HomeMy WebLinkAbout2011-12-5 - 191 Hillside Drive - B100a ApplicationTown of South Windsor -Health Department
1540 Sullivan Avenue,South Windsor,CT 06074
Phone:860-644-2511 ext.24s Fax:860-644-7280
May 2011
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.
IQ!#/.7(<:&(~(OA
Street Address of Proposed Activity/Structure
é g /I Q{M H s‘xe/(t 0r /gee/A /ué “L
Owner Name Mailing Address Telephone
gray!It.“Caaghwas L<e /4cm rériJsgTZwm M Ca b;/ywwg 33‘7973
Applicant Name (if different than owner)Mailing Address Telephone
Describe the proposed structure or activity with dimensions:
iép.4 mag Z 33c Is“?"dude
Residential &Number of existing bedrooms 3
Non-residential Please describe
Property served by on-site well?Y ®If No,List name of water company
Property served by septic system?@ N Age of system Fl 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 ofthe 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 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 B100a application
approval and affirm such with my signature below.
Applicant Signature:w X 2%,“Date:i‘Z/f/(I
FOR OFFICE USE ONLY:
Approved:l N By:Date:ill §I iiII
Comments/Conditions:).V\SC ~4.r-
Notes:
1FOR OFFICE USE ONLY¢
Application complete:
Form:
Plot Plan:
Building Plan:
Information Needed Y N Notified Applicant
Soil Data Available
Test Pits
Perc Test
Need Soil Data Y N Notified Applicant Scheduled
Activity
Building Conversion
Change in use
Addition w/increase
of flow
Addition w/no increase
of flow
Code complying area found Y N
Will proposed change result in expanding system?Y N
Addition w/no increase.of flow
OR potential repair area found that meets the following conditions:
1.Replacement area provides 50%of effective leaching area Y N
2.Replacement area provides 50%of MLSS requirement Y N
3.No exception(s)to well separation distance is required Y N
4.The addition does not reduce the potential repair area Y N
5.The addition does not increase the design flow of the building Y N
Accessory structure Code complying area?Y N
Potential repair area identified?Y N
Lot size reduction \
Lot line change
Code complying area?Y N
General Information
Will this activity negatively impact existing sewage disposal system?Y N
Will this activity negatively impact existing well(s)and/or drains?Y N
Are separating distances okay?Y N
MEGSON &HYYPPA
CIVIL Enamszns
aLAsTouaunv.couu.
KUQCLV w rigs
z"x
\Qa }\M /
,‘J;at_ATxc)Ns
czRYlHED IUIsYANHALLY ccnntc7:
gio 8"‘awff $96W§i§3