HomeMy WebLinkAboutSeptic Correspondence 685 Governors High rctcEiVED
' � . Town of South Windsor - Health Department
w4 1540 Sullivan Avenue, South Windsor, CT 06074 APR 2 a 2014
Phone: 860-644-2511 ext. 248 Fax: 860-644-7280 SOUTH VV►NpSOR
a. APPLICATION HEALTH DEPT
B100a
(for building conversion,change of use,building addition,accessory structure and lot line change)
Standard a lication review time is 5-10 da s if soil testingis needed additional time will be re aired to com fete the review `rocess.
U er O s
Street Address of Proposed Activi /Structure
Owner,Name Mailing Address Telephone
GtV .S Telephone
Applicant Name(if different than owner) Mailing Address
Describe the: proposed structure or activity with dimensions:
Residential Number of existing bedrooms
Non-residential Please describe
Property served by on-site well. Y N If No,List name of water company
Property served by septic system? Y N . Age of systei 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
ro 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 a ointment with the health department for s agree to allow9that
As property owner or duly authorized representative of the property owner of the above referenced property,
health department staff to enter the above referenced property as part of this B 100a application review process.I further ag
this authorization to-enter the subject property may extend through a period of time ending with the final B100a application
approval and affirm such with my signature below.
Date:
Applicant Signature:
FOR OFFICE USE ONLY:
Date:
Approved: YQ N By: y
Comments/Conditions:
#lL OCaJC�. 1 e
May 2011
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Plan. Showing Location of Proposed Garage
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