HomeMy WebLinkAboutApp-Permit-ComplianceNo. bb-e,
�C�I2�TF 15 -003r6-77 FEE
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6�/Oi'NWE�IJH OF MASSACHUSETTS c ,32A Sfa
Board of Health,� jj!jnUT &
APPLICATI®N FOR DISPOSAL SYSTEM[ CONSTRUCTION PERMIT
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) - ❑ Complete System ❑ Individual Components
Location 73 RovTE 612
Owner's Name 7AS N(., NPER , (NfC)TZ)j— IAD" (_e_e_
Map/Parcel# ?j t
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Address '13 Rjv-7ZC a � U m �p0w GrM
Lot#
Telephone#
Installer's Name
R4S
Designer's Name N A
Address
Sr M,ASMM 625
Address
Telephone#
V81-7
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
Lot Size
No. of persons
sq. ft.
Garbage grinder ( )
Showers ( ), Cafeteria ( )
Design flow provided gpd
Revision Date
Name of Soil Evaluator Date of Evaluation
DESCRIPTION OF REPAIRS OR ALTERATIONS
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. PJ,3 FEEcJc��
f�
COMMONWEALTH LTH ®E M ASSAC14USETTS
Board of Health,. &i MQV , MA.
CERTIFICATE OF COMPLIANCE
Description of Work: 0 Individual Component(s) 0 Complete System
The undersigned hereby certify that the Sewage Disposal System; Constructed ( ), Repaired ( ), Upgraded ( ), Abandoned ( )
by: CAD6WVD& 6NTW&JSft C.C.G
at 5773 20v'rG --X% _. _ _W eST Yf W007VI -7 v
has been installed in a•`cco'rd'ance with'the ros is of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to
application No.� dated�Approved Design Flow. (gpd)
Installer 'C APF-wcD 9
Designer: NIA Inspector: Date:
The issuance of this permit shall not be construed as a guarantpe that the system will function as designed.
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No. �Wt>C �54'%%'7._3" t,+�TC�WI Gr FEE 59.00
7
COMMONWEALT14 Of MASSACHUSETTS
Board of Health, `1a-m0yrt+ , MA.
DISPOSAL SYSTEM[ CONSTRUCTION PERMIT
Permission is hereby granted to; Construct( ) Repair( ) Upgrade ( ) Abandon ( ) an individual sewage disposal system
at `> % 3 kOuTE o;Q W M'T YAAAcvT?l 5111N3'� % ,as des rii d in the application for
Disposal System Construction Permit No.date
/7/"7
Provided: Construction shall be completed within three years of the date of this perm�j AIJ local conditions must be met.
Form 1255 Rev. 5/96 A.M. Sulkin Co. Charlestown, MA Date Board of Health �f't� / L �✓L /�-'K;F'®
No.: BOHDC-15-1773
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 AOUTE 28
WEST YARMOUTH,MA 02673
Phone:
SepHc System Installer Designer
CAPE W 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: Gsrbage Grinder.
Other Type of Building:MOTEL No.of persons: Showers:
Other Fixtures:
PlanDate: NumberoPSheets: Cafeteria:
Title: Revision Date:
Design Flow(mio.required): gpd Calculated design tlow: gpd Design flow provided: gpd
Description of Soils:
Soil Evaluator Form No.: Name of Soil Evaluator: Date otEvaluation:
DESCRIPTION OF REPAIRS OR ALTERATIONS:MINOR REPAIR-REPLACE H-10 DBOX
The unde�signed agrees to Insfall the above described Individual Sewage Disposal System in accordance with the provisions of
TITLE 5 and further aarees not to olace in oceration until a Certificate of Comoliance has heen Issued hv the Board of Flealth.
Signed Date
Inspec[ions
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: 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.: BOHDGIS-1773 ,Dated: April 21,2015
� Provided: Construction shall be completed within six months of the date of this permit. All local conditions must be met.
Conditions
I.MINOR REPAIR-REPLACE H-10 DBOX
2. SYSTEM 7 =SYSTEMB UPPER RIGHT PER ASBUILT PLAN 07/27/85
,�1 �f Gx-�c:x"r
. Bruce G. urphy, MPH, R.S., CHO/Amy L. von Hone, R.S.,CHO
� Health Director/Assistant Health Diredor
The issuaoce of this permit shall not be construed as a guarantee that the system will function as designed.