HomeMy WebLinkAbout2018 Apr 26 - Sign Off Transmittal Sheet, Plans - Finish Basemento--Yqk TOWN OF YARMOUTH
HEALTH DEPARTMENT
�- PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location:
Proposed Improvement:
I
Applicant:
Address:
**Ifyou would like e-mail notification ofsign off, please provide e-mail address:
Owner Name:
I)
Tel. No.. �_
Date Filed: - 7 r.
„ 5,/f
Owner Address: Z i U Owner Tel. No(
RESIDENTIAL AND/OR COMMERCIAL BUILDING
HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements
For Septage Disposal and other Public Health Activities.
REVIEWED BY:
CO
Please submit three (3) copies of plans, to include:
(L) Site Plan showing existing buildings, water >line location,
and septic system location;
(2.) Floor plan labeling ALL roomswithin building
(all existing and proposed)'— d
Note: Floor plans not required for decks, sheds, windows, roofing;
(3.) If necessary,
'Title 5 application signed by licensed installer
with fee.
DATE:
PLEASE NOTE
IONS.
S wv_—Z�-
LOT 14 mRPeo
LOT NO.: ADDRESS: "
OWNERS NAME
SEWAGE PERMIT NO.:f6�_i NEW: ✓REPAIR:
DATE ISSUED:_ DATE INSTALLED: '?IZS/$5
INSTALLERS NAME: .
INSTALLATION OF:
WATER TABLE: FINAL INSPECTION BY:
DRAWING OF INSTALLATION ON REVERSE SIDE:
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LOCATION
SCALE . !.�'=.'�.�.... DATE
PLAN REFERENCE
.................................
CERTIFY THAT THE ...............
SHOWN ON THIS PIAN IS LOCATED ON THE GROUND
AS SHOWN HEREON AND THAT IT CONFORMS TO THE
SETBACK REQUIREMENTS OF THE TOWN OF
WHEN CONSTRUCTED.
DATE ...... .....
REGISTERED LAND SURVEYOR
EL.
TOP OF FOUNDATION
sN&&r z o f Z zlweeTS
CONCRETE COVERS
4" SCHEDULE 40 P.V.C.(ONLY)
PIPE - MIN.
PITCH 1/4"PER.FT.
SEPTIC TANK
`-INV RT `INVERT
EL.. p.,o3 DIST: , BOX EL I. -Ii
/oe o , , .. GAL, INVE jT
EL..
z'
SEWAGE
SOIL LOG
DATE ate../? TIME./O:oyrAry
TEST HOLE I TEST HOLE 2
ELEV.... So.... ELEV, ..........
e..A"f 0
.t-
st ZA.5
BZ. ZB.So
HeD�
PROF) LE OF
DISPOSAL SYSTEM
NO SCALE
04-1 I &Z. A?. sa—
OVo.,WATER ENCOUNTERED
4-K-
AP ROVED ./..... .. . ... BOARD OF HEALTH
DATE A/51
AGENT OR INSPECTOR
Lo7'" � •� A
............ ...... ...
,g�cc.e's• , P,R-rte! .. .
PETITIONER : ��,��' ' ' /` ' �1L'•s:'���.
CONCRETE COVER
2" MAX
' LPIT EACH,
01-4-d PRECAST
LEACHING
"-7
PIT OR
4" CAST IRON "
.
OR SCHEDULE 482
0 •
'
P.V.C. PIPE
314 -TO I Vf
'
PITCH 1/4"PER.
WASHED
e'
NVERT
EL....o:..
�.i
INVERT
EL. 3a,Zo„
sN&&r z o f Z zlweeTS
CONCRETE COVERS
4" SCHEDULE 40 P.V.C.(ONLY)
PIPE - MIN.
PITCH 1/4"PER.FT.
SEPTIC TANK
`-INV RT `INVERT
EL.. p.,o3 DIST: , BOX EL I. -Ii
/oe o , , .. GAL, INVE jT
EL..
z'
SEWAGE
SOIL LOG
DATE ate../? TIME./O:oyrAry
TEST HOLE I TEST HOLE 2
ELEV.... So.... ELEV, ..........
e..A"f 0
.t-
st ZA.5
BZ. ZB.So
HeD�
PROF) LE OF
DISPOSAL SYSTEM
NO SCALE
04-1 I &Z. A?. sa—
OVo.,WATER ENCOUNTERED
4-K-
AP ROVED ./..... .. . ... BOARD OF HEALTH
DATE A/51
AGENT OR INSPECTOR
Lo7'" � •� A
............ ...... ...
,g�cc.e's• , P,R-rte! .. .
PETITIONER : ��,��' ' ' /` ' �1L'•s:'���.
CONCRETE COVER
2" MAX
' LPIT EACH,
01-4-d PRECAST
-►}•�— 6' DIA.. I N�w�
DIA,
GROUND WATER TABLE
WITNESSED BY:
ac:_
,BOARD OF HEA H
Sir•=o•� ;e ENGINEER
DESIGN DATA: 314 Spd s'�
d
NUMBER OF BEDROOMS .....3.. ... j'l-j,
TOTAL ESTIMATED FLOW. , , 330.. , , GALLONS/DAY
K BOTTOM LEACH I NG AREA 7� .. SQ. FT. /
SIDE LEACHING AREA .. !S7.o8... SO.FT,/ PIT1-;yz.-jc,P.P
GARBAGE DISPOSAL j6�A 6f .. ASO % AREA INCREASE)
TOTAL LEACHING AREA , Z3.S;.G SQ.FT
PERCOLATION RATE MIN/INCH
LEACHING AREA PER PERCOLATION RATE f7e-X. SQ.FT. G'•P,D,
NUMBER OF LEACHING PITS . P:A(-°.r.
,~0. )C%z7' oF" Syan!r— o.✓
.. . . . .. . . . . . . . .. .. . . .. 4 . . . . .... . . . . .
LEACHING
PIT OR
EQUIV.
0 •
°'
314 -TO I Vf
'
°.
WASHED
3.sa
STONE
-►}•�— 6' DIA.. I N�w�
DIA,
GROUND WATER TABLE
WITNESSED BY:
ac:_
,BOARD OF HEA H
Sir•=o•� ;e ENGINEER
DESIGN DATA: 314 Spd s'�
d
NUMBER OF BEDROOMS .....3.. ... j'l-j,
TOTAL ESTIMATED FLOW. , , 330.. , , GALLONS/DAY
K BOTTOM LEACH I NG AREA 7� .. SQ. FT. /
SIDE LEACHING AREA .. !S7.o8... SO.FT,/ PIT1-;yz.-jc,P.P
GARBAGE DISPOSAL j6�A 6f .. ASO % AREA INCREASE)
TOTAL LEACHING AREA , Z3.S;.G SQ.FT
PERCOLATION RATE MIN/INCH
LEACHING AREA PER PERCOLATION RATE f7e-X. SQ.FT. G'•P,D,
NUMBER OF LEACHING PITS . P:A(-°.r.
,~0. )C%z7' oF" Syan!r— o.✓
.. . . . .. . . . . . . . .. .. . . .. 4 . . . . .... . . . . .
P
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PR 2 6 2018
EALTH DEPT.
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Usling
JetarthY Jvryelus
21 kSakets Patti
South Yarmouth 02064
'Jeremy's Howse
j 21.9akers flash IT ,.. s
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Kitchen South UUMVtb 02664
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Garage
Dining Roam i
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Living Room
4
A;tU;
I , Waiting areaL-
Stairs
2a 2, 7. 7' T
Y N
:. i. .. 3"
OR
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M I I I 1•1 - 1 4 1 1
illaill
Z 4'
Y 4'
17f
Bei!
Muster Red Room ed
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Room
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