HomeMy WebLinkAboutApp-Permit-Compliancep No.FEE -5,®6
COMMONWEALTH OF M ASSAC14L SETTS 32J O G
Board of Health, 7 A4,m0 on4 , MA.
APPLICATION FOR DISPOSAL SYSTEM[ CONSTRUCTI®N PERMIT
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) - ❑ Complete System ❑ Individual Components
Location 27
a Q Owner's Name T gI5 HAVU &AM AIVTM lDa(�:g LJ -C
Map/Parcel# 311133
Address 513 A2
Lot#
Telephone#
Installer's Name CAPULA ( g
G r I?l-'ZS CLC—'Designer's Name NIA
Address i5 C
` A -g4 Address
Telephone# 771
3 -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
No. of persons
Lot Size sq. ft.
Garbage grinder ( )
Showers ( ), Cafeteria ( )
Design flow provided
Revision Date
Date of Evaluation
DESCRIPTION OF REPAIRS OR ALTERATIONS -*t�,
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 to place the system in operation until a Certificate of Compliance has been issued by the Board of Health.
Signed Date
Inspections
No 501 C—t5-17%is
COMMONWEALTH OF MASSACHUSETTS FEE
\r j f �c0z�3ZI�8�
Board of Health, AICD 0OT"14 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 ( )
by: CA0E(J1-D re' EJOTC-u��UAM LV -
at -513
.G.atir'1 ROUTE -Xg WEST' Yo1AA(ow774 * R -%�
has been install` it4eccrd ce A(> the rov0_
isions o10 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to
application No. �Ci � dated � /CC� . Approved Design Flow (gpd)
1,.
Installer A Q D xis
i/.
Designer: ��� Inspector: 11 641 Date:
The issuance of this permit shall not be construed as a guar a that the system will function as designed.
No. 15-1772- FEEIt 5r 0
/S-- -S-1 COMMONWEALTH Of M[ASSAC14USETTS Clz-*32 1 12
Board of Health, V412,M.0 t -n+ , MA.
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission is hereby granted to; Construct( ) Repair( ) Upgrade( ) Abandon(
at
Disposal System Construction Permit No. �, dated 5— ,
Provided: Construction shall be
Form 1255 Rev. 5196 A.M. Sulkin Co. Charlestown, MA
pletd�nn-thin hr e Vefirs of the date of this
Date �� %Board of Health
an individual sewage disposal system
_ as described iinn•the a a lic' n for
�,/,/
No.: BOHDC-15-1772
Commonwealth of Massachusetts FeB
sss.oa
Board of Health, Yarmouth, MA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to:Repair-minor- [ndividual 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
Dweliing-No.of Bedrooms: Garbage Grinder:
� Other Type of Building:MOTEL No.of persons: Showers:
. Other Fixtures:
Plan Date: Number of Sheets:
Cakteria:
Title: Revision Date:
. Desigo Flow(min.required): gpd Calculated design flow: gpd Design Flow provided: gpd
Description of Soils:
Soil Evaluator Form No.: Naroe of Soil Evaluator. Date of Evaluation:
DESCRIPT[ON OF REPAIRS OR ALTERATIONS:MINOR REPAIR-REPLACE H-l0 DBOX
The untlereigned agrees to install the above described Individual Sewage Disposal System in accordance with the provislons of
TITLE 5 antl further aarees not to olace in ooeretion until a Certlficate of Comoliance has heen issued hv the 8oard of Health.
Signed Date
Inspections
Commonwealth of Massachusetts
Board of Health, Yarmouth, MA FBe
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 Cons4�ction Permit No.: BOHDC-1S1772 ,Dated: Apri121,2015
Provided: Construction shall be completed within six months of[he da[e of this permit. All bcal conditions must be met.
Conditions
1. MINOR REPAIR-REPLACE H-10 DBOX
2. SYSTEM 6=SYSTEM B LOWER RIGHT PER ASBUILT PLAN 07/27/ 5
�v
Bruce G. Murp , MPH, R.S., CHO/Amy L.von Hone, R.S., CHO
� alth Director/Assistant Health Diredor
The issuance of this permit shall not be construed as a guarantee that the system will function as designed.