HomeMy WebLinkAboutBHDC-21-2632No.L- FEE ✓✓
211011 COMMONWEALTH OF MASSACHUSETTS
Board of Health, Yarmouth, MA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to Constructg(Repair ( ) Upgrade ( ) Abandon ( ) - O Complete System Xindividual Components
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Map,�'Parcel
Address
�.
�liL;�C.
Type of Building �Z
Dwelling - No. of Bedrooms
Lot Size sq. ft.
Garbage grinder ( )
Other -Type of BuildingyVv�Q� No. of persons
Other Fixtures
Showers ( ), Cafeteria ( )
Design Flow (min, equir d) 1, &31 pd Calculated design flow Design flow pro�v/
Plan: Date Number of sheets Revision Date
Title
Description of Soil(s) l
Soil Evaluator Form No. {` �� Name of Soil Evaluator ;C Date of Evaluation
DESCRIPTION OF REPAIRS OR ALTERATIONS _,See 731 c��
The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
further agrees to not to place the system in operation until a Certificate of Compliance has been issued by the Board of Health.
Signed Date
Inspections
No. 2—t - 2-Le32-
COMMONWEALTH OF MASSACHUSETTS
Board of Health, Yarmouth, MA I.
DISPOSAL SYSTEM CONSTRUCTION PERMIT
FEE
V
Permission is hereby granted to; onst uc ep it ( pgrade O Abandon O an individual sewage disposal system at
iCt3. A(Q as described in the application for
Disposal System Construction Permit No. 'dated Z Z
Provide : Co truction shall be complete t ears to of this permit. All local conditions must be met.
Date 'i ! Board of Health
TOWN OF YARMOUTH
SEWAGE PLAN REVIEW CHECKLIST
Location: A.M. Lot
Street: la � Alf-4-
Village:
Owner:
Address:
Phone: -
Builder:
Address:-
Phone:
Zone of Contribution: In Out A Acreage
Commercial: Residential Y-
Floor Plan: i S #f Bedrooms: Z
Installer: leg, Y� l Qv V�
Phone:
Engineer:
Phone:
N/A
YES
NO
L Required # of copies received
2. Date of soils exam and percolation test not older than 2 years
3.4-5 ft of naturally occurring pervious material, above water table
4. Foundation 2 ft above high point of road H.F.: Fnd: Var.:
5. Water line 10 ft from septic components Var.:
6. Benchmark indicated and shown - NGVD if near wetlands
7. Septic tank minimum 10 ft from foundation, deck Var.:
8. Leaching minimum 20 ft full, 15 ft crawl, 10 ft slab Var.:
9. Leaching minimum 100 ft from wetlands Var.:
10. Leaching minimum 150 ft from drinking well/25 ft irrigation well Var.:
11. Tank/leaching minimum 10 ft from property line Var.:
12. System meets all other setback requirements Var.:
13. Uses adjustment for maximum high groundwater Var.:
14. Leaching set 4-5 ft above ad'. water or bottom of test hole Var.:
15. System not in top or subsoil (A,B horizons) or 5' removal
16. Proposed contours are suitable
17. System meets slope requirements - min. 1/8", V4" preferred
18. System meets breakout requirements PVC liner: Wall:
19. Specified tee sizes are pro2er, gas baffle on outlet tee
20. Sewaize is under 10,000 gpd for parcel
21. No garbage disposal
22. System adequately sized for its intended use
23. Minimum 6" stone or compacted below tank and dbox
24. Manhole covers within 6" of grade, pump chamber cover to grade
25. Inspection port on plastic chambers/leach field
26. Electrical permit for pump chamber/Separate meter for duplexes
27. Pump system -2" line,weep hole,check valve, tee in dbox, -Pump size
28. Septic tank/pumptank/pump chamber to be factory waterproofed
29. Vent provided if leaching below 3 feet, under driveway/parking
30. Buoyancy calculations for tank/pumptank/pump chamber
31. Engineer to inspect and certify soils: wall: commercial:
32. Engineer/Registered Sanitarian and Land Surveyor stamps/signature
33. H-20 loading is subject to vehicular traffic, groundwater
34. Title V Application and permit fee, installer signature
35. Foundation footin min. 2 feet above adjusted ground water for new house
36. Deed Restriction required max. # bedrooms: max. flow: gpd
37. Check area lots forgroundwater/Label groundwater in Assessor's Ma
Plan reviewed by: I VIA/f/ 4 o 0; 01
9
TYPICAL END UNIT
11,1710
12's10'
LI9ING AREA
15' a 14'
DINING Aim
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SECOND FLOOR PLAN