HomeMy WebLinkAboutApp-Permit-ComplianceNo. &ovv -4 s 1'7% 1 _ 1,15rR -15-00 5'017 FEE $ 55,00
COMMONWEALTH Of MAS SAC14USETTS
l
Board of Health, \ &MQ t nV , MA.
APPLICATION FOR DISPOSAL SYSTEM STEM CONSTRIJCTIO1V PERMIT
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) - ❑ Complete System ❑ Individual Components
Location 5,73 RoU -m a.8
Owner's Name 'M F- iyAIu M E)L /A,jbjv_ (,LC-
Map/Parcel# 133
y�/ S
�Lp
7t
Address 513 Ra)7ie a8 We -S -r U1bJ
Lot#
��
Telephone#
Installer's Name
Designer's Name
Address� �i � J �Z
M
Address
Telephone# 5D 2- 4 7 7 .. 2 9f 7
Telephone#
Type of Building
Dwelling - No. of Bedrooms
Other - Type of Building _
Other Fixtures
Design Flow (min. required)
Plan: Date
Title
Description of Soils)
gpd Calculated design flow
Number of sheets
Lot Size
No. of persons
sq. ft.
Garbage grinder ( )
Showers ( ), Cafeteria ( )
Design flow provided god
Revision Date
Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation G
DESCRIPTION OF REPAIRS OR ALTERATIONS P -c- P ;5 YST&4
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 a system in operation until a Certificate of Compliance has been issued by the Board of Health.
Signed Date
Inspections
No.13ti1ADC-5-4-771 FEE :15500
Board of Health, VAV-M n II j}} , MA.
CERTIFICATE Of COMPLIANCE :��G?� C.�Al
Description of Work: ❑ Individual Component(s) ❑ Complete System
The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired ( ), Upgraded ( ), Abandoned ( )
by:
at
%ii
has been installedih-t?(6rdAce/w7V1he provisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to
application No. �/ ��'" % dated ".a `% Approved Design Flow (gpd)
Installer CA ew t D <—'
Designer: W!d A Inspector: Gp� ''� Date:
The issuance of this permit shall not be construed as a guaran a that the system will function as designed.
ec..00-ooeacooeocoeug000. oaoeeon00000c,y 000-o-roeaucou accec00000cono+
No. 3bi�tic-�5",'%% CAPeW 1 D5- FEE It G�.L5", 0
COMMONWEALT14®F MASSACHUSETTS Wiz, 4 320 S(
Board of Health, �Y� , MA.
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission is hereby granted to; Construct`(, ) Repair( ) Upgrade( ) Abandon( ) an individual sewage disposal system
at °� 7?a Rovrc a-2 W it rA-zwoc-n4 5VST6k4 -4.5 as described in the.appliic�aption for
Disposal System Construction Permit No.!- , dated�Li��%
Provided: Construction shall be completed wtthS th�reetyears of the date of this permit. All local conditions must be met.
-.21Form 1255 Rev. 5/96 A.M. Sulkin Co. Chadeslown, MA DateBoard of Health
No.: BOHDC-15-1771
Commonwealth of Massachusetts Fee
555.00
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: ll9,790.00 Acres
Dwelling-No.of Bedrooms: Garbage Grinder:
Other Type otBuilding:MOTEL No.of persons: Showers:
Other Fixtures:
Plan Date: Number of Sheets:
� Cafeteria:
Title: Revision Date:
Design Flow(min.required): gpd Calculated design Flow: gpd Design tlow provided: gpd
Description of Soils: .
Soil Evaluaror Form No.: Name of Soil Evaluator: Dah of Evaivation:
DESCRIPTION OF REPAIRS OR ALTERATIONS:MINOR REPAIR-REPLACE H-l0 DBOX
The undersignetl agrees to install the above described Individual Sewage Disposal System in accortlance with the provisions of
TITLE 5 and further aarees not to olate in ooeration unHl a CeRifitate of Comuliance has been issued bv the Board of Heakh.
Signed Date
Inspections
Commonwealth of Massachusetts
Board of Health, Yarmouth, MA Fee
DISPOSAL SYSTEM CONSTRUCTION PERMIT 555.00
Permission is herby granted to;
CAPEWIDE ENTERPRISES, LLC, 153 COMMERCIAL STREET, MASHPEE, MA 02649
To perform: Repair-minor an individual sewage disposal system.
Owner: THE MARINER MOTOR LODGE LLC
573 ROUTE 28
WEST YARMOUTH,MA 02673
Location: 573 ROUTE 28, WEST YARMOUTH,MA 02673
Disposal System Construction Permit No.: BOHDC-15-1771 ,Dated:Apri121,2015
Provided:Construction shall be completed within six months of the date of this permit. All local conditions must be met.
Conditions
1. MINOR REPAIR-REPLACE H-]0 DBOX
2. SYSTEM 5 = SYSTEM B LOWER LEFT PER ASBUILT PLAN 07/27/85
r.lf �C�
Bruce G. Murph , M H, R.S., CHO/Amy L.von Hone, R.S., CHO
� H Ith Diredor/Assistant Health Diredor
The issuance of this permit shall not be construed as a guarantee that the system will function as designed.