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HomeMy WebLinkAbout2022 Sign off Transmittal - Sunroom :mak TOWN OF,14‘,.,t,;:':: •7t,i,tst HEALTH DEPARTMENT ''�• `� PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To he completed by Applicant. Building Site Location: 7 7 / 0. 42ivi s RID YARmouTitAfo F. C /1/1.75 Proposed Improvement: A O VI C- A 1 v f x / 0 0" SII"�') -SIJNgod AI Gr(j<4 0$c9 0 A rAVNo zi'gee 2 (7- 8 if-95"O2 Applicant: Ve,oMs x-)e« Tel. No.: Address: 1?7 /ZL 4 t' a' Date Filed: 6 " 2— 2 **If you would like e-mail notification of sign off, please provide e-mail address: <44 Al Y•(.54 .t . a 217 0 42-4,141c" C r✓4/ Owner Name: b .k,„„)(,s 0`Ne/L- Owner Address:LW/I Qe,vu,s RQ(&$Lik( o`) !jA Km crri4 I' C 4rOwner Tel. No.: 207-S I-? 02 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; JUN U 2022 (2.) Floor plan labeling ALL rooms within building (all existing and proposed) — HEALTH DEPT. Note: Floor plans not required for decks, sheds, windows, roofing; (3.) If necessary, Title 5 application signed by licensed installer with fee. 011° REVIEWED BY: DATE: " I7//at, PLEASE NOTE COMMENTS/CONDITIONS: aiaAzl I7' ' \''s' 'M a / 0 o a (t.:-:do 2 .... Dz> '- , 1. e m N , . - V © -L q ?3. f .., N.... .c. 7. it C7 0 ln 0, l. -(A 0 L.:1:311:2_-_-c:.72-1(:r1,4:1,@),:,,,I,,,),,. 4' s a GALL1NM UIIiSAht (1-obd-S44-/233) AND LEACHING VERIFYING THE LOCATION OF ALL UNDERGROUND & 5 FACILITY OVERHEAD UTILITIES PRIOR TO COMMENCEMENT OF )CATIONS OF ALL WORK. UTLETS AND ELEVATIONS BOTTOM TH-1 Sc TH-2 60.6' 11. ANY UNSUITABLE MATERIAL ENCOUNTERED F SEPTIC SYSTEM NO GROUNDWATER FOUND SHALL BE REMOVED 5' BENEATH AND AROUND THE PROPOSED LEACHING FACIUTY. 12. EXISTING LEACHING FACILITY SHALL BE PUMPED CS AND REMOVED OR PUMPED AND FILLED WITH CLEAN SAND (NOTE: UNKNOWN LOCATION). NOTE: EXISTING SEPTIC SYSTEM LOCATION UNKNOWN 0 PROVIDE T CLEANOUTS `s, X00.00. LOT AREA L47,891± S.F. SYS TI GARBAGE DI 1. o ST 1 EXISTING 2 o / DESIGN FLO\ o EXIST. O aivpyyELL / USE A _440 O Fo' 0 ' TOP FNDN. - / SEPTIC TANK EL 74.6' o C.O. W USE (2) 15C / W / (1 EACH FOf 12.0, 72 57 BENCH MARK - TOP OF P. o 73`W r CONC. BOUND EL. a 71.5 �� o \ce•p \ / USE 2 INLET ,I \ . N J 73.70 1ti1^7 .t LEACHING: GARAGE C •7" 2) �_ N / SIDES: 2 (4, j •7; 79 41 - -- 37 G 7298 BOTTOM N i•• - ,7�FL P DIRT ORI •72.31 r `.• -- / s` OAK �E o TOTAL: _____ g° o h �. ,__ _ •/72 26 USE (6) H—: \ ,,, n �° > ' 1 WITH 2' STO 4-- \ \ 72 13 11 y I ), T 71.98 .r .._ _ / S7 2 n'4.59� •70.42 02.00 r .3 Q 0.45 �-Q 1.79 .oi G N. G / Q APPROVEDo — 1:9? 11.10 O COTTAGE J 71.3' I / / TIT' N• 10 •69.6k •71.77 / 7167 / \ �" 497 N ■69.92 l 69 50 >O ! O Y /PROP. 2 INLET D'BOX r*69.3%9-- ik IN 700 00. �" DIRT 08I1E it' /55 77 -�fr MA0I9E8L0 C amotn Health Department _Fnt'iAsAPPROVED vpis-,y x'°".'4,9q ;;71 Nm''r / / 1 �y " JO WIIaO 2- 94 1 1 _. _tfRVE 9.: 40 50 FEET DATE DANIEL A. OJALA, P.E., P.L.S./ JUN U C 2022 HEALTH DEPT f") uu ON d N Q QG 4- 1J • � v 1 dl 672.) 41,12) c� -T r j 1