HomeMy WebLinkAbout0541 BUMPS RIVER ROAD - Health .541 BUMPS RIVER ROAD, OSTERVILLE
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AURA � TOWN OF BARNSTABLE
LOCATION't �iI 0,"Jg2C R, tz Tl? R 6 SEWAGE #
VILLAGE 0`1pi—y 111 f— ASSESSOR'S MAP& LOT
INSTALLER'S NAME&PHONE NO. r,J
SEPTIC TANK CAPACITY o
LEACHING FACILITY: (type) G o c7 {al /- P— (size)
Na.OF BEDROOMS 3
BUILDER OR OWNER Z
PERMIT DATE: COMPLIANCE DATE: 7 - 14 - Cl :2
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist .
on site or w n o eaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist '
within 300 feet of leaching facility) ` 4 ✓/ .''' Feet
Furnished by 64f "At"O"14
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THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
TOWN OF BARNSTABLE
Appliratiou for Uhnpw ttl lVarkii (nowitrttrtilatt Prrmit
Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal
System at:
------.J�....:ll........lurm. .s---- �.v ----------- ------O-s:f
ADeaf' n-Address +\ 1%or Lot No.
Owner Address
w ..... Owner
Lew :-5-------------------------------- ------d S°t•?�� r f 8' ' oZ 63
Installer Address
UType of Building 3 Size Lot............................Sq. feet
Dwelling— No. of Bedrooms.............................. .............Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building -.-_---------------------- No. of persons------------.--------------- Showers ( ) — Cafeteria (
a' 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 ( )
aPercolation Test Results Performed by........................................................................... Date........................................
,4 Test Pit No. I................minutes per inch Depth of Test Pit-------------------- Depth to ground water------------------------
(X4 Test Pit No. 2................minutes per inch Depth of Test Pit..................... Depth to ground water......--................
....
•------------------------------
-----------•-
Descriptionof Soil..................................................................................... -----------------....------------•-------------------------••---•----___-_--•----
W
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•.
VNature of Repairs or Alterations=Answer when applicable...._L-Clo......`4-. .7 R----.-.T.-tl--------.....................
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�jbeen issued by the board of health.
Signed ...... ���: . --- ........................ '... tS
� Dace
Application.Approved By ............. .----- '" ---------------------------------------------------------------------------- ---------t%=,
Application Disapproved for the following reasons: ......... ............ . .. ............ .. ................. .. .. . ....................:...
.. - - � Dare
-. 0 . .. .........Permlt N Issued .......... "�
Y1 ace
3000
No.---• -------�-----•- "�.' Fps............................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF, HEALTH
TOWN OF BARNSTABLE
1
Appliratinii for Bi-aip3M1 nrkii C�nnitrnrt"inn amit
Application is hereby made for a Permit to Construct ( ) or Repair (✓f an Individual Sewage Disposal
System at:
2� e
......�`� .►'n. ..s e
ocat}on:Address S i t i i or Lot No.
Owner 1 !-e/- "_s-f e/-v r,I � e !y
Address 'R
a LV L Q w S v `-
Installer Address
Type of Building Size Lot----------------------------Sq. feet
.� Dwelling—No. of Bedrooms________________3_______________________Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( )
dOther 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 ( ) 9
aPercolation 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------:___-I............
"1 r tr - .'
Descriptionof Soil..........................................................................................................................
W
U Nature of Repairs or Alterations—Answer when applicable.----U_.D.:___ '�a-a{-_P.'------� t-------_--_--�Z_--:--::--_:
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 ------ V ........
-------------------------------
--
- ------- ----
. Dare
Application.Approved By ------------ E- ----------------------------------------------------------------------------- '' ..:
rhte
Application Disapproved for the following rearon : --------:__------._...._..
-
� Date_
Permit No. ........ ` ...---5-9---------------------------- •,-, Jssued ---------------------a�e". .. .. .-" 5
THE COMMONWEALTH OF MASSACHUSETTS i
BOARD OF HEALTH
TOWN OF BARNSTABLE
(111,Er#if rate of C�oznylianee
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired
by .......... G.�.t:.P--------Le� 5---------------------------------------------------------------------------------------------------------------------------------------------------------
RI nr.J ler
at . 5. _L.....-6 ti '- -e-r--------------- ----- ------- S e_1----------- ( ----------------- ------------------
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. .._. ..-_... .Q` -t z--------- dated
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY!
DATE---------------------------------J- , ,_ - " cr)..I--------------------- Inspector ---------------------...C�...._ -- =--------------------_--
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE 1
ll R11polltt1 nrk.5 Tnnntru.dion Wrinit
Permission is hereby granted......... ----- ------------- ......................................................
to Construct ( ) or Repair (-,4 an Individual Sewage Disposal System
atNo.....S j'-•-•• _ta"np-)---•--. ----- --------- ------------------
Street /�- j' Cy
as shown on the application for Disposal Works Construction Permit
q
gNo. ,,7�_:-C)9 ___ Dated..... ��_�1_ ...........
Board of Health
DATE........ 3 0� �L..-_ --------
FORM 36508 HOBBS 6 WARREN.INC.,PUBLISHERS
TOWN OF BARNSTABLEn� p
� /yl S 7/ ' �N '`SEWAGE #
L4C ATI,ON y r 2
VILLAGE," �� °� f ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE NO. 4 Ew Pt/
SEPTIC TANK CAPACITY e
LEACHING FACILITY: (type) �/ (size)
NO.OF BEDROOMS /
BUILDER OR OWNER v t'01 w 5
PERMIT.DATE: COMPLIANCE DATE.--=-�
Sepazation Distance B tween e:
Maximum:Adjusted Groundwater Table and Bottom of Leaching Facility
Feet
Private Water:Supply Well and Leaching Facility (If any wells exist
Feet
on site.or.within 200 feet of leaching facility)
Edge of Wetland and Leaching Facility(If any wetlands exist Feet
within 300 feet of leaching facility)
)
Furnished.by
--------------
0
F
No......... ..rL ps.... +�................
lqql
j� THE COMMONWEALTH OF MASSACHUSETTS
BOARD
SUBIECT TO APPROVAL or
BARNSTABLE
.'+1..............o F.........�r,h,...1"�...........................................---- CONSERVATION
COMMISSION
Appliration for Mqpnnal Worko Cnnnutrurtinn rantit
Application is hereby made for a Permit to Construct ( <Repair ( an Individual Sewage Disposal
Sys e� at•
.................. ... ........... ......................................._._..... ..........._.....-_._I ._........._._._..--_-...-.---......__.._......_......._.............._
Loc ion-Address or Lot No.
v/Gl v� 2 cv
Owner Address
...__......X.....�__._.__.t ................................................................ .............................f....__........................_.__..._......._.........._..........
Installer Address
Type of Building Size Lot............................Sq. fee
Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder (/VP
aOther—Type of Building ............................ No. of persons...._.......I................ Showers ( ) — Cafeteria ( )
A. Other xtures
.............................................................................gallons
W -
9 Septic Tank-4 Liquid capacity®®�a__gallons Length................ Width---------------- Diameter................ Depth................
W
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No..................... Diameter.................... Depth belloNy inlet... ___S-.f/otal�Ching area..................sq. ft.
Z Other Distribution box ) Dosing _
Percolation Test Resul Performed by____;��
....------ - �.._..---... Date.--- ---�� 'tZ.7 .
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........................
Q+' -------•--•- ---------- I. Wde4
---.---
�t -O Description of Soil--------6,1_-.i.._-_ ..: _: ----. .-----/-�-------- �� ----�-- -�- --
x
c.,
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 TIT?.;... 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.
Sign - • - ---------------•----- -•----------Da't'e-------•------
� ` -- � Date
I Application Approved By..... -- %
�-7�
-----...........................
Date
Application Disapproved for the following reasons---------------•---------------------------------------.........................................................
...............•-•--....-•-•---------•--.............-----------..............------------------------------•-•---------------•-•---------------•--------------•--.....................................
Date
/ 3O-Z�--
Permit No.... .. Issued....ll'_----------------------•--•--......._--•-•-
Date
FF
THE COMMONWEALTH OF MASSACH'USETTS
�&7.47-
�A c BOARDG
H A TH
rptiratiou for UisVjaAa1,.JVvrkii Tonstrurtion amit
;, Ap. )yication is hereby made fora Permit to Construct ( or Repair ( an Individual Sewage Disposal
em
SVC
_
�k
e
V tG! L. ion Address . LotNo.
. ...... -
.........................................
Own Address
W1�.-_. . ...... ...................•-----•. .. . ----._......_.... .... -............................................•
Installer X Address
Type . uilding�r Size Lot_...........................Sq. fee
U ,MAR Dwelling
a� g—Y'No. of Bedrooms.__._ Expansion Attic ( ) Garbage Grinder VVP
p.l Other—Type of Building ............................ No. of persons. --_:•.`4-_. __ _____ Showers ( ) — Cafeteria ( )
p•l '� Othe xtures -•------------ ----- '--- ------------------------- -----------
d j Design Flow... .................................gallons per person per day. Total daily flow........,J .... gallons.
Septic Tank t Liquid'capacit)/jQ ..gallons Length................ Width-------
_......... Diameter__---- -- Depth................
xDisposal Trench—No. ........ ......... Width........._.......... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No--------------------- Diameter................ Depth belo inlet____ :_.. Total leaching area..................sq. ft.
z Other Distribution box ) Dosing ®; L 5"•// 7'
~' Percolation Test Resul Performed by.__ _____._ _.�_. ._.t' ............ Date_. �` v !-'__-______-.
aTest Pit No. 1 ............minutes per inch Depth of Test Pit.................... Depth to ground water _-_-_______..._.......
(s; Test Pit No. 2................minutes per inch Depth of Test°Pit.................... Depth to ground water.........................
_• .
iZ
O 'Description of --- .... . _Soil--•-- r �
W •-----------------------------------------------•--------••-------.......•-----------•--------------------------------•-----------==------•---••-----•-•---.--=--•••-•-•-•-•--•-•--••--•-------•----
UNature of Repairs or Alteratiofts—Answer when applicable................................................................................_......._..._..
Agreement: ;:,< •,
The undersigned agrees to install the`aforedescribed Individual Sewage Disposal System in accordance with
4 the provisions of TITLE 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.
Sign ...........
�;A
Application Approved BY _...... . :............. �j' n �
Date
Application Disapproved for the following reasons:.................=..............................................................................................
.........................................................................................................................................................................................................
Date
}
zPermit No.................... --------•--...................... Issued-----•------------- -_-------•------
Da-- r
THE COMMONWEALTH ,OF MASSACH SETTS"
BOARD HEALT
?i
I< ...........OF......... ..........`; .............
Tatifiratr ,af (9jam-4liattrr
T IS S T ERTIF hat theeI dividual Sewage Disposal System constructed ( or Repaired ( )
by ---------------•-----
• • -�Installe ' wrw...
has been mst�lle fin;accordance with the provisions of ` of The State Sanitary de as described in the
application for Deposal Works Construction Per N _ ______( .: ........... dafed. - �'" .�`'" ". x.......
THE ISSUANCE OF THIS CERTIFICATE.SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION"SATISFACTORY. 4
DATE.. ----------------------------------- ..................... Inspector ------....__••="-' .......................................
THE COMMONWEALTH OF MASSACHUSETTS "
BOARD HEALT
meµ.
7 ... :...........OF....... . L1i � aa' FEE. .................
Y
to CPer Repair ( ) an Indio :............
Permission s reby granted__:
%__3emN.,ag, p al Systat No. r� �i * "� ----- -----•------_.......street
— a
as shown on the application for Disposal Works Construction Per it o.......... :. :.. ed... '" 2 ............ 1
G Board of Health
i� / Z�
DATE----- 1. -- •............................. .......•-•- .
FORM 1255 HOBBS 3e WARREN,. INC:.' PUBLISHERS
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