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HomeMy WebLinkAbout2015 Jul 21 - Sign Off Transmittal Sheet, Vision Info, Floor Plans, Inspection Info � ti. oF�'+!e TOWN OF YARMOUTH � ,- '� o - �� HEALTH DEPARTMENT � ,. x •'•, ••` pERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To be compdeted by Applicant: Building Site Location: ��9 � 5 ��2 Gt/� �� Proposed Im rovement: !�A�'Is'1l'r,�� /2l�o i1- / �<i/�" � �tr �'L�U<Y1 � A��iir��v1 L/-�d20✓�/ ��� oH� r j.r'� . ��� Applicant: /i'/� / �rH_ � � � �t_- Tel.No.:_S�� 33� /G��� ���� -7<<r� Address: .3�I �'1/�•2 (n/✓�-�/ Date Filed: �j � ' /U• /� � �� _ •*Ifyou would like e-mail natrficatior!o,�ign t�J;please prrnide e-mail address: Owner Name: ��f y,�-c / �'�� Owner�lddress: /u OwnerTel.No.: SL� 33//(�c� � ..__...........__..................._........_....._..............._........._........._...................................._:............._...................................................................................._....................................................................................................... RESIDENTIAL AND/OR COMMERCIAL BUILIIING 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 tocation, , 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, roofang; (3.) If necessary, Title 5 application signed by licensed installer with fee. .. .__......_......_........................._................�... ............................................................................................................................................................................................................::.......................................................................... REVIEWED BY: (/�e3-6 ""V�/l DATE: � i S PLEASE NOTE COMMENTS/CONDITION$: �� � n • '/ � �'{U f'�LW�cL�� ..��� P�VUc�..^ — I �-��c-H NC�T � i r vS'r � .4 �-u�--,— c�Scw�r tc,�. 2 i v� � S �+ f.� - Nc> f oa ?�1�� / + /1�-c� 1 `r �,�,��I u-�, �- '��a, /�s- „ .�.,�. �..� .. . ��� �' ...,�,�,e..�,_�.-�..,��.u.�� � �_._ s_._.�_ _---- —�.v__.____ __. ---_ .__ ._--_�_,_�T________ __�W___C_..�. �� �� i ; � �� ^ ti � a � � I : �+ �' @'+� ' � � � I _� N � � , . � . 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WN ��a � � �Zzzz d ya � `_ ^p �{�'m3 �c 3 �ooyFaFa� � qe a ; ' �, .^.i �.CCp T� ° ��a5 Y'1U m� �'� y� > Z � � qv� .whae . .. . y e �$�r�i, Fa 'i$OOy}Y � m 2 s0 F F G O � €� " JU° � e m ;�..7�Q D'o �� dUUmfOo] .;>' "' C 6 X S i4 'a: �. �WWa Oe ._i WWW�.... ^: o�u .. .� a > -. ,... m - , , �, - ��-a7 .9SSetS�zS i"�:tr.Li /rst <<c�,ts� e� .� .�«:a�, /��-�y �e�isT . . {�Cu St C![r��i�/� .� /�s2�.17'IN1�7 — �`lely%!� ✓ , TROY WILLIAMS �`'�""�� � •���`� fa � ��'r��v�.� � SEPTIC INSPECTION5 � � Certified by MA Department of Environmental Protectiun (508) 385-1300 19 Hummet Drive &iuth [)ennis, MA 0266t1 � CUMMONWI'sAl TH OF MASSACiiUSf:'i'CS � I'�XF.CU'flVl? OTl�1C'r c�r I?NVIRONMF.N'I'A1.AFI�AIRS UE!'AR'TMi:N'1' ol� I�:NVIRONM�iN'1'N. PRO'I'I:(YPION 'TI'I'LE 5 QF'FICIAL INSI'I�,C770N FARM11 — NQ7' FQIt VOLUN"1'ARY ASSESSAIF:1`!7'5 SUI2SUR[�ACG SLWACG 111SPOSAI.SYSTI?M FORD4 1'A R'I' A (:F.FZ'1'I!�!CA'1'ION Prnpern ndrtress: 39 Astor Way S `, Sou�h Yarmouth, MA .A;;� �1 '�,` . � � i1 t�� Oaaer'sNamc: NurmaTecoraro ,j �L �+P� � Uwnn�s Anares,: c/u RicharJ Montague,Davenport Realty � 20 Nocth Main Saeet,So.Yarmowh,MA 02664 � Date nf Inspedinic Sepcember 13,2006 ��V �.;=. r �� �� rMC� D Name of Insprclor. Troy M.Wi1118RIS tlr� Company Name: Troy Williams Sep[ic Inspeciions �� SFP 2 2 2QU6 Mailing AJAress: 19 llummel Drive Sou�h Deru�is, MA 02660 IiEALl�rt C)EPT. Tetephone Number: (506)385-1300 CGR'fIFICA"I'!ON S'1'ATf'D1I•:N7' I ccntf��that I have personally inspccttJ the sewage Ji<pasal system al lhis address and U�al die informalion reported below is Irue,atcurate and cnmpltte as of tht time o(ihe inspeciinn 'i he insptction was prrfonned baaed un my training and experimce in the proper fimction and maimcnance olon si�e sewage disposal systems. l am a DEP appro�rd s�stem inspntnr pursuanl lo Seclion 15.340��f Title S(319 ('Mlt IS.0001. 'lTie s��ctrm � Passcs ConJilionap• 1'asscx Nceds Iluthcr i.valuauuu t�� dic Lui;d App�uvmg Awhnin� rails inspector's 5ignalure: ��,w� ���� Dale: p/I3/ol+ l�he sys�nn inspec�or shall submi� a copy of this inspec�ion�epon�o d�e Appro�ing Autho�ity(Iloa�J of I leahh or � DFP)wiihin 30 days of aimplcting�Uis inspcctiun. If�he sys�un is s sl�ared system nr I�as a design Ou�v of 10,000 gpd ur greater,the inspectm and Ihe syslem owner shall submit the repott to�he appropriate regionxl ofCice nf the DEP. Fhe original should 6e srnt lo�he system owner and cnpits saN�o the buyer, if applicaUEe,and the apptoving audiorily ' Notes and Comnunis Allhough�yelem meela Niem6dmum reqitiremenls sel brlh by the Maesachuse�ls UeportmaM o� Ern3rormenlal Protectbn.corli0callon la nol lo be conelruetl m o gunranlee of tuture wo�Mng condihon of eyalam,plpir�or componants. lhl�Irupecllon represenls Ihe coru111ions nl 1he ayslem ori Ilie Uote ot Iropectlon rroted a6ove. •••'TAis report only d�scriLes candilions at Ihe tlme of Inspecllon anJ under Il�e rondilians af use a1 Ih�1 time. 't his inspa�ion dues not aJJress how Ihe sys�eni wi11 perfotm in Ihe luture unAer Il�e same ur different condltions o(use. Tide S ��ispection Fomt 6/IS/2000 paFe 1 ot I I • • Yuge G u1'I I (11�l�t(:tAIJNSE'liC�'IUN 1�[)1tM -NO'1� ('lllt VO1.UN"1'A�tY ASSP.SSMCLN'fS SUIiSU1tI+ACI:SIs�yA(;ls IIISP[)SAL SYS77i.M INSI'I�CI'!ON !�l)RM pA EY►'C SXsI'I.MY INI'URMA'1'ION Property Address: 39 Astor Way Sou[h Yarmouth, MA �)��„�r: NormaTecoraro �)a��������i���i�j,���; Seplember13,2006 I�LUW CON�11"fiUNS ItLS1111SN'I'le►l. NumLm u(bcd�uunu�i{cSIyB�:_I_.._ �`I4NLL'1 O(UUIIOOIIIY(aGuul}:__� I)1sSl!iN Il�w h;�xcd mi S 10 C'MR I5.2U3(fu� cxamplc: I 10 gpd x!!u!'Lcdrnnms): ��p._. Nuudicr ul nit�cul�esidcnls: ' GZ I�ifCY ICSItIL'lIL'C II�VC il 6'JIIli16C y'11O�IGC�yCS Of ILU): � IY IJIIIIIIIY�lll u]L'�Ii11diC SCWYb'C 5Y51CIII�yC]UI u0�:�� III yL'Y 5L'�)JfLIC IIl5�7L'CUOiI ICIfl711'Gljl l.�uud�y syslem iuspnctcd(Ycs n� ni�):�M Scusuual usa(yc.w o� nu): tyd Wulci mcicr ieadings, II'uvaila6lc iIJSI 2 YCflI'!11]J6C I6I1tI��: C� `_ ��Lpu 5,�6,,n y v'f e SG�oao ,,,�G�� Sp[ll�l'f1110�1�YCS UI 310): p.0 5 l.ns�da�o u(uccupancy: _Q�.W .a.J� F - I:OMM LRCIAi/INl)U5'1721e\I. 'I'ypc uf cs�u6lisLuu:n1: 1)csign I1�ow(l�axd��u 110 CNIIL I520J): _ . _ _gp� ISusis of Acsign Auw(seuls/persous/sqfi.cltJ:--- -..._ _ (ii'casc I�np�iicscul(ycs u� uu):_ _ _ --____ . _'_. Indusl�iul wuslc Lulding tauk picscut(yu a nu): Nuu-saniiury wusic disc6�uged In Il�e"fitke 5 sy� a�(ycs o� iw): W�uei n�der rc:idings, il'xvailahle: • {.asl Julc af�>tcupuncyhisc: ---_'-. O'1'�Il:lt(desc�ibc): _ -- —T.--- -. 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