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HomeMy WebLinkAboutApp-Permit-Compliance"h No. i L� ^�V'ZO ` L� /I / FEE J �7 -71 COMMONWEALTH LTH ®f MASSACHUSETTS C**?,22,13 7 Board of Health, %A LZ M-©QD4 , MA. APPLICATION FOR DISPOSAL SYSTEM[ CONSTRUCTION PERMIT Application for a Permit to Construct( tepapK i pgr e(/) Abandon( - Ll Complete System I4Individual Components rrw-� o, /I,,/ Location0� Y Owner's Name 'r 6(SPzi(7' (,4 Map/Parcel# f Address Lf -710 ROUTt 'a,g Lot# Telephone# Installer's Name 0,4 P6&)jj) & 5 fJ-123el0k6" LP� (( Designer's Name NI/A Address 15-3 Address Telephone#4 7 Telephone# Type of Building Dwelling - No. of Bedrooms. Other - Type of Building Other Fixtures Design Flow (min. required) Plan: Date Title Description of Soil(s) _ Soil Evaluator Form No, gpd Calculated design flow Number of sheets Name of Soil Evaluator Lot Size No. of persons sq. ft. Garbage grinder ( ) Showers ( ), Cafeteria ( ) Design flow provided Revision Date Date of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONS REP V- -,?-oy '0X- AUD U)S M-4, H -Z-0 215 'to 6AAXs9 'W,�me_m t= gpd 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 system in operation until a Certificate of Compliance has been issued by the Board of Health. Signed I Date Inspections No. 4.ro��%t. FEE. COMMONWFALT14 OF M ASSAC14USETTS cFz4 32:zs-7 Board of Health, A0VT- , MA. CERTIFICATE Of COMPLIANCE Description of Work: Individual Component(s) ❑ Complete System The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired Upgraded ( ), Abandoned ( ) by; 0_APG ha 6 EO 0J5� CA,"G at 14-7G- has 4-7 has been installed in accordance with the provisions of Q.CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to application No. , �f dated r� Approved Design Flow (gpd) Installer (2Ap W_)CD6 1u?&P_P &;; U,<� PZ Designer: NIA Inspector: of t' Dater S The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Cl: _C��C.;•� ::C:, -C ., I., 1,C JG: Q.c.r yb� C Gi-,. 6..9<—o -Te=; .e--?;, ._-.•c .r_ ., ., .,rl �[. Cru. - _'„' - _ _. No. TAtJ^• ( �g P FEE 65. OC) 7f COMMONWIFALT14 Of MASSACHUSETTS ck-4 322.87 Board of Health, �111Rd 1 , MA. DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to; Construct( ) Repair(X) Upgrade( ) Abandon( ) an individual sewage disposal system T at 4-76 R O u -r a 8 {5Ys7EM +c--) as described in the application for Disposal System Construction Permit No. / S r % , dated Provided: Construction shall be completed within dar-, y�ar5 f pft date of this permit -All local conditions must be met. Form 1255 Rev. 5/96 A.M. Sulkin Co. Chadeslawn, MA Date `� ? Board of Health No.: BOHDGIS-1878 Commonwealth of Massachusetts Fee sss.00 Board of Health, Yarmouth, MA APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to:Repair-minor-Individual Componeot(s) Location:476 ROUTE 28,WEST YARMOUTH, MA 02673 Owner: THE POINT LLC Map/Parcel#: 031.77 476 ROUTE 28 WEST YARMOUTH,MA 02673 Phone: Septic System Installer Designer CAPEWIDE 153 COMMERCIAL STREET MASHPEE, MA 02649 Phone: � Type of Building:Other Type of Building Lot Size: 128,502.00 Acres Dwelling-No.of Bedrooms: Garbage Grinder: Other Type otBuilding:MOTEL No.of persoos: Showers: Other Fixtures: Plan Date: Number of Sheets: Cafeteria: Title: Revision Date: . Design Flow(min.required): gpd Calculahd design flow: gpd Design Flow provided: gpd Description of Soils: Soil Evaluaror Form No.: Name of Soil Evaluator: Date of Evaluation: DESCRIPTION OF REPAIRS OR ALTERATIONS:MINOR REPAIR-REPLACE H-20 DBOX AND RISER FOR SYSTEM F The untlersigned agrees to install the above describetl Intlividual Sewage Disposal System in accoMance wkh the provisions of TITLE 5 and further aarees not to olace in oceratfon until a CerNflcaM of Comoliance has been issued bv the Board of Heakh. Signed Date lnspections Commonwealth of Massachusetts Board of Health, Yarmouth, i�i[i Fee DISPOSAL SYSTEM CONSTRUCTION PERMIT su.00 Permission is herby granted to; CAPEVNDE ENTERPR�SES, LLC, 153 COMMERCIAL STREET, MASHPEE, MA 02649 To perform: Repair-minor an individua7 sewage disposal system. Owner: THE POINT LLC 476 ROUTE 28 WEST YARMOUTH,MA 02673 Location:476 ROUTE 28, WEST YARMOUTH,MA 02673 Disposal System Construction Permit No.: BOHDC-15-1878,Dated: Apri130,2015 Provided: Construc[ion shall be completed within six months of the date of this permit. All local conditions must be met. Conditions 1. MINOR REPAIR-REPLACE H-20 DBOXAND RISER FOR SYSTEMF 6''-!/���� r�Kf/�� Bruce G:�� rphy, 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. Commonwealth of Massachusetts Board of Health, Yarmouth, MA F� CERTIFICATE OF COMPLIANCE $55.00 Description of Work:Individual Component(s) The undersigned hereby cedify that the Sewage Disposal System; Repair-minor by:CAPEWIDE ENTERPRISES, LLC at:476 ROUTE 28, WEST YARMOUTH,MA 02673 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-15-1878,dated OS/O8/2015. Installer: CAPEWIDE ENTERPRISES,LLC Address:153 COMMERCIAL STREET MASHPEE,MA Inspector:AMY VON HONE,R.S. 02649 Designer: Conditions 1.MINOR REPAIR-REPLACE H-20 DBOX AND RISER FO SYSTEM F � eruce . Mu hy, MPH, R.S., CHO/Amy L.von Hone, R.S., CHO Health Director/Assistant Health Direc[or The issuance of this permit shall not be construed as a guarantee that the system will functioo as designed. BOH_Disposal_Construction_CofC.rpt