HomeMy WebLinkAboutApp-Permit-ComplianceNo. �O 1 C_f5��-3995_ &L. b 1`" �U-OOO891 FEE GOV
COMMONWEALTH LTH Of MASSACHUSETTS C04TW
Board of Health, MA. S
APPLICATION FOR DISPOSAL SYSTEM[ CONSTRUCTION PERMIT
Application for a Permit to Construct( ) Repair( ) Upgrade1 -)"Abandon( ) - ❑ Complete System Zk�diividual Components
Location a
Owner's Name
Map/Parcel# ti 17
Address
Lot#
Telephone#
Installer's Name
Designer's Name CIO,
Address
Address l`f%
Telephone# OL S700
Telephone#Q�
Type of Building _j.2&AA
Dwelling - No. of Bedroo
Other - Type of Building
No. of persons
Lot Size I c'l; &W — sq. ft.
Garbage grinder ( )
Showers ( ), Cafeteria ( )
Other Fixtures
Design Flow (min.required) 1 I{ (1. gpd Calculated design flow -330 Design flow provided -144 a. A 5 gpd
Plan: Date Z I
ag I rJ Number of sheets 0 Revision Date
Title
Description of Soil(s) _
Soil Evaluator Form No,
Name of Soil Evaluator
DESCRIPTION OF REPAIRS OR ALTERATIONS
. .- A - w -
of Evaluation
The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and
further agrees o no Ie the systeeration until a Certificateof Coen issued by the Board of Health.
Signed V v Date 0
Inspections
AC1IU ETTS �e
COMIMION�LTII OF SSEE
Gk49 S
Board o Health,h1'12 Mtn e1'i 1% , MA.
f -- 64#4
CERTIFICATE Of COMPLIANCE � x � ���1-10e,
Descri.tion of Work: Individual Component(s) ❑ Complete System
The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired ( ), Upgraded (V, Abandoned ( )
by: , t-
at
has been instalUPi c�orat%Fwith-thI pr sions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to
application No.;' / ✓ ,dated 6 ' 1 . " •'" ;Approved Design Flow gpd)
Installer M 1 rjC-_ 0 ` LO V 64A U 903 11 (
Designer: aL1(s't�-t_.f to Inspector:
Lz Date:
The issuance of this permit shall not be construed as a guarantee that the system will function as designed.
6-35q '5 �,.-- � O cam. a V�S1^�'t-� /V� l o c, FEE _ __ .. o . —
c.r-C n„C... c0r C, 1� ^c,C)
am 11 11 cg000ds��ccoo� u,reo coo of'nac•C:�-c �,.: �zc>i_. c6v _'�c.7C,= 0 r ` , o o o e o o o 06r 0 c 0 or)
No.000 0000�c
0 �o
C-- !�-�45-7" MMM
Board of Health, p- M ?t io1T y�,T MA. g�,
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission is hereby granted to; Construct( ) Repair(,) Upgrade(yj Abandon( ) an individual sewage disposal system
at 'a V .( _Q^,Q Q `�r'11 , as described in the application for
Disposal System Construction Permit No.r .7r , dated�-x
Provided: Construction shall be complete within tkpo&4@,!of
date of this permit. All local conditions must be met.
n j
Form 1255 Rev. 5/96 A.M. Sulkin Co. Charlestown, MA Date 5 Board of Health C�/,
i
� .
�
No.:BOHDC-15-3595
� Commonwealth of Massachusetts Fee
$55.00
� Board of Health, Yarmouth, MA
� APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
;
Application for a Permit to:Upgrade-Individual Component(s)
Location: 2 VILLAGE LN,YARMOUTH, MA 02675 Owner:
RYAN EDWARD J JR TRS
Map/Parcel#: 124.17 RYAN MARGARET M TRS
124 LUCE ST
LOWELL,MA 01852
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 Building: No.of persons: Showers:
Other Fixtures:
Plan Date:07/28/2015 Number of S6eets: 1 Cafeteria•
Tit1e:SEWAGE PLAN 2 VILLAGE LANE Revision Date:08/14/2015
Design Flow(roin.required):330 gpd Calculated design flow:330 gpd Design flow provided:342.25 gpd
Description of Soi1s:SEE PLAN
Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation:07/16/2015 '
• MICHAEL O'LOUGHLIN,SE
DESCRIPTION OF REPAIRS OR ALTERATIONS:SEPTIC DISPOSAL-REPAIR-EXISTING 1000 GAL SEPTIC TANK,H-20 DBOX,2
� -500 GAL H-20 PRECAST CHAMBERS W/STONE 4'ENDS,3.58'SIDES:25'X 12.5'X 2'
The undersigned agrees to install the above described Individual Sewage Disposal System in accordance wRh the provisions of
TITLE S and further aarees not to nlace in oueration until a Certificate of Comoliance has been issued bv the Board of Health.
Signed Date
Inspections
Commonwealth of Massachusetts
!� Board of Health, Yarmouth, MA Fee
�
DISPOSAL SYSTEM CONSTRUCTION PERMIT $55.00
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: RYAN EDWARD J JR TRS
RYAN MARGARET M TRS
124 LUCE ST
LOWELL,MA 01852
Location: 2 VILLAGE LN, YARMOUTH, MA 02675
Disposal System Construction Permit No.: BOHDC-15-3595 , Dated: August 17,2015
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-EXISTING 1000 GAL SEPTIC TANK, H-20 DBOX, 2-500 GAL
H-20 PRECAST CHAMBERS W/STONE 4' ENDS, 3.58'SIDES: 25'X 12.5'X 2'
2. MFC VARIANCE APPROVED: a. LEACH FACILITY DEPTH
J, (��
_ Bruce G. M ph , MPH, R.S., CHO/Amy L. von Hone, R.S., CHO '
ealth 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 sss.00
Description of Work:Individual Component(s)
The undersigned hereby certify that the Sewage Disposal System; Upgraded
by:J.O'LOUGHLIN INC.
at:2 VILLAGE LN,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.: BOHDC-15-3595,dated 08/20/2015.
Installer:J.O'LOUGHLIN INC.
Address:2 HAROLD STREET HARWICH PORT,MA Inspector:AMY VON HONE,R.S.
02646
Designer:J.O'LOUGHLIN,INC.
�v Wf
G�%���
Bruce G. urphy, MPH, 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.
BO H_Disposal_Construetion_CofC.rpt