HomeMy WebLinkAbout2015-4-17 - 233 Long Hill Road - B100a ApplicationlOwn OT §Outn WINGSOI'—Health Department1540SullivanAvenue,South Windsor,CT 06074
Phone:860-644-2511 ext.248 Fax:860-644-7280
APR W201};
SOUTH WINDSORHEALTHDEPT.
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 daysbilf soil testing is needed,additional time will be required to complete the review process.$3 (me/Hm Pm ’
S,eet Addres f Proposed Activity/Structure"i Ci,é Mum9 ,q Ci /Sim /E9¢a eigérzee /bwner Name-Mailing Address Telephone
//Applicant Name (if different than owner)Mailing Address Telephone
Describe the proposed struct re or activity with dimensions:
I'iaéOU'a a]{DU A Pozk.‘2 t\JCombs:eawt/Ladeier (UM/é gate(JUL,A Law“I’V‘
Residential ‘>_<‘Number of existing bedrooms 3
Non-residential Please describe
Property served by on-site well?@ N If No,List name of water company
Property served by septic system?®>7WNWP
WAWge of system UO Wm Date last pumped UA /Utd’1,J,/\
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 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.Ifthe 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 thehealthdepartmentstafftoentertheabovereferencedpropertyaspartofthisB100aapplicationreviewprocess.I further agree thatthisauthorizationtoenterthesubjectpropertymayextendthroughaperiodoftimeendingwiththefinalB100aapplicationapprovalandaffirmsuchwith/my signature helow.E
,Ali/ta Date:¢l ll]/Si /Applicant Signature:‘,V/pi l
FOR OFFICE USE ONLY:
Approved:Y N By:,.d/Date:Li“q i i yk‘'V’V Q
Comments/Conditions:S ()1 \i vu’A loo é\KKeQ RECEIVED
N
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NOTES
’70.;+0 fc “é SOUTH WINDSOR HEALTH WPARTMENT
LOCATIoN Z La”Alil/&
OWNERTYPE OF
DATE
,or
WORK i?it
PERMIg PxPE
‘INSTALLER
INSPECTOR QQ DRAWN BY rel)
(Househo1d System)
PERMIT TO DISCHARGE
Approva1 is hereby given to ouuz£¢‘L Li‘f EV.“¢£to discharge to aOwner
subsurface'sewage disposa]system Iocated at 9-33 Lew;Hm {Rd‘
in the town of .fk)L\LAJ~cr~which w111 receive treated domestic.sewage
is—
from a dweHing containing trophy bedrOoms.
PROVIDED:
1.Liquid discharge volume shaii not exceed 125 gaiions per‘
bedroom per day.
2.The septic tank shal]be inspected reguiariy and cieaned
not iess frequently than every Five years.
Construction Permit No.
Instaiiation inspected by Q\Défmwla “'Hme EnV‘HcmdHx&H3u%
Date of fina]inspection 7‘fAev ’ié :
2i ’wggfa _
Issued by:52s Devoivitc .aggéf
(DirectoE of'Heaith or Registered Sanitarian)
Titie EmmHCaE‘Ha OFdfi‘cef‘
Issuance date '7‘{‘1‘7’EKPWiaMWé
SPECIAL REQUIREMENTS OR RESTRICTIONS:
EXCEPTIONS: