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HomeMy WebLinkAbout2016 Mar 15 and 2015 Dec 30 - Sign Off Transmittal Sheet, Floor Plan, Assessor's Info ,_,--,-...,�.�,�„'. -- "`' ,�� � ��� �-'�a� TOWN OF YARMOUTH • .� >� �;� �� _ `�`c HEALTH DEPARTMENT � � �� � � � � "', `+� pERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET '.'.!� AOMEi'� . ���:,'i�. � � � . �'o b completed by Applicant. � � a� �� � ��b� Building Site Location: � 0 � \� � M G V M � Proposed Improvement: R e-c`�`C�v 1Z. � R e ��� T(�S��°-����n p f� �('S'� \ C. � v e.. �-- �.ch cT,�- GOi . C'�c�o c \c�.c � a�► I c t � APPlicant: C.v`$�G M C���`�(',U �M�S ..�, ��oc'ITeI. No.:�OQ - ���' �4 3 0� Address: �o� C,�6� M�tS G �• G�,((`'� Date Filed: 3 `��-�G � **Ifyou would like e-mail notification ofsign off,please provide e-mail address: Owner Name: ���.� �,U c`�� Owner Address: � O Cd f`�A�� S• � � q �(Ol Owner TeL;No.: �'1�2j `��`S y 8s � ,� i ............:....................................................................................................................................................................................................................................................................................:..............................::........................:.:.s.: .:� � RESIDENTIAL AND/OR COIVIIVIERCIAL BUILDING fHEALTH DEPARTMENT: Determines Compliance to State and Towri 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 t�-LL,room�s �vithin building (all existing and proposed) - �::��,� Note:Floor plans not required for decks,sheds, wdndows, roofang; (3.) If necessary, Title 5 application signed by licensed installer with fee. ................................................................................................................................................................. ....:................................................................................................................................................................................................ REVIEWED BY: DATE: ��/�/� PLEASE NOTE COM ENTS/CONDITIONS: � ��o a,� / r�2�'JOY �1'�'LJi' ��¢ I Y�/Y_'.�' L G'i�q�.GPl.� �i i Z. - �tJ�/� � y _�-,� -_....,.�.m _ -- ��_ _ .-��--. �:_ � .:�:. � � .ati=�a�? TOWN OF YARMOUTH ' � � � `�c HEALTH DEPARTMENT , �"�. � � � -�- 4S.�'M A �j�J��E��`` PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET r�,;�.�, � .T be compdeted by Applicant: � Building Site Location: � � Q,� M��� �� ��V� `�aE ��v�� Proposed I provement: C��Ce n� �"�o M � ti R �C'q'C d� f o e C� haS 3 b�tooMS i be coo�^ w��� e. CQ.c��ve� oM Seco S�,c� t�^+v���n � G, a. e��C�oM W e.�1� , 1 �\� � W a� e. c� "�o �eCo �,C y Cn`� cj r� c5r C4f1. p Applicant: J Q`��� 1�c�C�n� p� Cc.�51or� CCa��e� FIoMeS Tel.No.: �'j� C7' �0���� �`13� Address: �� c�t�5��'�'�5 LV°`� � � t �� M 4V� Date Filed: 4�" �- � � **If you would dike e-mail notification of sign off,please provide e-maid address: �n'�C�� C IJ��C7�C s����e�,�pM Owner Name: Qe��� �F 1�vn �� Owner Address: q 5 ��� ��n `J� �- �C�C(„�G�l�'10wner TeL No.: q��` �7�' S��� ........................._........................................................................................................................:.................:............................:............................................................................................:.................................................................. RESIDENTIAL AND/OR COMIVIERCIAL BUILDING �HEALTH DEPARTMENT: Determines Complianee to State and Town Regulations; i.e., Requirements For Septage Disposal and other Public Health Activities. � Please submit three (3) copies of plans,to includes (l,.) Site Plan showing existing buildings, water line locatioa, and septic system location; (2.) Floor plan labeling ALL rooms within building (all existing and proposed) — Note:Floor plans not required for decks,sheds, windows, roofing; (3.) If necessary, Title 5 application signed by��icensed installer with fee. ................................................................................ ................... . ..........................:...................:......................................................................................................................................................................................................... REVIEWED BY: DATE: I�-/,jGf/� PLEASE NOTE COMMENTS/CONDITIONS: � � �� ( �v�� � ,� � '�� !� l4 �v � � �J �j, � �� .j� a r 3�c�✓��� `� �,y C �a� � °� S� (�.-- Vision Government Solutions Page 1 of 4 ;, _:� � 95 OLD MAIN ST Location 95 OLD MAIN ST Assessment $444,700 Mblu 50/ 154/// PID 6273 Acct# 6273 Building Count 2 Owner TRAUB JEFFREY J Current Value Assessment a�. ._...........__.._ .�. _ _�_...._�_._.__. _ _. _�..__ _�__ _ __�...........------...__..�w_...._..._.._...__ _.._._.___ __ _ _.m�______�.._..._.__.........---______�. � Valuation Year Improvements Land Total r =2016 � $254,300 f $190,400; $444,700 � Owner of Record Owner TRAUB]EFFREY J Sale Price $0 Co-Owner C/O DUNBAR PETER&MARYELLE Certificate Address 396 WEST MAIN ST Book&Page 2163/255 ROCKAWAY, N7 07866 Sale Date 03/21/1975 Ownership History Ownership History Owner Sale Price Certificate Book&Page Sale Date �TRAUB JEFFREY J ��� 2163/255 �� 03/21/1975 i �TRAUB JEFFREY] $0 Building Information Building 1 : Section 1 Year Built: 1960 Building Photo Living Area: 2576 Replacement Cost: $358,460 ' - ' _� Building Percent 45 Good: =;A Y � Replacement Cost �" �` Less Depreciation: $161,300 � _ _.___ ____........____.____.___, Building Attributes Field Description Style Conventional �Model Residential E ;Grade: ;Average+20 Stories: i 2 Stories Occupancy !1 � (http://images.vgsi.com/photos/YarmouthMAPhotos//\00\02 Exterior Wall 1 �Wood Shingle \67/67.jpg) i [ I http://gis.vgsi.com/yarmouthmalParcel.aspx?Pid=6273 12/29/2015 ' { ' SiOZ/6Z/ZI £LZ9=Pid�xds�•Ia�.ze�er.uu�nouu�A�.uo�•is�n•si���:d�u i � se� �an�;eaH' ! 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Heat Type: Hot Water AC Type: None Total Bedrooms: 1 Bedroom 'Total Bthrms: '1 � Total Half Baths: 0 ;Total Xtra Fixtrs: Total Rooms: Bath Style: Old Style Kitchen Style: ;Old Style Buiiding Sub-Areas Legend, � Code Description � Gross Living � � Area Area t �BAS r First Floor i 805 805 UHS €Half Story,Unfinished �575 0 3 �UST �Utility,Storage,Unfinished �30 0 � F � '1410 805 Extra Features _ .... _ . ... __ _ _ . �� _.___ ___ _ ......____�m__ � .__ _..___.. ________ � __ �__ __ _._._ Extra Features e end � Code Description Size Value Bldg# �FPL3 2 STORY CHIM 2 UNITS; $2,500 1� t FPO �EXTRA FPL OPEN 1 UNITS; $400? 1 '_,FPL2 ;1.5 STORY CHIM ( 1 UNITS; $1,800 2 m._._.._. _..._e._. .............S________._......_............_..__._ ..._.:_...._.....____............._.__. �._.._..�_____.__.._.._....._��, Land Land Use Land Line Valuation Use Code 1090 Size(Acres) 0.97 Description MULTI HSES MDL-01 Frontage 0 2one Depth 0 Neighborhood 0070 Assessed Value $190,400 Alt Land Appr No Category Outbuildings ; Outbuildings Legend � � Code Description Sub Code Sub Description Size Value Bldg# 'FGRl =GARAGE-AVE 324 S.F. $1,300� 1 � Valuation History i Assessment � Valuation Year Improvements Land Totai i2016 $254,300 $190,400; $444,700 http://gis.vgsi.com/yarmouthma/Parcel.aspx?Pid=6273 12/29/2015 ' ; � SIOZ/6Z/ZI £LZ9=Pid�xds�•ia�.re�u��nouue�i�uzo�•is�n•si�/�:d�u �paniasa�s346!�Ild��u�'suoiln�og;uawwano�uoisin q�pZ(o) _....�.�. _..._.......__......_ ___.._______.______.__. __._....._V_.....__ , _._______.____._.._.___._.___ _...�_.......__��._._____�.�. _._._._. 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( � ob � � r� ��v � � � :b o `O � eCo . o�' �N��S.� o .'C �/� ,y J C <C A � 'a y Vl � � ' lr y�.Neo� � � y � C � O a, T�A a � A uai � O � w.+ j O o A a OD '�ii O �l N a y � 't A r J �n N rr�0� � i1 O O t�o � � �l 00 O l O O O O� � � - O O C� O O O O O O O O O O �. . . ; i , ' M SD . � Commonwealth of Massachusetts p�� � ,�= M J^ Title 5 OfFicial Inspection Form t A;.;c ; _ _ Subsurtace Sewage Disposal System Form-Not for Voluntary Assessments ; � � �r1L-r;� _. . P��. 95 Old Main Street-Guest house �"""'""T'T"�"��" � �—�-:�,� Property Address — ,` � Traub ��� '� ./��,�j •' �ef OwnePs Name � � informaGon is South yarm0uth MA 02664 8/9/2011 required for every page. City/Town State Zip Code Date of Inspection Inspection results must be submltted on this form. Inspection forms may not be altered in any way.Please see completeness checklist at the end of the form. Irnportant:wne� A. General I nformation fiiling out fortns on the computer, useoniytnetab 1. Inspector: � ���� � key to move your cursor-ao not Patrick K. McDowell use the retum Name of irtspedor key. pKM Contractors, Inc. � ��"'_ �1f��� ' � � ��13�'��� � Company Name Qi`l'""c P.O. Box 775 Company Address � East Dennis MA 02641 CitylTown State Zip Code 508-385-5993 SI 13023 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. t am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000�.The system: � Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by t Local Approving Authority ��,� b ' !ns ector's Signature Qate �- The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shali submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. "'*`This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perfonn in the future under the same or different conditions of use. ISins•11H0 Tftla 5�fficial Inspecdon Form:Subaurtace Sewage Diapoaat Syslem•PBpe 1 of 17 , , _ � � � Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not fo�Voluntary Assessments 95 Old Main Street-Guest house Property Address Traub Owner Owner's Name inforrnation is South ysmtouth MA 02664 8/9/2011 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: � leaching pits number: (1)6'pit ❑ leaching chambers numbe�: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overFlow cesspool number: ❑ innovative/altemative system Type/name of tech�ology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation,etc.): Area surrounding pit shows no evidence of hydraulic failure. Top pf pit is 16" below grade. Pit was found dry at time of inspection. Stain lines indicate that pit contained approx. 3'of liquid at some previous tirne. Cesspools(cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No i t5ins•11N 0 Title 5 Officiel Ins ' padion Form:Subsurface 3ewepe Dispoaal 3ystem�Pepe 13 of 17 � --- - i � � , � � s � � Commonweaith of Massachusetts Title 5 Official Inspection Form SubsurFace Sewage Disposal System Form-Not for Voluntary Assessments 95 Old Main Street-Guest house Property Address Traub Owner p�er's Name information is SOuth yarmouth MA 02664 8/9/2011 required for every page. �YR� State Zip Code Date of Inspedion D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: � hand-sketch in ihe area below ❑ drawing attached separately b� m��� s' � . � �-=1 = !� � a - �9' 3 - �6 ' P � _ i - � ' ' a �1 � t 3 _�c� � � � 3 t5ina•11/10 Tifle S ORdal Inepedian Form:3u6auiface ' Sewepe Disposel Syatom•Pepa 15 of 17 , i E - -' _ -_ � I a , , . � Commonwealth of Massachusetts ; Title 5 Official Inspection Form Subsurtace Sewage Disposal System Form-Not for Voluntary Assessments 95 Old Main Street-Guest house Property Aad�ss Traub Owner pwners Name infomiation is South yarmouth MA 02664 8/9/2011 required for every C��� page. State Zip Code Date of Inspection C. Checklist Check if the following have been done.You must indicate"yes"or°no"as to each of the following: Yes No � ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ � Were any of the system components pumped out in the previous two weeks? ❑ � Has the system received normal flows in the previous two week period? � � Have large volumes of water been introduced to the system recently or as part of this inspection? � � Were as built plans of the system obtained and examined?(If they were not available note as N!A) � ❑ Was the facility or dwelling inspected for signs of sewage back up? � ❑ Was the site inspected for signs of break out? � ❑ Were all system components, excluding the SAS, located on site? � ❑ Were the septic tank manholes uncovered, opened,and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? � � Was the facility owner(and occupants if different from owner}provided with information on the proper maintenance of subsurtace sewage disposal systems? The size and location of the Soil Absorption System(SASj on the site has been determined based on: � ❑ Exis�ng information. For example, a plan at the Board of Health. � � Determined in the field(if any of the failure criteria related to Part C is at issue � appFaximation of distance is unacceptable)[310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): NA Number of bedrooms(actual): � DESIGN flow based on 310 CMR 9 5.203(for example: 110 gpd x#of bedrooms): ( �- �l!�`�"��� � �� � l�-��s c5im•,,,,0 rnle sorfiaal r�spacua,F«m:sub.�na� Sewape Disposal System•Pege 8 af 17 � �^ -- -- �� -------