HomeMy WebLinkAboutApp-Permit-ComplianceA
No. It—I J
17
FEE 5 1 C/ U
COMMONWEALT14 OF MASSACHUSETTS
Board of Health, Y/ 10\7 TNA , MA. ! ��
APPLICATION FOR DISPOSAL SYSTEM[ CONSTRUCTION PERMIT
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) - ❑ Complete System ❑ Individual Components
Location pa 3
Owner's Name
Map/Parcel# I apt 5 S
Address
Lot#
Telephone#
Installer's Name , D t
d Designer's Name JV,,e,
Address') (l� l l '
Address �� J
Telephone# 7
Telephone# SciKq1q1qQ
Type of Building _
Dwelling - No. of Bedrooms
Other - Type of Building _
No. of persons
Lot Size sq. ft.
Garbage grinder ( )
Showers ( ), Cafeteria ( )
Other Fixtures
Design Flow (mij. required) '? !� gpd Calculated design flow - 2 Design flow provided 1 �• gpd
Plan: Date CJ 0� ills 1 s Number of sheets I Revision Date
Title
Description of Soil(s)
Soil Evaluator Form No.
Name of Soil Evaluator Date of Evaluation
DESCRIPTION OF REPAIRS OR ALTERATIONS
aka) Co-
The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
further agrges tM;=
e system in operation until a Certificate of Com fiance has been issued by the Board of Health.
Signed i, `. �9�.1/ & Date S1191 (5
No. Do"� " 354-7 _.__� j�f ��FEE
COMMONWEALTH Of MASSACHUSETTS
Board of Health, yA2Nn0 VT!-\ , MA.
CERTIFICATE Of COMPLIANCE /
Description of Work: ❑ Individual Component(s) ❑ Complete System
The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired ( ), Upgraded (t/f , Abandoned ( )
by: /j
at
has been instal?ed aa(co?gnceli thk2l'
isions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to
application No. �� , dated 'A;_Approved Design Flow:L!�d)
Installer r t (..A l) W 0
Designer: 0 IAS Inspector: C1Date: f_
The issuance of this permit sKall not be construed as a guarantee that the system will function as designed.
ii00'. 13(",C, r:') o Oti (tea -L "o C.)�. JOp..�CJt0 .-0 1, 0-. 'r-0 C:O( 0c O.'? O O C: 0 oO'Ali0C;O-a ('of,( )C>G`.-v_lD GGe C>_Qo 60-0 ) O O C: Q C C, 6 O b C% C, C. C.
No. &CDC, 1` i i � � v �.1P•1, � (*�� . FEE
®NIM[ON WE, ALTH Of MASSACHUSETTS ,� � c .. 49 361
Board of Healt $h, �Pr(LM O VT" , MA. f `
MSP®S : S!1TEM[ CONSTRUCTION, PERMIT
Permission is hereby granted to; Construct(/)Repair( ) Upgrade (o Abandon( ) an in$hidual lsewage disposal system
at ��_ 1, I J UA.l
Disposal System Construction Permit
Provided: Construction shall be com
Form 1255 Rev. 5/96 A.M. Sulkin Co. Charlestown, MA Date
,dated���
are�Ste f the date of this
%�_Bo rdof Health
— as
in the application for
local conditions must be met.
� No.:BOHDC-15-3947
Commonwealth of Massachusetts F�
555.00
Board of Health, Yarmouth, MA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to:Upgrade-Individual Component(s)
Location: 23 OUTWARD REACH,YARMOUTH, MA 02675 Owner:
MARSH PAUL J
Map/Parcel#: 125.87 MARSH KATHI.EEN M
23 OUTWARD REACH
YARMOUTH PORT,MA 02675-2049
Phone:
Septic System Installer Designer
J. O'LOUGHLIN INC. J.O'LOUGHLIN.INC.
2 HAROLD STREET HARWICH PORT, 714 MAIN STREET
MA 02646 YARMOUTHPORT,MA 02675
Phone: 508-362-4942
Type of Building:Dwelling Lot Size: 12,632.00 Acres
Dwelling-No.of Bedrooms:3 Garbage Grinder.
Other Type of Buildiog: No.of persons: Showers:
Other Fixtures:
Plan Date:OS/21/2015 Number of Sheets: 1 Cafeteria:
Tit1e:SEWAGE PLAN 23 OUTWARD REACA Revision Dah:06/02/2015
Design Flow(min.required):330 gpd Calculated design 11ow:330 gpd Design ilow providM:342.25 gpd
Descriptioo of SoiIs:SEE PLAN
Soil Evaluator Form No.: Name of Soil Evaluator. Date of Evaluation:04/22/2015
MICHAEL O'LOUGHI.IN,SE
DESCRIPTION OF REPAIRS OR ALTERATIONS:SEPTIC DISPOSAL-REPAIR-EXISTING ]000 GAL SEPTTC TANK,H-20 DBOX,2
• -500 GAL PRECAST CHAMBERS W/STONE 4'ENDS,3.58'SIDES:25'X 12.5'X 2'
The undersignetl agrees to install the above tlescribed Intlivldual Sewage Disposal System in aecordance with the provisions of
. TITLE 5 and further aarees not to olace in ooeration until a CerfiFlcate of Comolianee has heen issued bv the Board of HeaHh.
Signed Date
Inspections
. Commonwealth of Massachusetts
Board of Health, Yarmouth, MA F�
' DISPOSAL SYSTEM CONSTRUCTION PERMIT ase.00
Permission is herby granted to;
J. O'LOUGHLIN INC., 2 HAROLD STREET, HARWICH PORT, MA 02646
To perform: Upgrade an individual sewage disposal system.
Owner. MARSH PAUL J
MARSH KATHLEEN M
23 OUTWARD REACH
YARMOUTH PORT,MA 02675-2049
Location: 23 OUTWARD REACH, YARMOUTH,MA 02675
Disposal System Construction Permit No.: BOHDC-15-3947 , Dated: August 25,2015
Provided: Construction shail be completed within six months of the date of this permit. All local conditions must be met.
CONDITIONS:
1. SEPTIC DISPOSAL- REPAIR-EXISTING 1000 GAL SEPTIC TANK, H-20 DBOX, 2-500 GAL
PRECAST CHAMBERS W/STONE 4' ENDS, 3.58' SIDES:25'X 12.5'X 2'
2. BOH TO INSPECT SOIL REMOVAL
�CJ�I
Bruce G. Murphy PH, R.S., CHO/Amy L. von Hone, R.S., CHO
He th Director/Assistant Health Director
The issuance of this permit shall not be construed as a guarantee that the system will function as designed
Commonwealth of Massachusetts
Board of Health, Yarmouth, MA Fee
CERTIFICATE OF COMPLIANCE $55.00
Description of Work: Individual Component(s)
The undersigned hereby certify thai the Sewage Disposal System; Upgraded
by:J.O'LOUGHLIN INC.
at:23 OUTWARD REACH,YARMOUTH,MA 02675
Has been installed in accordance with the provisions of 310 CMR 15.00(Title 5)and the approved
design plans or as-built plans relating to application No.: BOHDG1S3947,dated 08/27/2015.
Installer:J.O'LOUGHLIN INC.
Address:2 HAROLD STREET HARWICH PORT,MA Inspector:AMY VON HONE,R.S.
02646
Designer:J. O'LOUGHLIN,INC.
'��U�
� Bruce G. M hy, MPH, R.S., CHO/Amy L:von Hone, R.S.,CHO
Health Diredor/Assistant Health Diredor
The issuance of this permit shall not be construed as a guarantee that the system will function as designed.
BO H_Disposal_Construction_CofC.rpt