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Home My WebLink About2009-10-21 - 1043 Ellington Road - B100a ApplicationSouth Windsor Health Department B 100a application (for building conversion, change of use, building addition, accessory structure and lot line change) ! V `S Owner Name ii/1,(� , . proposed activity street number Address Applicant name & address if different from above Describe the proposed structure or activity with dimensions (e.g. _ in ground/below ground pool, deck, winterizing porch) telephone telephone Residential V" Number of existing bedrooms '3CA V IVpo Non-residential Please describe served by on -site well? Y N Property served by Dublic water? r Y N 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 windy v locations. Soil test data (deep test pits and percolation test) are required for the review of this a] If the data is not available, you will need to schedule an annointment with the health As property owner or duly authorized representative of the property owner of the above referenced property, I agree to permit 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 ; '�� f r` Date �r South Windsor Health Department B 100a application (for building conversion, change of use, building addition, accessory structure and lot line change) Address of proposed activity street number Owner Name Address telephone Z''%- Applicant name & address if different from above telephone 4�pcv�+�4 )< At, I 4�c% lac .rac,a •C/Tcr�� QED Describe the proposed structure or activity with dimensions (e.g. _ "addition with bedrooms, bathroom, family in ground/below ground pool, deck, winterizing porch) Residential C. - Number of existing bedrooms �—' Non-residential Please describe Propertyrroperty served by on -site well? & N Property served by public water? 62 N 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 existin and ro osed rooms wiih 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. As property owner or duly authorized representative of the property owner of the above referenced property, I agree to permit the health department staff to enter the above referenced property as part of this B100a 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 's N D, m 0 0 CL �Pv�6 �trry~J �R n P. v n Q •C � Ltl w: ryi 7 Er `: 21N Zo —49 �y 74 VV� 05V A tJ 0�000 I-mc, o Z o Z 0 m A A ° z p N ,N m J r Z Z Z N A A 6 1 Z Z SOUTH WINDSOR HEALTH DEPARTMENT AF?Ur.AI'Tiv►V :10- IlT '�IGJITICR FC!R SgNAGE O=nAI. LOCATi019r U `7 - J�} SOIL HOISTup : MCC,TA'IOIf TES'r5: (Record all. testa) , mad., lovi, esc pate g� �1 Tim Reading pa Time 'rARV A ON CP TAT FtESLfLTS jDapth prrsaax Hole Location - i'F'2��— z 4 �ERPA^_'IOIf FITS : ( Record ■ ll Pits) PIT 0 D. 75 f6, S` Pit n 01L"5S�I yocaticl P'IT D Mime j Resdiru ?tinimum .peSsolstion nstit (arias. Inch) Ground •dater Tsble' �UU.'IoR of Ogejc'7A"'IQR Pi""S Le Ground Soil water At f�C` �.r r CVi F=4 #2 SOUTH WINDS0R HEALTH '2- Iavestlgi you for wage 01syn4al.3ysz- DEPARTMENT SFECM CMMITIORS System design urger than 2,000 g-p-d- Kates supply watershed g1gh ground water (less than 14 ft.) possible seasonal high ground water ;ratsrccurse, marsh or pond possible seasonal flooding meted suitable axes YArV,aa,l soil (30 - 60 m`ins-/inch) Lmderlying tight soil (less than 4 ft) Slope over ISV Shallot ledge (less than 7 ft.) COWLLMICU Suitable for savage disposal Unsuitable for sewage disposal Additional investigation. required Retest during wet season er'.s plea required DESIGN R 0jA�MkTj0N5 C bw'1�- 'A"- cc� Iavestigsted by Title Confirmed/Witnessed by Title Comments: Heath.mLrk location Elevation Town of South Windsor — Health Department _ y- 1540 Sullivan Ave., South Windsor, CT 06074 - Mailing Address 1530 Sullivan Ave., South Windsor, CT 06074 - Office Address Phone Number: (860) 337-6173, Fax Number: (860) 644-1930 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. y'3 C_ 1_L I N t- Ta .J Street Address of Proposed Activity/Structure -M VllkL Owner Name Applicant Name (if different than owner) Describe the ng.Address Mailing Address structure or activity with dimensions: Residential X Number of existing bedrooms N 6 lO at/ &.o "� 11i`1- Telephone Non-residential Please describe Property served by on -site well? Y Z) If No, List name of water company Property served by septic system?( Y) N Age of system Telephone 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 testi 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 I00a application approval and affirm such with my signature below. Applicant Signature: t-ot Date: Zt jq_0 FOR OFFICEE IUSE ONLY: Approved:U N By: r4� Q ;-; j Date: Comments/Conditions: ry iptz utr(L4, Rev. 7/16/18 FOR OFFICE USE ONLY Application Complete: Form: Plot Plan: Building Plan: Info Needed: Soil Data Available: Test Pits: Perc Test: Need Soil Data Y N Notes: I Notes: Activity Code Complying Area found Y N Building Conversion: Will proposed change result in expanding system? Y N Change in Use: Notes: Addition w/ Increase: Addition w/o Increase: Addition w/o Increase OR potential repair area found that meets the following: 1. Replacement area provides 50% of ELA Y N 2. Replacement area provides 50% of MLSS Y N 3. No exception(s) to well separation distance Y N 4. Does not reduce the potential repair area Y N 5. Does not increase design flow of building Y N_ Accessory Structure Code complying area? Y N Potential repair area identified? Y N_ Lot size reduction Code complying area? Y N Lot line change General info Will this negatively impact existing SSDS? Y N Will this negatively impact existing well(s)? Y N Area separation distances approved: Y N Notes: . ��'�� j'...,. r '"�.,! �3� • • � s. •' ]+• � � r. i 'fir �.' . r / •i•� - t Ir - _ •tit } � 'b :+Z f'� t I�' F ,�'•t�eiL'� • 0-14f it ;i. ,�� ,sec •y��y; �` ,� ' � r.: 1 • •y,.. 4- It .. . A�: _ •• -i 1w • 'mil• •�1�._T =� •. � -Y, i �itir� .� '�' -•..� . nt � `�.�d'�'; �- ti- ,={' � it ' • �.•t r;141�• ' J • •4 i ;'7 �+ ' f !� $ fir'' ��` � � I' •�ri •V,�� ti.,