HomeMy WebLinkAbout2022 Sign off Transmittal - Build Deck TOWN OF YARMOUTH
. HEALTH DEPARTMENT
'�• ` • PERMIT APPLICATION SIGN OFF TRANSMITTAL ET
To he completed by Applicant: '7 2 NOV 1 5 2022
Building Site Location: "1- IJ e,✓ �< <✓ �c� HEALTH DEPT,
Proposed Improvement: P3ut ( / 2 // / /1i'dh -71
G� u S 2_, — c) v\ CGti cL �v L'
Applicant: a✓g , Tel. No.: 419Z 6 ' 1f/62
Address: 72 n c V l/'? / 6 L '72 / , t263 Date Filed: ////J7o2o2
**If you would like e-mail notification of sign off,please provide e-mail address:
Owner Name: -e-ryo /jR✓7��
Owner Address: /7 6e L✓i c-k Oe d 9curfrI o LA Owner Tel. No.:((60) 190- 7/
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: // / /�-
PL ASE NOTE
COMMENTS/CONDITIONS:
b o r1 vl tq t • g C GU 5--e--u)-t„e• ti -e
I
Zone: R-25
Notes 25,aaa Sq.Ft.
1.) Assessors Mop 22 Parcel 223 �� �� tso'Frontage
2.) D1333146 LOT 9 }`
3.) LC Plan 114356-A s, �\ �/ Setbacks
�.
4.) This lot Is not located in the Aquifer •)• rp ��;Ci Side 15
Protection District �� 3p �\ Re 20'
5.) This lot is located in Zone AE shown on `�6 / �` �� �°® O
Firm Map 250Q1C0588J Doted 7/16/2014 � J O
Elev. 11 h'J_ Proposed •
� O'
Porch \\ ---- - ------ .. .
•,o o(2..... 7- LOT 10 44 \
S wg 10,080± SF O. \
Map 22 O ^\ West Yarmouth, MA
Parcel 224 t� C`,�r•- ",`>ST / \ -
�• r; / SAS /' )' SITE LOCUS
.s aw c, / \ NOT TO SCALE
`�!� :;►::• '^ ' D/W /
N.
<,...... Deck House#17 a: \ \x / ),\ /
7.77E • ,' ; ✓'
\/ 1$.34f ,� `'
�� �� ` fay. Preliminary
*so, \/ \ Garage Plot Plan
2p22 / LOT 11
0 Map 22 �✓ �:.4 Located of
1` Panel 231 �4'�' 17 Berwick Road
Ham` A°EP a <,\> �k� West
Pepa Booth, MA
Map 22
Parcel 222 Lewis Bay Builders
SAS Prepared by.
\
All Cape Septic and SiJrVey
NOTE:
DB GRAPHIC SCALE 618 Route 28
LOCATION OF UTIUTIES IS APPROXIMATE AND ALL 10 _ t m b West Yarmouth, MA 02673
UNDERGROUND AND OVERHEAD UTILITIES MUST BE �t i (508) 771-4200
• DETERMINED IN THE FIELD PRIOR TO COMMENCEMENT olicapesepticOgmoil.corn
OF ANY WORK, THIS INCLUDES,BUT NOT LIMITED TO, (IN FEET) Date: August 25, 2022
REQUESTS TO DIGSAFE, ANY PRIVATE UTILITY COMPANIES t Ina, - 20 ft.
AND THE LOCAL WATER DEPARTMENT.
_ Dw¢. #506
i
NJSOS V.10141V?r41,11M1/11“
,1,41 S3SthIcl U3J-N 3 AO Notia trot OI A0/4 .0.1.'0/c alVDO
N01.1.2A2,2 3.1408.A al/dYM,:i •“0,17Z X6.174G )r..,21(..1.1..NOtig)
Y114 HICIOWZAVA AS3I1/1 OVOU)11MLI3E1 LI
NI.LaVY4 AtikraD
'.''Il C,s1 a_
c1 ,c:1
u-)
s— 1-
'''-`,) _J
.., t - --_,
v.) ' - Z
0
1 ' 4 - 4
-t------ . ..,,
---Tr---- it
. _-__--- —
\ fif
t tt:ti, I
.. .
,
P 4 I /
/
I 1 1,, 1 • i/t4
-,:z.:-,.._----•-•.---- ---4' . .. t 3 •
1 x :
,_, 4' : ,..• • I,
it "----"•-----I--- Ir-74 I) 0 1 1 0 .1',
I•
I I i tr,i • s. '''
0 i iz f,,..:,,,,-..t.=_--7-_-,,,,,--,..7.-------,_ - I 21 \ • U
, ,N\
\ JIA A,•,',,\• lif
gr.
. . . 1
N...
3 31
i
. , .
v ,„,
-,, 4. ....
lt
. E . ii ..___,... R >1>•,,,..,.
gi 0,0------------------ -, u 1 pA .,,-...,.....--..-.--
.........-.........---
s
1 II 1 , •
Id 111157 I • _
1 I id 1 i 0 I I I T_-;_-...-2---_7...1-- 1 i '
,„,_...i.,A1..,g , ' 1-....--J,...----i ---'--- ' / '-\''N .W1// 's '
- . ' v
wIC ' '
' '
6.141 gl 1`''''' : .
—..
ot•
ro.
* 4N
at
t W
..1 • ti Iii .2
t 0 12 _,_._.._.-
4llJI
_,______ 1,_______ -'04.1...=-.."=„,-.-
i'l 1 0
I)' r--- ---'--- g"*, ,'Z. :::-=--------7-.7 -,...;:z.;i:;:-.:' '8• " z
0 I Ir— IIII 1 °
i • .it.(, t) L ' --7--J --____,
i - — ---,---ad-....t.-_---
-sesn,tiaVrTakt...Stor
1 s
fix„...--,4i o.
Jll
—I Ai
..,......_ 0 k
:...:-;7'_- --IIUI4-, 1 Z
0• ; i <
J
---z--4.--7f,--""Z."."..-L-::--'.----- ) I a.
...., (../
.- _=..------___.:..:_ I -----
YOS W4:.(1).1-tiXt la J.U1t)('On1:1 3 Vdt/t”.3 1
:,...4:I.N...,N. //// \:.'N'''s
f
• Commonwealth of Massachusetts
raliiii---f Title 5 Official Inspection Form
_fit- Subsurface Sewage Disposal System For -Not for Voluntary Assessments
_ a s
Property Address
Owner Owner's Name CA./-'&
/ M
information is s a/�o0111 /�� c27 _
required for every _ ________ �'I "T v 7(
page. City/Town State Zip Code _Date of Inspecti
D. System Information (cont.)
Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to
at least two ermanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate
where is water supply enters the building. Check one of the boxes below:
hand-sketch in the area below
❑ drawing attached separately
NOV 1 2022
HEALTH DEPT. Fri va I-
a,-^52 JP-
a c..._
l�l� _y
1 alV U/
__
p(``JVV II k►S-e r
/coo
left 11v 4
504tc Tn✓tom
Sr.,Lir
1
•i
i I l I el
c1- a7
d el- 19 Col-3/1
r(01r1,74sJa r-5 goz - 30
w Ia s4 4 63- a S
4 )- 33
t5lna.doc•rev.6/16 Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 15 of 17