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HomeMy WebLinkAbout2019 Oct 21 - Sign Off Transmittal, Floor Plan - Garage into Bonus Room Ot-YAk TOWN OF YARMOUTH =�v Idro 7 8 201 HEALTH DEPARTMENT ALTH DEPT PERMIT APPLICATION SIGN OFF TRANSMITTAL To be completed by Applicant: Building Site Location: 34 t-1-0.54- Proposed "1-05-Proposed Improvement: l r h I car- Tak- vtuct ypowl ,. IA at 3//(__." r�_sed ( *4101 c.ea I,h 7 q49,ja�, ,n', 4-kg- .`A1 D,LA 1 7 --de1OVlay COM Applicant: att. 0Tel. No.: '7 ia-372( Address: (ato - J ckr Date Filed: /0 0/1f,, **/fyou would like e-mail notification of sign off please provide e-mail address: Owner Name: (71:01 leAke_ Owner Address: sti IZves - 6e., Owner Tel. No.: 77 `P-a-j t-3q/(, 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. 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 for decks,sheds, windows, roofing; (3.) If necessary, Title 5 application signed by licensed installer with fee. REVIEWED BY: DATE: /4/At'hr PLEASE NOTE COMMENTS/CONDITIONS: (—kL4 S 3 e. crV O Cnnt,r= C' 4*-ce_ o-re ti Ce c � Frri�.. !G t��-��4 t 4. /0 Pew q tout cs Adou, r / W C Wi qr ta, tl/ c. .�.�� 4 G tic f 6 (CV/ n CP:1 C" e(J&)1 Ca-,54e JC"RC,~—c:)k- re of c /ter f S y CIS, - o J ,� o _ ..> o Sr rr J c . V-i- 1/271,4 --1., cn cb _ J--"7 -0 T % •43 14 1 t. 11.t 2A E ti: i 0 F jju 1— JJ J: o 0 s4t1 �'� 4 v 0 z '1 f Commonwealth of Massachusetts Title 5 Official Inspection Form r Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Fiof k-e-- .�r Owners Name/required II ation is c7`- a4✓9o4�1 >t_63te4e/A9 every PageCity/TownState Zip Code date o D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties tc at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where publ' ater supply enters the building. Check one of the boxes below: and-sketch in the area below 0 drawing attached separately F-/-01^ r 6 4/-a /91f - 110); 12- c2 di(-3if t5ina•OWN Tine 5 Olio*Inspection Form:Subsurface Sewage Oiaposai System•Pape 16 of 17 i x 9/y 5 0 /2- �f1 ) /5;07 e 3C f 848 89.5 DIED. . 8,Io µ 8Y 4PIgaP. .-71)1- `kr; PROP✓000si DLDG . _ D 8, �i B/8 ( N (` 778 7/V /Z'•. M NO .W/7 f.e,E,vcw J7EeE I TE5 T: /HOLD z:7 ./zd 4'° /eE S/JLT5 PER.`T o,L•/A-/RECoR; DATE 1-;,a7 75 TOGJN WATER ''1,,5 AV.cL/L.ABLE //L'$p D /e/9�n/ES MI:NIli UI.1 E.J/LD/.NG 5E7 ' e /< REOUI2E/`1E7vT5 ` • F2Q,AJ7 301_,.. '. S%DE /5 REA,e, /S D;o^-/7-* voTO SE LOC ATED . ` PROPilLLED 8EDR00Ms`,_3 'OVER '5 E- 0E .SYSTEM li UiVLESS• DESIGN FLOW.3_564;,j 3..30 , E/9 , +=Iy` AY-20 R7 DES/GIV L0AD///G, /5` 'USD :PROOSD' LEACH / EA .'Z©O SEPT/,. '$;Y-5_1- J$T ✓7 'CQ/\/57-'e'° Oni• UC r/div 5H'LL PE,ecaL�IT/oN � 'r�s7- CONFO- M TO '/-1'C s 7-'e'° R`0. 1:EIIITAL ' - , /8E5 UL7.S _< Z" M/,.1/ /,t/CH C Ob E �": D f�,TEZ?i .TY1`1-Y:-1�/9.77,�ND,.TOW/✓AF .. ,.. ,,. . , • . _-: _ .� _._ _ y�,G ov�"y HE'AL'TH .RE'GUL.HT/O%V8 SILL ELEV 70 L3E >' 2. FT A5OVE A 7`ap oF:.'„ .- s o` T:yp� c L PR . . / L , - %;;M/n/. /,/SHED,: 'G.eAl E A13Ov. L:EAC. F0 UND RT/ON C 90 30 Al 0 SC FILE ' ,9,..A / c3$ : .-/M_PE,2VIOUS COVE2 / ✓ .MANHOLE4`coVER To EXTEND, 7-6 .TO 7 /A/ NT', /NES =/O-�1 3 ` W/THIN ,l'•OF F/N/SI-lEA G�'HDE „•-,e07 M/nIIMU/9 1 T0,'J F/L7 e19Tl�IG �.� ir_ `: /O M/,/r"IUM=� STONE E' OF/g�TO/ 24/:QOVE 5- _ a4. ', D/• 7`y /e''''.4.‘ � . :.,---6//:1-----/, ►1--- .COVE,e WfISHE p\E "W/b '- ‘,,,,,SHED flLL y D,STG •SOX c ` /: .20 UN 4•/CRST/,@ON -, t- 3 Alin/ unir M/N(/yUM -�T..2.2-_i_ � 2 roIN: 4 D/H Ni6'NT 'S D/ �AS'L /� ” ... -. 9 _ 7�ITCH FL 01✓ L/NE ;'� MlN PST%1- �- ,.. • .; 3 , '7/ FOOT /o HiN •:' /¢ �Foor:- z , •M/NP/TcH '/000 �4^/�Z E ., 0' 'H/N G 9Z' /4 l/F°er Orr G E COn/ 3J/�SHED r /000 •_Y /NVE2r 8f'P.`T LEACH a� STONE 830 GALLOnI rnrvezT ; PIT CeeLL r i'87--g CA I;FI C/TY-� iS,E., /z SEpT/C Tf1NK F 8rc.3i 8G 0 �7' .., `_(wf1TE,errEHr), 'i NYEET ; '', F/q GAN Fe„. .,../2�/"/i /,{IFFY -:.,,48-Al,5 iNveET: N0 GR�H;9GE GRINIDE/2 • j tI E'ER } ' 20 'Ai/Al/NI UI"1 "` <, 'x 6 u 1'> 4 FI r V. :DrsT T.o M