HomeMy WebLinkAbout2016 Mar 15 and 2015 Dec 30 - Sign Off Transmittal Sheet, Floor Plan, Assessor's Info ,_,--,-...,�.�,�„'. --
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��� �-'�a� TOWN OF YARMOUTH
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�;� �� _ `�`c HEALTH DEPARTMENT
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� � � "', `+� pERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
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�'o b completed by Applicant.
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Building Site Location: � 0 � \� � M G V M �
Proposed Improvement: R e-c`�`C�v 1Z. � R e ��� T(�S��°-����n p f� �('S'�
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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
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**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
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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: �
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� � .ati=�a�? TOWN OF YARMOUTH
' � � � `�c HEALTH DEPARTMENT
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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,
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Vision Government Solutions Page 1 of 4
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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
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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
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;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)
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Vision Government Solutions Page 3 of 4
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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
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� 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
� �^
-- -- ��
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