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Home My WebLink About0049 WILLINGTON AVENUE - Health 49 Willington Ave. , M. Mills �03-040-001 — f / TOWN OF BARNSTABLE 1� LOrATION �t/1 /'�ti JLD�/l ��a P SEWAGE # VILLAGE / lTy'��/�5 /��<S ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. �� / CDs�S�` 77/ SEPTIC TANK CAPACITY LEACHING FACILITY: (type S ✓//-(/) NO.OF BEDROOMS 3 BUILDER OR OWNER PEIRMI'TDATE: OMPLIANCE DATE: ""' nl Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility �f 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 4, 31 r/ I g,b 04 o W'1 No, Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01ppYicatiou for Mtgozal *p.5tem ctCon5tructton i9ermit Application'is hereby made for a Permit to Construct( )or Repair(V�an On-site Sewage Disposal System at: Location Address or Lot No. Owner's Name,Address and Tel.No. y j fail/1f nQr�e re Pe, e54 Installer's Name,Address,and Tel.No. Designer's Name,Ad ress and Tel No. 4909rfoZ-0 17t) Gd'��s ,, Z l 1/r 16 Type of Building: Dwelling No.of Bedrooms Garbage Grinder(.1� Other Type of Building &5iA2,W4CG No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow / gallons per day. Calculated daily flow _✓2e gallons. Plan Date Number of sheets Revision Date Title Description of Soil Nature of Repairs or Alterations(Answer when applicable) Q' O®O /OAl 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 issued by i of alth. Signed - Date z Application Approved by Application Disapproved for the following reasons Permit No. �Tn ��i Date Issued ——————————————————————————————————————— 4 4T11 op yr No. Fee o_ THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01ppYication.f6r migpogar bpttem construction, vermit i Application is hereby made for a Permit to Construct( )or Repair(tan On-site Sewage Disposal System at: Location Address or Lot No. Owner's Name,Address and Tel.No. fie Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 7 7/- 93f,9 Type of Building: Dwelling No. of Bedrooms Garbage Grinder(4/0 Other Type of Building AP�e47' No. of Persons Showers( - ) Cafeteria( ) Other Fixtures Design Flow /� gallons per day. Calculated daily flow 32e' gallons. Plan Date Number of sheets Revision Date Title Description of Soil t' Nature of Repairs or Alterations(Answer wheq applicable) ✓/!�'�� D'1D ,-/f//Dw Al 6 yZi t w% 3 Date last inspected: `�. Agreement: The undersigned agrees to ensure tloconstruction 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 issued by is Boaz of alth.Signed "" Date Iv b/ Application Approved by Application Disapproved for the following reasons Permit No. l'� — / Date Issued THE COMMONWEALTH OF MASSACHUSETTS /�� "'�"rl/•�0��_s�= PUBLIC HEALTH DIVISION - BARNSTABLE. MASSACHUSETTS Certificate of (compliance K THIS IS TO CERTIFY,that the On;site S wage Disposal System installed( )or repaired/replaced(V0)0`on - by 6or��L� � DbSf for /'007 AeAll_l as �/l/lr� D DIIP 4'11-715 DPI A; has been constructed in accordance with the provisions of Tit e 5 and the for Disposal System Construction Permit No. dated Use of this system is conditioned on compliance with the provisions set fo below: 0' * 4:!;!—s - .7fy If 7�2 No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Migo.gal *poem Cotwtructiou permit Permission is hereby granted to f�0/r)d E to construct( )repair( V1 an On-site Sewage System located at 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. All construction must be completed within two years of the date below. Date: �� —T Approved by CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION 1'E1ii1 l'I' (1V1'1'IIOUT DESIGNED PLANS) �f1Lo —llhereby certify that the application for disposal works construction permit signed by me dated b//Z concerning the property located ate � " ®NI meets all of the following criteria: t✓ There are no ivellands within 300 feet of the proposed septic system •I✓ T cre are no private wells within ISo feet or the proposed septic system The observed groundwater lable is 14 feet or greater below the bottom orthe leaching radHty There is no increase in flow and/or change in use proposed i/ There are no variances requested or needed. SIGNED: DATE: LICENSED SEPTIC 4STEM INSTALLER IN 114E TOWN OF BARNSTABLE NUMBER IAtfach a sketch plan of the proposed system. Also if the licensed Installer posesses a certified plot plan, this plan should be submitted). .r x a . i i..i''. t if 'r}hy ,.r{,1�,�3t}.k . 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Oxt� .1— ", 1 , IrX18TI�iQi CONTOUR - 0 — tr 7 d 1rY7�`.. ✓E FINISHED SPOT ' ELEVATION 't a 4-. �? . . .� /t /.n c, r , FINISHED CONTOUR. - --- 0 L,, Alt. ._T ..___ I :7- , . __ _ : A ' AWROVED v 80ARD HEALTH 1. . ¢ 4 1 `i,a r •J _ V 7 1 t,� DATE A. ENTJ " : ' ,, + !9'79. SALE ! 10 ATE, v L_OREDGE ENG1(IyEER/NG CO. IN CL:IIkf§I Dq �� I CERTIFY THAT THE'-'pROP08ED EGISTEAE REQI9TERED r 0+<°-j8vzl ' .g�i1LDIN0 SHOWN qN "THIS .PLAN CIVIL LAND �._ , :CONFORMS TOT ZONING_ LAWS ENGINEER SURVEYOR ��• —".' , .. �� ' ' L. F A 0 8 RNST 9L MAS 33 'N0. MAIN S#" 712 MAIN S.T. 8Yw /3�-2 ;! cT , , SO.:,YARMOUTH�/JMO�SS HYANNIS� MASS. % z, , / - :.._. , .. $ 1,7 OF GATE R 0°' LAND 'SURVEYOR _— - _ ' . - I Jl.',•. . ...... r .,4, .;is -- L 0•C AT ION f SVW A G E PERMIT NO. -VI LAG E = INSTAL ER'S MAM & ADDRESS GUIDER OR DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED � d.� ' '� , , � �/ � � , �o >' i " e / �� `� ��1 � �. � `� I � . �� No..... ................I...,.............. THE GOMMONWEA;_TP. OF MASSACHUSETTS BOARD OF HEALTH OV.'-7........................OF... !L ......-.:._ _....... ... .._........_ Allp iratb4 a far Tiri oii ai Works Tow3 union Famit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at ea �/ ................_�. .............................r'�- tax-- ........... ... _ Location-Ad re ss or Lot No. - Address Owne -----_-----••-••-•••••-•---- nsta er Address d Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms........-______________________________Expansion Attic ( Garbage Grinder ( ) p, Other—Type of Building _____ ....... No. of persons______.___............ Showers ( ) — Cafeteria ( ) a Other fixtures ----------------------------•--- --- W Design Flow.............. —_----___________gallons per person per day. Total daily flow__..,-2.40. ........................gallons. WSeptic Tank—Liquid*capacity gallons ,Length_ ____ Width---44,....... Diameter................ Depth................ x Disposal Trench—No_____________________ Width..................... Total Length.................... Total leaching area`----_...............sq. ft. Seepage Pit No---------------------- piameter.................... Depth below inlet___:________________ Total leaching area..................sq. ft. Z _ Other Distribution box ( Dosing Ajk.. )Percolation Test Results Performed by..___ ,` _. ��Z i/ .._____.._. Date...... .7_3! .____.... Test Pit No. 1�_®....minutes per inch Depth of Test Pit____________________ pth to ground water_-_________ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-------_................. W'.. ______________________ ................................................ .__.....__....__ __,�______________.�...__._......._.... `s De�crl on of Soil X`.._._lOA..�I' � �� C' --- -- 9 USA _ _._ r F----•--- ----------•--••••-•--•---•------•------•------------------------------- -----__:__�::___:_._------- --- -----_ W -----•-------------------- -----------------------_------•------------___._..--•-------.-•.---------•-------•------------------------------------•---------------•-••-•------•---••--•--•-------- VNature of Repairs or Alterations—Answ.11''. 11,11111 J!,J] 5, !!cable. 77 7777--777......... ............................................................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITL is 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been ss d he b f ealth. Sig -- -- / Da Application Approved By......... --•---•-•--- --- -----•-•-•- --. . ........... { ��rf`te .. Date Application Disapproved for the following reasons:-------•----•--•----•-•-------------•----------------------------------------------------------•--------•---•••- •----•---••------------•-•-----------•------------------------------------------------------------•-•---- Date _'7�- - Permit No......................................................... Issued...�f2- -'---------.._..._...... ate THE COMMONWEALTH OF MASSACHUSETTS BOARD OF EALTH .....................OF............... .............................. .............................. V' rrtifi tr of ToattpliFatta TH IS TO CE TI Y, That the idual re , D sal System constructed ( or Repairedby_------ �- ----- ........-- •-• -- •- ----- •- / - s ., has been installed in accordance-with the provisions of T r Th State Sanitary Coe as descri,4ed in the application for Disposal Works,Construction Permit No._ � ---�..-••---__ da.ted._.. �J'��'_______________ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE........... : —2 . 'Inspector ....-•-••••••••-...-••-••-••• No.---- ... .. .............................. THE COMMONVMALTF60F MASSACHUSETTS BOARD OF HEALTH .......................................... ........................OF....0� .4;r Appliration far Dhipagal Workii Tonotrurtion Prrutit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal Systerfi, at .............. ........1; . ........... _./ff..5577 1: 4 mxe.. ...A<... L9"tion or Lot No. 7 Address .................................................................................. .......... Qlnsta e, Address Dwellin No. of Bedrooms____.._ Size Lot............................Sq. feet Type of Building ...........t,.,a.............Expansion Attic Garbage Grinder ( ) g— P4 Other—Type of Building ..... of p�er*sons_�.........AL........... Showers Cafeteria ( ) P4 Other fixtures ......... -----------------------------*----------------------------------------------------*------------------------"--•• -----. n, Design Flow.„__........016r...................gallons per,,person per-day'. Total daily flow._,r-244,0... ....................gallons. 9 Septic Tank—Liquid*capacity/.M.Ogallons Length.t_<.0".... Width...,0.1120'... Diameter________________ Depth___._.____.,.... Disposal Trench ...................... Width....................Total Length.__---._. ........ Total leaching area....................sq. ft. Seepage Pit No....... ........ iameter.................._ De P *pth below inlet.................... Total leaching area.__ _.__.._....sq. f t. Z Other Distribution box ( Dosing to , :Y,„ I r�....A, i.,4...... .. Date...... Percolation Test!Results Performed b) 14epie.-A,- --/.T-/- -'KVA 6--------- Test Pit No,. I'g.0....minutes per inch Depth of Test.Pit.................... pth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit._.-_.__-.__._____.. Depth to ground water___..__....._..._...___. .............I------ ................................................ ..............................j--------------- ------------------- 0 De§cripM'on of Soil..... ..... _,dL,4....... . .............. .... ...... ... Al244.&......qeow-"q.. ................................................................................I......................................................................... ..... ....................---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- U Nature of Repairs or Alterations—A-n-swer-Wherrarp-pri7c-able------.-----`......................w................................................ 41. .........................................**------- ----- ---------------------------------------- ---------------------------------------- ................... -------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual'Sewage Disposal System in accordance with the provisions of TIT IL 5 of the-State Sanitary Cod The undersi•gned further agrees not to place the system,in I operation until a Certificate of Compliance has bee ss d y he he b f ealth. Signed.... . . ...... .... ........... .......:.................................... Application Approved By.......... 7. Date Application Disapproved for the following reasons:_A�......*.................................................................................................... .............—------------_--------_------_..................................................................................... .................................................... Date Permit No.._......_-'----------'----'--- . . �.... ._..__.--Date - -Z — .•........7 Date --- ------------ THE COMMONWEAL MASSACHUSETTS BOARD 6F HEALTH,-, ..........................................OF...... ...............................7..........I................................... Trrtif yt, tr of Tjoutpliaurr TgI,S' IS TO CE3j,?TIFY, That the 1 ual I eDsal System constructed or Repaired by__-1*�k=tM--------------------- ............ ....... . . .. ............................ . ------- ----------------------- I taller . ..... .... . .........7.2.......... f , A/ ...... at........ has been installed in accordance with the pr6visions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No_________________________________________ ,dated------ .............. ...................... THE ISSUANCE OF THIS CERTIFICATE SHALL.NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTMN SATISFACTORY. F k -Inspector---'- .... ........... ................................. .................... DATE............................. . . I. THE COMMONWEALTH OF MASSACHUSETTS t BOARD OF :... ... HEALTH NoC...... . 1 .K FEE........................ Btqpao�al 00114rhls v Sinuitio rr rpt ... . .... .... Permission is hereby grahied_:!?..'_ ...... .. .............. Wep,�i �an I divid I to Construct (e ewa Di yst ... ..... .. . .................................. at No....... . ......t....... .... ..... Street as shown on the appl ication for Disposal Works Construction PeL"NO.. ......... Ore. .r.......................... Board of Health DATE---..._ :-."'. .................................... FORM 1255 HoeBS & WARREN, INC.. PUBLISHERS