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HomeMy WebLinkAbout0071 BUMPS RIVER ROAD - Health �a = C)o T� N�O BNSTABLE LOCATION L0+ SEWAGE # g -s61 VILLAGE 05-6Akii ASSESSOR'S MAP 6z LOT���� INSTALLER'S NAME 6t"PHONE NO. ��- �6 i SLd�� - SEPTIC TANK CAPACITY LEACHING FACILITY:(type) ��"G�' Q (size) j ov Q6V4 NO. OF BEDROOMS 3 PRIVATE WELL O PUBLIC WATER BUILDER OR OWNER DajS%(� IJ-yl�=�S DATE PERMIT ISSUED: I ` 7jy" q q DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No :�..�v '� .� �_ p� �;' , �.� �ti ' �� � .� �r�, ' ��� ��� ,, ,;� No...._ -...... 1�:�Sf �)�� Fmi.Ze` `..THE COMMONWE HUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Diripwial EvrkB Tnnitrnrtinn runtit Applicati0o hereby made or a Permit to Construct (1/) or Repair ( ) an Individual Sewage Disposal ystym .. a ,_..9..._�.� .._.le,x �a1-........ ....... , - -�e------------------------------------------------------ ..... ......... ��ryry rct'.6d, � t No. ..._............. �......... ................... ......•.................. . .......... ----.......---•--•---.......................----•- `--�n� ddress Installer Address -a ,76 d Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms_._.,.'.`. --_-Expansion Attic (N() Garbage Grinder (A-16 UV�f No. of ersons____________________________ Showers — Cafeteria p�, Other—Type of Building:....... . p ( ) ( ) 04 Other fixtures --------------------------------------- W DesignFlow..................... ..�Q gallons per per day. Total daily flow---___.--_33.Q...................... lons. � -- ---------------g< P P Y• Y -- 1� WSeptic Tank—Liquid capacity_0gzalIons 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 t nk ( [ ~' Percolation Test Results Performed b . --�--�-�1 ---•------------------- Date-------------`----• e---�-•---_.. ,.a Test Pit No. I.... -!.....minutes per inch Depth of Test Pit..... ----- Depth to ground water./o..4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ................. ....---••............... .. ...... •--•------- .._...... ................ ....... ..- ................. .•...... .................. ...... Description of Soil - '-------------------------------------------- V ---.....•-•••----------•-••------•----•--•-•--••--•---•-••••--------•-----•-••--•-•••-•----•--•--•--•--•--•-•--•-------••••-•--••---•------•---••---•••-•-•••-•----•--•••---••-•................•....... 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 mplian has e issueabX-t�e oard of h t Signe - - -------- ------------ . ......... �(.... ----- .� / .......................... . Da Application Approved By .... ...... 2 ....... .............................................. ............. .... ....... ... .`` ........................'--- Dace ................ Application Disapproved for the following reasons: ......................................................................................................... ........................... .............................................................................................................................. ................................. .............. ............ .....Permit No. I '�.. �............... Issued . ......... .. .Z�Q>� Dace r•^4`•� ����!�� ��,r:°�.,-mew,�o.:��.:..`}bh4'..��;;r"•t'•�, �,_ ��� -�j _ ! '..:..-s,.,...,.«�ue�;,�+..,,.e�..r.a_�,u.-y - _� -L -.r..�•-r.�vrJ v-*:7 No THE COMMONWEALTH OF ASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliratinn for Diripwial Wnrk.6 C owitrnrtinn Permit Application hereby made for a Permit to Construct (V) or Repair ( ) an Individual Sewage Disposal System al, 9 .0 led,• .............. ........ ---- �z --------------------- ... No. ...... --- --------------- .---------- ............................................... W ��// //�..�1��'lric/—uT�-nc- `•—t it i . lAddress Installer - ..... -- ....................Address ......................•----........._..__. � Type of Building Size Lot______________ /___Q --------Sq. feet �.. Dwelling— No. of Bedrooms.__.__.��______________________________Expansion Attic (,Vo) Garbage Grinder (NC) `4 —T li pa Other ype of Buildi ! ��!+ . No. of persons____________________________ Showers ( ) — Cafeteria ( ) C4 Other fixtures --------- ----------------------- ...... _... d W Design Flow..................... n.__.__._____..gallons per per-son per day. Total daily flow..........33A......................gallons. WSeptic Tank—Liquid capacity_ ©®UgalIons 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.-___�7 fit Pi!...Y._AjV:1'_______________________ Date._.___ 0_______qf_._�_3_.._. a Test Pit No. 1.... ��._._..minutes per inch Depth of Test Pit------ ....... Depth to ground water_A/ .._ 't GZ4 Test Pit No. 2................minutes per inch Depth of Test Pit----................ Depth to ground water........................ P+ •----•-----------------•.=-----------------------•--•----------------•-..__._._.._.__.._._.._..._._._..__._........_..-•--•---•-....---...•--•••-......:---• xDescription of Soil....//lt_.../� _� � ............... V ------------------------------- ------------------------------------------ -----•-------------•-••------------•--------•----- W VNature 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 mplianc has bDee'n issued�b,,t e board of he t. - 0, ned . ......... .... - .. . ................ Application Approved By �... .:.. .. . 9 � -Dace �.` Application Disapproved for the following reasons- --------------------- 17 ... .......................................................................... ........ ..................... . -- ... .................... .... ..................:....................... ... ...................................................... ........................................ Permit No. .. � ._25 l '' ................ Issued /.................. ......��.` .... Dare / THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE C�er#ifira e of Cnumplinure THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( t/ ) or Repaired ( ) by .....�� .. �./Z lCfJL at . `. .... ......�-...U1....... ...... .- .......... . . _............................................................. has been installed in accordance with the provisions of TITLE 5.,of The State Environmental Code as described in the application for Disposal Works Construction Permit No. dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRU A AS A GUARANTEE THAT THE ( SYSTEM WILL FUNCTION SATISFACTORY. DATE......../�%�' `_ lnspec ....._._........... - ..._..... ... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE 11ispout Workii Tonotrurtion .rrmit Permission• i Thereby granted-----�..'=�-----69_!56UL�-- to Con (V) or Repair ( ) an Individual Sewage Disposal System y --------------------------------•----•--•----_--••-- � Street as shown on the application for Disposal Works Construction Per - 1�Yo-_r�__.'=4�/Aated..�,_?-_._'�-__-._7''._99__-.� 1 -�� . ----- ----=--------_ ,-9 � Board of Health / DATE. 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