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HomeMy WebLinkAbout0281 WILLIMANTIC DRIVE - Health _ 281 WILLIMANTIC'����{, MARSTONS MILLS -" A=103-043 TOWN OF BARNSTABLE LOCATION �I W t ~�lL SEWAGE # VILLAGE ASSESSOR'S MAP &LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK GAPACTTY Ale LEACHING FACILITY: (type) NO.OF BEDROOMS BUILDER OR OWNER PERMTTDATE: ' • COMPLIANCE DATE:.' 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) �G - Feet`` Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by aft ct 4 + No._ Fee — ti • THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Zipplication for ]Digogar *pgtem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address o Lot No.z �1A.✓ i 1Owner's Name,Address d el.No. � Assessor's Map/Parcel Installer ame-Address,and Tel.No. Designer's Name,Address and Tel.No. rvta­ � j�' c� -� 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 0 O" Type of S.A.S. Description of Soil Nature f Repairs oorAlterations(Answer when applicable) 2— Date last inspected: Agreement: The undersigned agrees to ensure struction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of tle 5 of t e XEnvinment ode a not to place the system in operation until a Certifi- cate of Compliance has been issued b this Bo dltSigned - -- � Date Application Approved by Date Application Disapproved for the llowing reasons Permit No. Date Issued # No. Fee ter.. . ..�.,` THE COMMOJEAL'TH OF MASSACHUSETTS Entered in computer: Yes V PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS 0(ppYtcation for Miopoai *pgtem Con5tructton Verifitt Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Loca ( wn's Name,Address d 1. o. Assessor's Map/Parcel o Installer' amg4dress,andjl.No. Designer's Name,Address and Tel.No. 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 G v a Type of S.A`i- Jr Description of Soil ti Nature f Repairs o Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the-construction and maintenance of the afore described on-sitensewage disposal system in accordance with the provisions of Title 5 of a Envi nmenta ode an not to place the system in operation until a Certifi- cate of Compliance has been issued b this Bo d o ealth. Signed Date Application Approved by V'�-....�,...�.: Date �TT� Application Disapproved for t�lowing reasons Permit No. Date Issued - --------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance Ir THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired( Upgraded( ) Abandoned( )by — /`,- at H F ( as been constructed in accordance with the provisions Title 5 and the for Disposal System Construction Permit No. 7 7-,57V t dated Installerp---« Designer The issuance of this permit shall Qt be construed as a guarantee that the system will function as designed. Date to- 7 Inspector Q ——————————————————————————————————————— No. 7-A r't Fee ( THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS lwtopozai *pgtem Congtructton Permit Permission is hereby granted to Construct( )Repair( <Upgrdde( ) don( ) /�,J - L0 System located at t� Cyl � /may® 1;r � �2 /" "( and as described in the above Application for Disposal System Construction Permit.The_a 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: �d " - Y 7 Approved by .1 1 NOTICE. This For1111 is to In used for (lie lZelmair-of. Failed / Septic systel,rs"0111y RTIrICA'I•ION OF SKETCH ANU ArrLICATION TOIL A DISPOSAL CC ►WORS CONS'I-RUGHON I EItNll�I (I I' 'IIOU IUC I( NEU PLANS 1, hereby-grtify that the application for disposal works construction permit signed by me dated %a— / — , concerning the •property located at / is all of the . ;_I_�� � �''"" following criteria: There are no wetlands within 300 feet of the proposed septic system There arc 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 fncility There is no increase in now and/or change in use proposed • There are no variances requested or needed. �-SIGNED Mrs: _— —' LICENSED SE-I" SYSTEM 1NS"TALLER IN 71111 TOWN OF BARNSTABLE NUMBER (AUach a sketch plan of the proposed system. Also if the licensed installer posesses a certifi plot plan, this plan should be submiticdj. .: ---��� � � r-- Z � ,� --� � --- C - .r-� �. TOWN OF BARNSTABLE LOCATION Tle- SEWAGE # 42 VILLAGE � 1-� ASSESSOR'S MAP&LOT INSTALLER'S NAME&PHONE N0. �G SEPTIC TANK CAPACITY lea. G!� LEACHING FACILITY: (type) NO.OF BEDROOMS BUILDER OR OWNER PERMTTDATE: ' I© ' COMPLIANCE DATE: 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 o q-l�d P0. No.. •-- Fim... ................ THE COMMONWEALTH OF MASSACHUSETTS BOARD O HEAD H OF........ . ....1� - I....... ...... .......0 3 ; Ie, S Appliration -for Di-4puiittl Works Towdriirtion Prrutit Application is hereby made for a Permit to Construct ( or Repair () an Individ 1 Sew a Disposal System at. � 5 Loca on•Address or Lot No .........._ ' Owner Address --•----•- --•--------•--•-•---------•--------- � Installer Address ° Q Type of Buildi*/ Size.Lot... -----•--•-- ----- S feet Dwelling No. of Bedrooms------ ____________________________Expansion Attic ( ) Garbage Grinder ( ) p, Other—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Pa Other fixtures ________________________ _ fy Design Flow-------------- uid cy_ -.��&.gns --- Length Width -flODia• .ete `---�--••••.----•--- w � � P P P Y• Y - - gallons. Septic q 1g Depth w Disposal Trench—No. _•------------------ Width.- --__-_-- ---C1 Le ^ Teaching area---------------.....sq. ft. x Seepage Pit No...... Diameter.. Zl._ _.. Dept bel o inlet__.____._.__.._..___ otal leaching area-------__.__•-_.sq. ft. z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by-------------------------------------------------------------------------- Date---------------------------------------- ,a Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water.._._.__.__.___._-____- (4 Test Pit No. 2................minutes per inch Depth of Test Pit--------------------- Depth to ground water_'._ .________-__--_.... -•-•----•--------------------------------------•--- -- ..........------ ------------... -- ------------........ Description of Soil____________________—.. .�'..____.......... ®_ x # s-------------------- U ------------------------------------------------------------------------------------------------ --------------------------------------------------- w UNature of Repairs or Alterations—Answer when applicable------------------------------------------------------------------------------------------------ ------------------------------------------------- --------------------------------------------------------------------------------------------------------------- ------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary ode The a rsigned further agrees not to place the system in operation until a Certificate of Compliance has be n is by oard 9j health. z3 vW ?a Sign ------------------------------- ------------------ --=-- ---- Date Application Approved By---- ----- ---- ---- -- ---- ---•----- -----. •.. ��D e Application Disapproved for the following reasons------------------------------------- -- ---------------------------------------------------------------------- ---•-----•-••--------------------•------------------•--•------------•--••-----------------------------...----••---••--------------------•--------------....•-------------------•--•......----------•---- Date PermitNo......................................................... Issued........................................................ Date 1 , No....... ................... THE COMMONWEALTH OF MASSACHUSETTS BOARD QF HE ' H Appliration -fur 43itivlosal Workii Towitrurtion PPrutit t Application is hereby made for Permit t Construct ( r Repair ( an Individ. 1 Sew b Disposa System at• �: �" •4i ----• -• ---• (.G..... l ------- ....... ------ Loc on A dress �^ _f} or Lot No ---- ...... - -• -• --------•-••------------------ `R°y{ .............. h� Owner A dr s Installer Address Q `Type of Buildi , woe* Size Lot.. ------------Sq. feet Us Dwelling No of, Bedrooms.--_ . _--___- Expansion Attic (. ) arbage Grinder ( ) a.. Other-Type of Building ---•--------------- No. of P ( ) ( ) ersons........::.:................ Showers — Cafeteria Other fixtures-------------- -------•---------- W Design Flow __::__ s per person per day. Total daily flow....... _ _..gallons. <x Septic T.tnk Liquid capacity Length Width llia eter Depth ]' Disposal Trench No Wtdt i_` - Le T, leaching area sq. ft. x "" Seepage--Pit-No._____ Diameter._ �De t belo inlet____________________ otal leachin trea.----.-_-.- -_sc ft. .,. P g t 1 Other Distribution' ox Dosing tank Z ( ) g ( ) s. Percolation Test Results- Performed bY----------------------=--------------••--...-----•----•--..-------AI'�_ Date....-------•------------- ------------- Test Pit No., I................minutes per inch Depth of Test Pit.........._--------- D th to ground water.:---_----_-.--------- Test Pit No. 2________________minutes per inch Depth of Test Pit.................... Depth t ground water... ._:._..____...... a' ----- - --------------------- ----• ............. --- O Description of Soil_---_:. x W ---------------------------------------------------------------.............------------------------------------------------------------------------------------------------------------------------------ UNature of Repairs or Alterations Answer when applicable.-.-_------------------------------------------------------------------------------------------- ------- -. - t Agreement: The undersigned agrees to -install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary ode The Aersigned further agrees not to place the system in I operation until a Certificate of Compliance has be is by, card health. l . Sign d`�1� .. 1,i _. --- . -- �� > ;'—Application Approved BY .._- ate -' � D 'e Application Disapproved for Me following reasons:--•---------------..................... •----•-------•-----------------------------•--------•---------•------- ,. =l--------------- ---------------------------------------------------- ------------------------------------'---------- Date PermitNo.......................................................... Issued-----------------..................................................... f Date AV THE COMMONWEALTH OF,,MASSACHUSETTS BOARD O AEALTH 11 .7i6ok ........OF..... ..... . .�rxt �ir�tr �f �nnt�rittrcrr CERTIFY,'That the Individual Sewage Drsposal_System constructed ( or Repaired ( ) by •/--y----- . ---- = � a 4MA�l� - Installer J 1 I!�Jill." at •� ----- - 'r K has been installed in accordance with"the provisions of Article XI of The.'State. Sanitary Code as described in the" application for Disposal Works Construction Permit No....-:._._..i---------------------------- dated......................._...__ .____________.___ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GIJARANTEE THAT THE SYSTEM WILL FU CTIO ,`SATISFACTORY. DATE � --•----•---- ."Inspector---.._..•-- ---•-- ---- --- -------------------------------- THE I COMMONWEALTH OF MASSACHUSETTS BOARD F HEALTH , .........OF.... ----- FEE Permission i reby granted_-_ to Constr t ( or Repair ( an Ind• 1 Sewa tspsal System at No ttl s eM 1. w� t .......- J-• .. ....................... i Street as shown on the application for Disposal Works Construction Per o. Dated...4_ 4 -__- •` � � o rd- Health ---------- -� Q DATE---•---- -- FORM 1255 HOBBS & W RREN. INC.. PUBLISHERS A, x': r Cla iat ` try v LQ. RZ lox cc 6 7— � � �► per � . ; _ '', . D r 1' ` "4 4 OR A 61CA4 f` f�Dr ,C? '_ ?- 9'-A.3 i �\ �\ 1\� \. •' ` � . y iT wlZ-I-/R1Yn-T1c Mfil?Sroh_5 MILL 5 MV L4,rc� 0 ' o — /0o �— /000 6:6` 5FO/L