HomeMy WebLinkAboutApp-Permit-Complianceµ Nom' 150 W I '-15�i -Ali� d x ,��9 j iT �Zi' (.-0 -6-77
COMMONWEALTH LTH ®F MASS C14USETTS
Board of Health, y 0-4-V , MA.
FEE 456CM
32t3(a
APPLICATION FOR DISPOSAL SYSTEM[ CONSTRUCTION PERMIT
Application for a Permit to Construct( ) RepairN Upgrade( ) Abandon( ) - ❑ Complete System XIndividual Components
Location 5,13Roo-re �g ('
Owner's Name-fj4Q HA -Raja, tja-M2 a L LC'
Map/Parcel# 3 ` j 33 —
Address .5"j 3 'ppUTE ;Lg W o 1/AZjKO JT,4
Lot#
Telephone#
Installer's Name CAP6w>ai5 15�— Ma5g
Designer's Name N 1A
Address 15 3 C OrMit AL, S -r NA5055
Address
Telephone# -568-4-17-2277 i
Telephone#
Type of Building
Dwelling - No. of Bedrooms _
Other - Type of Building _
Other Fixtures
Design Flow (min. required)
Plan: Date
Title
Description of Soils) _
Soil Evaluator Form No.
gpd Calculated design flow
Number of sheets
Lot Size
No. of persons
sq. ft.
_ Garbage grinder ( )
Showers ( ), Cafeteria ( )
Design flow provided
Revision Date
Name of Soil Evaluator Date of Evaluation
DESCRIPTION OF REPAIRS OR ALTERATIONS Rcsp t-k<�— D — B o 1, S yd T13LA 4
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 to place the system in operation until a Certificate of Compliance has been issued by the Board of health.
Signed Date
Inspections
r No. t3OWDC -J -V71677 FEE S.d
COMMONWEALT14 Of MASSACHUSETTS 32J
Board of Health, YA i' nio 1 , MA.
(ERTI°EICATE Of COMPLIANCE
Description of Work: ❑ Individual Component(s) ❑ Complete System
The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired ( ), Upgraded ( ), Abandoned ( )
by: IU -
UJ --
at -_ 0V- guaw
has been install _M in accord'a ce wit the provisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to
application No. dated ``I i 'Y . Approved Design Flow (gpd)
Installer C k 1 -?
Designer: &YA Inspector 'k wnw Date: P �« - �%^
Vhe issuance of this permit shall not be construed as a guarantee that the system will function as designed.
No. P.`ORrDG-IrJ�I-7V7 FEE 5,00
r j -®NISI®N I.TII Of MASSACHUSETTS
Board of Health, YUhjQ Un4 , MA.
DISPOSAL SYSTLM CONSTRUCTION PERMIT
Permission is hereby granted to; Construct( ) Repair( ) Upgrade( ) Abandon(
at
Disposal System Construction Permit No. / 16 71 , dated -4 --4
! �
Provided: Construction shall be completed within three years of the date of this
Form 1255 Rev. 5/96 A.M. Sulkin Co. Chadestown, MA 'I) ate / Board of Health
an individual sewage disposal system
_ as described in the application for
All local conditions must be met.
No.:BOHDGIS-1767
Commonwealth of Massachusetts Fee
E55.00
Board of Health, Yarmouth, MA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to:Repair-minor-Individual Component(s)
� Location: 573 ROUTE 28,WEST YARMOUTH, MA 02673 Owner:
THE MARINER MOTOR LODGE LLC
Map/Parcel#: 031.133 573 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 Siu: 119,790.00 Acres
, Dwelling-No.otBedrooms: Garbage Grinder.
Other Type of Building:MOTEL No.of persons: Showers:
Other Fiztures:
Plan Date: Number of Sheets: Cafeteria:
Title: Revision Date:
Design Flow(min.required): gpd Calculated design Flow: gpd Design 11ow provided: gpd
Description of Soils:
Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation:
DESCRIPTION OF REPAIRS OR ALTERATIONS:MMOR REPAIR-REPLACE H-20 DBOX -SYSTEM 1
The undersigneA agrees to install the above describetl Individual Sewage Disposal System in accordance with the provisions of
TITLE 5 antl further aarees not to olace In ooeration until a Certificate of Comoliance has 6een iasued 6v the Board ot Heakh.
Signed Date
Inspec[ions
Commonwealth of Massachusetts
Board of Health, Yarmouth, i�iti Fee
DISPOSAL SYSTEM CONSTRUCTION PERMIT E55.00
Permission is herby granted to;
CAPEWIDE ENTERPRiSES, LLC, 153 COMMERCIAL STREET, MASHPEE, MA 02649
To perform:Repair-minor an individual sewage disposal system.
Owner: TF�MARINER MOTOR LODGE LLC
573 ROUTE 28
WESTYARMOUTH,MA 02673
Location:573 ROUTE 28, WEST YARMOUTH,MA 02673
Disposal System Construction Permit No.: BOHDC-15-1767,Dated: Apri121,2015
Provided: Construction sha11 be completed within six months of the date of this permit. All local conditions must be met.
Conditions
1. MINOR REPAIR-REPLACE H-20 DBOX -SYSTEM 1
2. SYSTEM 1 =SYSTEM D UPPER PER ASBUILT PLAN 07/27/85
� C�c
Bruce G. urphy, MPH, R.S., CHO/Amy L.von Hone, R.S., CHO
Health Director/Assistant Health Diredor
The issuance of this permit shall not be construed as a guarantee that the system will function as designed.
i
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