HomeMy WebLinkAboutSeptic Correspondence 200 Scott 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
za5 E)GC5fl-pa / 5
Owner Name Address telephone
/62 2� -1 o�
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)
-C
Residential �+ Number of existing bedrooms
Non-residential Please describe
Property served by on-site well? Y N PrODerty 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'
re 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,
affnm such with my signature below.
Applicant Signature PP g Date
OFFICAIL USE ONLY
A44,
20'-0"(Open)
10=0"(Open) 10'0"(Open)
CO
�--8_ -. o
DECK 9 Da DECK O 4 DECK
00
N
$ v b 5
DEC 9=0" co w 10'0"(Open)
o eQ 49
m v a' 110'0,,-8Wh)
N +
4 N
8=0" 010"
=�4
Ken &Peta Hinks Deck
200 Scott Dr
S. Windsor
S �
F
Electric # APPLICATION FOR BUILDING PERMIT
Plumbing#
HVAC# Date:
Sprinkler# Estimated Cost $ 1 br bbo '
FINAL APPROVALS Permit Fee $ 190
Building COMPLETE RED BOXED AREAS
Occupancy Fee $ ja
Engineering TYPE OF PRINT ONLY Eng.Insp. Fee $
Affidavit ea
Appr.for CO. ► SIGN ON REVERSE SIDE
Total F $
TO THE BUILDING DEPARTMENT, TOWN OF SOUTH WINDSOR, CT (Additional Cost) $
The undersigned hereby applies to do work according to the following:
Applican IRAII Dgne Location of Work Lot No.
Applicant's Address <57 Gpm mRRR,Gw DM Tel #��3- �f
a Town - Zip 1*)(,Dal Lic.#141C, t �3 to
Owner Ker Architect
Owner's Address Architect's Address
:�.V31n1 soa- Zip OC�07�1 Zip
Sq.Ft. New Area: 1 st Fl. 2nd Fl. 3rd Fl. Total New Area
Purpose of this permit
City Water oo" Well ❑ Septic SystemV Sewer
Ins: HO SP Cert. Area Basement Garage
Approved by Date Use Group Construction Type
^ .- 15
Revised 1108
R _ Check List
For Applicants with Food Establishments, Wells and
Active Septic Systems
The following projects require special review
by WPCA OR the Sanitarian
prior to your submittal for Town of South Windsor
Building Permit Applications
WPCA Review: Food Establishments(sewer connected only)
• Grease Interceptors
Industrial, Commercial(sewer connected only)
• Recycling, Processing
• Renovations, Change of Use
Major Home Occupations(sewer connected only)
• Nature of Business
Sanitarian: Public Swimming Pools
Food Establishments
• (Septic or Sewer)
• Gas Stations
• Fairs and Carnivals
• Mobile Home Parks
Private Sewage Disposal and/or Wells
• Additions, ren and detached permanent structures
Name of Applicant/Owner
Addres r
Applican Owner: Z p�5 l c� DES. Cv.
Please review your project wilT*propriafe parties above. They will sign below
their approval and you may submit an application for a Building Permit.
WPCA Date
Sanitarian Date
Bldg 6/09
20'-0"(Open) 10'-0"(OPen) 10'-0"(Open)
V
O
O c
0 DECK
12=0"( j#o.aaso w DECK ;19a din m o DECK "Qo 0
0
N 4
4 a
r m m3 _ N_ 10'-0"(Open)
w
DEC 10 Railer'
m o O
$ a
4
N N Septic Tank
m
X.2" 81-0" 2'40"
12'-0"
Ken&Peta Hinks Deck
200 Scott Dr
S. Windsor
20-0" 10=0"
s
z
- 6-o"
o r
4 0
Q 10"DIA Q 10"DIA 0 10-DIA �F
010"DIA 010 /A
w 1010"
0
14.0"
0
Q 10"DIA 0 10"
12-0"
r.
Y=A
yak 10
O Jst-
RA
C [�
1540 SULLIVAN A NUE • SOUTH WINDSO , CT 06074
SOR•C `. TELEPHONE (86 644-2511
t59' �45-- �7
0
O L �€
o �� �ta�
is ' '`v24aY - 35•� j� .���,/ �
COIJ
€�
150,
` t
V
f
t
G.C>'T T Dt-tvF-
LOT #148, "BIRCH HILT, .STATES" SECTION #7
TOWN OF SW%nH WINDSOR, CONNECTICUT
SCALE% 1" = 5101'
r - - FteCk�* G, Corm.
�cc 7f 12/ (��