HomeMy WebLinkAboutApp-Permit-ComplianceNo. tlDC-1G3-A770 FEE
C®NIM[® 61.111 Of MASSACHUSETTS
Board of Health, Y8ghib UTU , MA.
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) - U Complete System U Individual Components
Location 513 P1
Owner's NameTj4ir MA4104DL i4o7ba- Lo/p� LLC-
Map/Parcel#
/�
Address 973 RO UTG R2 Ltl m Il!}kwbU-7w
Lot#
Telephone#
Installer's Name QA&aA
(„(C,
Designer's Name N /A
Address s
Mets
®E15'
Address
Telephone# .-'Y7
-. VS'77
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
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 lace the system in operation until a Certificate of Compliance has been issued by the Board of Health.
Signed Date *-tro fS
Inspections
No. NDC -i5"1%-70 FEE J-0
COMMONWEALT14 OF MASSACHUSETTS C.+ 32.4.8
Board of Health, y D , MA. [ j
CERTIFICATE Of COMPLIANCE f/�X
Description of Work: U Individual Component(s) U Complete System
The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired ( ), Upgraded (. ), Abandoned ( )
has been iins?le/d"ffk cco5(]7anc itH the provisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to
application No. �Z5 - a-, dated . Approved Design Flow -- (gpd)
Installer CAMWIDPE SWMWALLSES LA -C- .4 N
/
Designer: WA Inspector '` / r Date:
The issuance of this permit shall not be construed as a guarant that the system will function as designed.
C t'r):>V X00 C`IC I..: C., J"C .:CC,-- C -,Zv C, j .,C _ U o 0 0..00 CC:: 1 0vC r'JCC';;^,
No. VVIR— 5-17%0 FEE 4 55.0
,�- Q6 COMMONWEALTH LTH Of MASSACHUSETTS C -k -*.32I 8
Board of Health,��� )DA , MA.
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission is hereby granted to; Construct( ) Repair( ) Upgrade ( ) Abandon ( ) an individual sewage disposal system
at 523 ROUTE aA WEST MRAW- I SYs dwt * 4 as described in the application for
Disposal System Construction Permit No. % , dated -_ 4.
Provided: Construction shall be cofufpie with three ye� s of the date of this permit. All local condi 'ons must be met.
Form 1255 Rev. 5/96 A.M. Sulkin Co. Charlestown, Ma Date � ! card of Health C�C� .l�
/
No.: BOHDC-15-1770
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
� CAPEV✓IDE
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 persons: Showers:
Other Fixtures:
� Plan Date: Number of Sheets:
� Cafeteria:
Title: Revision Date:
Design Flow(miarequired): gpd Calculated design Flow: gpd Design flow provided: gpd
Description of Soils:
Soil Evaluator Form No.: Name of Soil Evaluator. Date of Evaluation:
DESCRIPTION OF REPAIRS OR ALTERATIONS:MINOR REPAIR-REPLACE H-20 DBOX
The undersignetl agrees to insfall the above tlescribed Indivitlual Sewage Disposal System in accortlance with the provisions of
TITLE b and further aarees not to olace in ooeretion until a Cerfificate of Comoliance has heen issuetl bv the Board of Heakh.
Signed Date
Inspections
Commonwealth of Massachusetts
Board of Health, Yarmouth, MA Fee
DISPOSAL SYSTEM CONSTRUCTION PERMIT sss.ao
Permission is herby gnnted to;
CAPEWIDE ENTERPRISES, LLC, 153 COMMERCIAL STREET, MASHPEE, MA 02649
To perform: Repair-minor an individual sewage disposal system.
Owner: THE MARINER MOTOR LODGE LLC
573 ROU7'E 28
WEST YARMOUTH,MA 02673
Location: 573 ROUTE 28,WEST YARMOUTH,MA 02673
Disposal System Construction Permit No.: BOHDC-1S1770,Dated: Apri121,2015
Provided: Construc[ion shall be completed within six months of the date of[his permit. All bcal conditions mus[be me[. �
Conditions
L MINOR REPAIR-REPLACE H-20 DBOX
2. SYSTEM 4 =SYSTEM C LOWER PER ASBUILT PLAN 07/27/85
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 guarautee that the system will functioo as designed.