HomeMy WebLinkAboutApp-Permit-ComplianceNo. �'tJ�K, " 0050-7-7 FEE 55: 0�
COMMONWEALTH ®N LTH ®F MASSAC14USETTS 3 8
Board of Health, MA.
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) - ❑ Complete System ❑ Individual Components
Location 5
C #, Owner's NamelhYi5
Map/Parcel# 3
1 , Address 57,,g R -t .2s 1N g -r Vi -..F
Lot#
4,Telephone#
Installer's Name
Designer's Namew LA
Address
6 OpAddress
Telephone#
-7 I 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 gpd
Revision Date
Date of Evaluation
DESCRIPTION OF REPAIRS OR ALTERATIONS iza"4c�- D "BOAC SY STct�
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 lace the system in operation until a Certificate of Compliance has been issued by the Board of Health.
Signed Date " f o — 15
Inspections
No. ipC"(5'"1768 FEE 155,00
A -.__ ;� COMMONWEALTH OF MASSACHUSETTS d&43218(o
Board of Health, YAM rif M4 , MA. )s
CERTIFICATE OF COMPLIANCE
Description of Work: $Q Individual Com onent(s) ❑ Complete System
P P P i'S
The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired ( ), Upgraded ( ), Abandoned ( )
by: C P GLC,
at % r
71 `i /77LL
has been installi�accord�nee Wi�ku e provisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to
application No./ - y�'`� dated l Approved Design Flow -- (gpd)
Installer
Designer: F.%/� Inspector: f %�� Date: ~.
The issuance of this permit shall not be construed as a guaranee that the system will function as designed.
No. bogpc -IS (7405 CfA-KwVD6: '
91-94L C®MMONWEALT14 Of MASSACHUSETTS
Board of Health, Taffin UTIA , MA.
DISPOSAL SYSTEM CONSTRUCTION PERMIT
FEE
x- 3218(0
Permission is herebygranted to; Construct( ) Repair( X) Upgrade( ) Abandon( ) an individual sewage disposal system /
at 51.3 R00 -It 2,2 ''� %/7 �� �6f'l tt g& "401 as described in the application for
Disposal System Construction Permit No. Z!5�'– Z-4 , dated 1 �I—L�•
Provided: Construction shall be completed within three years of the date of this permit. All local conditions must be met.
Form 1255 Rev. 5/96 A.M. Sulkin Co. Chadeslavn, MA Date --7 "..2- -' ` Board of Health
No.:BOHDC-15-1768
Commonwealth of Massachusetts Fee
$55.00
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 Size: 119,790.00 Acres
Dwelling-No.of Bedrooms: Garbage Grinder:
Other Type of Building:MOTEL No.of persoos: Showers:
Other Fixtures:
Plan Date: Number of Sheets: Ca&teria:
TiUe: Revision Date:
� Design Flow(min.required): gpd Calculated design flow: gpd Design Oow provided: gpd
Description of Soils:
Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation:
DESCRIPTION OF REPAIRS OR ALTERATIONS:MINOR REPAIR-REPLACE HQO DBOX
The undersigned agrees to install the above described Individual Sewage Disposal System in accortlance with the provisions of
TITLE 5 and further aarees not to olace in ooention until a Certificate of Comollance has heen issued bv fhe Board of Health.
Signed Date
Tnspections
Commonwealth of Massachusetts
Board of Health, Yarmouth, MA Fee
DISPOSAL SYSTEM CONSTRUCTION PERMIT 555.00
Permission is herby granted to;
CAPEVNDE ENTERPRISES, LLC, 153 COMMERCIAL STREET, MASHPEE, MA 02649
To perform:Repairvminor an individual sewage disposal system.
Owner: THE MARINER MOTOR LODGE LLC
5�3 ROUTE 28
WEST YARMOUTH,MA 02673
Location: 573 ROUTE 28, WEST YARMOUTH,MA 02673
Disposal System Construction Permit No.: BOHDC-15-1768,Dated: April 21,2015
Provided: Construction shall be completed within six months of the date of this permit. All loca]conditions mus[be met.
Conditions
1. MINOR REPAIR-REPLACE H-20 DBOX
2. SYSTEM 2 =SYSTEM D LOWER PER ASBUILT PLAN 07/27/85
�� , �'v� �'
Bruce G. Mur y, 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.