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HomeMy WebLinkAbout2022 Sign off Transmittal - 3 Season Room addition }�F•y Q TOWN OF YARMOUTH x ,;;~. ;, ,c HEALTH DEPARTMENT 1,,,co.t.' PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET . To be completed by Applicant: n Building Site Location: 58 HAt es A. s YQrt Proposed Improvement: 13 `a Ct. t g'x 3.0 3 —. .5--egr oeN. coo't oEr -tfe, back_ of iitp.. (Aov r-C, c v\ G iu c t S Applicant: Pact-nk (C cobs Tel. No.: `7 74("35-3--G gra Address: P.O• 16 O X 3,1i4 Ya r 04.001-(A Pow . Date Filed: 11 a5 f- .**Jfyou would like e-mail notification of sign off,please provide e-mail address: Owner Name: My SI M O A eA l i Owner Address: 5 «"OW 5 7. S. ‘iGI,r,M.Ov .A Owner Tel. No.: 7 7 q-353-G6f-•L-- 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, ..,,r and septic system location; °'� ` .) �`_.14`.�. (2.) Floor plan labeling ALL rooms within building LEALTH DEPT. (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: i, DATE: G d V.:2)... . PLEASE NOTE COMMENTS/CONDITIONS: Commonweal h of Massachusetts Owner Title 5 fficial Inspection Form information is Subsurface Sew4ge Disposal System Form- Not for Voluntary Assessments required for every page. ,sQ /Howes Road Property Address John Schlegel Owner's Name Yarmouth MA 02375 8/29/14 City/Town .tato 7ip Code fl tP.of Inspection D. System Information (cont.) 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: ❑ hand-sketch in the area below 0 drawing atached separately •ooc» Sprint - 7:30 AM -1. i ). Septic As-Built Card (5)-pdf (-u] ,.._.0-, tY 7 r77' .b 33 I .:d.urZ ADD RE S S : .._5--S' /-fa..✓�s X'--< OWNERS NAPIE : •�/ L.-% SEWAGE PERMIT NO. :SIJ - GO', NEW : REPAIR: DATE ISSUED ,:— f.2 /.1• (.'> DATE It7STAI.LED : 3,-4,) /....E T.NS TALLERS NAME : -� GQ 7 ....- J'<../ t---&_., 1-y INSTALLATION OF : l c7c.>4.> - 0 ir� ,..2 v( - s r,� a'-,) WA ER TABLE : FINAL INSPECTION BY :�'rc., ; Dr TING OF INSMI-LAT ION ON REVERSE S IDE : 33f 1 r 3'I` 53 SI- p-3• iictioilit O e-Fri'' + --- I t5ins•11/10 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 15 of 17 i 1 MAP 33 1 PCL 97 I 1 —�'-- S 82'54'15" E 61.99. MAP 33 N PCL. 89 r— I1 1---4 I LEACH AREA L--1 aPROPOSED ADDITION -" TO BE BUILT ON SONOTUBES Z., SEPTIC 0) _ oi TANK ru, I I PROPOSED DECK -- 21' WITH OUTDOOR 4J 18' 22' SHOWER �.` w L in o MAP 33 0 4 DE N a PCL 86 CO , � (P. o m MAP 33 z EXISTINGPCL. 88 DW;yaING .. 158 N J_ ;.1 .( HEALTH DEPT. LOT 6 8,514± S.F. N 82'54'00" W __________ (0.20± AC.) 80.00' HOWES ROAD FLOOD ZONE: AE(EL11) THE SEPTIC SYSTEM SHOWN IS AN APPROXIMATE LOCATION BASED ON BOARD OF HEALTH RECORDS SITE PLAN LOCUS : 58 HOWES ROAD SOUTH YARMOUTH, MA �Ho ssq Ar c REF : PLAN BOOK 75 PAGE 27 i 0 JOHN y4$ z. PLAN PREPARED FOR r DEMAREST,JR N 4 NO. --.,59,,, MICHAEL & COLLEEN SIMONELLI ©� DATE •REG. ^ . SURVEY*. SCALE : 1"=30' DATE : 1/4/2022 87 D E MAR EST LAND S U RV EYI N G ASSESSORS MAP: 33 PARCEL 338 MAYFAIR ROAD SOUTH DENNIS, MA 508-364-9049 FILE---21 146.DWG