HomeMy WebLinkAbout2014-3-31 - 108 Griffin Road - B100a ApplicationTown of Soyth Windsor —I-!ealth Department RECEIVED
1540 Sullivan Avenue,South Windsor,CT 06074
Phone:860-644-2511 ext.248 Fax:860-644-7280 MAR 3
May 2011
B100a APPLICATION so T(for building conversion,change of use,building addition accessory structure and lot linen}W’NDSORStandardalicationreviewtimeis5-10 da s,ifsoil testin is needed,additional time will be re uired to com lete he aW cess
i0 §Grk£1£ih Q4
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Street Agdress«wk k“of Proposed Activity/Structure
z.aQL/(hac/i /los’art Wm R oi so;cram eév ‘1 36 ‘m;
Owner Name Mailing Address Telephone
//
Applicant Name (if different than owner)Mailing Address Telephone
Describe the proposed structure or activity with dimensions:
f 5 keciia:x [G
Residential §1¢5 Number of existing bedrooms 3
Non-residential Please describe
Pmperty served by on-site well?Y N 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 proposedstructures,and site features such as driveways,wells and septic systems,drains and water courses.
Building plan —attach a sketch/floor plan ofthe 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 ofthe above referenced property,I agree to allow the
health department staffto 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 oftime ending with the final B100a application
approval and affirm such with Hy signature below.
Applicant Signature:’,I Q a Date:3"2 l ‘Hp
FOR OFFICE USE ONLY:
Approved:®N By:.J Dateé ‘.aleK.Comments/Conditions:3 fate/t .."",$‘egk
1540 SULLIVAN AVENUE o SOUTH WINDSOR,CT 06074
TELEPHONE (860)644—2511
April 1,2014
Mr.George Backhaus
Mrs.Mary Backhaus
108 Grimn Road
South Windsor,CT 06074
Dear Mr.&Mrs.Backhaus:
On March 31,2014,this department received a B100a application for a proposed 12’x 16’foot
shed to be installed on your property.
Upon review of the infomation provided on your appiication,the proposal has been approved with
the foilowing conditions:
o A minimum of 5 feet shouid be maintained between the shed and the existing septic
system.
Be advised,you must obtain all appropriate approvais from other town departments prior tocommencingworkonthisproject.
Should you have any questions,please do not hesitate to contact me at 860-644—251 1,extension
248.
Sincerely,
Sherry Me ann,as,REHs,HHs
Environmental Health Officer
SKIPS SEPTm TANK SERVICE,INC.WK
6 Nutmeg Driv€-P.O.Box 29 °Ellington,Connecticut,06029
Solids'../<‘k.3’,,+LIQUId..Depth yq ,,=‘/3/er oi/°Distance from tank to truck when pumping:9{a r ftNote:State Heaith Department recommends <25%accumulation ~
WM 7.Approximate vertical (uphill)pull-if any:“‘“W‘”ft
/
Tank:D Good /@5Acceptable El Poor Outlet Filter ..
Inlet plpe:‘A:air)?5:9“w ft 5 _p C I C b a“w
gMulti
T pe orTank:
Compartment
a Steel gooncrete
D Other:Battles:Type TI ”ff-37‘(3Aba -‘‘f)*_..Fields appear to be:.EECE f Lt?!N?Ly .g C
.:g i t .Tank at:Normal Level .z’I ‘t’9{§lightly above
Considerably above Water running back
Last pumped:Next pump:
Need to call office re:
Location of tank:Diagram w/dimensions and locations of covers .....*>
Not responsible for change or damage due to seasonal water table variationsorchangeinhouseholduse.if yOu have any further questions,please call ourofficeoryourlocalorstatehealthdepartment.
I Condition é:C35$C1y
>'k
(860)875—2332 ‘www‘skipsseptic.comTHISISNOTAREALESTATE INSPECTION Date 1’.L.i i
C:J[Street a““"gg}\1%;J House (Lot)#I f)y Owner Mak§“if’géLéx’i’widgTownSE;u‘?‘£\LJ iL-qéjtigf‘;i‘Telephone AC‘T‘”("7 a?éwz
Building Serviced:Kéesidential D Apartment D Commercial Garbage YDisposal N
Size of Tank:/a Ci C3 Gal.Depth Below Grade:=2}!I,
Separate_Separate Graywater System Y NRiser(s):IO i'(a)?(“fie/Z farm
Z@E€E%G @@MPEEEAN€E FQR §§VMLL §?R&§€TURE§
(Sheds and detached decks 200 sq.ft.and smaller)
Address of Proposed §§rggtu e:Wefié‘mpicQOC Q J Zone:
Name of Owner:Gav/M ,$az;k£x6iv<GIS PIN:IPhoneNumber:W30 ([36 L13 7 ’3)
1.Name ofApplicant:§eor§n3 gftékhkv§
Address:MS?értWm K0?
PhoneNumber:8Ga LL36 (“[375
2.Structure cannot exceed 200 square feet.
TYPE OF STRUCTURE:i4“SHED DECK (not to exceed 30"from grade)
DIMENSIONS OF PROPOSED STRUCTURE:r![6/r
3.A Class D survey must be submitted with the application showing the property lines,all other
buildings and the location of the proposed structure.
4.Is the property served by a septic system?“Yes No If yes,the applicant must
complete and submit a BlOOa Application to the Health Department for review and approval.
The undersigned hereby permits Town staff to enter onto and inspect this property during
reasonable hours for the purpose of reviewing this application and to determine final compliance
once construction is completed.
I,the undersigned,acknowledge that the above information is true to the best of my knowledge
and that the above requirements e understood.Wk /Date:$‘VD I ‘J 1
.M.Date:T3 5:35 ~W
***************************************>k*************************
Applica nt Signature:
Owner Signature:
x”)
Reviewed and approved by:”rune Date:.3
Zoning Enforcement Officer‘§\Reviewed and approved by:Q§g ‘Iwim Date:3'3’3 4v:
Environmegtal HealthbO’fficer
'3t
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cc:Assessor
Building File
3/26/14
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108 Griffin Road �� w m,o,.�o�� 1 inch = 30 feet PARCELS TOWN LINE CENTERLI... m ,�„�e,�,xnw��=• 'GIS
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