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HomeMy WebLinkAbout0046 BUMPUS ROAD - Health �� �tmPus �., l-��r'nrs e , TOWN OF BARNSTABLE LOCATION �� 5uk ►,0,•S rd SEWAGE # l3 I VILLAGE Yc<.,n,`c' ASSESSOR'S MAP & LOT w INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY /900 LEACHING FACILITY:(iype) A& (size)' leng NO. OF BEDROOMS PRIVATE WELL OR UBLIC WA^ ER BUILDER OR OWNER afw DATE PERMIT ISSUED: DLATE COUPLIANCE ISSUED: VARIANCE GRANTED: Yes No �.; �._, _ r _ _ r� �� . r- � _ �,�� `d' 'vim c,., w � - � �• �, ' 4 ¢ y V �^ I 1' F No. .4 ..� - Fss^ :_...r THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE Appliratinn for Biopnstti Works Tonotrnr#inn 1hrmit Application is-hereby made for a Permit to Construct ( ) or Repair (/<) an Individual Sewage Disposal System at: y(o Qorv�i�S CzoR� �L�H� L�ccation;Address ro or.Lot No. owner Add ess a ...............................' �?.:-".:��-............... ...........`40�--...... 6 ����l�:�J��of Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms____.. Expansion Attic ( ) Garbage Grinder ( ) '4 Other—Type of Building No. of persons............................ Showers.( — Cafeteria 44 Other fixtures ------------•---------------------------•-••. W Design Flow.....................................•-.•___gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area_...•..--_.......__sq. ft. Seepage Pit No--------------------- Diameter__-____.-___-__-___- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) '-� Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ----•-••-•••-------•-••---••-------•-•-••••••••••••-•-•---•-•••••-•.......................•----.............................................................. 0 Description of Soil...... :......._-S_`_��__.•......•......----•-2--•--•�—....... L-E r?---- �� S� ... ---•--•---- x •••-••-•--------------------•----•••-•••-----•--•------•-•--.=------------------------••••-••••--••---••-••---•-•••-•--------------•--•-------•--••••---•••-•-•••-•----•-.........-----• ... UNature of Repairs or Alterations—Answer when applicable..�P �..-_�....r.�C?w?-�____...___�.O©L............... ri�o _•-•••__. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance.with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed . --- . . --- -a 41 . lot Application Approved By -- -- - ----- ------ - .. ---...... . une Application Disapproved for the following rear s- -------------------------------------------------------------- ------------------------------------------ ..................... ....................... ---------------------------------------------------....------. ------------------- e Permit No. Issued ------� - q ti T - No.-? Fps ..�_- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 4 TOWN OF BARNSTABLE. Applirntilan for Dispugal darks Tonotrnr#uan Frrafit Application is hereby,made for a Permit to Construct ( ) or Repair (C)an Individual Sewage Disposal System at: `I� �3�1�.�S • 7 Czofa t r . ..................`ti �l��C L�cocainon�Address f G f /,j� f or Lot No. • `-......... "..... �.... .................................. .................... ----•--- ....------------...............------. ------ Owner " Address e - a � ... caw S- -----� . ---•--•--------- --P Z-:40 •Lq.;....-----L� N J 1 Lts-•--•-..... Installer Address d Type of Building Size Lot............................Sq. U feet Dwelling—No. of Bedrooms.__... �3............................Expansion Attic ( ) Garbage Grinder ( aOther—T e of Building ............................ No. of persons............................ Showers — ( ) d Other fixtures - Cafeteria --------•-•--•-•------•-•-----•-•-----•••-•-P----------•--•-••-•------•......•-•--•-------------•----(----)-----.. ---------- w Design Flow.............................................gallons per person per day. Total daily flow............._11..............._.......•....gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No_______ ___________ Diameter..................... Depth below inlet..................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water_-___-_-______-_--__---- �r4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ---------------------------------------------------•--....---------........-------------•----.-•--•-............................................, Description of Soil......0-2.......=S.... `-L l- C LL r�. S x U ----••......•••••••---------••••----•.............•------••--•--•-•-----•---------...------------....------•---------•.....---•-----•-•-------•...--•--------------------------••----••-••-------•----- w UNature 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 TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. ff Signed --.....:. lt. \ .--�.. `�" -1.. .� 5r�}. �,::.._..... O. .. ''�..... Date Application A roved B .���� '�------ g l.1� M�� - E PP PP Y --....----------------- Date Application Disapproved for the following rear•. s: .................................................................................. .. ... ................ ..... . ------------------ -------------------- -- ------------- ................ .--`4-......--.......................- _e. - 2 Permit No. + Issued ----. .. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE ' C�Er#t£ira e d QUIantyliance } THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired by....... ..--- _ . .. _...,. +� -- --------..........--------------..............-- Installer at ��R-------------- .------- ............. ----------------------- ------------ --- ---------- has been installed in accordance with the provisions of TITLE�(of he St te= vlronmental Co 2 as described in the application for Disposal Works Construction Permit No. .. - �'.....C ... dated . ------- - 1Q. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONST 1-f- A A A TEE THAT THE S GU �AtI�Y E SYSTEM WILL FUNCTION SATISFACTORY. DATE ` �.-'. .. .. ....................... Inspector .... -----v .... .............. _. f / THE COMMONWEALTH OF MASSACHUSETTS ` BOARD OF HEALTH TOWN OF BARNSTABLE No....�... FEE........................ E4.011 11al Works Tonstratiatt frrmff Permission is hereby granted........ `Z 4........0a:^l....... to Construct ) or Repair ( ran Individual Sewage Disposal System at No......... ......... .............. 5` I!"...1-r treet as shown on the ap lication for Disposal Works Construction rr it No. ._.__._.__/yahed.__ __. _y__.._ ....... ..... Board ofIealth DATE............... .... ._ .................................... FORM 36508 HOBBS&WARREN.INC..PUBLISHERS