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HomeMy WebLinkAbout0111 ACORN DRIVE - Health 111 ACORN W. BARNSTABLE A= 216-012 TOWN OF BARNSTABLE LOCATION f�COCLI`{ ��� SEWAGE #��-I 6-7 VELLAG ASSESSOR'S MAP & LOT-IL, INSTALLER'S NAME&PHONE NO. two -C A k—spot c, SEPTIC TANK CAPACITY I t.00 LEACHING FACILITY: (type) (site) NO.OF BEDROOMS BUILDER OR OWNER 4C PERMITDATE: q .. y COMPLIANC �DATE:T_` 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 7� . E,S Sg !E Q.a TOWN OF BARNSTABLE LG' ATION i 1 \ ��3�v^ • ��^i�`� . SEWAGE # v VILLAGE �u�S"I r . ASSESSOR'S MAP & LOTs�I(� �f INSTALLER'S NAME Si PHONE NOC�j 411 SEPTIC TANK CAPACITY IOC?' 0 LEACHING FACILITY:(type) L (size) l D NO. OF BEDROOMS PRIVATE WWELL OR PUBLIC WATER BUILDER OR OWNER bl� --c-N b esi DATE PERMIT ISSUED: \5 CN 91 DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No r � O�. :�� i ,L F ,,9,�� '��� 9 �� s�. i �L �� ��� �� ��•, TOWN OF BARNSTABLE LO .ATION '-III SEWAGE# flD—�6 VILAGE tV ASSESSOR'S MAP &LOT INSTALLER'S NAME&PHONE NO. y � e LPYIS- SEPTIC TANK CAPACITY 1000 !z OA`' a'j LEACHING FACILITY: (type) (size) • a NO.OF BEDROOMS 3 ' BUILDER OR OWNER a—c>vV.,V,—I, PERMUDATE: ,.� COMPLIANCEsDATE: / � 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 8-4 S13 �G No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 01ppYication for Migogal *pgtent ComAruction i3ermit Application for a Permit to Construct( )Repair(w<Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. ,Zowc, Owner's Name,Address and Tel.No. Vol Assessor's Map/Parcel ot� wB E� ��Nw'�S Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. r—P-001i ems -0>0 Q �� 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 3 3 0 gallons per day. Calculated daily flow 33-Z) gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank /000 Type of S.A.S. Description of Soil S-7-k"fr4 eu-"y G e4 vma it./ /.b yT11-ae Jq Nature of Repairs or Alterations(Answer when applicable) --rV-,GT W-k� �cc v t 6W 91z��� Cti0-4yOrv—, 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 's B Signed �— Date '1-�i Application Approved by Date Application Disapproved for the following reasons Permit No.a 7" :7 Date Issued No. ` _ /!� } .�..5.. Fee I -5 (a. , ?r THE MOMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLES MASSACHUSETTS 2pprication for Oiopooar *p.5tem Con6truction Permit Application for a Permit to Construct( )Repair(vTUpgrade( )Abandon( ) ❑Complete System ❑Individual Components 'Location Address or Lot No. III PCO(LI ( 1Dfw1C11 Owner's Name,Address and Tel.No. 0 Assessor'sMap/Parcel '�, p'� �� - Vr+v►�-iJ Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. I 4 Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) i Other Fixtures Design Flow 3 3 O gallons per day. Calculated daily flow gallons. j Plan Date Number of sheets Revision Date Title Size of Septic Tank /DOD Type of S.A.S. j ; Description of Soil � f+� <w r y G 44 U*sj2 i ry �o YTPI_ j i Nature of Repairs or Alterations(Answer when applicable) Ohl tok w -60 wiz l�i.. evo_ee -r-c 4 ctT � f 1"ro4. 6L r`6t— P,fit e_-e n .,//c > o !���—Xio-k i 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 iss a this B —He. th. Signed Date Application Approved by Date �— i Application Disapproved for the following reasons Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Y Certificate of (compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired(V<Upgraded( ) Abandoned( )by�_�I Ae n tit !L6"Ize i .:z A! a.%c S&e at �� has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 7, dated 41 9 7 Installer Designer The issuance of this permit shall not be construed as a guarantee that the syste will function as designed. Date L Ll '�?—7 Inspector --------------------------------------- No. 7;/G- Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS lwigogal 6petem Construction permit Permission is hereby granted to Construct( )Repair(-'rUpgrade( )Abandon( ) System located at W 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: r�/..-9` 9 7 Approved by L� u � rN NOTICE: This corm is to be used for the Repair of Failed Septic Systems Only CERTIFICATION�ETCH AND APPLICATION FOR A DISPOSAL WO JZKS CONSTRUCTION PI_,IZMIT (WITHOUT DESIGNED PLAN hereby certify that the application for disposal works construction permit signed by me dated -` 7 concerning the I property located at ► meets all of the following criteria: • There are no wetlands within- eet of the proposed septic system &5 • There are no private wells within 150 feet of the proposed septic system • 'I*Iie 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. SIGNED : DATE: LICENSED SEPTIC S STEM 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). jxcrt .t . . -,, �. D O I � � � .. Q . ( © 12 C� No.... ,5 ..- �/ �rC� Fim .............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD- OF HEALTH TOWN OF BARNSTABLE Allpfiratiun for Uivjipuuttl Worku Towitrnrtiun ramit Application is hereby made for a Permit to Construct ( ) or Repair (�n Individual Sewage Disposal System at 1 y2`°-"` chn, ` -A..................................................... .............................. --------- ---.�...&T . Location-Address or Lot No. ON Address .........1 `,► ---------------•--•• l_QS'__ary�a� ... ` IW �"-_Ak�.o:�l�•-�{1 Installer Address UType of Building 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 capacitv--_-_-_--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 ( ) ~' Percolation Test Results Performed by...................... ... Date........................................ Test Pit No. I----------------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........................ � ...........................-........................................................................:......................................................... Description of Soil..........'-....L�?cx ---------------------•------------- -••-•--••----•--•-••--••••----...--•••-•---••-•--•---_.. U ................----•--••-•-------......••-•-•-•••...- ------------------•••. ------------------- w .� . - -` ' M. �Naturq of Ike airs or Alterations— ter kvhen a able------- i. � �5 y ee a. :__.._ _ ---.................. 0 P PP ---- ------ . _ 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 Compkme has been issued by the board of health. q Signed CA�1�-. ......... �^ -........ . o s.�---- S^-� --Date-- Application.Approved By .................... ! J........ ----...._..._:------- --------------------------------- ^4 Date Application Disapproved for the following rearonr: ... . ........................... .......... . .. ................_................q...... ............................................................... ........ .._...... .......... . ....................................................... ......3 g `` _ Date Permit No. ............. .1... .-.........(o..tV 1---------------- Issued ------------� � aS.^IS. .................. Daze NO..... Frzs. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Uhnip t ial Works Tajntitrnrtion 1hrmit Application is hereby made for a Permit to Construct ( ) or Repair ( n Individual Sewage Disposal System at _. ............................ ....... ....................................r)................ ........................................ Location-Address or Lot No. .... n1 ......•.............................•. --••--------•---•------.......................................................................... •-•-••••-•-••-••-••---•........................••...Owne Address µ Installer Address UType of Building Size Lot............................S q. 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...................................... Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water--____-_-_______---__--- (i, Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ 9 --------"----------------------"--------------•------•--------------------------•••-.....--••••--••-......................................................... 0 � ----i x Description of Soil----------= "--• , k ---------------------------------------------------•------------------------"--••-----------.-- �., ••-•--........--•------•••----•••-••--••-•-••-•••••••-•••• ... ......--••--•-- ••---- �j - ' ------------- U Naturey of Repairs,or Alterations—Answer when applili`cable._____- _ .�. 5- �_5_... _t______.ec, x?t?-•�__-.......t...-_•- �^i"�.4 � l� f.t�QQ r�� •' �. _N1l�n 1R.�1c2. `T`"ye �A-}ir =��f_L+ • 0\fe'r'ti ` � . r? 0`�.. ... y� Agreement: f 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 Compliaze has been issued by the board of health. Signed . ��%' *��.~r~ f- - �...17,,� ------------------------ Date Application.Approved By -----------------. }, w�- -- -� .. -- `-- ,.:5..'4..5...... Dace Application Disapproved for the following reafons- ------------------------------------------------------------------------------------------------------------------------- -------- --------------------------------................-------........._-------------------..._..----.............._------..............--------------------------.._............---------------......---- -------3 _5 ...?J. Date Permit No- ------------1 5........... `------------- Issued ............ ?...`oZ_ .."�L------------------ Dace THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE CIlEr#tftra#e of Tompliartre THIS-fS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired by 4— ��P. .r.�..c_ S.r... .... __... . .......... .....: _...... ---------- ......... - - ............ lwauet at .......P---------P-1-........... ..f�.�r..t er.......... .•r-4- ....... t r 5 - ....... 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. ...__ . ��:.._- ...L/../----- dated -------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE------------_................--_.�- ....---;q-'�------.------------------------ Inspector .... (J_.. . - THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH (� )) TOWN OF BARNSTABLE / (l� FEE... �I O 0... �i��ar��t1 �rk� �un�tr�tUan �lerutit `--� Permission is hereby granted-----. ,_.�x_s\ Q`....--- . ' � �' to Construct ( ) or Repair (1?4 ,,an Individual Sewage Disposal System atNo. -------- ... I •.....==...!!`<.. "----".............. Street ^ as shown on the application for Disposal Works Construction Permit No._k-4y4. Dated----- *N17D �� �Q C Board of Health DATE...... 3._ _•. (........................................ FORM 36308 HOBBS Q WARREN.INC..PUBLISHERS