HomeMy WebLinkAbout2016 Sep 12 - Sign Off Transmittal, Plans, Photos - Sunroom on Outdoor Concrete Patio .o�-''-rq�r TOWN OF YARMOUTH
.�.��
�{ ;�`�° HEALTH DEPARTMENT
o;;�` ". - :;�
��'' ``4�� PERMIT APPLICATI4N SIGN OF��'RANSMITTAL SHEET
'-.,��`'
To be completed by Applicant:
Buildin Site Location: �� �� � •
S 1f t W V�
Proposed Improvement: ,� ��� �U ��T ��..�� �� ��..Ye�
� �
Applicant: ��-'V�X `tl�-- Tel. No.:
` � `��.�Q�-'�- ���'Y� �VY1�-U I`�'
Address: t,�.! � L � 'Date Filed:
���.YleC,c��t r�j `2 C>t S��/Ct�►o o. � ((b
**If you would dike e-maid notification of sign off,please provade e-mail address: G C�. {/J�
Owner Name: /.��i� �v` W�t,-Y� `-�"�`2-1�
Owner Address: 2� �a� �t � � ����E►�ier Tel.No.��� �� ( 3�� �
........................:........................................................................................................................:.........................................................:........................................................................................:..............................:..............................
RESIDENTIAL AND/OR COMMERCIAL BUILDING
HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements .
For Septa.ge 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 existing and proposed) —
Note:Floor plans not required far decks,sheds, windows, roofing;
(3.) If necessary, Title 5 application signed by licensed installer
with fee.
........................:................................................�...........................
.......... ................................................................................................................................................................................................................................................
�
REVIEWED BY: DATE: / /��
PLEASE NOTE
COMMENTS/CONDITIOIy,�:
�-�5�r Sc.rc.� (�.�c� Now �-�-, �✓'n,.� f�c ( �-
�
i
I ��
� �
� �
--„ �
$
J g"
,� � ` I
g � �J
��
t
�
\\��`_ � �
� � �'\ ���
�
S � `� i
� �
,� � :
� �
� � ` �
� r � -� � o
� �� � �
� s � o ;
S s S � �
i
� ° � s �
� �� � �
�
� �
�� � E
� � r
� �
� .�
�� S �
� �
� �
,� F�
1
.. _-....
'i :: •: Y' �'�' �'
�. �y�.� .wso M tea.
N
LOT 6 LOT 5
�
�
137.97' � �►
� �
� �
LOT 7 �r �. 29�'
LOT 4 0 �o , l�
O 8,316t S.F. 3 � � p � ;
� � ^ � �
� �44.9' 3p�. ,
Bj �
DECk iV T C�NC cV �
117.89' � � �
CB/DH fnd
�
LOT 3 �, '
o � �
RK MUST CONFORM TO ALL
N BYL WS EGULATIONS �
�
�'��1 ;
Y RMOUTH WATER DEPT DATE
ZONING DISTRICT — R-25 CB/DH fnd
LOT COVERAGE — 17.27� '
OWNER: EDWARD COHEN� SR. & DIANE COHEN
I HEREBY CERTIFY THAT THE BUILDING IS
LOCATED AS SHOWN. �v.�� CERTIFIED PLOT PLAN
����4�"°F�'Assqc #46 PAWKANNAWKUT DRIVE
o CLIFFORD yG IN
G
o ac�E� � S• YARMOUTH, MA I
" No.3:��ns �_ (BARNSTABLE COUNTI�
�'�r,-s�,,c��`' SCALE: 1"= 30' DATE: 7/2/2016
� ����SUI;VC`��j !
__ ��-�_��� I
� _
�T 0 30 6Q 90 ft �
' ����� z� � ROBER SURVEY
CLIFF E. ROBER, PLS DA 1072A MASSACHUSETTS AVENUE '
THIS PLAN MAY HAVE BEEN ALTERED IF ARLINGTON, MA 02476 '
THE SIGNATURE IS NOT SIGNED IN BLUE. (781) 648-5533
4918CP1.DWG
�
r
N °�
� �
� �'
! �., -�
t �
� �S
LOT 6 1� � � LOT 5
� Z
� ��
137.97' � �' :
�
o �
LOT 7 � � `o � r �- �9�'
� L T 4 �` � �' ,�0� ,� �„� �►
0 8,3 6t S.F � � � o �
�/'� �,��i�l P A � . .
W
h�'`` cp �
3a). �
.d'f �
Df�K N T c�NC N
117.89' �'
CB/DH fnd �ECE�``/��
� ��� ; � 2�1n
LOT 3 � HEALTF{ DEPT.
M �
O
RK I�UST C�NFDRM TO ALL :
N BYL WS EfiU1_ATION�
�
�r�+ .
� ��ouT� �vaT�� D�P-� oa��
ZONING DISTRlCT — R-25 CB/OH fnd
LOT COVERAGE — 17.2�
OWNER: EDWARD COHEN, SR. & DIANE COHEN
I HEREBY CERTIFY THAT THE BUILDING IS
�.oca-r�o As �owN. ��.►.�1` CERTIFIED PLOT PLAN '
'��`N°�"'A�ss4� #4fi PAWKANNAWKUT DRIVE
a� curFORo � IN :
� � �� S. YAR�[OUTH, l�A '
� �
� rvo t�s �� (BARNSTABLE COUN11O '
�ta-,-�,-,���`' SCALE: 1"= 30' DATE: 7/2/2016 '
! _"
{�Q�u,,�r�;vc`J
�r� �
� 0 30 60 90 ft I
' - ..�.-�`�ji �% ` z � R�BER SURVEY �
CUFF [S E. R08ER, PLS DA 1072A MASSACHUSETTS AVENUE V
TH1S PLAN MAY HAVE BEEN ALTERED IF ARLINGTQN, MA 02476
THE SIGNATURE IS NOT SiGNED IN BLUE. �781) 64$-5533
4918CP1.D WG
. .s • a���j���r���
' � Commonwealth of Massachusetts � NQ�J 2� 2010
T�tle 5 Off�c�al inspect�on Form
SubsurFace 3ewage Disposai System Fonn-Not for Voluntary Assessmen HEALTH DERT.
���,',.
46 Pawkannawkut Drive ����`� �' � ��
Property Address '�� �
Steve Sinko *� , � -
�,.:;e �.,
�g� Owner's Name ��j
informatwn is South Yarmouth MA 02664 November 9,2010 ��g
required for
every Pa9e• C�YR� State Zip Code Date of Inspedbn
Inspection resu{ts must be submitted on this form.inspection forms may not be aitered in any
way. Please see completeness checkllst at the end of the form.
'""�°'�"�: A. General Information
When fllling out
forms on the
�p���"� 1. Inspector.
only the tab key
to move your Jason C. Ellis
_ cursor-do not Name of Inspector
use the retum
key. J.C. Ellis Desic�n Co. inc
Company Name
� PO Box 2152
Co►npany Address
� Brewster MA 02631
� c�yrrown s�te zip coae
508-385-2228 RS 1126
Telephone N�nber License Number
B. Certification
I certify that i have personally inspected the sewage disposal system at this address and that the
information reported beiow is true, accurate and complete as of the time of the inspection.The inspection
was performed based on my traini�g and experience in the proper function and maintenance of on site
sewage disposal systems. 1 am a DEP approved system inspector pursuant to Section 15.340 of
Title 5(310 CMR 15.000).The system:
� Passes ❑ Conditionally Passes ❑ Faiis
❑ Nee s Fu Evaluation by the Local Approving Authority
Navember 9, 2010
I d s Signature Date
The system inspector shall submit a copy of this inspection report to the Approving Authority(Board
of Heaith 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 shall submit the
report to the appropriate regional office of the DEP.The original shouid be sent to the system owner
and copies sent to the buyer, if applicabie,and the approving authority.
'*'*This repo�t oniy desc�ibes conditions at the time of inspection and under the conditions of use
at that time.This inspe�tion does not address how the system will perform in the future under
the same or different conditions of use.
�r�.pgpg TiUe 5 Ofl9da1 InapecUon Fortn:Subwr(aoe Sewaye D"ispotal by�an•Pape 7 d 17
� Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurtace Sewage Disposai System Form-Not for Voluntary Assessments
46 Pawkannawkut Drive '
Properly Address
Steve Sinko
Owner Owners Name
fnfortnation is �uth Yarmouth MA 02664 November 9,2010
required for
e�ry P� C�y/r� State Zip Code Date ot Inspedion
D. System Information (cont.)
Septfc Tank(con�)
Distance from top of studge to bottom of outlet tee or baffle 33"
0"
Scum thickness
Distance from top of scum to top of outlet tee o�baffle
6"
Distance from bottom of scum to bottom of outlet tee or baffie
14"
How were dimensions determined? measu�ed
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outiet invert, evidence of leakage,etc.):
Good condition�umpina not necessarY at this 6me.
Grease Trap(locate on site plan):
Depth below grade: �t
Materiai of construction:
❑concrete ❑ metai ❑fibergiass ❑polyethylene ❑other(explain):
Dimensions:
Scum thidcness
Distance from top of scum to top of outlet tee ar baffle ;
Distance from bottom of scum to bottom of outlet tee or baffle
Date of last pumping: Date
��.pgpg Title 5 Offieid ImpacHon Fartn:S�bsuface 3ewepa Ditposd 8ystem•Paps 70 of 17
� Commonwealth of Massachusetts
Title 5 Officiai Inspection Form
SubsurFace Sewage Disposal System Form-Not for Voluntary Assessments
46 Pawkannawkut Drive
Property Address
Steve Sinko
Owner Owners Name
infurmation is South Yarrnouth MA 02664 November 9, 2010
required for
every pege C�yRp� State Zip Code Date of Inspedion
D. System Information (cont.)
Distribution Box(if present must be opened)(locate on site plan):
�,�
Depth of liquid level above outlet invert
Comments(note if box is level and distribution to outiets equal,any evidence of solids carryover,any
evidence of leakage into or out of box,etc.):
D-box in aood condition-2"below�rade.
Pump Chamber(locate on site pian):
Pumps in working order. � Yes ❑ No
Alarms in working order. � Yes ❑ No
Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.):
Good condition-controis replaced by electrician 11-1-2010
Soil Absorption System (SAS)(locate on site plan, excavabon not required):
If SAS not located, explain why:
cSBu•oa�8 Title s olGdal rupectlon F«m:s�nsr.os s�Di�poai bysfem•Paw 72 or 17
� � , �
� Commonweatth of Massachusetts
' ' ' s ection Form
�al In
Titie 5 Offic p
Subsurface Sewage Dlsposal System Fonr�-Not for Voluntary Assessments
46 Pawkannawkut Drive
Property address
Steve Sinko
Owner O+nmers Name
infortnation is South Yarmouth MA 02664 November 9,2010
required for ���� State Zip Code Da#e of Inspedion
every page.
D. System Information (cont.)
Sketch Of Sewage Disposai System: Provide a view of the sewage disposal system, including ties to
at least fin+o permanent reference landmarks or benchmarics. Locate ail welis within 100 feet. Locate
where pubiic water supply enters the building. Check one of the boxes below:
� hand-sketch in the area below
❑ drawing attached separately
,
W
I
�w�w�+r '
I ��
� r a�- �C
`�L"� 14 �1.��C�� St�1'« T7�w1� �� � ?.(�' �Z�
f��1` . ..�-�—�- - Q Sc1R�e 1'.4•��c. wT L�' 17�
��� ��(�- � � D-Ra o�r ,
� y 1 S' '3L
-t;u '� .�--�� , 0� �s,i��aa� Sv�cx�w. � P� 4•�H�wic�- o� z9' 18'
� t � �"�i�S
��.J �, � � '4----..-""` -,...�"�'""
� --��.� ���,� ° (�
,� `
,��1� � -
�^ ��,`�
��� 1�$0,� � t..�� �►�
�� � �
� �v
� ,�`
� ,
�,� � �� r�tlo s oread maneeaon Fam:s�wurrao.sew+o.ot�voaa►sYar«n•P+co�s a n
� �� ` - -