HomeMy WebLinkAbout2019-10-22 - 1071 Ellington Road - B100a Application��A'I3Nl"al`�
Town of South Windsor — Health Department
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 applicatinn review time is 5-10 (lays, if soil lestink is needed, additional time will be required to complete the review process.
Street Address of Proposed tivity/Structure
Owner Name Mailing Address Telephone
bo
Applicant Name (if different than owner) Mailing Addr s Telephone
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Describe the proposed structure or activity with dimensions:
Residential C// Number of existing bedrooms 0?
Non-residential Please describe t-tj(JL G(N/I,tL'e/S % 0 n
Property served by on -site well? Y lW If No, List name of water company
Property served by septic system? � N Age of system 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 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 zir f this B 1 n application review process. I further agree that
this authorization to enter the suhjec rty t exte d. t a erie� f tin ending with the final B 100a application
approval and affirm such with ill ,i na re caw.
Applicant Signature: Date:�¢'�
FOR OFFICE
USE ONLY:
Approved: N By:.C/l7�`z" / �Gt I Date:
Comments/Conditions:
FEE PAID: CHECK # DATE PAID:
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1540 SULLIVAN AVENUE • SOUTH WINDSOR, CT 06074
TELEPHONE (860) 644-2511
October 22, 2019
David Sherwood
400 Chapel Rd., #36
South Windsor, CT 06074
B-100 APPLICATION
Street address: 1071 Ellington Rd. Town: South Windsor, CT 06074
Dear Mr. Sherwood:
On September 20, 2019, this department received an application proposing a conversion of a home into a business
on the above stated address. Based on the information provided and paperwork in our files this request has been
approved under the following conditions:
Approval is being granted under Section 19-13-13100a 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) 337-6171
Sincerely,
4-d� D
Heather Oatis, REHS
Environmental Health Officer
cc: South Windsor Building Official
South Windsor Town Planner
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