HomeMy WebLinkAboutMisc Correspondence 2620 Ellington Road South Windsor Health Department
B 100a application
(for building conversion, change of use, building addition, accessory structure and lot line change)
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Address of proposed activity street number
Owner Name Address telephone
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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)
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Residential Number of existing bedrooms _
Non-residential Please describe
Property served by on-site well? Y N Property served by public water? Y N
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 de artment.
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 l0
OFFICAIL USE ONLY
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w� 1540 SULLIVAN AVENUE • SOUTH WINDSOR, CT 06074
r�Osoe•co TELEPHONE (860) 644-2511
February 3, 2009
The Bullock Co., Inc.
123 Middle Road
Ellington, CT 06029
Re:Proposed bathroom renovation at 2620 Ellington Road, South Windsor, CT
To Whom It May Concern:
A properly functioning septic system is essential for the occupancy of your home.
Section 19-13=B100a of the Connecticut Public Health Code requires that property
owners demonstrate that their property contains a suitable septic system repair area
before building permits for building conversions, change of use,building additions,
accessory structures (sheds, decks, gazebos, detached garages, etc.), and pools can be
approved by the local health department. Also, all building additions, accessory
structures and pools must be located the required distance from the existing septic tank
and leachfield. The purpose of these requirements is to protect your existing septic
system and to ensure that properties do not become overdeveloped to the point where a
septic system repair or expansion would be hindered or limited. Please submit the
enclosed 13-100a application for our review.
If you have any questions,please call the health department at 860-644-2511, extension
248.
Res ectfu y,
Robert De Vito
Environmental Health Officer
CC:Christopher Dougan,Building Official
Patricia Hall, Owner
APPLICATION FOR BUILDING PERMIT
Electric# 2620 Ellingtot Rd
Plumbing# A n n Dater
HVAC #
Sprinkler# Estimated Cost
FINAL APPROVALS Permit Fee $ •�
Building E;;;PL;
AREAS Occupancy Fee
Engineering LY Eng.Insp.Fee $
Affidavit E SIDE
Appr.for CO. Total Fee $ -=—
TO THE BUILDING DEPARTMENT,TOWN OF SOUTH WINDSOR,CT (Additional Cost) $
The undersigned hereby applies to do work according to the following:
Applicant 7,A r- -e-0 - Location of Work Lot No.
Applicant's Address /2-,7 a DA Tel.
Town k�L:�rr�-mar✓ t�/� Zip p6 p 2.4 Lic.
Ownef s a ` Architect Z.i».w�ra�!-i✓ �� ��s�' y �-
Owner's Address aL� �i• ✓ Architect's Address s±;'Z i ax-�i C
N ogft Zip 0(P2 1%�T
/i�a� a Zip T
Sq. Ft. New Area: 1 st FI. 2nd FI. 3rd FI. Total New Area
Purpose of this permit T3 �•� ��� �►�
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City Water Well[] Septic Syste
_ Ins: HO SP Cert. Area Basement Garage.
Approved b Dat - �® Use Group'�.Q.�Construction Type _
Revised 6/02
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