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Home My WebLink About2012-9-25 - 169 Maskel Road - Septic Application and As Built1540 Sullivan Avenue South Windsor,CT 06074 Ph:860-644-2511 ext.248 Fax:860-644-7280 South Windsor Health Department To:Margaret Shea,Dzen Realty From:Sherry McGann Fax:860-648-9559 Pages:5 (including cover) Phone:860-644-8988 Date:1/9/2013 Re:Septic Tank Replacement —169 Maskel cc: Rd,South Windsor,CT D Urgent M For Review U Please Comment D Please Reply D Please Recycle o comments: 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 \qz,$\\‘ag (Property Ower) ,in accordance with Public Health Code Section 19-13—B103e (h)to discharge to a subsurface sewage disposal system located at llaCl W‘FQ tkmpk (Street Address) in the town of Xxda“\)\_'lw~e§u&>l’,CT that will receive domestic sewage from a: Residential building containing ‘3 bedrooms.Single family (Y/N):Y, Restaurant containing seats. Commercial/Office building providing square feet. Other structure as described: Design Flow =Li SO gallons per day.Permitted Flow =Q gallons per day. The design flow shall equal the permitted flow,except for non—compliant repairs (See Section IV D). In order to provide a sufficient factor of safety it is recommended that the average daily discharge not exceed 2/3 ofthe permitted flow or r gallons per day. Operation and Maintenance Septic tank shall be 1nspected regularly and pumped as needed but not less frequently than every five years The septlc tank has an effluent filter (Y/N)Lt)Effluent filters requlre perlodic cleanlng Failure to clean filters can result 1n 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 stipulate pump—out requirements: .If yes, Special Requirements and Restrictions:l.In the future,if there is a septic system malfunction or failure,it must be addressed. Ex Vceptions(Repairs Only) s b gApprovedauiltontile(Y/N) Date of Final Inspection:.,6 I Inspected By:$RW\’K}\/\Lbm\¢\ Permit Issuance:Issued by:$\‘L€-Title:tint].MW“Seaw— (Director ofHealth 01 egistered Sanitarian) Date:will lL File Informatio:Construction Permit No. S i gn ature: 1540 SULLIVAN AVENUE 0 SOUTH WINDSOR.CT 06074 TELEPHONE (860)644-2511 Septic System As-Built Plan Street Address /(9§/470%6/KC£Date c7 0C7}/A Permit Number New Septic System k Repair of Septic System Alteration of System ’7 Number of Bedrooms \5 or Design Flow of Building Type of system installed "fww/a.4 tJ (e.g.stone trenches,intiltrators,galleries) 9FSquarefootageofsystem:Total length ? O Width a Effective Area a Capacity of Tank /cmo‘e/New Existing 1 IaLengthofhousesewerpipei7’i /M Minimum distance between septic tank and foundation i i?j Minimum distance between leaching field and foundation D.7 i F pg V 3" Minimum distance between sewage system and nearest well gQ/O f;/‘_e Public water supply 3MinimumdistancebetweenleachingsystemandpropertyboundaryI Curtain drain required?Yes No X Minimum distance nom leaching fleld to drains 4J//d (curtain drain,foundation,stonnwater,etc.) Septic System As-Built Plan Address ?7 m5w§é¢/KJ Date 3a;T/L Location of System @M /< (N,S,E,W,front,back side of house) Draft a substantially correct drawing showing separation distances of the septic systeminstallation.Include all of the following information to provide an accurate record of the entiresystemlocation: 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 affectingthesystemanditslocation. Installers Name \lC/JMJ r”i"OW"€/License Number 3?.r3/é Installers Address 97 Kiwi-5,-J (Jr,(/4,,.v,,..,,,q C7 aéaéé (street,city,state and zip code) Distance from comer A Distance from corner B Distance from comer C Distance from comer D §TATE OF C0NNECH€W DE‘i’ARTMENT OE i’UBLIC HEALTH Dzmnei P.Malloy Gmmwnm‘ kwei,Muiign,MI)”NLRB”MP.A. Lt»GovernarCommissicnerNancy\Xiym an Elwironmental Healih $ecti0n NOTICE OF EXCEPTION An exception is hereby granted to the requirements of Technical Standards HA of Regulation 19— 13—B103 of the Public Health Code of the State of Connecticut for the REPAIR of a subsurface sewage disposal system at 169 MASKEL ROAD in the Town of SOUTH WINDSOR,CT.It has been found that the well located at THE SUBJECT PROPERTY is unlikely to be polluted in such a manner as to cause a health hazard,provided: l.The septic tank shall be located not less than 60 feet to the existing private well at the subject property. é 2.Prior to the septic tank installation,the leachfield should be evaluated to confirm that it is operating satisfactorily. 3.The existing septic tank shall be properly abandoned. 4.The installation shall be inspected and approved by the local health department. 5.An approved as—built plan shall be submitted to the local health department before a Permit to Discharge is issued. 6.All variances granted shall be noted on the Permit to Discharge. R ed at the Department of Public Health,Hartford,Connecticut. ’b \Z (o 2b\LSigadDate Sanitary Engin r I Environmental ineering Program .e agxvé LUQWECTK‘,’¢§yamf “Wt ”g Phane:(860)509-7296 'Fax:(860)509-7295 0 VP:(860)899-1611 410 Capitol Avenue ~MS#51SEW PO.Box 340308 Connecticut Department Hartford,CT 06134-0308ofPublicHealthwww.ct.gOV/dph/subsulfacesewageAjyirmativeAction/Equal Opportunity Employer ,’ State of Connecticut,Department of Public Health Well Separation Distance Exception Application To:Environmental Engineering Program Date:&5-je‘lo"/Z Department of Public Health 4-10 Capitol Ave.,MS#SISEW Local Health Department:wk \fQ)k megv‘wf P.0.BOX 340308 Hartford,CT 06134—0308 Mailing Address \S‘XQ ‘N\3\\~vw\“\K‘Vt. §Vs.)\rekw!‘L‘T Dmylg Attn:$QW \Mum “A Phone Number \J Email Address: Subject Property Address:Town:36,u/lm jfoif‘ Replacement of:Exception for:Wells affected:Basis of Design:X‘Sepu’c Tank 2l: ,'><Septic Tank K Owner's well #of Bedrooms: Leaching System**Leaching System Neighbors'well(s)or Both Both Both Design Flow: Shallow well pump(s)With suction p1pe(s)7 YES Q0)If yes,show on plan &note distance 1f <75 feet Building sewer or dismbution piping <25 feet to well?YES /®lf yes show on plan &note distance Potability testing of affected wells?YES /@ Ifyes,are results satisfactory?YES /NO ls the replacement tank or leaching system located closer to well(s)than the eXisting system?YES N Does the subject property have any compliance issues conceming PHC Section 310037 YES /lfyes explain *Leaching system has been evaluated to contirm it is functioning satisfactorily?YES lf no explain “Septic tank has been evaluated to confirm 1t is in satisfactory condition and properly bamed"YES /f no explain Comments.lazp/Jami);Tan/Z m Sam/L Spi/i / Plan prepared by'Documentation Submitted: Professwnal Engineer Soil Test Data J6 Licensed Installer QCW f‘nWJ-i—L‘‘—+£3g5‘0 >_<Detailed Plan Other: Plan reviewed by:m((\.\Mew/x“,Emu JWLNW'h M (Print Name and Title') Please note,in accordance with CT General Statutes Section 19a-209c,the applicant is required to notify owners of properties with water supply wells affected by this exception request.If applicable,property owner must sign below. i Applicant's Signature:N le (Subject Property Owner)Date of Certified Mail Notification 12/2011 V/ Affected Properties Lot Number or Address Property Owner's Name Well Type Distance from well to: New Tank New System Subject Property k A At It xv ’Xséx‘ Front Adjacent i li J l l ’l Rear Adjacent j Co!m<§kg 1 A ak To mate Ox‘fla A cm Left Adjacent '"1 “W Right Adjacent 10/02/2012 TUE 16:10 FAX 21o 349 2464 ERCC OFFICE 001 ********************* *H FAX Tx REPORT *** ********************* TRANSMISSION OK JOB NO.4235 DESTINATION ADDRESS 98602822684 PSWD/SUBADDRESS DESTINATION ID Jim Throwe-Vans ST.TIME 10/02 l6:09 USAGE T 00'50 PGS.1 RESULT OK Town of South Windsor —Health Department 1540 Suilivan Avenue,South Windsor,CT 06074 Phone:860-644-2511 ext.248 Fax:860-644-7280 PERMIT TO DISCHARGE Approval is hereby given to in accordance with Public (Property er) Health Code Section 19-13-B103e (h)to discharge to a subsurface sewage disposal system located at (Street Address) in the town of \k‘Nre‘W‘CT that will receive domestic sewage from a: Residential building containing bedrooms.Single family (YIN):Y . Restaurant containing seats. Commercial/Office building providing square feet Other structure as described: Design Flow =Ll SO gallons per day.Permitted Flow =gallons per day. The design flow shall equal the permitted flow,except for non-compliant repairs (See Section IV D). In order to provide a sufficient factor of safety it is recommended that the average daily discharge not exceed 2/3 of the permitted flow or gallons per day. Operation and Maintenance Septic tank shall be mspected regularly and pumped as needed but not less frequently than every five years The septic tank has an effluent filter (YIN)g Effluent filters require penodic cleaning Failure to clean filters can result 1n sewage backup mto the budding 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).Ifyes, stipulate pump out requirements Special Requirements and Restrictions:1.In the future,ifthere is a septic system malfunction or failure.it must be addressed. Town of South Windsor —Health Department Subsurface Sewage Disposal System Inspection Report PROPERTY LOCATION:Ié‘l Wasm w N/eBOTTOMOFEXCAVATION:DATE:WITIAL PERCOLATION TEST “FILL CHECK”:DATE:INITIALWR FINAL INSPECTION:SANITARIAN 'M DATE:C)"L/’L. ‘u)1 3n’A13 W 1.SEWER LINE:*Com5cc&—*p m‘s‘1 ,,Mr A.SEWER LINE CEMENTED AT FOUNDATION (Y/N)................PIPE LENGTH \‘Li com B.PITCH (.25 inches per foot min)REQUIRED .-FT ................PROVIDED ID.Li FT D.PIPE TYPE &ASTM SPEC.§C§x¢.bib ......................PIPE SIZE (INCTES)I; 2.SEPTIC TANK: A.MANUFACTURE M ‘\m DATE MED ’L SIZE.‘‘GALLONS B.TANK COMPARTMENTS PLACED ROPE Y (Y/N)................................................_5{___ C.INLET BAFFLE (not in middle of opening)...........OBSERVATION OPENING (slag removal)Iv/n D.OUTLET BAFFLE FILTER TYPECM N$\1V\muguqg RISERS NEEDED (YIN)3 SIZE IQ“mm E.TYPE OF PIPE m ’5€(approved by code) PUMP CHAMBER/GREASE TRAP: A.PUMP CHAMBER MANUFACTURER ...SIZE GALLONS B.TYPE PUMP ............PUMP ALARM CHECKED (Y/N) C.FLOAT CONTROL ELEVATION VERIFIED (Y/N).......TYPE OF PIPE D.GREASE INTERCEPTOR TANK SIZE GALLONS ........MANUFACTURER D BOXES: A.LEVEL (Y/N)SERIAL DISTRIBUTION (High level overtlow within top 3”)....... C.LEVEL SYSTEM (Ends tied together)(Y/N)5.TRENCHES: A.LENGTH OF TRENCH ............I.2.3.4.5.6. B.GALLERIES (stone around all units).l.2.3.4.5. C.CENTER-TO-CENTER SPACING FILTER FABRIC PRESENT (Y/N)TYPE D.APPROVED AGGREGATE FREE OF SILT DIRT &DEBRIS (Y/N). F.AGGREGATE MEETS PHC SPECIFICATIONS (Y/N)TYPE OF PIPE G.LEACHING SYSTEM DESCRIPTION: 6.SEPARATION DISTANCES CONFORM WITH APPROVED PLAN (Y/N) S ARATION DISTANCES FIELD VERIFIED (Y/N)PASS FAIL COMMENTS 'a t ’YONVR 3 ‘_..\Jwa.CEOx O K K "E.T ’..AA ‘A a gm \A (Axohrwm WELL INSPECTION:SANITARIAN DATE. WELL LOCATION Sanitary Well Cap Rev.April 20 l 2 DEPTH HOLE #DEPTH HOLE # TIME READING TIME READING PERC PERC PROPERTY LOCATION:_wk T \-&TOWN:,’.1 FPROPERTYOWNER: INSTALLER: SANITARIAN: \a ;s\\-L"‘VKOO ‘ucm.O a §\(‘QJT\A KNXLQ-imn\ LEVEL TO BENCHMARK (ROD READING) BENCHMARK ELEVATION HEIGHT OF LEVE FINAL INSPECTION ELEVATIONS Page 2 L SEPTIC TANK INLET H :IESEPTICTANKOUTLETL1Ht; PUMP/GREASE TRAP INLET PUMP/GREAsE TRAP OUTLET D-BOX #l INLET S A SOFLOWLINERIGHT 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 LevelHEIGHTOFLEVEL=Benchmark +Rod ReadingReference: 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):Leslie Tripp STREET ADDRESS:169 Maskel 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 NEWsewage disposal system must conform to ALL requirements of Section 19—13-B103 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 LOCA TIONS of PROPERTY LINES,WELLS, SIGNATURE:DATEISSUED:10/01/2012 RENEWAL:// APPROVED BY:Sherry cGann,REHS/RS EXPIRES:10/01/2013 EXPIRES:// 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 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 #N/A DATE PAID:0912512012 and BURIED UTILITY LINES 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:09/25/2012). 2 Install a 1,000 gallon two-compartment septic tank,with an approved outlet fllter.Risers are to be installed if there is to be more than 12"cover over septic tank cleanouts. 3.Replace existing sewer Iine with approved building sewer pipe.Sewer Iine pitch to be at least 1/4 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. 7.Variance granted:separating distance between existing well and new tank is less than 75 feet. Town 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 SUBSURF‘ACE SEWAGE DISPOSAL SYSTEM Application/Permit #: To the Director of Health,Town of:SMAXG Lk/Hm A51 T“Date:>r;7 /’2. Application is hereby made for an approval to construct a subsurface sewage disposal system for a: (Residential Building,Restaurant,Retail Building,etc.) located at:ié’a MmdQi RA (Street Address,Lot Number,Subdivision Name,Map,Block,Lot,etc.) New System Addition Repair Xi Other OwneS i/m‘i’bl‘LL;\\‘Te ddress Te1.No. Installer Vang awi agingrvla.UL Address §7Klws é $‘Zc/vml Te1.No.E60 g7 1770 <7 Installer License No.3 gjé In accordance with detailed information stated below: Application fee paid ‘90“g giu;Na Signed i/lA....‘_/ (Owner or duly authorized representative) wok/Z “Vexvx AWWMW‘M"GIN/A GENERALINFORMATION Soil Tests Conducted (Date):wwf‘rK,Lot size ,LY)N“,sq.ft. Area of Special Concern (Y/N):Ifyes,Reason(s): Basis ofDesign (#of Bedrooms,Restaurant Seats,Building Size,etc.):$6 €14 tim“ Engineered Plan Required (Y/N):A)If yes,Name of Engineer: Address of Engineer: Design Plan Approved (Y/N):j Date of Approved Plan:lb l 7.7.Revision Date: Approval to Construct issued by:%\V\LW Wgbu,‘n Date:LOI l i lb (Director of Health or Registered Sanitarian)l l Signature:$\NAAAA /"’W’LL/l/Title:Envy ORAAHA “@RLV Type of Water Supply M l l If well,has location been approved (Y/N): Well Driller’s Name:Address: OFFICE USE ONLY RECEIVED SEP 25 2012 SOUTH WINDSOR HEALTH DEPT. APPROVED TOWN OF SOUTH WINDSORHEALTHDEPARTMENT DATE:_LJ0 ‘i \(L, s1G:_4&xwL6%)‘h/M L‘Jg"“if:mg?:35 m W535 Y. 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Primary Construction Details Report Created 0n 9/20/2012 g“\"$§Town of South Windsor,CT "Property Listing Report Gls PIN 57900169 Account 57900169 Property Information Property Location 169 MASKEL ROAD Sewer Service TRIPP LESLIE JOwner Census Tract 4871 Co—Owner Neighborhood 45o 169 MAsKEL ROAD Zoning Code RRMailingAddress SOUTH WINDSOR CT 06074 Acreage 0.47 Land Use 101 Res Dwelling Book /Page 7a!a7 Land Class R Lot Setting/Desc Water Service UNKNOWN c7 WATER AREA Trash Day THURSDAY Photo Sketch Year Built 1958 Bedrooms 3 Exterior Walls Vinyl Siding Stories 2.0 Full Bathrooms 1 Interior Walls Drywall Building Style Colonial Half Bathrooms 1 Heating Type Hot Water Building Use Residential Bath Style Average Heating Fuel Oil Building Condition c+Kitchen Style Average AC Type Floors Carpet Roof Style Gable Gross Bldg Area 2838 Total Rooms Roof Cover Asphalt Total Living Area 1614 Sales History Owner of Record TRIPP LESLIE J Sale Date Sale PriceBook]Page 78/87 0 Report Created On 9/20/2012 .s:‘.3 /I "é Town of South Windsor,CTxPropertyListingReport Gls PIN 57900169 Account Valuation Summary (Assessed value =70%of Appraised Value)Outbuilding and Extra item Appraised Assessed Type 579001 69 Items Description Shed -Lq 128.00 s.F.Buildings Outbuildings Improvements Extras Land Total o Living Area (sq ft) Sub Areas Subarea Type Gross Area (sq ft) 1614TotalArea2838