HomeMy WebLinkAbout2015 Sep 23 - Sign Off Transmittal Sheet, Floor Plans, Notes - Basement Family Room a , I
roF�q�,� TOWN OF YARMOUTH I
o y ��y HEALTH DEPARTMENT i
�' �/? �
, ^•_••` PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET �
,�
To be completed by Applicant:
Building Site Location: ,3 0� �l I'rt`�� ��, ;� C.�c �¢ �l �"`��� '�
Pmposed Improvement: � � �, ` �
� �
.. �
Applicant: f �.. �� a r� Tel.No.: J�� J��i g��3 � `
C a�l�l 4 1i3 �
Address: �." 4� �"' J ,.— Date Filed: - i ^ -/i�
'slfyou would like e-mail notrfication ofsrgn o,�;please provide e-mail address:
Owner Name: -�-� ,� �.e- i � �,t.-
Owner Address: � «;� �,� �" C7 p�.! Owner Tel.No.:S� d� �J 9 9�3� �
...........................................................................................................................................................................................................................................................................................................................................................
RESIDENTIAL AND/OR COMNIERCIAL BUILDING
HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements
For Septage Disposal and other Public Health Activities.
Please submit three (3) copies of plans, to include:
(1.) Site Plan showing existing buildings,water line location,
and septic system location;
(2.) Floor plan labeling ALL rooms within building
(all ezisting and proposed) –
Note:Floor plans not required for decks,sheds, windows, roofing;
(3.) If necessary, Title 5 application signed by licensed installer
with fee.
.._.........................................._.......................................................................................................................................................................................................................................................................................................................
REVIEWED BY: � /J"�� DATE: `�/J-��I S
PLEASE NOTE
COMMENTS/CONDITIONS:_
(3 ccs-�w�r�.T �-v�, � (� 2u�nn — �� �tv �� (iSr� a S c� ��<-c�✓cx>v�.-.
� (ill,t � z w.cziH ( -r Vo�wc- -1 S 1�7� ✓
� �� i � ,
� � � � I _M � _
� � �—T � � �
� �
f� � �
,
�
� "' a
�` C�J o
> � � �
V£ � � M
;, � fi � � �
� � a
._,. ° N =
U
L
�/ I
� i
�
� � ��..�....�..�-.� ._._..._...e
-r 4 r---.__.-_-_-_
: �}
� � f �
� V' I .
� � ` ? .'
� c.r- �_
4 � �
� �
�
�;
1
�--... _�. i� .
-__ { ��O
�y
! �
�1bT�E: =n5�'At.� i^�eGhaNicq-� VCn�<<..c�r�oN S�s+-cn� t=or� ��tM��y R�vrn
If�S�-� IMCL�tRiVlcPcL Lt�i1��'iNcj 7 N�A'1-0 S�� l C LRNS W1TH
4 wA-rr' t-en T�,MS
I
� � > Z�B�x ��� /T
� DoaRS rK�sTrn1� (�a-sEr1ENl
q '�'+ - � To ��k�N
( NEW 2xy wA�-�.* I l�AIF�lNIS� L�
16'� o,�, =a
�X�sT�NG s�"�4iu � n -° E�(�s�iN[� Ch�mne�
`.l SP� �wetil
Ch�Mne� ArND n�E
� WA�L
� i _+ � z� !�`
FINISµ
�� GEl�lf� (� Zo�� E �(1�TIN(� �12.1
� 11
�� iSriN� �n �z �S� u� 3oa�.D �nl�+c�,S
N £ GEr��nl�, , Zh(� WhL� VNDE�Z �I2T
�A�LA�E. � -� �
3�q" 5��c�rpp„�� -O
Z��1 F Zxb P.T Si��S ^
� 2xiv
� �c�sr�a� FIo�rZ Sois��
16�� O,C s� ��+-
= o
�
' I' G3�C5�G��DD
� 7� 0 -1' -
SEP � 3 'LUi5
HEALTH DEPT.
a�� 1-oa�M DN ��ie.� u�r�tLS
�A-TT In�Su�A=�loni bnl A�Lc. INTU�eiLWr4f.l.s
/`{�� l I � Dit
� ��/.7//
� !�"' ��C.��t CL4w� C��� 7
1
a, 6-��-� ,�=� �� a`�q -f- � -
�� � r o��� S
� �,-� -' � -a 3 7� l-�.�
, �
C c, ` � ` C�..� � �' p�- - ��s�
J�a`�
�. G'✓c
.r�ap �. , /�
LbT N0-~L�ADDRESS:3a �oe�P,�,�,y�, fl�,
OIJNERS NAPiE: Q/�i/G�
SEWAGE PERMIT NO. :_os.S�NEW: REFAIR:_�
DATE ISSUEU: OL / OJ DATE INSTALLED:d 0� '
IP�STALLERS NAME: /�}/J S��T(
INSTALLATIOPI OF: ,f� q� ������
JJ`V� C� ��,..7�'C �
�7�bJrC�c17'Zt
WATER TABLE: FINAL INSPECTION BY:�
DKAWING OF INSTALLATION ON REVERSE SIDE: -
- _ ,.
w� 6'/�6-P
1�T�o
ag�� �= �.s �
n .t=s�6�6�' • ' �=027�6 r.
L
.� 3=31�S�� g �5 3 = 3a�6'`,
y- s
� Y�� � ' Y' y ? ' 1
S, , �
y ��,,Q���y
�- --�' `.
- - . ,
\ _
, . . y
' . Page 6 of I]
OFFICIAL 1NSPL'CTION FORM-NO'C FOR VOLUNI'ARY ASSE55MENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM I1�ISPECTION FORM
PART C
. SYSTEM TNFORMATION
Properry Address: � a �'�R�'EN LA Np C12CC.E
�IARvrni)rA �MA, •
oWo«: -�R�Yu A �a«���.� _
Date of Iaspcctloat_ a-9 - 7..00S .
FLOW CONDITIQNS
RESIDENTUL �
Number of bedrooms(design): o� Number df bedrooms(actual): o?—
DESIGN ilow bued on 310•CMR 15.203(for exainple: I 1D gpTMd x N af bedrooms):�-O
Number of eurrent rcsidenu:_L
Does res[denec have a gubage grinder(yes or no): N o
Is laundry on�scpvate sewage system(yes or no):/VO (if yes separate inspection required�
Laundrysys�eminspected(yesorno}:ivo N�j�CGONnetTe..Cy-� TJ,es snr.i
Seasonaluse:(yesorno):�1p �o0 3yeoe Ys�r gi•�S- 6•/�� 1�•
Water mescr rcadings,if available(last 2 ycars usage(gyd)): + 7000 ' Stt �� �,�� 6.P c1.
Sump pump(yes or no):�o
Lase date of acupsncy: -u2tN,,�rc7 Oe e�.e�ar ec.(
of esublishmea[:
Dcsign• based on 310 CMR 15.203): ¢od
_ Bssis ofdesi� �eaWpenons/sqh,ecc.):
Greue trap presen�(ye o):�
Indus�iat was�e holding tank nt(ycs or no):_ '
Non•sani�ary wasze diseharged eo[he ' S sys�em(yes or no):_
Waccr mner readings,if available:
Lui date of occupancy/use: •
07HER(describe):
r
CETVEftAL INFORMATiON
PumpirtY Records '
Sourct of information: q�-Z6 �y�f.7t��oocf �„�k�„� �
was syseem pumped as part of� e mspecuon(yes or no): .vp
I f yes,volume pumped: -O- eallons•-How was quan�iry pumped decermined?
Rcason Ior pumping;
TYP yPlP SYSTEM
�,�Sepeie urilc,discibueion box,soil sbsorp[ion system
Single cesspool . ,
Overflow cesspool
_Privy
_ Shued sysum(yes or no)(if yes,a�tach previous inspection records,if any) '
ob]nnovativdpltemative technology. qttach a eopy of the eumnt operation and mai�tenance eontraa(to be,
�ained from system owner)
—T�81��� _,Atueh a eopy of the DEP approval
_O�her(describe):
Approximate a¢e of 1 eomponents.date insralled(if knawn)and source of infarma�ion: I
^� �� //-.��/4g •4•p /IO x 2�-YC�IY2 S 3 YLt6S OGG .
Were sewage odors detecced when uriving at the si[e(yes or no):/l�0
6