HomeMy WebLinkAboutSeptic Correspondence 140 Newberry Road Town of South Windsor - Health Department
1640 Sullivan Avenue, South Windsor,CT 06074
Phone: 860-644-2611 ext. 248 Fax: 860-644-7280 � # 25 2014
B100a APPLICATION NF.�,4H NOSoR
(for building conversion,change of use,building addition,accessory structure and lot line change) DE
Standard application review time is 5-10 days,if soil testing is needed additional time will be required to complete the review process.
Street Address of Proposed Activity/Structure
Owner Name Mailing Address Telephone
Applicant Name(if different than owner) Mailing Address Telephone
Describe the proposed structure or activity with dimensions:
6X. /0 deGf-- i n / tc?r ® - /av-5L
Residential Number of existing bedrooms
Non-residential Please describe
Property served by on-site well? Y If No,List name of water company_ it�
Property served by septic system? Y N Age of system Date last pumped Zor/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
pro osed 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 si afore below.
Applicant Signature: Date:
FOR OFFICE USE ONLY:
Approved: CY N By: Date:_yI2oC�lLk
Comments/Conditions:
May 2011
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DEC. 19, 1978 SCALE 1"- 40' MARCH 1973
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REVISED APR.,19T3
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