The URL can be used to link to this page

Home My WebLink About2013-3-19 - 1020 Ellington Road - Septic ApplicationTown of South Windsor — Health Department 1540 Sullivan Avenue, South Windsor, CT 06074 Phone: 860-644-2511 ext. 248 Fax: 860-644-7280 APPLICATION FOR APPROVAL TO CONSTRUCT A SUBSURFACE SEWAGE DISPOSAL SYSTEM Application/Permit #: To the Director of Health, Town of. �)Q�Yv\ \, &I ; , J-so r Date: I S ,01114 L Application is hereby made for an approval to construct a subsurface sewage disposal system for a: +C,011c -+C-) ) pw It �� c)c, A/ (Residenti�uilding, Restaurant, Re ail Building, etc.) located at: 10 e-) ed m �, h, t �II(j`` Address, Lot Number, Subdivision Name, Map, Block, Lot, etc.) New System Addition Repair Other Owner �� I [ CJ[ Address Tel.No. n 3� Installer .�+� r fvLv �' �� oaAddress �� 64vt ;� _ �c�,.z Te1.No. 6t)-- s t, - iO 1 Installer License No. In accordance with detailed information stated below: ' Application fee paid \0' Co Cixs��1 Signed (Owner ❑ duly authorized representative) GENERAL INFORMATION Soil Tests Conducted (Date): Lot size sq.ft. Area of Special Concern (Y/N): If yes, Reason(s): Basis of Design (# of Bedrooms, Restaurant Seats, Building Size, etc.): —S s Engineered Plan Required (Y/N):�j If yes, Name of Engineer: Address of Engineer: Design Plan Approved (Y/N):_'�__Date of Approved Plan: 3 _Revision Date: Type of Water Supply If well, has location been approved (Y/N): N I Vj, Well Driller's Name: Address: OFFICE USE ONLY Approval to Construct issued by: %( • Date: AA 13 (Director of He i or Registered Sanitarian) Signature: SMA � Gounr� Title: cr\+I , a� L Town of South Windsor — Health Department 1540 Sullivan Avenue, South Windsor, CT 06074 Phone: 860-644-2511 ext. 248 Fax: 860-644-7280 PERMIT TO DISCHARGE Approval is hereby given to � lark It UV6 r-' in accordance with Public (Property Owner) Health Code Section 19-13-B103e (h) to discharge to a subsurface sewage disposal system located at (Street Address) in the town of 7,.,` lr \vQ , CT that will receive domestic sewage from a: Residential building containing 3 bedrooms. Single family (Y/N):_. Restaurant containing seats. Commercial/Office building providing square feet. Other structure as described: Design Flow ='-/50 gallons per day. Permitted Flow = 450 gallons per day. The design flow shall equal the permitted flow, except for non -compliant repairs (See Section W 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 ':1W 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)_. 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) If yes, stipulate pump -out requirements: Special Requirements and Restrictions: 1. In the future, if there is a septic system malfunction or failure, it must be addressed. Exceptions (Repairs Only): File Information: Construction Permit No. . Approved as -built on file (Y/N) �` Date of Final Inspection: Inspected By:_ '!LL s Permit Issuance: Issued by:Title:'; [ or► Y��E1n C�� (Director of Healt or Registered Sanitarian) Signature: Date: 3 1"3 t'%W" SF1 o � 1540 SULLIVAN AVENUE • SOUTH WINDSOR, CT 06074 �OsoR c° TELEPHONE (860) 644-2511 Septic System As- Built Plan Street AddressE1111,111 Date J 5- )el Permit Number New Septic System Repair of Septic System Alteration of System Number of Bedrooms or Design Flow of Building �oXType of system installed I (e.g. stone trenches, infiltrate , galleries) Square footage of system: Total length Width Effective Area Capacity of Tank / c.)h r> New Existing Length of house sewer pipe Minimum distance between septic tank and foundation 05 Minimum distance between leaching field and foundation Minimum distance between sewage system and nearest well Public water supply Minimum distance between leaching system and property boundary Curtain drain required? Yes No Minimum distance from leaching field to drains (curtain drain, foundation, stormwater, etc.) APPROVED TOWN OF SOUTH WINDSOR HEALTH DEPARTMENT DATE: SIG- Septic System As- Built Plan Address ��` ��., ; �zCl � ak 1 Date Location of System (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 1 l l S I n it i ,ti License Number �� _1 Installers Address �� i _ r � .�� ^' , _ a _ (lr (street, city, state and zip code) Z 3 Distance from comer A � 6J Distance from comer B L' '' i I Distance from corner C Distance from comer D Town of South Windsor — Health Department Subsurface Sewage Disposal System Inspection Report PROPERTY LOCATION: Wo �L\ \ •; BOTTOM OF EXCAVATION: PERCOLATION TEST "FILL CIIECK": DATE:_ DATE: N ►r'r INITIAL INITIAL DEPTH HOLE # DEPTH HOLE # TIME READING TIME READING PERC PERC sl�W C--,I— LTV IC_ FINAL INSPECTION: SANITARIAN DATE: 3 1. SEWER LINE: c c,.nF A. SEWER LINE CEMENTED AT FOUNDATN (YIN) ................PIPE LENGTH i ? B. PITCH (.25 inches per foot min) REQUHtED --Fr.. ............ .. PROVIDED FT D. PIPE TYPE & ASTM SPEC.<_r_V4 A<_ `i0 .................................PIPE SIZE (INCHES) Ll'( 2. SEPTIC TANK: C IT _ )Of.() A. MANUFACTURER G b4 -�5 ATE MFD W SIZE. D6D GALLONS B. TANK COMPARTMENTS PLA ED PROPERLY(Y/N)............................................... . C. INLET BAFFLE (not in middle of opening). ........ OBSERVATION OPENING (slag removal)N 1Or D. OUTLET BAFFLE FILTER TYPE ` L%i Wwk _civ-,B�ISERS NEEDED (YIN) .L] SIZE E. TYPE OF PIPE -3Dk 2S f\>1 r- "�1' 1 _(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) (Y/N) 4 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 (YIN) 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 (YIN) SEPARATION DISTANCES FIELD VERIFIED (Y/N) PASS FAIL COMMENTS: __• WELL INSPECTION: SANITARIAN WELL LOCATION DATE: Sanitary Well Cap * 3 cam--V�- D-o - \/vaAt_r Rev. April 2012 FINAL INSPECTION ELEVATIONS PROPERTY LOCATION: Q U L�,r-r �1� TOWN: S. L,-J% �1-Sor PROPERTY OWNER: r INSTALLER: �yun—Ls SANITARIAN: S ,�„�(� ,,� DATE: LEVEL TO BENCHMARK (ROD READING) BENCHMARK ELEVATION HEIGHT OF LEVEL ROD READINGS TOP OF PIPE DISTANCE TO INVERT a of e& diameter of p f v e INVERT ELEVATION SEWER LINE AT FOUNDATION -pip , SEPTIC TANK INLET 3 SEPTIC TANK OUTLET PUMP/GREASE TRAP INLET PUMP/GREASE TRAP OUTLEr D-BOX # 1 INLET 5 ,� FLOWLINE RIGHT FLOWLINE LEFT 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: Paee 2 Town of South Windsor — Health Department -f 1540 Sullivan Avenue, South Windsor, CT 06074-2786 f� Phone: 860-644-2511 ext. 248 Fax: 860-644-7280 5 liip •< <� 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): Edward Kuehn, Jr. STREET ADDRESS: 1020 Ellington Road TOWN: South Windsor INSTALLER: James Throwe CT. LIC # 3856 EXPIRES: 05/31/2013 RESIDENTIAL: # of Bedrooms - 3 INSTRUCTIONS FOR INSTALLER 1. Construction plot plan submitted and approved by this office must be adhered to. 2. This office must be contacted for approval if any change is going to be made in the system location, size or design, or any changes in house, well or property line locations. 3. Any NEW sewage disposal system must conform to ALL requirements of Section 19-13-BI03 of the CT Public Health Code. 4. ALL new construction to be under DIRECT supervision of a CT licensed installer under Section 20-341 of the CT General Statutes. 5. The installer is RESPONSIBLE for VERIFYING LOCATIONS of PROPERTYLINES, WELLS, and BURIED UTILITYLINES prior to construction. 6. Installer to notify South Windsor Health Dept. 24 hours prior to the start of construction. 7. Installer to have septic tank covers removed at the time of inspection. SPECIFIC INSTRUCTIONS: SEPTIC TANK AND SEWER LINE REPLACEMENT ONLY 1. Install per approved plan, (James Throwe, Dated: 03/19/2013). 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: J\J- DATE ISSUED: 03/19/2013 RENEWAL: APPROVED BY: SherryIVZGann, REHSIRS EXPIRES: 03/19/2014 EXPIRES: _I 1 THIS PERMIT IS VALID FOR A PERIOD OF ONE YEAR FROM DATE OF ISSUE. IN ACCORDANCE WITH THE CT PUBLIC HEALTH CODE SECTION 19-13-13103e(F)(I). ONE RENEWAL IS POSSIBLE PROVIDED SOUTH WINDOR HEALTH DEPARTMENT IS NOTIFIED PRIOR TO THE EXPIRATION DATE NOTED ABOVE. IF PERMIT EXPIRES, INSTALLERS ARE CHANGED, OR ANY OTHER DEVIATION FROM THE ORIGINAL PERMIT, A NEW APPLICATION MUST BE COMPLETED AND ALL APPLICABLE FEES MUST BE PAID. FEE PAID: 10.00 (Cash) CHECK # NIA DATE PAID: 03119/2013 O m > z r� Z =c n m n m0 ram. �' < m :° o w v oar _ Town of South Windsor, CT ma Property Listing Report GIS PIN — Property Information roperty Location 1020 ELLINGTON ROAD Owner KUEHN EDWARD RJR Co -Owner Mailing Address 1020 ELLINGTON ROAD SOUTH WINDSOR CT 06074 Land Use 101 Res Dwelling Land Class R Water Service MDC 860.278.7850 Photo Primary Construction Details Year Built 1860 Stories 1.5 Building Style Cape Building Use Residential Building Condition B. Floors Pine/Soft Wood Total Rooms 30301020 Account 30301020 Sewer Service Census Tract 4874 Neighborhood 250 Zoning Code A20 Acreage 1.1 Book / Page 585/ 262 Lot Setting/Desc Trash Day MONDAY Sketch Bedrooms 3 Full Bathrooms 1 Half Bathrooms 1 Bath Style Modern Kitchen Style Average Roof Style Gable Roof Cover Asphalt Exterior Walls Clapboard Interior Walls Plaster Heating Type Steam Heating Fuel Oil AC Type Gross Bldg Area 3840 Total Living Area 1904 Report Created On 3/412013 Town of South Windsor, CT Property Listing Report GIS PIN 30301020 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 KUEHN EDWARD R JR Account 30301020 Outbuilding and Extra Items Book/ Page 5851262 Sale Date 5/29/1990 Sale Price Report Created On 3/4/2013