HomeMy WebLinkAbout2014 Oct 29 - Sign Off Transmittal Sheet, Plans - Sunroom t._,e_,._. ,�_.___--_ _� � _ __- �._,_� � .__
=of�aR,y TOWN OF YARMOUTH
a ' `�y __ HEALTH DEPARTMENT
� �"•_�°`� � PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed byApplicant:
Building Site Location: V� 1 II�C(�A/� �(�
$c.�u�2.uc,,w;
ProposedImprovement: �op��2v� ft Qo2C1-� �6 K ��� �l� i�-ft St`�1`'�� LoGJI-rlui✓
f�c iYtE cX�S�NG ��"C�, Fx���Nl> �zJG IS I�'ri� '
Applicant: ��.,�s �n»�� Te1.No.: S-OQ���jy�`l'S_�S
Address:_�`la N�<D�� �a. Sa�f I L3a���N . �A � 1 ?71 Date Filed: 0�9''
*"Ijyou would like e-mail notification ofsign o,JJ;please prrnide e-mail address:
Owner Name: F-o6 ER� �(/�ZL t
Owner Address: (�~( PI N��Nt ��. w��. L/�����`/ ►�'I►t. Owner Tel.No.: (,!�-�1Y0-886 �
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RESIDENTIAL AND/OR CObIMERCIAL BUILDING
HEALTH DEPARTMENT: Determines Compliance to State and Town Regula6ons; i.e.,Requirements
For Septage Disposal and other Public Health Acrivities.
Please submit three (3) copies of plans, to include:
(1.) Site Plan showing existing buildings,water line location,
and septic system location;
(2.) Floor plan labeling ALL rooms within building
(all ezisting and proposed)—
Note:Floor plans not required for decks,sheds, windows,roofing;
(3.) If necessary, Title 5 application signed by licensed installer ,
with fee. �
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REVIEWED BY: I / 1 "'� ///I DATE:-- � G/ ����
PLEASE NOTE
COMMENTS/CONDITIONS: I
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0�3 %? 9 Zi�14 Q,y,
HEALTH DEPT. �� y6$ �
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PR�R� �
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'£s. 1 �a 8, 7l4 S.F. "`
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TO THE BES7 OF MY INFORMATION, "PROPOSED�� PL(�T PLAN
KNOWLEDGE, AND BELIEF THE TIVEST YARMOUTH, MASS.
STRUCTURES SHOWN ON THIS PLAN LOT 6, BLK—F, LC11435—A i
NAS BEEN LOCATED ON THE GROUND DA7E 8�/9�14 SCALE i" = 20'
AS INDICATED. ,106 7456-00 CLIENT FlNNELU
/ �G:/" SWEETSE'_T�' E'NGINEERING �
� � �4 203 SETUGKET ROAD �'
DATE PRQFESSfQNAL LANQ SURVEYOR �"0 BOX 719 SQUTFi DEMIIS. �n ozsso
OFF. 508-365-69W fAX. 5p8-385-6981 ',,
C: 1 S8 l PROJ 1 �456-00 1 dwg 1 7A56-PPP.DkTG � 2014 SWEETSER EN6INEERIN&
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Page 10 of 1 I
; OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESS_ME1TS
� SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTIO\'FOR't1 .
pAR2'C
� SYSTEM INFORMATION(continue�
� G7 0.�. c�,� o„
Property Address• "'C.—
c.►�r.v �, /��f- ��3
Owner: ona t� �
Date of Inspection•
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a sketch of the seavage disposal sysum mclud'm8 ties m at least two permanent refere�e landmarks or
benchmaxics. Locate all wells withia?00 feet Loeau where pubtie water supply e�s the bnl �
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Page 5 of i l
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESS'_�i`TS �i
SUBSURFACE SEWAGE DISPOSAL SYSTEM YNSPECTIO*i FOR'VI I
PART C �
SYSTEM INFORMATION J�g,3,Y/ ',
/�/� /� v
Property Address- (0 / //N � � 3 �,P�,v„�� y�
N � I
QW02i: ON o+tl -� i
Date of Inspection: �
xi.ow coxnrrioxs ��a H j� ;
RESIDENTIAL
Numbex of bedrooms(design)_� Number of bedrooms(acwal):� ��� .
DESIGN flow based on 310 CMR 15.203(for example: 110�d x#of bedroams): ,
Numbet of ciarent nsideais: fJ
, Docs residcnce have a garbage ginder(yes or no):� ',
Is]aundry an a sepante sewage sysun�es or�);�GO [if 9es sepaiare inspection n9ussadl '
LaundrJ'sS'stem insPe�ted(Yes or no):/�A f
Seasonal use: (yes or no): e� 7��7 i
Water meter readings,if a avilable(Iast 2 Years usaga(gpd)). � " �� ����OOQ ',
S s o r n o • t�
�P P�P�S'e )•�-' /'
I.ast date of occupancy: /A� '�;
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COMH�RCIAIJINDUSTRIAL
Type of establishment:
Design flow(based on 310 CMIt 15.203): fiPd
Basis of design flow(seats/personslsqf�etc.):
Grease trap present(yes or no):_ �
Industrial wasu hold'm8�P��t�Y���)=— �
Non-sanitary waste dischazged to d�e Tikle 5 system(yes or no):_ ',
Water meter readings, if available: '
Last date of occupancy/use: '
OTHER(descnbe):
GENE AL INFORMATION '
Pumping Records ,�/ �
Soisce of informarion: /r �� �
Was system pumped as part of rhe inspe (yes or no):Gb
If yes,volume pumped:_gallons—How was quantity pw�ed deternrined? �
Reason for pumping:
F SYSTEM
_Septic tank,distnbution box,soil absoxption sysum
Single cesspooi
Overflow cesspool
Privy
Shared s}5tem(yes or no)(if yes,atffich previous inspection iecords,if any)
Innovative/Alternative technology.Attach a copy of the c�mznt opetation mmd mamtenance conuact(to be
obtained from system owner)
_Tight tank _Attach a copy of the DEP approval
_Other(descnbe):
i
Approxi;nate age of all componenis,date mstall��itkn and soucce tion: '
/ --�- �"- �o'i� !
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We:e sewage odon detected when arrivmg at the site(yes or no):/� ;
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