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Home My WebLink About2012-9-15 - 2085 John Fitch Boulevard - Septic ApplicationTown of South Windsor —Health Department 1540 Sullivan Avenue,South Windsor,CT 06074 Phone:860-644-2511 ext.250 Fax:860-644-7280 APPLICATION FOR APPROVAL TO CONSTRUCT A SUBSURFACE SEWAGE DISPOSAL SYSTEM Application/Permit #: 56cm:wzNbSmZ Date:9r /5’‘/fTotheDirector0fHealth,Town of: Application is hereby made for an approval Lo construct a subsurface sowage disposal system for a: (Residential Building,Restaurant,Retail Building,etc.) located at:Q o 3 5’form FWCH J24 VD (Kr 5i) (Street Address,Lot Number,Subdivision Name.MapfBlock,Lot,etc.) New System Addition Repair x Other Oww Fagwz/ck rave/2m Address gags Git/M Hmv Term.ae‘o 4%,3??é Installer 77m [0/41.Kfi/Za Address 21 (Int/Z r/Uf'y''D/Z TeiNo.?u «37$Z33 a. CEL’L r A;Gil-A N5/6/P§Mae/aw AFK Installer License Not 2z47 In accordance with detailed information stated below: Application fee paid O Signed (dwner or duly authorized representative) GENERAL INFORMATION Soil Tests Conducted (Date):Lot size sqft. Area of Special Concern (Y/N):If yes,Reason(s): Basis of Design (#ofBedrooms.Restaurant Seats.Building Size,etc): srP i7 2015 SOUTH WINDSOR HEALTH DEPT. Engineered Plan Required (Y/N):If yes,Name of Engineer: Address of Engineer: Design Plan Approved (Y/N):Revision Date:Date of Approved Plan: Type ofWater Supply ‘7u3L/C If well,has Io’cation been approved (Y/N): Well Driller’s Name:Address: OFFICE USE ONLY Approval to Construct issued by:Date: (Director of Health or Registered Sanitarian) Signature:,Title:RECENED Town of South Windsor -Health Department 1540 Sullivan Avenue,South Windsor,CT 06074 Phone:860-644-2511 ext.250 Fax:860-644-7280 APPLICATION FOR APPROVAL TO CONSTRUCT A SUBSURFACE SEWAGE DISPOSAL SYSTEM Application/Permit #: To the Director of Health,Town of:5OLCTH LUI‘NDSO'K Date:q”I 5/"/y Application is hereby made for an approval to construct a subsurface sewage disposal system for a: (Residential Building,Restaurant,Retail Building,etc.) located at:£035”J‘OHvJ Ff'%[-I dZLVD (IZ’I‘S)I (Street Address,Lot Number,Subdivision Name,Map,Block,Lot,etc.) New System Addition Repair x Other Oww Fagpgz/ck é‘xma/J Address £03”;32m rvT/H mm aac '29“?»3W6 Installer 'W ZU/qL KgS ,Address 2{('G'l/L/ZrNg‘i’3K Tel.No.?é¢’37-f’Z33 ?” Jk/.PS‘@H’g7g‘”‘i x ’4 .KK ¢La t A)(>75 Installer N License No.2 Z 4“7 In accordance with detailed information stated below: Application fee paid Signed % (dwner7 or duiy authonzed .representative). GENERAL INFORMATION Type of Water Supply 7a§£ic If well,has lgcation been approved (Y/N): Well Driller’s Name:Address: OFFICE USE ONLY Approval to Construct issued by:Date: (Director of Health or Registered Sanitan'an) Signature:,Title: Soil Tests Conducted (Date):,Lot size sq.ft. Area of Special Concem (Y/N):If yes,Reason(s): Basis of Design (#of Bedrooms,Restaurant Seats,Building Size,etc.): Engineered Plan Required (Y/N):If yes,Name of Engineer: Address of Engineer: Design Plan Approved (Y/N):Date of Approved Plan:Revision Date: 1540 Sullivan Avenue,South Windsor,CT 06074 Phone:860-644-2511 ext.248 Fax:860-644-7280 géKd Vbom SITE INVESTIGATION FOR A SUBSURFACE SEWAGE DISPOSAL SYSTEM Apphcatlon/Permlt Property Owner DATE:\A “IT Locatlon EU &6——‘—’ DEEP TEST PIT DATA/SOIL DESCRIPTIONS (Record all Test Pits) COMMENTS: GROUNDWATER TABLE (Near max.,below max,etc.): SOIL MOISTURE (High,medium,low,etc.): DATE: PERCOLATION TEST DATA (Record all Perc Tests) Town of South Windsor —Health Department TEST PIT:\KK “TEST PIT:TEST PIT:TEST PIT: gM ’\L § 0 Mottles:\Mottles:Mottles:Mottles: GW:\\GW:GW:GW: Ledge:\Ledge:Ledge:Ledge: Roots:\Roots:Roots:Roots: Restrictive:Restrictive:Restrictive:Restrictive: PERC:PERC:PERC:PERC: DEPTH:2,1“DEPTH:DEPTH:DEPTH: PRESOAK:“27,1 PRESOAK:PRESOAK:PRESOAK: TIME ‘READING TIME READING TIME READING TIME READING W53 WHO H“m \\‘M1 \\‘-M Z if'Ir;:v”'”-" H ‘\ Ig" \5’‘\ \LLN \M 5 V]" QwmUM PERC RATE: PERC RATE: PERC RATE: PERC RATE: SITE INVESTIGATION FOR A SUBSURFACE SEWAGE DISPOSAL SYSTEM LOCATION DRAWING INCLUDING ALL TEST PITS AND PERCOLATION HOLES 7"?Q!L 6 éWWX ?{¥\ DESIGN RECOMNIENDATIONS/COIWMENTS Form completed by: (Certified Local Health Agent or P.E.)Accuracy assured by (If P.E.completed form): (Certiiied Local Health Agent)Others present for site investigation @ngineer,developer,installer etc): SPECIAL CONDITIONS CONCLUSIONS Design Flow >2000 GPD Suitable for Sewage Disposal Public Water Supply Watershed Unsuitabla for Sewage Disposal Probable High Groundwater Additional Investigation Req’d Slope >25 percent Wet Season Monitoring Req’dPercRate<1 min/inch Retest During Wet Season Perc Rate >30 min/inch Licensed Engineer Plan Req’d Ledge <5 feet below grade Other: Limited Suitable Area Open Watercourse or Wetlands Flood Plain /Seasonal Flooding Max.G.W.<36 inches below grade I Septic RepairFor:f/ZweR/cé FE‘RRorJ #208g Vow mm $Lvz>50am w/Nbsdc 3376.HD pmc.pagtm MEL mss NM Am maaa 7m? O7Z GfiK8 6€$ISPD$§L 400 kfsmrC‘Tum Proposed:MOO ga .2mm P.Co»c;z€7z whdk w/fgpwzouga F/mEa +iit8€¢zf 7b GzzHae —45'w wmuTIS'f3é-2 f’z”/~u;)->4 //,=4q§$F gag Design Criteria: [BEEEJ MM gyma (m/ss»3mm”4.7'—— /:o5‘7m.;.A'é‘Méhl %5 PO55/3LE m EX/S 77am PLumg/Mé @i‘zaw znNCH)-£»as’rm¢7mk 2,2’hm?wave/J aw”Parr mawl §,:'735579 {WM Fnwl <Z§LUD 727’5 awmwm' w dfZogs :Dack *Sl 11F Qsasvmé 7mm7.4'+l-u4.6 mtK‘P‘3' 2°“£3 41$ 3°” WI?I&Q {3 x .2 45‘ x53. [‘3 #433”5m) [VHQAT IS pg;a~r’1u£ X—$¢7M €L£am70IJS Designed By:H.Thomas Walker Jr.Skips Wastewater Services 21 Courtney Drive Ellington CT License:2247 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):Frederick Ferron STREET ADDRESS:2085 John Fitch Blvd.TOWN:South Windsor INSTALLER:Tom Walker CT.LIC#2247 EXPIRES:07I31I2016 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-B103 of the CT Public Health Code. ALL new construction to be under DIRECT supervision of a CT licensed installer under Section 20-341 of the CT General Statutes. The installer is RESPONSIBLE for VERIFYING LOCA TIONS of PROPERTYLINES,WELLS, and BURIED UTILITYLINES prior to construction. Installer to notify South Windsor Health Dept.24 hours prior to the start of construction. Installer to have septic tank covers removed at the time of inspection. SPECIFIC INSTRUCTIONS: Install per approved plan,(Tom Walker,Dated:9/16/15). Licensed Installer to field stake house,well (if applicable),permanent benchmark,and septic system.Offset stakes to include bottom of trench or flow line elevations.Health Dept.staff to conduct stake inspection prior to construction of system. O\ NL- Permanent benchmark to be set within 50 feet horizontally and 12 feet vertically of septic system. Install 495 square feet of effective leaching area,consisting of one row 45 feet long of Mantis 536-8 units,bedded on the bottom and sides with sand fill meeting both the manufacturer's and select ml specifications.System to be installed per manufacturer’s specifications.Systems with total cover that exceeds eighteen (18)inches as measured from the top of the units to finished grade shall be vented at the distal (far)end of the system. Current Sieve analysis (within 3O days)for sand fill must be submitted to the South Windsor Health Department. hm 5. 6.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. 7.Installer to complete and submit septic system as built plan and drawing with ties to the house. 8.Existing septic system to be properly abandoned. SIGNATURE:DATEISSUED:9I23I15 RENEWAL:l I APPROVED BY:Dr.Schwartz,Director of Health EXPIRES:9/23/16 EXPIRES'I l 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)(I).ONE RENEWAL IS POSSIBLE PROVIDED SOUTH WINDSOR 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 DATE PAID:9/16/15 Town of South Windsor -Health Department 1540 Sullivan Avenue,South Wlndsor,CT 06074 Phone:860-644-2511 ext.250 Fax:360-644-7280 SEPTIC SYSTEM AS-BUILT PLAN Date Q‘z %’/3’Permit Number Street Address 2°3§'TOHrJ FI‘KH @LVD New Septic System X Repair of Septic System Alteration of System Number of Bedrooms 3 OR Design Flow of Building Capacity of Tank lo o o Tank:New ><Existin g Length of House Sewer Pipe Minimum Distance Between Septic Tank &Foundation 30 Minimum Distance Between Leaching Field &Foundation 4'5 Minimum Distance Between Sewage System &Nearest Well Public Water Supply X Minimum Distance Between Leaching System and Property Boundary 7o f‘+ Curtain Drain Required?No Minimum Dis tance From Leaching System to drains (curtain,foundation,storm water,etc.) RECEIVE-n ,t SEP 282015 SOUTH WINDSOR”*DRAFT DRAWING ON REVERSE SIDE OF FORM HEALTH DEPT. Installed Type of System zcmm amt/297:void/C '4 f I m#~77§e H/Z-/«)U £IZ7' (e.g.stone trenches,infiltrators,galleries etc.) Square Footage of System:Total Length 4 r Width ’3 Etfective Leaching 49 f @ g m: SEPTIC SYSTEM AS-BUILT PLAN (Commuea) Address ga$S d’oém Fmrz/JAE ’ Date 9-2%"/a" Location of System (N: Draft a substantmlly correct drawmgIncludeallofthefollowmgInformationlocatlon'At least two sides of the buildingdistributionboxes,trench ends,other features affecting the Installer’s Name m wgmg Installer-’3 Address 2f Installer’s Email 4w a S.E.W.Fm@ shomng separationtoprovidean accurate nearest the system,dry wells,curtain drain,system and its location. K ”1576 KP}'wed Cauzm e 9 ®7L (street,city,state,zip code)Ska/w tungsten side of house dlstances of septic system Insallatlonrecordoftheennresystem septic tank,house sewer, potable water supply wells,and any License #32¢? a e.m 670 «I Mari .CW4- N 6-“ bzwrmv #f z a as d J3 $Eck 22 °,4"5cpi 4-0 7’V c. i 22° /Iooo 6.9 T.i ~:22\—-c 4 45'men-m 4“3N:3 f Point #1 #2 ‘#3'#4 #5 #6 #7 #8Distancemmcorner“A”6o 'c "M4"43's "9/?a "t Dismnce from comer “B”t3}13'"3w '6"so.‘s7 ‘7 H ‘ Distance mm comer “C” Distance from comer “D” Town of South Windsor —Health Department 1540 Sullivan Avenue,South Windsor,CT 06074 Phone:860-644-2511 ext.248 Fax:860-644-7280 Subsurface Sewage Disposal System Final Inspection Report Property Owner:Appl/Permit # Property Address:ZQ X K”3?$Towu:S VU\\(\(\A of Licensed Installer:License #: Approved Plan Information / Check one:New System Repair/Replacement System \/ SResidentialBuilding:bedrooms Large Tub:YES NO/Garbage Disposal:YES ‘9\_/ Non residential Building/Residential Institution:GPD Plan Prepared by:Title: Plan Approved by:Date: Approval to Construct Date Permit Issued:Oil 7,é l l S/Permit Issued by: Registered Sanitarian or Director of Health Inspection Information Was 24 Hour (min)Installer Notice Given (Y/N):j Date Final Inspection Requested:Ctl‘u\\\Y Date of As-Built Final Inspection Completed by:wékQSi/VV b CA)“S Approval:\ Permit to Discharge Issued by:Date: (Registered Sanitarian or Director of Health) Type Date Licensed Installer Present?Yes/No Comments Field Stake Inspection (house, well,property lines,system etc.) Strip/Scaritication Select Fill Placement Sieve required (Yes/No) Other: Final Inspection Oi 12 kw.s”K 213 Subsurface Sewage Disposal System Final Inspection Report House Sewer Information Pipe Type and ASTM Specification:g (\x .kxCi Pipe Size:L '\‘‘in. Invert Elevatlons at g \\ft. \ Outlet Fllter Type/Manufacturer (W//\\zLPumpChamber Slze.\Gallons Pump Alarm Checked (Y/N):Pump Chamber Manufacturer:Float Control Elevation Verified (Y/N):Grease Interceptor Grease Interceptor Tank Tank Size:Gallons Manufacturer: Leaching System Information Approved Aggregate:Free of silt dirt and debris (Y/N):Sieve Required (Y/N): Filter Fabric Present (Y/N):Type:Aggregate Meets PHC Specifications (Y/N): Select Fill (Y/N):Meets PHC Specifications (Y/N):(Sieve Information on File (Y/N):ii g g égl Qua M cl Leaching System Description (product,size,length,number ofrows,level or serial etc.):‘V\<’i (i\a Rx\S Effective Leaching Area Required:L\‘i 3/sq.ft.Reserve Area Provided (N/A,Y/N):'M A Effective Leaching Area Provided:L/\0)f sq.ft.Center to Center Spacing: 'A ft. System Installed Per Approved Plan Elevations (Y/N):Elevations Field Verified (Y/N):saw-V Elevation noteS'QW/i (d \{\((V\/)(a mi vmciv Sim“€66 u [it-fie:W L \VS (Li!rm W lC \hR ..Qimr‘(w 0x 00am writ/MU‘\ [\x [iii b hm KM 'i/W 3b Q}@ng\\ Sit-Q l l i4 Y"\ . .k7 Jrb v (t\\3m \WM F“\Ni/oa (A L 1 {OW (\(VLKJ Separation Distances \Separation Distances Conform with Approved Plan (Y/N): Separation Distances Field Verified (Y/N): ~€\v Lk§V‘L 1i j§t ”\CY Pitch Required:bk ‘8 W §\ Septic Tank:{a Li Y Pitch Provided:/ \\i \’H-i 3W \\ Tank Information Septic Tank Size :i I OD J Gallons Tank Inlet Elevation:L\C Tank Manufacturer:\\ll\l \Tank Outlet Elevation:7 X Date Manufactured'a \\’W \(/Riser Needed (Y/N):Y MATERIALS TESTING,INC. 55 LAURA STREET °NEW HAVEN,CONNECTICUT 06512 '(203)468-521642BOSTONPOSTROAD0WILLIMANTIC,CONNECTICUT 06226 °(860)423-1972 This material as sampled and delivered meets the iisted specification. Materials Testing,Inc. Richard C.Kearns W7William J.Soucy DATE:09-01-15 REPORT:M-1 1 12 CLIENT:Tall Pines Land Development,LLC100BWindemereAvenueEllington,CT 06029 PROJECT:Client'slnformation SUBJECT:SIEVE ANALYSIS (ASTM 6-136.C-1 17) Materiai:Concrete Sand Source:Union Pit Sampled:by client and delivered to MTI on 8/31/15 Sieve Size Percent Passing ASTM 6-33 3/3”(9.5mm)100 100 #4 (4.75mm)99 95-100 #8 (2.36mm)83 80—100 #16 (1 .18mm)68 50-85 #30 (600pm)46 25-60 #50 (300um)14 1 0-30 #100 (150nm)5 2-10 #200 (75um)1.5 0-3 Fineness Modulus 2.86 2.3-3.1 File:Original RECEIVED 1cc:Tall Pines Land Dev.1cc:J.Luczak SEP 29 2015 wlb SOUTH WINDSOR'Test reporbrmynotberepmduwd M‘moulmeexpress pemiaeicnofMamrialsTesting,inc‘Results mly relalemitems W.HEALTH DEPT 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 Frederick Ferron ,in accordance with Public (Property Owner) Health Code Section l9-l3-B l 03e (h)to discharge to a subsurface sewage disposal system located at 2085 John Fitch Boulevard (Street Address) Other structure as described: Design Flow =450 gallons per day.Permitted Flow =450 gallons per day. The design flow shall equal the permitted flow,except for non-compliant repairs (See Section lV D). In order to provide a sufficient factor of safety it is recommended that the average daily discharge not exceed 2/3 ofthe permitted flow or 300 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)Yes .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 N .lfyes,stipulate pump-out requirements:) Special Requirements and Restrictions:l.ln the future,ifthere 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)Yes Date ofFinal Inspection:9/24//l 5 Inspected By:Heather Oatis Permit Issuance:Issued by:Heather Oatis.REHS Title:Env.Health Officer (Director of Health or Registered Sanitarian) Signature:,W (>14 Date:0(l20\\3/ U in the town of South Windsor ,CT that will receive domestic sewage from a: Residential building containing J bedrooms.Single family (Y/N):iX Restaurant containing seats. Commercial/Office building providing square feet.