HomeMy WebLinkAbout253 Main Street Town of South Windsor — Health Department
r c 1540 Sullivan Ave.,South Windsor, CT 06074—Mailing Address
1530 Sullivan Ave.,South Windsor,CT 06074—Office Address
11 Phone Number: (860)337-6173,Fax Number: (860)644-1930
U'°R` B100a APPLICATION
(for building conversion,change of use,building addition,accessory structure and lot line change)
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
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Owner Name Mailing Address Telephone
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Applicant Name(if different than owner) Mailing Address Telephone
Describe the proposed structure or activity with dimensions:
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Residential V Number of existing bedrooms
Non-residential Please describe a
Property served by on-site well? Y . If No,List name of water companyC-
Property served by septic system? YN Age of system 3 � Date last pumped a 0 b
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
m. signature below. q
Applicant Signature: Date:
FOR OFFICE USE ONLY:
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Approved N By:_t� t1 f 1- Date:
Comments/Conditions: A!A i iN "I CA R G ��Z„ ��Rapv�oa' Cps c��3 „a c� r1,•t 4-
FEE PAID: Alk Ir CHECK# DATE PAID:
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Building i Ction 1
Year euitt, Building Photo
Lining Areas 2,&X;
Replacement Cast. i,2CS
Building Percent
Replacement Cost
Less Depreciation; i 56,9"0
Building Attebutao
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' 1540 SULLIVAN AVENUE • SOUTH WINDSOR. CT 06074
SOR c0N� TELEPHONE (860) 644-2511
September 27, 2018
Jeremy Mimitz
253 Main St.
South Windsor,CT 06074
B-100 APPLICATION
Street address: 253 Main St. Town:South Windsor,CT 06074
Dear Mr. Mimitz:
On September 20, 2018,this department received an application proposing an addition to the home that is on
your property. Based on the information provided and paperwork in our files this request has been approved
under the following conditions:
Maintain a minimum 10 feet distance from the existing septic tanks and leach fields from the proposed addition.
Approval is being granted under Section 19-13-B100a of the CT Public Health Code. This approval is given with the
understanding that you will provide proper care and maintenance of the existing system (the septic tank is to be
pumped every 3 years).
THE OWNER IS RESPONSIBLE TO SEEK PROPER AUTHORIZATION FROM ALL TOWN AGENCIES PRIOR TO START OF
CONSTRUCTION.
Should you have any questions, please do not hesitate to contact this office at(860)337-6173.
Sincerely,
4Ab-A-k D
Heather Oatis, REHS
Environmental Health Officer
cc:South Windsor Building Official
South Windsor Director of Planning