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Home My WebLink About0126 WILLIMANTIC DRIVE - Health 126 WILLIMANTIC DRIVE, MARSTONS MILL�--' A=102-175 C 1 rya, * LOCA'TICIIi �M 1 E f vII.LACa3. . -,.f..�11:_�C _ :,�. -A S SSESSC AkF*w&LO�'.1 � ®7 Y pp INSTAUIR'S NA a PHONJE NO._., _L_._' t �/ J SFIPTT C $ANY, C,> TTY C3 O L>rAC * FACB:I'Y'1': (size', NO.OF DEOROOM-S,- _ BIJMI)ER d$t 1p PERiMITDATE: e U---, -,�.� JC, DAUT, Sepa tion.Pistaiace Betwmm the: Ma durum Adjuste:!Groundwater Tible'am:`Bwmm df lx�%'Chirlg Facility _ _ Feet Private Water Sttipply WOI aril Leaching F tii hy (If any wells exist on sits or w_kh'in 200 f—i bf leach: 61<�Feet J`dge of We pmd and L%caal.ng,Fa,;ihoj(If any min- lands exist wr°*gin 3(J _�t cx leachi:.� Dili Feet Furnis_e&'ay—g Ozaz�. _.._� i3 -L - 7 �� _ r i T No. � Fee y9 6z) THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 01ppfication for �Bigogar *p.5tem Construction permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) O Complete System ❑Individual Components Location Address or Lot No. G �� Owngr's NSF,Adders and Tel.No. i wl� .1 is ) �I i (/r'ch�4;Q'scyvs Assessor's Map/Parcel S'l Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. P /M- ��R/V 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 S 3 y gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicab ) 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 nbythi of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issueBoard o alth Signed 4-+.� Date Application Approved by - Date /� Application Disapproved for the following reasons Permit No. Date Issued No. ,. '/ Fee Z THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS Zfpprtcation for X3igpo!6a[ *pztem Construction Vertu Application fora Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. '� Owner's Name,Address and Tel.No. Assessor's(u,I Icel�� 4-'G 1 ("\ M,f ( 1 S f Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. `7 SS4 l-f Type of Building: . Dwelling No.of Bedrooms _ Lot Size /,f a�rbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures r r, Design Flow_Z_3 e") gallons per day. lc>�ted daily ov/";,I gallons. Plan Date Number of sheets Revision Date Title . Size of Septic Tank, Ty, pef S:A S� Description of Soil 'I Nature of Repairs or Alterations(Answer,when applicable)�4C1,t4 �.� V ` / Date last inspected: Agreement: f The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of * e 5 of the Environmental Code and not to place the system in operation until a Certifi.- cate.of Compliance has been issued by thi Board of�alth. ' Signed Date Application Approved by _ Date//c_/� Application Disapproved for the ollowing reasons f` Permit No. r ' Date Issued i------------------------------------- THE COMMONWEALTH,OF MASSACHUSETTS BARNSTAB.LE,MASSACHUSETTS , Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed ( )Repaired (4,hUpgraded( ) Abandoned( )by Tp ✓t'1,�4 i ti �� 2� S IV at T C_ . ire has been constructed in accordance j.with the provisions of Title 5 and the for Disposal System Construction Permit No.QZ. dated 10 �5' R� Installer .!e_oa,, Designer The issuance of this permit shall not be construed as a guarantee that the sys wAl function as de '•ned. Date��"��..� �.lr Inspec ' —27 --------------------------------------- No. � �i�?3 Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS ;Digpogal *pgtem Congtruction permit Permission is hereby granted to Construct( )Repair((_,�+Jpgrade( )Abandon( ) ! System located at►'� / [.L�, l( r ..,. L�, �C n ,�/�l �l 5 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 pe it. Date:_ / '"� �� Approved by CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS) I, J �' �l�i2/a,/(J , hereby certify that the application for disposal works construction permit signed by me dated /0 — ' - 24 , concerning the property located at / 2� /��i�-t,4� i c �� /gtneets all of the following criteria: . t • There are no wetlands within 300 feet of the proposed septic system • There are no private wells within 15o 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. SIGNED : U -'ti- DATE. LICENSED SEPTIC SYSTEM INSTALLER IN T14E 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).