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Home My WebLink AboutApp-Permit-ComplianceNo. &N DG' (V 1 Ze,.e _4-7�-—1G't�Y"Zl - 1 lde,014�'� FEE ®� COMMONWEALTH Of MASSAC14USETTS d.,# soocr Board of Health, )6��OV-m APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct( ) Repair( ) Upgradeal Abandon( ) - omplete System U Individual Components Location 360 Owner's Name Qf Map/Parcel# St" 13 Address Lot# 10 Telephone# Installer's Name Mg.�j Designer's Name Address Address 2/y f Telephone# Telephone# Type of Building QWA j� Lot Size -P 5 CSG sq. ft. Dwelling - No. of Bedrooms 3 Garbage grinder ( ) Other -Type of Building No. of persons Showers ( ) , Cafeteria ( ) Other Fixtures Design Flow (min. req fired) gpd Calculated design flow Design flow provided 360., 0 gpd / Plan: Date �0 31 s Number of sheets 1 Revision Date Title Description of Soil(s) _ Soil Evaluator Form No. Name of Soil Evaluator DESCRIPTION OFREPAIRS ORALTERATIONS '-3ii1T&k�v�JC56 �•�%-�Q'ACi �..Q�_..La✓l..t.lVlNr of Evaluation 1.7– No. ^ 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 cyst operation until a Certificate of Co ph ce has been issued by the Board of Health. k Signed 8ka Date _ 1 No: poi ��., Ja FEE COMMONWEALTH LTH OF MASSACHUSETTS Board of Health, }/A-9M0QTV+ , MA. CERTIFICATE Of COMPLIANCE ��„� Description of Work: U Individual Component(s) fg Complete System The undersigned \hereby '.cern that the Sewage Disposal System; Constructed ( ), Repaired ( ), Upgraded ( ), Abandoned ( ) by: at �2 j4td`T.Cw, oYdZi e withathe pro�zsions of 310 CMR 15.00 (Title 5) and the approved design plans/as built plans relating to has been installed iuY�� application No. /C -->4 , dated // Approved Design Flow gpd), Installer i Ke 6 t "u cTf4 U !ti.) Z -- Designer: 17. 1) Z6 l Inspector: s - Date: ( ^ I l The issuance of this permit shall not be construed as a guarantee t)i6t the system will function as designed. ,:.:�..rr �. ,.i.l. ._-.-�.—_..Y..-_..n:.l .,:,...�.r .. .. c-,-..nr� .�.r;:c��";�;r•AD�r r. �_, �; ,y:+Ey/'-s,.•�^� ,<.t-7. cL�.c.(:�.r�c+.:^:.,.:��. �.).. .i.:'J.,2� G.iiO^.c�V..'�c-u.G!)J�. i�.�v U_;�vr,'ia ,. ^c:t.lU3s�-C No. �� % " r3 iJ 'i d i s O `Lo ucrwu" Wc, FEE $ . 00 C®MMONWEAL1I4 Of MASSACHUSETTS (.# 540(0 - Board of Health, YA-W00114 , MA. DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to; at ( ) Repair( ) Upgrade{__ ~Abandon ( ) an individual sewage disposal system as described in the application for Disposal System Construction Permit No. /C dated b1957 Provided: Construction shall be complete within of the date of this permit[ All local conditions must be met. Form 1255 Rev. 5/96 A.M. Sulkin Co. Chadeslown, M Date ! Board of Health No.:BOHDGIS-5891 . Commonwealth of Massachusetts F� $55.00 Board of Health, Yarmouth, MA APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to: Upgrade-Complete System Location: 60 ICE HOUSE RD, SOUTH YARMOUTH, MA 02664 Owner: HALFYARD FAITH M Map/Parcel#: 059.136 60 ICE HOUSE RD SOUTH YARMOUTH,MA 02664-4112 Phone: Septic System Installer Designer J. O'LOUGHLIN INC. J. O'LOUGHLIN, INC. 2 HAROLD STREET HARWICH PORT, 714 ROUTE 6A MA 02646 YARMOUTHPORT,MA 02675 Phone: 508-362-4942 5083624942 Type of Building:Dwelling Lot Size:32,670.00 Sq.Ft. Dwelling-No.of Bedrooms:3 Garbage Grinder: Other Type of Building: No.of persons: Showers: Other Fixtures: Plan Date:08/31/2015 Number of Sheets: 1 Cafeteria: ' Tit1e:SEWAGE PLAN 60 ICE HOUSE ROAD Revision Date:09/29/2015 Design Flow(min.required):330 gpd Calculated design flow:330 gpd Design flow provided:360.29 gpd , Description of Soi1s:SEE PLAN Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation:08/12/2015 MICHAEL O'LOUGHLIN,SE DESCRIPTTON OF REPAIRS OR ALTERATIONS:SEPTIC DISPOSAL-REPAIR-PROPOSED MONO 1500 GAL SEPTIC TANK,H-20 DBOX, 10 HIGH CAPACITY H-20 INFILTRATORS W/OUT STONE:62.5'X 2.83'X 11" The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further aarees not to olace in ooeration until a Certificate of Comoliance has 6een issued bv the Board of Health. Signed Date Inspections ! Commonwealth of Massachusetts ' Board of Health, Yarmouth, MA Fee DISPOSAL SYSTEM CONSTRUCTION PERMIT $ss.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: HALFYARD FAITH M 60 ICE HOUSE RD SOUTH YARMOUTH,MA 02664-4112 Location: 60 ICE HOUSE RD, SOUTH YARMOUTH,MA 02664 Disposal System Construction Permit No.: BOHDC-15-5891 ,Dated:November 20,2015 Provided:Construction shall be completed within six months of the date of this permit. All local conditions must be met. CONDITIONS: 1.SEPTIC DISPOSAL-REPAIR-PROPOSED MONO 1500 GAL SEPTIC TANK, H-20 DBOX, 10 HIGH CAPACITY H-20 INFILTRATORS W/OUT STONE:62.5'X 2.83'X 11" 2. BOH TO INSPECT SOIL REMOVAL 3. RELOCATE WATERLINE 4. MFC VARIANCE APPROVAL:a.WETLAND SETBACK b. GROUNDWATER ADJUSTMENT 5.ZONE II MAXIMUM 3 BEDROOM V lJ� Bruce G. rp , MPH, R.S., CHO/Amy L.von Hone, R.S.,CHO Health Director/Assistant Health Director i The issuance of this permit shall not be construed as a guarantee that the system will function as designed. i i I Commonwealth of Massachusetts Board of Health, Yarmouth, MA Fee CERTIFICATE OF COMPLIANCE $55.00 Description of Work:Complete System The undersigned hereby certify that the Sewage Disposal System; Upgraded by:J.O'LOUGHLIN INC. at:60 ICE HOUSE RD,SOUTH YARMOUTH,MA 02664 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.: BOHDC-15-5891,dated 12/Ol/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. Conditions 1.SEPTIG DISPOSAL-REPAIR-PROPOSED MONO 1500 GAL SEPTIC TANK,H-20 DBOX, 10 HIGH CAPACITY H-20 INFILTRATORS W/OUT STONE:62.5'X 2.83'X 11" 2.BOH TO INSPECT SOIL REMOVAL 3.RELOCATE WATERLINE 4.MFC VARIANCE APPROVAL: a.WETLAND SETBACK b.GROUNDWATER ADJUSTMENT 5.ZONE II MAXIMUM 3 BEDROOM �V , Bruce G. Mur y, PH, R.S., CHO/Amy L.von Hone, R.S., CHO Health Director/Assistant Health Director ' The issuance of this permit shall not be construed as a guarantee that the system will function as designed. BOH_Disposal_Construction_CofC.rpt