HomeMy WebLinkAbout0085 BUMPS RIVER ROAD - Health 85 Bunips River- Road r
Osterville
A= 120 001 010
G TOWN OF BARNSTABLE
LOCATION SEWAGE #
!. VILLAGE %e (Jf 6.�. ASSESSOR'S MAP & LOT - l-&16
:I INSTALL
�ER'S NAME Sz PHONE NO. -1>
j SEPTIC TANK CAPACITY
it LEACHING FACILITY:(type) . — i % (size) f _
NO. OF BEDROOMS _PRIV•ATE WELL OR PUBLIC WATER
BUILDER OR OWNER
i
DATE PERMIT ISSUED:
DATE' COMPLIANCE ISSUED: G
L
VARIANCE GRANTED: Yes No
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L ' TOWN OF BARNSTABLE
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LOCATION_ PAS ,t RAy SEWAGE #
VILLAGE �S 7� t/9 L-L� ASSESSOR'S MAP 6 LOT LaL at-(91b
INSTALLER'S NAME & P14ONE NO.
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type) 2 s ? i /�S (size)
NO. OF BEDROOMS. PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER ��J��
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No `�
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THE COMMONWEALTH OF MASSACHUSETTS
l 9ti
B d 3 � OARD OF HEALTH
TOWN OF Y. H
its
Appliration for 14sposal Works (funstrur#inn jJprmit
Application is hereby made for a Permit to Construct (1/) or Repair ( ) an Individual Sewage Disposal
Systemas44 . ....... ..--• ....... �..._.. � w- .....- . •- .... ---.. . .. .....-• --------- - -- ----..---)_.......•..
Lti �pd�ress....� -...� v"..,...-.... ...�:�A................ ....----------•-... •.. dd ......-••--.....•...........................
- r Lot
...
Owner r A ress
a ......,.. ...... — ..... / ........ -. 9...... :........................... .•...------•--•--...........••••.....................•.....
••.-Installer
Address ' Y %
Type of Building Size Lot._y�.__... (.. Sq. feet
Dwelling No. of Bedrooms: --------..--•----_--_.--•Expansion Attic ( ) Garbage Grinder ( )
Other—T e of Buildin 4' -._U'� No. of
a YP g -------....-•-- •-._. persons............................ Showers ( ) — Cafeteria.
Other
WGd fixtures
--...---•-•-•-••-•---•--•-•••...-- ......................................
DesignFlow.................. . YDPer day. otaiY ow........ ...........................
.... ..____gaonsPer P . gallons.
Septic Tank—Liquid capacity............gallons Length............... Width................ Diameter................ Depth-.:........
R
;
�
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 ( )
aPercolation Test Results Performed by...........................................•.................••••...•.... Date........................................
Test Pit No. 1................minutes per inch Depth of Test Pit.................:_. Depth to ground water........................
44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
'
:�
Description of Soil•......................
------..----=-•..._._.. ------••-- ----------------------.._... ------
•...
U ---•--------••.............................•-.---••--•-•-----------•-.---------------.-----------------•------•--- `
W
U Nature of Repairs or Alterations-Answer when applicable...............................................................................................
-•-•---------------------------------•-•---•-------•---...--------.....-•------........-----...........----•----....----•----- -----••---•--•-•----------------.................
Agreement: ,
The undersigned agrees to install the aforedescribed Ildividual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Sanitary Cod —The undersigned further agrees not to place the system in'
operation until a Certificate of Compliance has n 's d b t board of health.
Q
Application Approved By........................z...... 2....\=................. .......... .....
Date
Application Disapproved for the following reasons:...................................... ----•-.....•••-•-......•---•-••••-•••••••-•-•.......................
---•.................................••......... ----...-•----•--. .....--•---............._.......•••...-•---..... .-•-•--..........-••--•--•.......-•--........ -••-•-••--•-•---
/......r Date
Permit No... .^:_/ ...... Issued_........................:t `. �.1..........
' Date
"I.V_...14 , -^''
No `? .._� � Fic �Gs
THE COMMONWEALTH OF MASSACHUSETTS
-�� BOARD OF HEALTH
TOWN'OF Y.ARMOUTH
1 \"
;- Appliration for Disposal Works Tonotrurtion rrrmit
pplication is hereby made for a Permit to Construct (1.4 or Repair ( ) an Individual Sewage Disposal
System�at:
� " �P�t_ P _ _ /_ _
• - Location•Address � �..•..••.... _......� /,� Lot No./ ...... ......._..
........ _ _... �f y (J
...........).......
.
Owner •• Address14
-.....
Installer Address
Type of Building Size Lot__y3:... / Sq. feet
U Dwelling No. of Bedrooms...........................................Ex ansion Attic a g— p ( ) Garbage Grinder ( )
Other—Type of Building�� � - No. of persons............................ Showers —
W yP g .............•--••----- P ( ) Cafeteria ( )
dOther fixtures --------------- ----------------------� -•...........---•---•••••-••....-•••-•-•---••-•---••.......--•---•-------_.........----............._..
W Design Flow................... U!............_...gallons per person per day. Total daily flow._.....y.y .........................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 ( )
1-4 Percolation Test Results Performed by-----•-•--•-•-••-•------•••..........................•----•---•••-.---_. Date_......--
Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water......:.................
44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
a ------------------------...............---------------------------------------------............------............
._.
ODescription of Soil.. 7.............T......----........---------------------------------------•----------•------------ -------------•----
U •---•-••----------•----------•.--..... ---
e------------------------------
------------•-----
------------------
-------------------
•...
•---
•-----------
---------------------
------------•----.:.
W
UNature of Repairs or Alterations-Answer when applicable...............................................................................................
..............................................................................................................................-------•----.....------------.................-•--•-......--------•--•---
i Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITIS 5 of the State Sanitary 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..... ---------------•--------•--
Application Approved B .-- E G - ��(......... .. .!4 .. �Dale
Application
.............................Date
Application Disapproved for the following reasons:.....................................�/..._..._..._......_ ._......._.._
••-•--•......................................G.............................--•-------•-•-----...••••-••--_.....
. J Date
Permit No... '.. �"/b�1 !�
------•----------------7..._.._ Issued...---''�-�---==--..�: ..��..�.r.--•--....
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH r
TOWN of YAR;MOUT'fI
Trr#if utttr of Tomp' liattrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (✓) or Repaired ( )
by.......!�ICif1'. ......(J �................:.. .
--- --••----••----•-----------•---•--------•.......................................•-.................---._.._......
, Installer
at...�...�'�''.�--w••••. .... ... --•-- - (/ r .
has been installed in accordance with the provisions of TIXLE 5 of The State. Sanitary Code as described in the
application for Disposal Works Construction Permit No,. �..� ..... dated_
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE............. ....�.....�r?-•----.....•-•--..................... Inspector......---....�.... ..._._.-•------•---•-----....-----...............__.............
---__---------------------- lip
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH _
TOWN of-XA&MOUTH
Disposal �Works Tonotrurtion Permit
Permission' i 'hereby granted...... `-I1`T ...._C..!f.../f.............•----...-----...........----.........._....--•------.........................
to Construct V) or Repair ( ) an Individual Sewage Disposals System
at No. ---•............../1).... -/.. .......
......
Streetn `
as shown on the application for Disposal Works Construction Permit ._•--•--�.•--_-- Dated-.-,f--=:�..-W..•�`�.. 7-.
r-
1 ....................................... .. ......................................................
,,�IIoard of�Health
DATE ......--•------•%---•.......:.........................
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