HomeMy WebLinkAboutMisc Correspondence 164 Carriage Drive South Windsor Health Department
B 100a application
(for building conversion, change of use, building addition, accessory structure and lot line change)
Address of proposed activity street number
Owner Name Address telephone
Applicant name &address if different from above telephone
Describe the proposed structure or activity with dimensions (e.g. _"addition With bedrooms, bathroom, family
in ground/below ground pool, deck, winterizing porch)
Residential +' Number of existing bedrooms
Non-residential Please describe
Property served by on-site well? N Property served by public water? Y
Plot plan-attach a scaled drawing showing property lines and dimensions, location and size of
existing and proposed structures, and site features such as driveways, wells and septic systems,
drains and water courses.
Building plan-attach a sketch/floor plan of the proposed structure, addition or renovation showing
existing and proposed rooms with door and window locations.
Soil test data (deep test pits and percolation test) are required for the review of this application.
If the data is not available, you will need to schedule an appointment with the health department.
As property owner or duly authorized representative of the property owner of the above referenced
property, I agree to permit the health department staff to enter the above referenced property as part
of this B 100a application review process. I further agree that this authorization to enter the subject
property may extend through a period of time ending with the final B 100a application approval and
affirm such with my signature below.
Applicant Signature Date 7
OFFICAIL USE ONLY
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SEWAGE DISPOSAL SYSTEM DESIGN BEM LOT #1-3 CT MAP EW�LSDI NSAND $ALL
Percolation Rate: 1 in 8 min. IaSgA'P5.'� 3T t ' 3 SAYt 1 `QTC
Soils 011 . - ll" Loam. NOV., M2.
11" - 92" Clean Sand I HWBT CERTIFY THIS F .SST `UI,LI
No Ledge No Groundwater CCSECT. ,AND 0 ZGKINq RMMO GKS T IOLMD.
4 Bedrooms
JAM E. 7�
Use 1�250 Gal 'Septie Tank
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660 SF Zeaching 'ea - - — -
Regd... - - -Use 3 Leach:I g trenches: -
3 e wide.`.- 75' length - 12' O.C. PLO?"' PC A/Y0
675 :SF,
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cc. SKIPS SEPTIC TANK SERVICEs INC.
27 laiuddy Brook Ro2d - P.O.Box 29 • Ellington,COnntCdQLr,06029
fU E D (860)$75-2332 • www.skipsiepuccom
C0 THIS IS NOT A REAL ESTATE INSPECTION
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' FRiser(s): 0 v1.k% . t 11t�3 r,Yater Ireahnent discharge to septic Y N
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Solids: 4,,1 OistancA from tank to.hu�<'when pumping.-,MIA
Tank: C Goad [[P].Acceplable C Poor Oudal Filier..�AJO Approx'rnale vertical(uphill)puR•if any: f
Inlet pipe: EU. Type of Tank:0 Steel &oncrete
Sales: 1YW 1 `t'�CC() Condition riot,r 0,4iuiti Compartment [I Other: t!)
Fefds appear to be: Ah5ollb 'At. US
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Need to cal afiice re:_ -!3tCf jn5j-c,,_�
Localion of tank: Diagram Vridimensions and locations of covers.....
Not responsible for rahange or damage due to seasonal ujaler table var.•altons
Of change in household use. 1f you have any lurrhar questions/x+ease call our
offl'oe oryour iotai or slate heallh oepartmant
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PROFLEXO 5454
Optional Accessories
K-9696 Jet trim kit(metal finishes) Ll CP Ll PB U_Other
Technical Information Required Electrical Service
Fixture*: Two dedicated circuits required, each protected with
Basin area: Class A Ground-Fault Circuit-interrupter (GFCI):
Bathing well 44"(111.8 cm)x 36"(91.4 cm) Pump/control 120 V, 15 A,60 Hz
Top area 56"(142.2 cm)x 43"(109.2 cm)
Weight 70 lbs(31.8 kg) Locate the outlets behind the whirlpool and within 24"
To overflow: (61 cm) of the pump.
Water de Installation Notes
L-C9—pDacity /f76 gal (288f'L
Install this product according to the installation guide.
q APPMXWU"4:40&r-ft6lFemeftt���parlson only. Floor support under whirlpool must provide for a minimum of
Pump: V Hz A 36 lbs/square foot(176 kg/square meter)loading.
1-speed 120 60 7.5
Corner Proflex 5454 Bath
Whirlpool = K=1154=CC
by Kohler I Model Number: K-1154-CC
K-11S4
1 .5cera 3Q•314"(73.1e.�r
30-314" 6' Gcir+}
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