HomeMy WebLinkAbout0863 BUMPS RIVER ROAD - Health 863 Bumps River Road
Centerville
A= 167-031
Slll �A
UPC 10259
No. H 1630R F'
MAR*A4GO M&
'1 1
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\I THE COMMONWEALTH OF MASSACHUSETTS
Of� BOARD qF TH
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0F.... ............ ....Q..: ... ............................ .....----
1� V
Apphration -for Uhipoiitti Workii Tono#.rurtton Vrrmd
Application is hereby'made fora Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
Sys at• /� `
a
---- -- -
/ Loca on-Address or
J_--... •- ---........................................................
---�....L-....•-----••----------------------•....- CG ........ G...........
[[//,, Owner / Address
a ........... a.-
_____________ -_-_••_---•-•.-_-_-__----------_.------.:--._-__----___-_ _-----
__-.[/ �--_____-__-__-_-•___-.--_.____------_. --.•__------.--____
Installer Address A ��
Type of Building Size Lot_..__..,�..................Sq. feet
U Dwelling—No. of Bedroomsf,}- _____________ Expansion Attic ( ) Garbage Grinder ( )
g -s6_ C.-••-•--•••••--- No. of persons-__Z/------------------ Showers (�) — Cafeteria ( )Other—Type of Building _. �
d Other fixtures
W Design Flow_______________________..-.........gallons per pet-son per day. Total daily flow._.._?_0V_-..--__-________-.-..--.---gallons.
WSeptic Tank•-1 Liquid capacitv./ --gallons Length---------------- Width---------------. Diameter---------------- Depth.--..--_-------
x Disposal Trench—No- --------------------- Width-------------------- Total Length------------........ Total leaching area--------------------sq. ft.
Seepage Pit No--------- _......... Diameter....(PY.r... Depth below/'inlet.................... Total leaching area------------------sq. ft.
z Other Distribution box ( ) Dosing tank ( ) / �y tdG�— "��' %
Percolation Test Results Performed by----------- -------------------------------------------------------------- Date------------------------------------
a Test Pit No. I................minutes per inch Depth of "Pest Pit-----............... Depth to ground water------------------------
rxq Test Pit No. 2-____-__•.-_____minutes per inch Depth of Test Pit____________________ Depth to ground water------------------------
r
--
r�-- -.i... y -
Descri ------------------------
Description of Soil---- ' � �� = '.. ........... %�:.c�f� r 1 --
V •-•--------------------•-•-----,'��-----•-r-•x-i--•• v.W..,-- W��
._-�� -�=i ---
1 v
.V Nature of Repairs or Alterations—Answer when applicable--
Agreement
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article NI of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has be is tied th b f he h.
Sign - - -_ ---- ------ A_ ................••--..._.._........
6-Z
��� � Date_
Application Approved By...... --- --- -- --__---------P` �.--- -- -----•--•--•---------- •--•• Ile 77-----••-
Date
Application Disapproved for the following reasons----------------•-----------------------------------------------_------------------_---•---•---•-------------•---
-•..............••-•---•.-----••-••••....................................... .............--•••------•-
Date
PermitNo......................................................... Issued.---f�------- -•--••--- _.-----
Date
711sy•-•--• Fsa./I..'.............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD � �TH
----- -----------OF... .-.. -- -----...........-----...............................
Appliration -fur M,gpuottl Works Ton,itrurtiun Prrutit
,P�
Application is hereby'made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
Sy at
W- 1__ ,,' Q ` -------------•-------•----•- ••-
Loc on•Address or L
X
..d Owner + Address
--
Installer Address
Q Type of Building s Size Lot_. 0: 2______Sq. feet
U Dwelling—No. of Bedrooms. ���� ____Expansion Attic ( ) Garbage Grinder ( )
04 Other—Type of Building- _ 2"................ No. of persons-___ ________.____._._Showers (`) — Cafeteria ( )
dOther fixtures .. '.
w Design Flow_____________________ -.-.------. Mons per et-son per day. Total daily flow_.._ ___..._______
g g< P P P Y Y -- - gallons.
USeptic Tank l Liquid capacity_��__gallons Length---------------- Width-------......... Diameter----------.----- Depth___-_______-._.
xDisposal Trench—No-____________________ Width.__..... .._........ Total Length------------------._ Total leaching area--------------------sq. ft.
Seepage Pit No........ .......... Diameter.__�A_ ..... Depth below inlet____________________ Total leaching area.___-_-________.sq. it.
z Other Distribution box ( ,) Dosing tank ( ) , � ., �1" T 7
Percolation Test Results Perfp�rAd by---- -- -- - -- -•-•-••------•---------------•----------------------- Date_. ------------------ -
a Test Pit No. 1..............._mtriute5 per inch teptb,.of Test Pit....__,____---------- Depth to :round water...;___--_-__--__-__--..
f=, Test Pit No. 2----------------minutes per inch Depth of Test Pit______:_____________ Depth toiground 4.ter__-__-_--___________-_-
O ,Description of Soil ��r Iv-� 6�
U --------------------------------%�.... •1-----.t....... _-
w
U Nature of Repairs or Alterations—Answer when applicable..---------------------------------.___:__-______-__-_________-____-__-_-__--_..__________-____--
Agreement: +�
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System.in accordance with
the provisions of Article \I of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has be IFAUe y t b° f hejKh.
Sign ' = --•-- ----------•-••---••-•--•------------ •--------------------------
Date
Application Approved By. -• - ------'-- ----- - -- ----------------•-• ..... --------
Date
Application Disapproved for the following reasons------------------------------------------------------------------------------------------------•---•-----•---------
----•----•------•--•----•--._. ............... ------o...................................................-----------------------------------------------------------------------------------------------
Date
a
PermitNo......................................................... Issued........................................................
Date
."THE COMMONWEALTH OF MASSACHUSETTS
BOARD F HEALTH
... ..... ...."..........OF......-... " ... ► ... ......................... ...............
.. `
r.,Trrtifiratr of 0,11utphaurr
ti�:r
" v
IS TO RfIF:Y, That"the Individual Sewage Disposal System constructed (�r Repaired ( )
< =
by..- . ...................... ---• ----------------- ..............................
L4nstaAr f r ------------------•-------------------------------
-- --- ---���)o
st1 e
�
has been installed:,in accordance with theprovision s of . I of The State Sanitary C eras described in the
7
application_for Disposal Works Construction Permit N .7 -___.�.7/___________________ dated_._ ._:'7/7_____......_._______.
THE ISSUANCE OF THIS CERTW(Ir-.ATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL,4UNCTION SATISFACTORY.
DATE........................................................................--•••••--•- Inspector.................................................................
i
THE;COMMONWEALTH OF MASSACHUSETTS
BOARD: HEALT.
N
6o /�`�"%``
... - :...... .....................
FEE--./—$—LL `.....
ispotittl ork CITIonotrurtion Vrrntit
Permission is hereby granted_ _->� �------ -- -,...........................................
to Constru ,(�/,oi RepX&PO',
( ) an In ivid a Sewag ispo ail ystem
at No..-- 4T------ -- s�e' c 4 r
f 7-7
as shown on the application for Disposal Works Construction Pe No__ ____ k__ D ated..._ �� ----_.__.._.._.....__••_._---- GR -••••••--__---
_ ea th'�
DATE..................
FORM 1255•HOBBS & WARREN. INC.. PUBLISHERS -
0
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95. 94
_ s,
�EA,^WJN0 Pi t
RI N., VN N j
1,000 G L 0�
V 3T� SE-PTIL TANK
n. k �.
L.C. 3 906.3A
i
20 672
5F �
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c � v 53 29 37
31 po
Foundation Plan
In Barnstable , Mass.
for
ALDEN I-10ME5, 1rc.
I CERTIFY THAT THE ABOVE FOUNDATION
IS SHOWN ON THE PLAN AS IT L�xl' TS ON
THE GROUND AND THAT I T CONFORA/S TO
THE TOWN OF SA NS TA BLE REv UL^ONS,
Scale.- 1 " 20" Feb- 1977
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