HomeMy WebLinkAbout2022 Revised Sign off Transmittal - Deck Expansion n 0- cc2 ,
Jtet..,i,� TOWN OF YARMOUTH
,°c HEALTH DEPARTMENT
_ '' PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: 5 � t r,�/�1_i f i a h I Y.► 11 � qormhb-1(4 i'O tr
Proposed Improvement: p X A A l n ( -S1N 4� le
- c� i-- h i/ 12.4 1q7
eG1ctrp 1-lef o2n moi
_ r/
t
,-, Applicant: ., , . .". , ` .. "' Tel. No.• 3( � 51A0
��-, _,7, 0.Q ( .� ft 4/AI
ti\V,V Address: L - . .• • • .. .-. .• • ° 6-644641444-- Date Filed: DI 2 -5 I i
"If you would like e-mail notification of sign off please provide e-mail address: 7:4:2_ F(1 D✓ OR V yA4 Cl( 1 -cc)
Owner Name: ri(+p v7) 1 Ptrl'D✓
Owner Address: J e M 1(4/ k ✓ \i t(W L Cdr t Owner Tel. No.:3 5 2. ‘)(5] 9 5?4
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:
AUG 20 (1.) Site Plan showing existing buildings, water line location,
and septic system location;
t E;r_.---1 0^PT. (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: pAi/a1
1
/ PLEASE NOTE
COMMENTS/CONDITIONS.. Re_vic-eJ 8 -ts-- ,?..
C) -(,,,p, Vvl tlfG YZ uCdi- -
`•_ p,-o pose A ' X i l„'
. -......
•
V
4.00
1‘11
Ie."."."....
.,.
Cr'
:, :. ,,. • C
.74 t Ili .
• N 4
. .J...
i, , . .
,
,
1...... .0 ! ..1
--15 -6 ..,coD . ,
. , .
.. • , 4..
,... I i i A k.
V* ..• ,
I
.,..... i
.0 4 • ,,6:3 t' V'..' 1, ' ; : CY ) 1 i •C
i
' 1 1
,
h
1 J I,
,
1-,-,--k1 1 i' ; i Li
. i Z.1
Ili
l'i to 7-
. In
1 • •
•
(1/4...
......c
Cr)
tr•
><•
.77.5
. ' r , el cll
•I ,
%..) I
• . 1 ! ?.'
,
I , : • .1 '
..... . ;
1 0 ;
; ; 1
I ' 4f:1 t. Ift,.....,104 . 0 c-- 1.--:
1
i — ...,-t. (7: f-- LU .,:=-----, Lua• I i .....•••••••••••••••••••••........01
H f ....''' kf) '
i
1 1 ! 1 --I.() -- •Z ':'' 0
. 1
I ..
•••••••••••••••••,........................4-441 i
; Hk j .... . .,....3
ILI ;_.. i
. , .,............___ :
,.........______:
HH :
1 -•-i 6 -J-
i ,• , co X.
- i i1
''.1
-1.4 .. . 1 ,. 4 1 ftk q'.. •
I t 1 • • — a .
- -t,
I " . 4, 0
- ,
: 1
, ,o..).... .....: ,,, .
--- 1 , • r,.„1... .
...... ..4
; lil
--::'t...: —0 —
— d •,>c (.4 —1—
I — ottrm .
..- ----
VI
_sz .
. .
pgis
w.,.7, s//mait.googto.
•
i ► *SAW' -''s-
Sok•
■ re i to? two;t A+►e„ e!
•
•
•
•
f .
• •
•
no
•w• •
• ' - ,
•
•
•
t
it* i=1111112:12424
•
IN
•
r.
•
#" f.`
i
a•
t
•
•
•
O�r •
. ' • -
s.rr�•rryy L �� , fir• , • . - .
ems- -a,
401 WAY .
•
•
•
•
•
•
•
•
•
•
r �ull� '17,3,1- �t2
EA1 25?42
NE�LDEPT.
H ACTH oFPr L___-- -----
HEALTH
10/24/2021,9:48 AM
1 \ Commonwealth of Massachusetts
1 '�,�,,.--:-__!i Title 5 Official Inspection Form
= Subsurface Sewage Disposal System Form-Not for
- _• Voluntary Assessments
r,;
58 Miriah Dr.Yarmouth Port, MA
Property Address
Dennis Soloman
OwnBr owners Hams
information required for is Yarmouth Port,MA
every MA 02675 9-12-14
page. Cit VTown Stats Zip Code Date 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:
►Z� hand-sketch in the area below
0 drawing attached separately
I I i '
l
0
0: Q
fl
i�l 1 J LOZZ
. . T H DE=PT.
A B
1 I$-t( ( 7-0
2 VT- o Z2-(/
3 3(- ( 2i-6
4 36- Z Zq-6
5
6
•
iso•31f3 Ties 5 Official inspection Ferny Subsurface Sewage Mapped*slim•Page 15 of 17