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Home My WebLink About0011 WILLINGTON AVENUE - Health 11 WILLINGTON AVE. , MARSTONS MILLS ` -A=103-038 I I TOWN'OF BR;STABLE . v L ATION SEWAGE #�39- 3N VILLAG 01 I LLs ASSESSOR'S.MAP& LOT`10.3- 03 fs INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) c-JVG (size) NO.OF BEDROOMS BUILDER OR OWNER PERMIT DATE: ZOl COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet a Private Water Supply Well and Leaching Facility (If anyJwells.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 4. f Furnished by y � 3 � 3to C� �1d 'ol LL. w� rry �� No. Fe THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Yes 2ppItcatton for ntopooar *petem Comaructton 3permtt Application for a Permit to Construct( )Repair(X,)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. ItVE Owner's Name,Address and Tel.No. �- G1� cS rr�� Gvrdvsz Assessor's Map/Parcel "()- Q Installer's Name,Address, d Tel.No. Designeree,,Address apd Tel. o. b �q� A1,!e6 YL Type of Building: Dwelling No.of Bedrooms Lot Size m geo 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 ��a 0 % Number of sheets Revision Date Title C d-fu Size of Septic Tank Type of S.A.S. Description of Soil Nature of�epairs or Alterations(Answer when applicable) 1V� l / 4 'x Y X Z ' V-9,41J&ilf 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 Environmenty Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by Ps Board of Health. Signed Date Application Approved by Date, - Application Disapproved for the following reasons Permit No. '' ► Date Issued ZAV 9,0 J TOWN OF BWSTABLE 3N OCATION f�lrSEWAGE # VILLAGE 1.Z U,� ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. d�a� SEPTIC TANK CAPACITY LEACHING FACII.ITY: (type) UV� (size) y X X Z NO.OF BEDROOMS BUILDER OR OWNER PERMTTDATE:. 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 No. �r � t Fe THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: �� Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS Z(Ppfication for Mi000l *pgtem Construction Permit Application for a Permit to Construct( )Repair(X-,)Upgrade( )Abandon( ) O Complete System El Individual Components Location Address or Lot Na f rn��5/I 1�v Owner's N 1� 77Mand Tel.Ijo. ,fly L0 1-1 Assessor's Map/Parcel /� �2— p _g15Z)i/ 17 Installer's NW��saand Tel.No. Designer's Name, aid;)� b 0 X 3 0 7( -- w (�r/ J> Z z 4 Type of Building: �1 Dwelling No.of Bedrooms 7 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 ?-U Number oj�sheets Revision Date Title 5 `Tl(f- r }7 i Y l d-^-) Size of Septic Tank ? Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable, D 0.0 q ' X V-7L,!�Iv c Date last inspected: Agreement: s 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 Environment 1 Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by is Board o Health. Signed Date Application Approved by Date-L7��"` �' Application Disapproved for the following reasons Permit No. Date Issued A' THE COMMONWEALTH OF MASSACHUSETTS c BARNSTABLE, MASSACHUSETTS "' Certificate of Compliance THIS IS TO CERTIFY, th5t the On-site Sewage Disposal System Constructed(, )Repaired (A)Upgraded( ) Abandoned( )by 141A le7L at L tlY� 4f_ 4404as been constructe in actor ante with the provisions of Title 5 and the for Disposal System Construction Permit No - dated Installer:'"' Designer The issuance of this permit sh 11 not onstrued as a guarantee that the system will Lunction as designed. Date Inspector 1 _ __ __ No. / -------------" __=_ _— Fee 11 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE: MASSACHUSETTS f " Mizpogaf *proem Construction Permit i- Permission is hereby granted'to,Constructl(, f)Repau()()Upgrade-( )Abandon System located at *wl - ��f (r-t-0 7l_, 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:Constru 'on must be completed within three years of the date of this it. Date: 1y Approved b !,/ t/ . PP Y . l ION/97 f NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CCRTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT ENGINEERED PLANS) ,6 l certify that the application for disposal works �� , hereby fy pp construction permit signed by me dated q7 concerning the 91 ed at JAI t- L 1 A)6 v'V AVZ ' meets all of the property located rl 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 J • There is no increase in flow and/or change in use proposed v • There are no variances requested or needed. If lice proposed leaching facility will be located within 250 feet of any wetlands,the bottom of the proposed leaching facility will W 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) B)Observed Groundwater Table Elevation(according to Health Division well map) SIGNED /�� DATE: : V" 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:urt 130. oo ' L.o-rr 711 a D, 000 t 5, gd X Ll rX'Z l 01 SnNG- o P no VIC% ovs� 4f 11 d �� t k , F J a �3p .op� 56-4�-C / r 30 G�c(.Lu km bra � laQ-porn 5 = `/ by VJm: w tfb tI'L C tI t�R M� AA) IN�LDVv GP�F= LL NG�`n�l AV la-o( q' MCDONALD RESIDENCE SH 11 WILLINGTON AVE MARSTONS MILLS, MA C Bath Bedroom KitchenEEI C n 0 SH Down Living Room Bedroom C Up �• SH r—C \' First Floor o �• S B o Down n •� SH pB NEW UPSTAIRS FLOOR PLAN New Second Floor EF MCDONALD RESIDENCE 11 WILLINGTON AVE �p a� MARSTONS MILLS, MA r O Up \ SB Bosemenl ` One Cor Attached Gorage ZI 1 �. Bath Bedroom O O Kitchen Dining \•�. `'•� Room C O �• Mud Room �•� SB Down Living Room \ Bedroom C Up o \ C \� First Floor � 08 Down Unfinished Bedroom Unfinished Bedroom EXISTING FLOOR PLAN Existing Second Floor