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Home My WebLink About0017 ORR'S AVENUE - Health 17 Orrs Ave 290-063 Hyannis it e � i i i TOWN OF BARNSTABLE LOCATION a SEWAGE # VILLAGE ASSESSOR'S MAP &.LOOTT . N 3 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type)�_�"� bl (size)fo NO.OF BEDROOMS �P— � '' BUILDER OR OWNER �°p A- PERMIT DATE: COMPLIANCE DATE: JA ^R 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 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 1 40 { A f s y t ASSESSORS MAP- NO:_ , No. PARG11 NO: ------ ?- 0- _ `'� Fee - a THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 0[ppYication for Migool *pgtem Comaruction 30ermtt Application is hereby made for a Permit to Construct( )or Repair('r/)an On-site Sewage Disposal System at: Location Address or Lot No. 7orrs A-c Mya n Owner's Name,Address and Tel.No. D Assessor's Map/Parcel &C0- V&2:�> Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow "J gallons per day. Calculated daily flow —33;c> gallons. Plan Date Number of sheets Revision Date Title Description of Soil Mao / f Q,F&iff+I�% p Nature of Re airs or Alteration�s(Answe when applicable) &3 S r4 1. Q0 �. OV 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 Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this lth. Signed Date Application Approved b Date < Application Disapproved for the following reasons Permit No. ��r Date Issued `-C✓ �/� No. (/ 6 6: Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01ppYication for 33igaal bpgtem 'Cow6truction Permit Application is hereby made for a Permit to Construct( )or Repair(V`)an On-site Sewage Disposal System at: Location Address or Lot No. f 7 o rr,5 Owner's Name,Address and Tel.No. „y -Assessor's Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Description of Soil / e- ZCOS C,,LSi4NL) M Nature of Re airs or Alterations(Answe when applicable) Date last inspected: t Agreement: The undersigned agrees to ensure the constructiori and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has b issue d by s B d-oI Signed Date Application Approved by--- Date Application Disapproved for the following reasons Permit No. fir • Date Issued �✓ " �� --. .'---- — --_-- --- -------------- '----- --- — —— — THE COMMONWEAL H2OF MASSACHUSETTS r BARNSTABLE, MASSACHUSETTS Certificate of Compliance /� IS IS ��T ,that the On-site Sewage Disposal System installed( )o repaired/replaced(V)on by'~l�� TOGF � O�S{ Y�1CkS Installer -:�hcb+R �t-� S at 0(7 Q S AV-,e_, NN t S has been constructed in accordance with the provision of Ti e 5 and the for Disposal System Construction Permitlo. dated r Date l Inspector w F THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYS- TEM WILL FUNCTION SATISFACTORY. ———— —————————————————————— — —— i; No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Migogal *pgtem C��l'�ojngtruction Permit Permission is hereby granted tooJ� to construct( )repair( an On-site Sewa a System located at No.# / `7 O r r.5 /I- Street and as described in the above Application for Disposal System Construction Permit. I le *` No. Date The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. All construction must be completed within three years of the date below. Date: Approved b Board of Health i f CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT(WITHOUT DESIGNED PLANS) hereby certify that the application for disposal works construction permit signed by me dated concerning the property located at —7 ®rl'.5 meets all of the following criteria: • There are no wetlands within 300 feet of the proposed septic system • There are no private wells within 150 feet of the proposed septic system • The observed groundwater table is 14 feet or greater below the bottom of the leaching facility • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. Oe SIGNED:-- _ DATE;. -- LICENSED SEPTIC YSTEM INST R IN THE TOWN OF BARNSTABLE NUMBER [Attach a sketch plan of the proposed system.Also if the licensed installer posesses a certified plot plan, this plan should be submitted]. �� °O0 .. S r