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HomeMy WebLinkAbout0015 BUMPUS ROAD - Health 15 BUMPUS RD., HYANNIS A= o r. a d i r I ®a, 0 TOWN Ok BARNSTABLE LOCATION V SEWAGE # r y-7 Y VILLAGE ck—k S ASSESSOR'S MAP.& LOT 367_ ®37 INSTALLER'S NAME&PHONE NO. "" SEPTIC TANK CAPACITY U S dT( _S LEACHING FACILITY: (type) _}-�1/l ®Cd1� (size) t size NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: '7,'17. _COMPLIANCE DATE: 7 ` Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by -� W ��, � I� � � I � _ �� 1� L �� n ` r4i . � - .. �� _ a _ _, .. 4 e _' v e\\`� , � _ �`"' III' � � � • -- - � . � � Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01ppYication for ]0i_qpo!5a1 *pOtem Con!5truction Permit Application for a Permit to Construct( )Repair( )Upgrade jl Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. I S Q CA 1�us ► 6 Owner's Name,Address and Tel.No. Assessor's Map/Parcel:3C 1_0T Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow —7,Zi y gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank 1 75- CD S+T, Type of S.A.S. t4%3r�Cc pc �` Description of Soil mati� Nature of Repairs or Alterations(Answer when applicable) tA- Sge t u Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the E ' onmental Cod and not to place the system in operation until a Certifi- cate of Compliance has b y t is Signed Date Application Approved by Date Z-2-7 Application Disapproved for the following reasons Permit No. 9 y7 / Date Issued 7 No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 0(ppYication for ;igpoga[ 6pgtem Congtruction J)ermit Application for a Permit to Construct( )Repair( )Upgrade )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. t S u M US Off Owner's Name,Address and Tel.No. �1%�+ti t�f y O CjGYa�T Assessor's Map/Parcel de)i'CT t Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq. ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow ��y gallons per day. Calculated daily flow 3�: ! `! gallons. Plan Date Number of sheets ;, Revision Date 1 - h Title i Size of Septic Tank 15 S,7, 1 Type of S.A.S. 14 Cu d c X'r- Fi Description of Soilr�14 Nature of Repairs or Alterations(Answer when applicable) \A ) Srt'0-t K_ S+ —U e o Ins S\ Y) f 1 ( V t V )Cv Lr=� Date last inspected:F Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the En onmental Codj and not to place the system in operation until a Certifi- cate of Compliance has b y this Signed r Date _ 12 Application Approved by. , F Alret4 Date 2-7-9F_ Application Disapproved for the following reasons Permit No. 9�'y 7 / Date Issued -7 Z 7-7/_ THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY that the On-site Sewage Disposal System Constructed( )Repaired( )Upgraded V,.,) Abandoned( )by �-_)'GY4 S L. -\ l at tn^ U5 V UP, C.. wh-1 has.been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. --'179 dated -7 ` Z 7"r� Installer Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date 7t . q �? Inspector \ , v v No. 7 � y� � ---- ——————— -------- Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE: MASSACHUSETTS Migpogal *pgtem Congtruction Vermit Permission is hereby granted to Construct( )Re )Upgrade1c,) bandon( ) System located at l ,j No 44 CI\ � I and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:C�onstruct`"ionlmust-be-completed within three years of the date of this ermit. d Date: _ Z g - Approved by r., 7 it119191 _ � .: NOTICE: This Form Is To Be Used For the Repair.Of Failed 54gg • Septic Systems Only. i CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT(WITHOUT ENGINEERED PLANS) r r 44' hereby certify that the application for disposal works � eon permit signed by me dated ,_concerning the ¢. located at meets an of the y following otiteric �• There are no wetlands located within 100 het of ON proposed leaching Iklilty t4 , 1 F • ere no pivete wells within 130 hd ohhe proposed septic system 4 • There d no be ion in Aow andlor change lu m proposed i • are no vat las eqmled a needed. ; • If the proposed leealting hetlky MR be located within 230 feet of any wetlands,the bottom of the proposed bathing heility will n2i be located less then fourteen(14)feet above the maximum adjusted gtoundwner table elevation. Please eomplete the followlag: s '` s.. A)T p of Or and Elevation(neording to the Engineering Division O.I.S.map) 11)Obeewed Oroundwatar Table Elevation(according to Health Division well mepo 0 31t31VED:i DATE: �7-� LICENSED SEMC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER_ Alleeh a dmfth phn•NM Pepmd ovwa.Abe NO*Il wmd hwul1w p•a� m•omlfl•a plat Oluy PIN*MM be submitted). «tNuld�Aft:•M . �© N j �, Ad C- LJQ Al- 131 S 31 ILL TOWN OE BARNSTABLE LOCATION V SEWAGE # 7 VILLAGE c�L ,g cti.a'l JC S ASSESSOR'S MAP.& LOT__ INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) 1 NO: OF BEDROOMS 79 BUILDER OR OWNER O V7i, PERMITDATE: '7- �.7- _COMPLIANCE DATE: 7 -2 9 - 9R _ Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by.