HomeMy WebLinkAboutSeptic Correspondence 82 Deerfield Lane ToWn of South Windsor - Health Department
1640 Sullivan Avenue, South Windsor, CT 06074 �►'�`Jy�
r: #� Phone: 860-644-2611 ext. 248 Fax: 860-644-7280 qp "C�
B100a APPLICATION So ��Zpf
(for building conversion,change of use,building addition,accessory structure and lot line ch
Standard application review time is 5-10 days,if soil testingis needed additional time will be required to compfete the
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Street Address of Proposed Activity/Structure
La RF,J A , Davis Vk -644 .8312
Owner Name Mailing Address Telephone
Applicant Name(if different than owner) Mailing Address Telephone
Describe the proposed structure or activity with dimensions:
L 'T 1L 66C M S d n/ A/4Y 2 2 a 12
LAJ L/1GK o A-2 0 Or- P K ob er ILvi
Residential Number of existing bedrooms
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Non-residential t/ Please describe 12, X 1 6 Sjo¢ld--6�jq� G y -
Property served by on-site well? Y(N) If No,List name of water company �T ITT 2
Property served by septic system? I'V� N Age of system If4 Date last pumped
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 for soil testing.
As property owner or duly authorized representative of the property owner of the above referenced property,I agree to allow 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.: L2,QZ12-
FOR OFFICE USE ONLY:
Approved: (V) N By: 5MM, qac C_"" Date: iZ
Comments/Conditions: 'x `
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LOT #145, "BIRCH DILL ESTATES"f SE
TOWN OF. SOUTH WINDSOR# CONNECTIM"
SCALE: 1" - -40'
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LOT 1 5, "BIRCH HILL ESTATES", SECTION #7
TOWN OF SOUTH WINDSOR, CONNECTICU'T `
SCALE: 1" _ 401 06 �
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