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HomeMy WebLinkAbout2021 Sign off Transmittal - Dormers of YAe TOWN OF YARMOUTH { ' t* a,je HEALTH DEPARTMENT ..,, PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To be completed by Applicant: Building Site Location: 959 West Yarmouth Road, YarmouthPort Proposed Improvement:Dormer Addition with bath and-laundryro k c) t%r.cI v"o c> & f. Applicant:W.D. PRICE,Inc Tel.No.:774.212.2942 Address: 161 Main Street,YarmouthPort Date Filed:21/11/02 **If you would like e-mail notification of sign off,please provide e-mail address:wesley@wdprice.com Owner Name:Jesal Patel Owner Address:959 West Yarmouth Road,YarmouthPort Owner Tel.No.:201.362.0604 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; ````'w " i'U 11 (2.) Floor plan labeling ALL rooms within building HEALTH DEPT. (all existing and proposed) — Note:Floor plans not required for decks,sheds,windows,roofing; .� gi (3.) If necessary,Title 5 application signed by licensed installer with fee. .k.„,_-- REVIEWED BY: DATE: i q i C al PLEASE NOTE COMMENTS/C 0 r I ITIONS: ((�� .l se To 1`r v c , vt 27 /Se . v'G ,✓„..5- _ 7., (L, - 9 E.11:=7::-:-,7,1,) NOV 1 6 2021 HEALTH DEPT. - S p _ ''-r �: N t 14: •, lflj O . N o O �4lit,+ { lr o - c m ,SZ. 1 e• ct D i k 1 Iti 1 co co , ,— }#X ..� ",�. 4 �,I CI. LL COQ'• "f. W Q Q CO ,C) '. 4, } i _ WmD M �; rh C.1 co in 1 1. �? d :fir ". ; s6 QCO p • , ' C ^- of ,i 711 cl . L. N — w . , 4, Nl N N 00 1n y,Ae° AN�° M .1 _ '4'7: V2M� O� Q V1.M+.M,—M R �bq w tC ; M N O m zo y., N cc e, y— O CO a 3 N Z : 4 . col ,..O .... `� ►� 0-08 a — © � Ue0 �0 boo0 1 NN V W _ 07=, 11.-- 7 � N �00 DO 00:°7N N A Q 000 ° VI n [� -- U—MI�RNN ti Q O —N O N .., CJ O o m —e e O IQ - ... z O. 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R R R o 0_ cl Uw)ka,C4'a, cn C7 v) Owwgg .54 .54 = = ¢ FO- EO EO- FO- EO- co U0.;w mwrww�� J .._____________ .q. ...._ II-: '-'......§C t.,, 0.4 a lag I S. 7 Irri) Q , LSA Lei (179 r c„., <-.\ fil v/ c. S� (5- 7 '- r ti c,) c). cj a C E. 1 (J j S t) IIda i c C , W m e. ' .�1 N .� W r) 11111rallsr nt J. I I •1::\ ��,jJ �N.. J ' IA _ - y it CO 'J (O 1 03 7L 44N C J 0) C • V^ T �13 J'L ._ V Q Y a CO u �� 0 (v p� Md(S Itg51 pa3 LOT NO. : - ADDRESS: (,✓ c'- ' /1.) OWNERS NAME�Jc0 ci-?7` 1.,Lay SEWAGE PERMIT 0. : $7-x.55 NEW: 7 REPAIR: DATE ISSUED: 5/aO,i7DATE INSTALLED: 9-/ -9 ' INSTALLERS NAME: -2 17 U/re Ce INSTALLATION OF: lc .17P7-..1 '_$47-23),e, WATER TABLE: FINAL INSPECTION BY y DRAWING OF INSTALLATION ON REVERSE SIDE: 5 /acX . . . 30 s 0 _______ 0 __________O 1,1.6 w'z: y , r s • No.S?dr!°Z�5„_ Fss �•�i . THE COMMONWEALTH OF MASSACHUSETTS BOARD 7)F t EALTH l'i" OF C , 1ppliratiun fur Disposal El urki Cnunutrurtiun 111rrmit Applicati n is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System a 'v? — /io 62 M Loi= 1453 imp P-a.- �.._». »�1__ s»��_1.0!».. tion-Address p ren w»........»»...»...........«...«... u +^ dress a �_...�.� v _(' am wlc r _.»».»._.. a Installer Address Type of Building Size Lot Sq. feet ,.., Dwelling—No. of Bedr..ms Expansion Attic ( ) Garbage Grinder ( ) ra, Other—Type of Buil.'ng No. of persons Showers ( ) — Cafeteria ( ) 04 Other fxtur- W Design Flow 111000._- Ions per person per day. Total daily flow gallons. W Septic Tank—Liquid •:pacit gall. s Length Width Diameter Depth Disposal Trench—No Width Total Length Total leaching area. .sq. ft. Seepage Pit No P iameter Depth below inlet Total leaching area. sq. ft. z Other Distribution box Dosing tank ( ) Percolation Test Results Performed by Date. ,�,1 Test Pit No. 1 minutes per inch Depth of Test Pit Depth to ground water (i, Test Pit No. 2 minutes per inch Depth of Test Pit Depth to ground water a 0 Description of Soil W U 41l UNature of Repairs or Alterations—Answer when applicable. _!/ -i cg � Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code---The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued board health. Sign-.. rir"--c -1 .-T7 Alr Application Approved By 7 Dhate Application Disapproved for the folio 'ng reasons: Q Date Permit No 4�r —». Issue .-- °1°�/9.31 � Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF A/HEALTH OF ,� QI rtifirntt of (aumplianri THIS IS TO CERTLF)7hat 4e Individualge Disposal System constructed ( ) or Repaired (! :..e.t...e.,,...j.•.»» _ J Installer (7/A,..--z..- pc i227--- een installed in accordance with the provisions of TIT�yLE of The State Sanitary ode as. d rib }'n the application for Disposal Works Construction Permit No.El____p 5 dated . i_A � 1 THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS Ate„ a •• TEE THAT THE SYSTEM W UNN TION SATISFACTORY. ili DAT .::.. .._ Zct.1 7 InspectuL �1 �!C �.r.d Commonwealth of Massachusetts r _', Title 5 Official Inspection Form r Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Witt ar- , i 959 West Yarmouth Road Property Address Anna Lloy Trust Owner Owner's Name information is Yarmouthport Ma 02675 9-5-19 required for every State Zip Code Date of Inspection page. City/Town D. System Information (cont.) 14. 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: Q hand-sketch in the area below ❑ drawing attached separately It I i 1 1' , ,,s, ,N ,, ,,,,, C v ,.L_____i ..i.,, ,,, ,,: .,,,, , , ,, ,,,,,, , 0 . . . . _ , ,, ,.. 1. 1 v� 1. CX11 i . a 1 0 3,;. i5 1 t5insp.doc•rev.7/2672018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 0118