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Home My WebLink AboutApp-Permit-ComplianceNo. „g©:ri�C"��—L%r0�1l��K V., FEE0o COMMONWEALTH OF M ASSAC14USETTS CO 32_6 G Board of Health, YA9MO f , MA. APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTI®N PERMIT Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) - ❑ Complete System ❑ Individual Components Location VT15 I;L-g 3 Owner's Name'(({E H ARl &)M k0-rv�L Lobar Lt C_.. Map/Parcel# 1 Address 5-73 "*1/Aj,,,WUTt4 Lot# Telephone# Installer's Name CAP&Lutv L G Designer's Name MIA Address j5j Address Telephone# 50 j?- y-1 7 — 29 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 No. of persons Lot Size sq. ft. Garbage grinder ( ) Showers ( ), Cafeteria ( ) Design flow provided Revision Date Date of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONS RG C LL`C= D `ZOiC z5 Vg:raAA 43 gpd The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees jo not to place the system in operation until a Certificate of Compliance has been issued by the Board of Health. Signed Date Inspections No.-7ICj—I �DC( FEE - COMMONWEALTH Of MASSACHUSETTS Board of Health, YAP_, M 0 ( rnj , 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 ( ) �- at 3 R nt has been installe'3 (,/a o d'a ce-/ n, the provisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to application No. O j , dated �"`j / Approved Design Flow (gpd) Installer Wt Designer: MIA Inspector: 2W Date: The issuance of this permit shall not be construed as a guaranVthat the system will function as designed. Oc;00Gcc 0000 .)G OOOC, 0()111110000000 C'00o cOO C1000100C:7 O G 00000CIC, DOO O 00000c:0000 C 00:0000-0O<1C OOO OOC 0600000,(OC,00 OG No. Cprpew1DE7 FEE _t55" 5" C®MMON LT14 Of MASSAC14USETTS 8t0 Board of Health, VAgmilL- , MA. DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to; Construct( ) Repair(X) Upgrade( ) Abandon( ) an individual sewage disposal system at 5:12Q)QUZj5 Qg(A)G7' Y,0 n L 5YSTG4�t as described in the application for Disposal System Construction Permit No. _L, dated 4 Provided: Construction shall be. completed Wtthin kee/yeadP of the date of this permit. All local conditions must be met. Form 1255 Rev. 5/96 A.M. Sulkin Co. Charlestown, MA Date �1 �� Board of Health !�''� `" > ! e No.:BOHDGIS-1769 Commonwealth of Massachusetts F� 555.00 Board of Health, Yarmouth, MA APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERNIIT 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: Carbage Grinder: Other Type of Building:MOTEL No.of persons: Showers: Other Fixtares: Plan Date: Number of Sheets: Cafeteria: Title: Revision Date: Design Flow(min.required): gpd Calculated design ilow: gpd Design tlow provided: gpd Description of Soils: Soil Evaluator Form No.: Name ot Soil Evaluator: Date of Evaluation: DESCRIPTION OF REPAIRS OR ALTERATIONS:MINOR REPAIR-REP[,ACE H-20 DBOX 7he undersigned agrees to install the above tlescribetl Individual Sewage Disposal System in accordance wkh the provisions of TI7LE 5 and further aarees not to nlace In ooeration until a Certificate of Comoliance has heen issued hv the Board of Health. Signed Date Inspections Commonwealth of Massachusetts Board of Health, Yarmouth, MA Fee DISPOSAL SYSTEM CONSTRUCTION PERMIT sss.00 Permission is herby granted to; CAPEWIDE ENTERPRISES, LLC, 153 COMMERCIAL STREET, MASHPEE, MA 02649 To perform:Repairvminor an individuai sewage disposal system. Owner: THE MARINER MOTOR LODGE LLC 573 ROUT'E 28 WEST YARMOUTH,MA 02673 Location: 573 ROUTE 28, WEST YARMOUTH,MA 02673 Disposal System Construction Permit No.: BOHDC-15-1769,Dated: Apri121,2015 Provided:Construction shall be wmpleted within six months of the date of this permi[. All local conditions must be met. C011di(IOnS I.MINOR REPAIR-REPLACE H-20 DBOX 2. SYSTEM 3 =SYSTEM C UPPER PER ASBUILT PLAN 07/27/85 �/CJ�I Bruce G. Mu , MPH, R.S., CHO/Amy L.von Hone, R.S.,CHO ealth Director/Assistant Health Diredor The issuance of this permit shall not be construed as a guarantee that the system will function as designed.