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Home My WebLink About0075 ACORN DRIVE - Health �-5 ACor(\ on ve, E t 1 A j 6 e TOWN OF BARNSTABLE LOCATION �� /�� /�• SEWAGE # VILLAGE ��5,�li!~�//��e� ASSESSOR'S MAP& LOT 1 Zo�33 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 45-06 s V LEACHING FACILITY: (type) 'I CI1L, � (size) NO.OF BEDROOMS BUELDER OR OWNER PERMITDATE: 9 '?`Q$ COMPLIANCE DATE: —if— 9Y 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 R-1 .23 6-2 30 4 — cl No. s ' Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS Zipprication for Zi-4pont *pgtem Construction permit Application for a Permit to Construct( )Repair(/Upgrade( )Abandon( ) IF/Complete System O Individual Components Location Address or Lot No. //� Owner's Name,Address and Tel.No. Assessor's Map/Parcel e,gBs�e cel Ub7`ei^�//1/�./�4 7,571A QW -1 �"• Installer's Name,Address,and Tel.No. f Designer's Name,Address and Tel.No. 7l-Q399 Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder(/ ® Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 11Z9 gallons.per day. Calculated daily flow ✓?� gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank >5�40 Type of S.A.S. 7— Description of Soil Nature of Repairs or Alterations(Answer when applicable) 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 t s d o Health. Signed ^/7� Date Application Approved by Date Application Disapproved for We folio ing reasons Permit No.T��sr-5'3 Date Issued TOWN OF BARNSTABLE LOCATION 7S—/�Cd//J rQ� q _ �$�I"Z/i/� SEWAGE # ! �—SS-: VILLAGE ASSESSOR'S MAP& LOT f ZO 3- INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 5 7- LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER OR OWNER M/- h e PERMITDATE: 9" ¢S COMPLIANCE DATE: Separation Dist ance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility(If any wetlands exist Feet within 300 feet of leaching facility) Furnished by Feet .23 4- 3 -2d 4 — cl /�—3 9 No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 2pplication for 33igpoof *pgtem eonmruction Permit Application for a Permit to Construct( )Repair( 1/)Upgrade( )Abandon( ) T'Complete System ❑Individual Components Location Address or Lot No. Qr Owner's Name,Address and Tel.No. �r�G.Orr! �orgdr� Assessor's Map/Parcel e.O5/ `rvf�� Or- 7.�filG0��1 Install 's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. �a�'t4Go�/ 7 7/- Type of Building: Dwelling No. of Bedrooms 3 Lot Size sq.ft. Garbage Grinder e v e Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flower gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank �$-00 Type of S.A.S. /Z dp/y'p O/� Description of Soil �d X jam,('� ,l G`/ G w 1-',�S j Nature of Repairs or Alterations(Answer when applicable) �� `Ld �" i��l✓ c 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 s do Health. q Signed �� i Date Application Approved by Date Application Disapproved for e following reasons Permit No. I �� '3 Date Issued j \ ——————————————————————————————————-- THE COMMONWEALTH OF MASSACHUSETTS I ZOO O 3 BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO CER,�, that t e O -site S wage Disposal System Constructed( )Repaired(Upgraded( ) Abandoned( )by /z ��S� at �15`14 /Tf? 011 D4 /"G has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 8 dated Installer Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date tt ' �/` rq Inspector 1l r� fJ` --------------------------------------- No. / S `r r✓3 Feet'J THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE: MASSACHUSETTS =igpogarpgtent Congtruction Permit Permission is hereby granted to Construct( )Re air(W15"Upgrade( )Abandon( ) System located at 7 S��G��,�? � • 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:Construction must be completed within three years of the date of this permit. Date: Approved by , , 10/9/97 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT ENGINEERED PLANS) 0,'W/.--9 Z0/kfereby certify that the application for disposal works construction permit signed by me dated �`�� , concerning the property located at 7s /¢G4/"�1 �� 7 �� meets all of the following criteria: 'There are no wetlands located within 100 feet of the proposed leaching facility There are no private wells within 1-40 feet of the proposed septic system ()There is no increase in flow and/or change in use proposed ` ere are no variances requested or needed. If the proposed leaching facility will be located within =50 feet of any wetlands, the bottom of the proposed leaching facility will be located less than fourteen oa) feet above the maximum adjusted groundwater table elevation. Please complete the following: A)Top of Ground Elevation(according to the Engineering Division G.I.S. map) ' B)Observed Groundwater Table Elevation(according to Health Division well map) SIGNED: 9w� DATE: LICENSED SEPTIC SYSTEM INSTALLER 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]. q:health folder.art IW/97 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT(WITHOUT _ ENGINEERED PLANS) 1 ,hereby certify that the application for disposal works ' construction permit signed by me dated ,concerning the property located at meets all of the following criteria: . There are no wetlands located within i00 feet of the proposed leaching facility . There are no private wells within !_'0 feet of the proposed septic system . There is no increase in flow and/or change in use proposed . There are no variances requested or needed. . if the proposed leaching faciiiry wiil'e located .vithin=`0 feet of anv wetlands.the bonom of:he proposed leaching facility will=�e located!ess than fourteen�,!-1 feet above the maximum aaiustea groundwater table elevation. Please complete the following: A)Top of Ground Elevation(according to the Engineering Division G.I.S.mao) B)Observed Groundwater Table Elevation(according to Health Division weil mao) SIGNED: DATE: y LICENSED SEPTIC SYSTEM INSTALLER 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]. ��U I ON CC O QO