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Home My WebLink About0234 WILLIMANTIC DRIVE - Health 234 WILLIMANTIC DRIVE, M. MILLS _ A=103-078 I 1 I I i li 0 ` TOWN OF BARNSTABLE LOCATION SEWAGE 0 VILLAGE ��'Uy` "!�`[ I ( ASSESSOR'S MAP & LOT •V 7 INSTALLER'S NAME&PHONE NO. S•t-EC�V1� SEPTIC TANK CAPACITY � LEACHING FACILITY: (type) (size) f�X 6e� x Deep NO.OF BEDROOMS BUILDER OWNER R O PERMTTDATE: /jG`(�7 y COMPLIANCE DATE: 2/420OS4 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) A Feet yv�► Furnished by �17 /NAV j=jjD7 'L s - No. Fee `=.7 THE COMMONWEALTH OF MASSACHUSE Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE,, SSACHUSETTS 2pplication for Migaar *pgtem Congtruc ton i3ermit Application fora Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.D �3C[ ,kV%repj� , ewner's Name,Address and Tel.No. 'or;.Pe.. -N IA�--y G cLrJ Assessor's Map/Parcel 3 Installer's Nam``g�,Address,and Tel.No. Designer's Name,Address and Tel.No. c -( ?(Gv.-( CAI-", c J 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 1'``'b o_ Type of S.A.S. Description of Soil Nature of Repairs 9,r Alterations(Answer when applicable) A— AC1 c I� fs 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 ed by this B eat . Signed Date f Cl Application Approved Date _ 6 Application Disapproved for the following reasons Permit No. `' Date Issued No. L Fee '�e7 THE COMMONWEALTH OF MASSACHUSETTfS Entered in computer: �� Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS 3pplication for ]Di!5po5af 6pgtem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. e-ner's Name,Address and Tel.�o. -if- W ID11: P,,r,-y G Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. sv'& M Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder(AV 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 S�'b O_ Type of S.A.S. Description of Soil f tt Nature of Repairs pr Alterations(Answer when applicable) Ac)y [� 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 syste,rjln operation until a Certifi- cate of Compliance has been 1"s ued by this B ea t ( Signed Date [ (C( Application Approved Date c� Application Disapproved for the following reasons Aoe Permit No. Date Issued ----------------------------- -------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired (Upgraded( ) Abandoned( )by 1A 3 r�— / r at 1 has been constructed in accordance with the t visions of Title 5 and the for Disposal System Construction Permit No.o �ldated07-1 P"�RR. Installer tN M k�-r.��l�, Designer The issuance of this permit shall not be construed as a guarantee that the system ill f nction as designed. Date _!3 C2 Inspector- --------------------------------------- No. F - /6� e./" S��> Fee �19�11 lot THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE: MASSACHUSETTS �Dtgogar bpotem Conotructton Permit Permission is hereby granted to Construct( )Repair( (/ Upgrade( )Abandon f� � ) _ System located at cam/ �1 us t l\ 1 N`G.w lci c �f Fx r, 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: Cons ction must be completed within three years of the date of thi p rmit. Date: � � F Approvedb 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) I, G c1N ;hereby certify that the application for disposal works construction permit signed by me dated f , concerning the property located at QJW t cV G Aic- q C. 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 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. • If the proposed leaching facility will be located within 250 feet of any 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 Elevation(according to the Engineering Division G.I.S.map) y B)Observed Groundwater Table Elevation(according to Health Division well map) r SIGNED : 2), DATE: G l 1r 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:cert �� t - ' 5 � � /: {; y �� t A-b t)(3c> TOWN OF BARNSTABLE LOCATION �� C l<<C StiG -� C SEWAGE # VILLAGE 3 (VIP- r l I ( ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. S• r �C. �� i SEPTIC TANK CAPACITY LEACHING FACILITY: (type) L j r-e—X l S � (� (size) l I X 6Q x NO. OF BEDROOMS i BUILDER OR OWNER PERMIT DATE: III G�r'/ COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility v 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