The URL can be used to link to this page

Home My WebLink About0125 ACORN DRIVE - Health _ 125 , OSTER VILLE A 144 021 D ii y 0 j TOWN OF BARNSTABLE LOCATION l�� GG R/� `�vz SEWAGE# 06 P VE.LAGE ,e ASSESSOR'S MAP & LOT ®O INSTALLER'S NAME&PHONE NO. P 016 2 f SEPTIC TANK CAPACITY O LEACHING FACILITY: (type)�� 6/WI,�Q hie) So K (O k Z NO.OF BEDROOMS 3 WELDER OR OWNER I PERMITDATE: A '02 F- 2 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the 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 b W No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: s PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01ppYication for Migoml bpotem. Construction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) O Complete System O Individual Components Location Address or Lot No. S 4 eUe�,V Owner's Name,Address and Tel.No. Assessor' ap/Parcel p� M - o ,)- Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. /3 4,2/4/gh-hl-,E G 2.C U Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. 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 Size of Septic Tank Type of S.A.S. 3 6 X 1 0 Description of Soil! Nature of Repairs or Alterations(Answer when applicable) U ��bC 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 o Tit 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issue by t s oar f lth. Signed A-) Date 2"2 ` Application Approved Date . �� Application Disapproved for the following reasons Permit No. Date Issued No. �"/ !~� Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: s PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZIppfication for -Miopogal *pgtemc Conotruction 3permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. -4-eU�-0V TJiC Owner's Name,Address and Tel.No. Assessor'snMap/Pazcel L 7jt,•�J 7r C��"`'✓ /' ^ O Y Installer'ss Name,Address,and Tel.No. Designer's Name,Address and Tel.No. G z c 3 0 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 gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title _ Size of Septic Tank Type of S.A.S. 3 X 1 U k 2— Description of Soil Nature of Repairs or Alterations(Answer when applicable) . -To U 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 o it 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 oar lth. Signed .�- Date .2- -2 Application Approved Date Application Disapproved for the following reasons Permit No. �flr'�f'3�- /�`� Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS 5 Certificate of Compliance THIS IS TO CE FY,that the On-site Sewage Disposal System Constructed( )Repaired(.Upgraded(`C ) Abandoned( )by at / has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No &'Dated _— Installer Designer iy �! The issuance of this pe. /'f shall noi bg construed as a guarantee that the system will function as designed A Date j "Il >✓ Inspector /� �/� /1� v�_ V ---------------------------------------- - No. 'Z17 Fee lC, THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE} MASSACHUSETTS Mizpozal 6potem Construction permit Permission is hereby granted to Construct( �c)Repair( )Upgrade( )Abandon( ) System located at //L 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 p t. Date: �i �i Approved byLu 4 "' '? 1/6/99 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 DESIGNED PLANS) hereby certify that the application for disposal works construction permit signed by me dated ado c) ,.concerning the property located at meets all of the following criteria: • This failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. • The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. • There are no wetlands within 100 feet of the proposed septic system • There are no private wells within 150 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. • The bottom of the proposed leaching facility will not be located less than five feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor method when applicable] IL . • If the S.A.S.will be located with 250 feet of any vegetated wetlands,the bottom of the proposed leaching facility will not be located less than fourteen (14)feet above the maximum adjusted groundwater table elevation, Please complete the following: A) Top of Ground Surface Elevation(using GIS information) B) G.W.Elevation +the MAX.High G.W.Adjustment. = r 3 DIFFERENCE B TWEEN A and B SIGNED: G -- DATE: -y`' Zv [Please Sketch prop# ed plan of system on back]. NOTICE Based upon the above information,a repair permit will be issued for bedrooms maximum. No additional bedrooms are authorized in the future without engineered septic system plans. q:health folder:cert C r I x O X O M C-U-7z �I TOWN OF BARNSTABLE LOCATION 1 �� CG /2 IV �� SEWAGE # VII.LAGE C.�,ey'Z U � 'F ASSESSOR'S MAP & LOT n , INSTALLER'S NAME.&PHONE NO. 3 1" V1010 2 SEPTIC TANK CAPACITY LEACHING FACILITY: (type) NO.OF BEDROOMS 3 BUILDER OR OWNER f PERMTTDATE: " '2 °�yU COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist ag) Feet on site or within 200 feet of leaching facility) j Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by i l L _ i