INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MMID MMIDDIYYY GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY S2139451 01/01/2017 01/01/2018 P REMISES Ea occurrence $ 500,00 CUUMSMADE a OCCUR MED EXP(Any one person) $ 15,00 PERSONAL R ADV INJURY S 1,000,00 GENERAL AGGREGATE S 3,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG S 3,000,00 POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,00 Ea aCCiderd A X ANY AUTO S2139451 01101/2017 01/01/2018 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE S AUTOS PER ACCIDENT) $ X UMBRELLA LLAS X OCCUR EACH OCCURRENCE $ 5,000,00 A EXCESS LIAB CLAIMS-MADE S2139451 01/01/2017 01/01/2018 AGGREGATE $ 5,000,00 DED I X I RETENTION 0 $ WORKERS COMPENSATION X V R ST M LL OTH- AND EMPLOYERS'LIABILITYI ER A ANY PROPRIETOPJPARTNERIEXECUTNE Y/N C9008341 01/0112017 01/01/2018 E.L EACH ACCIDENT $ 1,000,00 OFFICERIMEMBER EXCLUDED? N I A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEd$ 1,000,00 H yes describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT I S 1,000,00 B Commercial Auto 03012292-2 04/1712016 04/17/2017 Liability 2,000,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101.Additional Remarks Schedule,N more space Is required) Evidence of Insurance CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of South Windsor THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 1540 Sullivan Ave South Windsor,CT 06074 AUTHORIZED REPRESENTATIVE C O 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD Kebalo Electric Company, Inc. 175 Wheeler Road • South Windsor, CT 06074 860-644-5124 • FAX 860-644-2577 1 S State Lie. No. 104943 In accordance with Connecticut General Statute§ 29-406,we Kebalo Contractors, Inc., d/b/a Kebalo Electric Company, Inc. hereby agree to save harmless the Town of South Windsor and its agents from any claim or claims arising out of the negligence of the applicant or his agents or employees in the course of the demolition operations associated with 198 Smith Street, South Windsor, CT 06074. Andy Kebalo 0 Y (1YI r � � . K i ^5` 71. Ll C!_ _ . 5 ro 4 i - J t 4 4C/ O �l ' // ♦ !!�� ,T ~h - a . t'. ►�� �., 14 end _ . roc O _c CONTOUR LINES i s 4 TOWN LINE - r - •- ;•<;- .�" _ PARCELS _ \ Y _ 37 <•� ,. - t , i ;, '6' .M • k �- _ BROOKS, RIVERS, ETC. S _ -.r. South Winds ingnt performeu in spring of 2007 1 nis map is a giapliwal Gi representation of property information and is subject to change. ` 1 inch 6 0 feetSmith The Town of South Windsor and SBC assume no legal responsibility 19 8 S m i t h S for orr nfor action depicted on this map and is to be used for planning N �ZIP NM 1 M I � I /I i N� 2 C9 01) SMITH 04 � ) 1 inch = 80 feet 198 Smith St floodplain soils LINE6Q 02. 02. ) r 99. ,r n .< 3 R \ f r • I .6 � a 02. 02. j .�� 99. 9 �� M � •r l �ca R. �a J l an . . . . . Milo d? c9 1 1 0 o .4 . I 2 Cq 01) � 44J 1 V 4Cr) SMITH JR .�04 inch 80 feet floodplain soils �-�4,�-d.���.��m..���=off� •� 198 Smith St ,_.� . =.d,m_.�.N ��� 1 010 ' o1ow� WME lzr m ' 1 .• M I 1 I I % I I I I I 1 I i er' payCR CP T VTR floodphin soils 1 inch = 80 feet 198 Smith St � � � 8131/22,8 50 AM Town of South Windsor Building Department RESIDENTIAL CERTIFICATE OF OCCUPANCY Building Permit: BLDP-21 -645 kid soQ i�c APPLICANT LOCATION NAME:Walter Kebalo ADDRESS: 198 SMITH ST South Windsor CT 6074 EMAIL ADDRESS:w@kebalo.com OWNER:REDDY MADHU ADDRESS: 175 WHEELER RD 5-Oct ARTHUR DRIVE SOUTH WINDSOR,CT 06074 SOUTH WINDSOR CT 6074 DESCRIPTION OF WORK: CONSTRUCT A NEW SINGLE FAMILY HOME(PERMIT APPROVED ON 7/10/2020 VIA MUNIS PERMIT 202000968) CONSTRUCTION TYPE: This is to certify that 198 SMITH ST under permit number BLDP-21-645 conforms substantially to the requirements of the Connecticut State Building Code and the zoning regulations of the Town of South Windsor and is hereby approved of occupancy as indicated above. 41L/ w &1,/ June 13, 2022 BUILDING OFFICIAL DATE SIGNED —ALL WORK TO BE DONE IN ACCORDANCE WITH THE APPLICATION AND PLANS APPROVED BY THE BUILDING DEPARTMENT- -PERMIT ONLY VALID IF SIGNED BY BUILDING OFFICIAL— 1/1 SITE COMPLIANCE CHECKLIST TOWN OF SOUTH WINDSOR,CONNECTICUT *****FOR C OF O***** ADDRESS II �"1 LOT_/UN71 Reviewed by Lp / (Engineering) CONTACT/DEv �� Date Reviewed S/2441pied pro PH# 4SLoO Reviewed by 5'�-Y)-2(Planning) Date Submitted Date Reviewed 600rovedlienled Date Reviewed Approved/Denied(Health) As required in the Zoning and/or Subdivision Regulations,no Certificate of Occupancy shall be issued until grading plans have been complied with and approved by the Town Engineer. The minimum requirements shall include: Approved Denied N/A 1. Approved building permit plan' Finish.—� grading P 2 eraPP roved 9 building permit plan 3. Site work;i.e.trees,shrubs, dumpsters,required parking 4. Utility location; a. sanitary sewer/septic systems b. foundation drain f C. electrical&telephone d. water e. oi#Wz 64-5 5. Sewer connection charge paid 6. Appropriate certification 7. Bonding 8: Planning&Zoning/ Inland Wetlands Considerations lll!ll��� a. Lighting b. Signage Freestanding Wall C. Fee in lieu of Open Space COMMENTS: 4 d& s/engineering/molloy/site compliance cheddist SURVEY NOTES J 1. THIS SURVEY AND MAP HAVE BEEN PREPARED PURSUANT TO THE REGULATIONS OF CONNECTICUT STATE AGENCIES SECTIONS 20-30OB-1 THROUGH 2O-30OB-20 AND THE "STANDARDS FOR SURVEYS AND MAPS IN THE STATE OF CONNECTICUT" AS ADOPTED BY THE CONNECTICUT ASSOCIATION OF LAND SURVEYORS, INC. ON SEPTEMBER 26, 1996. THE SURVEY WAS PERFORMED TO THE STANDARDS OF ACCURACY FOR A HORIZONTAL CLASS A-2 BOUNDARY SURVEY MI rH STREET 00 0 TOPOGRAPHIC ACCURACY CONFORMS WITH T-2 STANDARDS AND IS BASED ON AN ACTUAL FIELD Q �� SITE SURVEY z THIS IS A PROPERTY SURVEY WITH A BOUNDARY DETERMINATION CATEGORY AS FOLLOWS: o DEPENDENT RESURVEY OF MAP REFERENCE #1. SITE 2. THE INTENT OF THIS SURVEY AND PLAN: DOCUMENT SITE IMPROVEMENTS FOR ZONING COMPLIANCE. U 3. THE FIELD SURVEY WAS PERFORMED ON THE GROUND BY BSC GROUP JANUARY 06, 2022 Rory 4. THE VERTICAL DATUM SHOWN IS BASED UPON NORTH AMERICAN VERTICAL DATUM OF 1988 (NAVD88), THE REFERENCE MERIDIAN (NORTH ARROW) SHOWN IS BASED UPON NORTH AMERICAN DATUM OF 1983 (NAD83), BOTH HORIZONTAL AND VERTICAL DATUMS ARE DETERMINED FROMLOCATION PLAN 1" = 1000' RTK/G.P.S. TO MY KNOWLEDGE AND BELIEF, THIS MAP IS SUBSTANTIALLY 5. EXISTING UTILITIES, WHERE SHOWN HEREON, ARE APPROXIMATE. NO GUARANTEE IS IMPLIED OR INTENDED AS TO THE ACCURACY, LOCATION OR THAT ALL UTILITIES AND/OR SUBSURFACE CORRECT STRUCTURES ARE SHOWN. CONSULT WITH THE APPROPRIATE UTILITY COMPANY OR AGENCY PRIOR C CONTAINS THE LIVE SIGNATURE AND EMBOSSED SEAL AS NOTED HERON. THIS SURVEY IS NOT VALID UNLESS TO DESIGNING IMPROVEMENTS, COMMENCING DEMOLITION OR CONSTRUCTION. "CALL BEFORE YOU CONTAINED HERON. SUBSEQUENT REVISIONS EC THIS PLAN OTHER THAN BY THE ORIGINAL SURVEYOR EFFECTUALLY VOID THIS CERTIFICATION. DIG" 1-800-922-4455. `oe�ttt n urn°0° C. MAP REFERENCE / N/F R.B. W/CAP 1. "PROPOSED LOT DIVISION PLAN K F REALTY LLC 198 SMITH STREET SOUTH WINDSOR CONNECTICUT MADHU REDDY _ MARCH 6, 2017" DATE REVISED TO: 5/18/01, SCALE: 1"=30'. PREPARED BY BSC GROUP VOL 2878 /' PG. 302 2. "PROPOSED SITE PLAN LOT 2 K F REALTY LLC 198 SMITH STREET SOUTH WINDSOR CONNECTICUT 190 SMITH STREET '�- �� �NO i7<d7zl JUNE 8, 2020" SCALE: 1"=20'. PREPARED BY BSC GROUP. 17-3-1 ��9il,C �CENSE� � BENCHMARK CI o� lRrvt� Lo Mog Nail in root of 24" Maple M EL = 109.91' 1 i MICHAEL HEALEY F P.L.S. #17247 Footing Drain R.B. SET 136.30' INV=100.93� N89'11'51"W R.B. SET i i o ZONING LOCATION PLAN 3 N F ^� MADHU REDDY +102.5 o f' � AS-BUILT / VOL. 2750 / PG. 244 102- / 198 SMITH STREET 17-3 ' N/F /, O MAMATA AGARWAL +103.1 VOL 2551 / PG. 118 AREA = 30,005f SQ.F LOT 2 T. 188 WHEELER ROAD / / / (0.689 ACRES) +103.1 17-2-5 � / 50 Setback LineExisting 20' Wide Sanitary Sewer Easement K F REALTY LLC n T in favor of Lot 2 (#198 Smith Street) / N/F per Map Ref #1 / / / o SCOTT & BEVERLY A. ANTOSIK 198 SMITH STREET Gross VOL. 897 / PG. 39 l l +105.0 +104.7 216 SMITH STREET SOUTH WINDSOR ' 17-4 dine of1ase +104., CONNECTICUT "gent a 1 �0 ) 6 �I \ineofEa Conc. G �J-'-Gas .'deier m � 3 / S ^� Mi Gross BENCHMARK / / / �Elec Meter Gra v M Top of Existing San. MH / WO2 STORYOD FRAME 10a/ I co MARCH 24, 2022 EL = 113.35' / \/ l Conc. / Existing I N/F - Residence SMITH'S CORNER oo ` FF =114.65 CONDOMINIUM ASSOCIATION ' �� 112 18 TCwr - 1�Z / 0 11 II 178-182 SMITH STREET l cV FBF -104.8f 53.2'f f l 113.16 +112 31 lo L + 12 1 .47 , Conc. REVISIONS: Porch 50' Setback Line 114.7 / 112.53 ' _-_ - N0. DATE DESC. Bit. Driveway Conc. �� •� _ 112.64 ' -, 44 l / / 112.26 Walk +112.1 , / +112.2 2 MAPLE / \ 112.5 orn to Grass +113.7 +113.4 LEGEND &ABBREVIATIONS - - - --- ® IRON PIN (I.PIPE) M.N. O IRON ROD (R.B.) I.PIPEO_ 26.1 ' SET _ MAG NAIL (M.N.) E ' ' " .......... �� LPIPE UTILITY POLE 117.97 h - °D N875720W -_ - ) "� 175.36' (Lot 2) O 117.96 117. ELECTRIC MANHOLE 8+1 - Stump �S SEWER MANHOLE Mon. Not _ ®_ WATER SHUTOFF Found all: EDGE OF PAVEMENT Q WATER GATE VALVE © GAS GATE VALVE (GG) PREPARED FOR: _>>8 S M T o ELECTRIC METER H S To KF REALTY LLC e GAS METER I�o}I HYDRANT (HYD) 17 J VVriEELER RVAU -W w w \` EDGE OF PAVEMENT N/F NOW OR FORMERLY SOUTH WINDSOR, CT 06074 SNET #1411� R.B. REBAR (860) 883-1391 CONC CONCRETE BIT BITUMINOUS FF FINISHED FLOOR (ELEVATION) TFW TOP OF FOUNDATION WALL (ELEVATION) BSCO V FBF FINISHED BASEMENT FLOOR (ELEVATION) TC Tnm nC C7oA,a- ,C /ATI IKI, 655 Winding Brook Drive IF IVC VF Fr\MIVIG �GLG V/111 VIVf `' INV INVERT (ELEVATION) Glastonbury, Connecticut ELEC ELECTRIC 06033 SAN SANITARY SEWER 860 652 8227 G - ELECTRIC LINE G-- NATURAL GAS LINE © 2022 BSC Group, Inc. W- - WATER LINE SCALE: 1" = 20' D - STORM DRAINAGE LINE -S - SANITARY SEWER LINE 0 10 20 40 Fmr PROPERTY BOUNDARY - - -- ABUTTER PROPERTY BOUNDARY FILE: P:\8364501\SURVEY\DRAWINGS - EASEMENT DWG.: 8364501_L2_AB.DWG JOB. NO: 83645.01 SHEET 1 OF 1 �� ass SURVEY NOTES J� 1. THIS SURVEY AND MAP HAVE BEEN PREPARED PURSUANT TO THE REGULATIONS OF CONNECTICUT STATE AGENCIES SECTIONS 20-3008-1 THROUGH 2O-30OB-20 AND THE "STANDARDS FOR SURVEYS AND MAPS IN THE STATE OF CONNECTICUT" AS ADOPTED BY THE CONNECTICUT ASSOCIATION OF LAND SURVEYORS, INC. ON SEPTEMBER 26, 1996. THE SURVEY WAS PERFORMED TO THE STANDARDS OF ACCURACY FOR A HORIZONTAL CLASS A-2 BOUNDARY SURVEY STREET 00 TOPOGRAPHIC ACCURACY CONFORMS WITH T-2 STANDARDS AND IS BASED ON AN ACTUAL FIELD ¢ °� SITE SURVEY z THIS IS A PROPERTY SURVEY WITH A BOUNDARY DETERMINATION CATEGORY AS FOLLOWS: o N DEPENDENT RESURVEY OF MAP REFERENCE #1. SITE 2. THE INTENT OF THIS SURVEY AND PLAN: DOCUMENT SITE IMPROVEMENTS FOR ZONING Z4 $ / COMPLIANCE. v �` 3. THE FIELD SURVEY WAS PERFORMED ON THE GROUND BY BSC GROUP JANUARY 06, 2022 Ro^° 4. THE VERTICAL DATUM SHOWN IS BASED UPON NORTH AMERICAN VERTICAL DATUM OF 1988 (NAVD88), THE REFERENCE MERIDIAN (NORTH ARROW) SHOWN IS BASED UPON NORTH AMERICAN DATUM OF 1983 (NAD83), BOTH HORIZONTAL AND VERTICAL DATUMS ARE DETERMINED FROM - LOCATION PLAN 1" = 1000' RTK/G.P.S. 5. EXISTING UTILITIES, WHERE SHOWN HEREON, ARE APPROXIMATE. NO GUARANTEE IS IMPLIED OR TO MY KNOWLEDGE AND BELIEF, THIS MAP IS SUBSTANTIALLY INTENDED AS TO THE ACCURACY, LOCATION OR THAT ALL UTILITIES AND/OR SUBSURFACE CORRECT AS NOTED HERON. THIS SURVEY IS NOT VALID UNLESS IT CONTAINS THE LIVE SIGNATURE AND EMBOSSED SEAL STRUCTURES ARE SHOWN. CONSULT WITH THE APPROPRIATE UTILITY COMPANY OR AGENCY PRIOR CONTAINED HERON. SUBSEQUENT REVISIONS TO THIS PLAN TO DESIGNING IMPROVEMENTS, COMMENCING DEMOLITION OR CONSTRUCTION. "CALL BEFORE YOU OTHER THAN BY THE ORIGINAL SURVEYOR EFFECTUALLY VOID DIG" 1-800-922-4455. THIS CERTIFICATION. MAP REFERENCE / N/F R.B. W/CAP .. 1. "PROPOSED LOT DIVISION PLAN K F REALTY LLC 198 SMITH STREET SOUTH WINDSOR CONNECTICUT / MADHU REDDY MARCH 6, 2017" DATE REVISED TO: 5/18/01, SCALE: 1"=30'. PREPARED BY BSC GROUP I VOL. 2878 / PG. 302 *: 17247 .. 190 SMITH STREET ��- e <.,, . ,�� 2. "PROPOSED SITE PLAN LOT 2 K F REALTY LLC 198 SMITH STREET SOUTH WINDSOR CONNECTICUT 17-3--1 s",y �SN5 ` JUNE 8, 2020" SCALE: 1"=20'. PREPARED BY BSC GROUP. 3 ,� SURVE�O�� BENCHMARK O o �'�'l�+�+r�e`� Mag Nail in root of 24" Maple ►� `� ^ EL 109.91 MICHAEL HEALEY = '\ � Footing Drain R.B. SET 136.30' lNV=100.93� / N 89'11'°i1"W 7 R.B. SET :\ 3 � � ZONING LOCATION PLAN MADHU/REDDY .5 0 ' �10 _ AS-BUILT VOL. 2750 / PG. 244 +102 2 J 198 SMITH STREET I N/F 17-3 MAMATAAGARWAL / � O2 +103.1 VOL. 2551 / PG. 118 / AREA = 30,005f SQ.FT. LOT 2 188 WHEELER ROAD / /17-2-5 (0.689 ACRES) +103.1 00 50' Setback Line �-104 I K F REALTY LLC Existing 20' Wide SonitoCy Sewer Easemen" in favor of Lot 2 (#198 Smith Street) / / N/F per Map Ref #1 �, SCOTT & BEVERLY A. ANTOSIK 198 SMITH STREET Grass VOL. 897 / PG. 39 l of +105.0 f +104.7 J \ 216 SMITH STREET SOUTH WINDSOR c;neoP I 17-4 CONNECTICUT as +104.1 ement pope t 'lY�; R.B. o _' Conc. '-Gas Meter / ) / je_ BENCHMARK Grass� / - "�Elec Meter rnI M Top of Existing San. MH wooSTORY O Y \ ` ^ Cn MARCH 24, 2022 EL = 113.35' Conc. Existing - ,N/F - -- - - - - �/ / O L Residence SMi 1 H S CORNER O FF =114.65 CONDOMINIUM ASSOCIATION / / / o / 112.18 TFW = 113.45 178-182 SMITH STREET N FBF =104.8f 113.16 / +112.31 53.2'f I Al +112.47 Conc.Porch t REVISIONS: 50' Setback Line 1 114.7 _ _ I 112.53 NO. DATE DESC. ---- Bit. Driveway Conc. 112.64 Walk 112.26 +112.1 112.5 +112.2 2" MAPLE to Grass +l i3.7 +113.4 �116 / I LEGEND &ABBREVIATIONS N M. . ® IRON PIN (I.PIPE) LPIPEO. 26.1 • SE ® ��� O IRON ROD (R.B.) _ -..� T MAG NAIL (M.N.) 117.97+ -- - -� � � �-'�� � '� ��� � .� �..��� .� � �` ..� � LPIPE � UTILITY POLE -- -- -- -- N8T5T20"W 175.36' (Lot 2) 117.96 117.81 Stump- OE ELECTRIC MANHOLE Mon. Not 7 _ _ _ _ @S SEWER MANHOLE Q WATER SHUT OFF Found - �- �-- EDGE- OF PAVEMENT ® WATER GATE VALVE © GAS GATE VALVE (GG) PREPARED FOR: ''8 M I T H S cm ELECTRIC METER To e GAS METER REALTY KF LLC EDGE of PAVEMENT � JH HYDRANT (HYD) 175 WHEELER ROAD - _ - SOUTH WINDSOR, CT 06074 SNET #1411 N/F NOW OR FORMERLY R.B. REBAR (860) 883-1391 CONC CONCRETE BIT BITUMINOUS FF FINISHED FLOOR (ELEVATION) BSC �O� 7� TFW TOP OF FOUNDATION WALL (ELEVATION) U FBF FINISHED BASEMENT FLOOR (ELEVATION) 655 WindingBrook Drive TF TOP OF FRAME (ELEVATION) INV INVERT (ELEVATION) Glastonbury, Connecticut ELEC ELECTRIC 06033 SAN SANITARY SEWER 860 652 8227 -E ELECTRIC LINE -G - NATURAL GAS LINE © 2022 BSC Group, Inc. --W - WATER LINE SCALE: 1" = 20' -D STORM DRAINAGE LINE -S SANITARY SEWER LINE 0 10 20 40 .ter PROPERTY BOUNDARY ABUTTER PROPERTY BOUNDARY FILE: P:\8364501\SURVEY\DRAWINGS EASEMENT DWG.: 8364501-L2_AB.DWG JOB. NO: 83645.01 SHEET 1 OF 1 2000349 TOWN OF SOUTH WINDSOR, CT PERMIT NUMBER BUILDING PERMIT DATE: 07/10/2020 GIS ID: 83700198 FEE: 3222.00 MUNIS APPLICATION # 202000968 BUILDING DESCRIPTION: APPLICANT LOCATION NAME: KEBALO CONTRACTORS ADDRESS: 198 SMITH STREET ADDRESS: 175 WHEELER ROAD OWNER: KF REALTY LLC 175 WHEELER ROAD SOUTH W INDSOR,CT 06074 DESCRIPTION OF WORK: CONSTUCT A NEW SINGLE FAMILY HOME SPECIAL CONDITIONS: ALL WORK TO 13E DONE IN ACCORDANCE: WITH TIES APPLICATION AND PLANS APPROVED BY THE BUILDING DEPARTMENT. CONSTRUCTION TYPE: OCCUPANCY GROUP: BUILDING OFFICIAL 7/10/2020 1:15 PM TIIE FEE ABOVE INCLUDES A$0.26 PER THOUSAND CC STATE EDUCATION SURCHARGE