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HomeMy WebLinkAboutApp-Permit-ComplianceNo. 3600.-.1 J 4 77� FEE `c7 / c -3ZL 8 C®�' MO L OF MASSACHUSETTS Board of Health, 0,01t , MA. APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION TIO PERMIT Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) - 0 Complete System ❑ Individual Components Location ,72) pwo-r6 a2 $k 8 Owner's Name' N � �- C,� u,G, Map/Parcel# 311133V, 1 Address 5-7 3 >P.ouTg -,� 8 W ag-r YAg&eo vn/ Lot# Telephone# Installer's Name j L • - Designer's Name A Address Z C M Address Telephone# SD2 —4-7-1 — '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 Revision Date Name of Soil Evaluator Date of Evaluation gpd DESCRIPTION OF REPAIRS OR ALTERATIONS RG�lif4�E �'!7©1� SYSZi� The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees to o place the syste operation until a Certificate of Compliance has been issued by the Board of Health. Signed Date 14 -i fes— % s: Inspections No. � � T I�J-t77T FEE COMMONWEALTH Of MASSACHUSETTS C�A 323 �J Board of Health, Af=MQ0T)4 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: CApP-uA1>G- CNTEi2?0J5e-r LL -e—" at ST -3 RbOT6 ZU2 k3 .0 S? has been installeYtn accordance with theme ro_visions of X10 CMR 15.00 (Title 5) and the approved design plans/as-built'fans relating to application No. /5-- C, �) dated -'� /1 -� . Approved Design Flow (gpd) Installer PAP64%4 15 CVe W/Z LLC-% Designer: N/A Inspector: Date: r✓ / ��� The issuance of this permit shall not be construed as a guar tee that the system will function as designed. JC."+00 j000000 C0,10000CC"),100-3 _` C')G J G 1000u ol)o 0000000)1,010100 U_ 0000 n(; O.; c. J VU O G 0001)1 .f:VO�.Oc)00,000OD0O0o000_0 ct, (101"e, O C 0000 UO O00 c00.01C No. b0Q �. -i 5.4 r ! � "�'Yt� IDe- IFEE / 12-1- � 0 COMMONWEALTH Of MASSACHUSETTS ch -4 3e� 9(0 Board of Health, YA-A- L10 Q Tf4-' , MA. p DIA SPOSAL SYSTEM ST CONSTRUCTION PERMIT Permission is hereby granted to; Construct( ) Repair( ) Upgrade( ) Abandon( ) an individual sewage disposal system at 5 93 RVJ7-6 -"M fit% CS t Yf4"Unyl SVSTS * NO as dcespiib ed in the ap licaatiion for Disposal System Construction Permit No%, dated Provided: Construction shall be completed within three years of the date of this per it. All local co ditions must be met. 1�/Jj 11 , Form 1255 Rev. 5/96 A.M. Sulkin Co. Charlestown, MA Date L� 1 I '� Board of Health No.: BOHDC-15-1774 Commonwealth of Massachusetts Fee ass.00 Board of Health, Yarmouth, MA APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to: Repairvminor-Individual Component(s) Location: 573 ROUTE 28,WEST YARMOUTH, MA 02673 Owner: THE MAR[NER 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:OtherType 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: Cafeterie: Title: Revision Date: Design Flow(miarequired): gpd Calculated design ilow: gpd Design flow provided: gpd Description ot Soils: Soil Evaluator Form No.: Name of Soil Evaluaror. Date of Evaluation: - DESCR[PTION OF REPAIRS OR ALTERATTONS:MINOR REPA[R-REPLACE H-10 DBOX 7he untlersignetl agrees to install the above tlescribetl Intlivitlual Sewage Disposal System in accordance with the provisions of TITLE 5 antl furfher aarees not to olace in ooeration until a Certificate of Comoliance has heen Issued W the Board of Heakh. Signed Date Inspecfions Commonwealth of Massachusetts Board of Health, Yarmouth, MA Fee DISPOSAL SYSTEM CONSTRUCTION PERMIT 555.00 Permission is herby granted to; CAPEVNDE 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-1�1774,Dated: Apri121,2015 Provided:Construc[ion shall be completed within six months of the date of[his permit. All local conditions must be me[. CondiNons 1. MINOR REPAIR-REPLACE H-10 DBOX 2. SYSTEM 8 =SYSTEM B UPPER LEFT PER ASBUILT PLAN 07/27/85 ���/�! ���� Bruce¢r 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 guarantee that the system will function as designed.