HomeMy WebLinkAboutSeptic 40 Ordway Drive Town of South Windsor — Health Department
*S C6r 1540 Sullivan Avenue, South Windsor, CT 06074
' Phone: 860-644-2511 ext. 250 Fax: 860-644-7280
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.
�C:3 ��Pzv�� fE�l1-• �O�► ��rn���n �--�
� .[Street Address
.o_ roposed Activity/Structure
Owner Name Mailing Address Telephone
(l L s / 9 Ca Cry
Applicant Name(if different than owner) Mailing Address Telephone
Describe the proposed structure or activity with dimensions:
4,0
ResidentialNumber of existing bedroom}_
Non-residential Please describe
Property served by on-site well? Y b If No,List name of water company
Property served by septic system96J N Age of system �C)('1 Date last pumped At-a sty
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 wi signature below.
Applicant Sign u e: Date:
FOR OFFICE USE ONLY:
Approved:a N By: f Date:
Comments/Conditions: 7 •Z . /S t Pyt V-0 5-f e
May 2011
ZONING COMPLIANCE FOR SMALL STRUCTURES
(Sheds and detached decks 200 sq. ft. and smaller) �; �� ;_;'"
Address of Proposed Structure: Lio Zone: -a
Name of Owner: l rr '�-J c GIS PIN:
Phone Number: �W - c 30 . ice'1' Application #:
1. Name of Applicant: L-eDif
Address:
Phone Number: S-Llo �� S
2. Structure cannot exceed 200 square feet.
TYPE OF STRUCTURE: A— SHED DECK (not to exceed 30"from grade)
DIMENSIONS OF PROPOSED STRUCTURE: 10
3. A Class D survey must be submitted with the application showing the property lines, all other
buildings and the location of the proposed structure.
4. Is the property served by a septic system? Yes ,� No If yes, the applicant must
complete and submit a B100a Application to the Health Department for review and approval.
The undersigned hereby permits Town staff to enter onto and inspect this property during
reasonable hours for the purpose of reviewing this application and to determine final compliance
once construction is completed.
I, the undersigned, acknowledge that the above information is true to the best of my knowledge
and that the above requirements are understood.
Applicant Sign re: Date: }�
Owner Signat Date:
Reviewed and approved by: Date:
Zoning Enforcement Officer
Reviewed and approved by: Date: �lJ
Environmental ae�akh Officer
cc: Assessor
Building File
04/15/14
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