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HomeMy WebLinkAbout0015 TURTLEBACK ROAD - Health 15:Turtleback Road Marstons-Mills A= 047 072 No. . IS Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes application for �Dtzpogal 6p!5temc Construction Permit Application for a Permit to Construct( ) Repair�,('�) Upgrade( ) Abandon( ) ❑ Complete System El Individual Components Location Address or Lot No. �.�T.V— '` 11 ;_I c.c,�C a Owner's Name,Address,and Tel.No. Assessor's Map/Parcel © �-0 6 ^ l Installer's Name,Add Tess,and Tel.No.�'�tw� ' /.�'c 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(min.required) gpd Design flow provided gpd 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 applicable) :l Date last inspected: Agreement: The undersigned agrees to ensure the construction and m in na ce of t of re d on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental a nd n t p c aeration until a Certificate of Compliance has been issued by this Board of Health. Signed � n Date y// f1? 7Application Approved by _ Date �/ �d Application Disapproved by: Date for the following reasons Permit No. ;-6D"7 S. -- Date Issued / �U ��� Oq BARNSTABLE THE COMMONWEALTH OF MASSACHUSETTS MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disq6sal System Constructed ( ) Repaired (� Upgraded ( ) Abandoned( )by 16 at lt- has been constructed in accordance with the provisions of Title 5 and the for Disposal System onstruction Permit No. �t?d7_ S dated Installer Designer. #bedrooms Approved design flow gpd The issuance of t i permi shal of be construed as a guarantee that the system w' fu t' n s de Date Inspector p No. . a°D-7 -I s )-- Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Ye,!/ ZippYication for aigpo!ml *pgtem Construction Permit Application for a Permit to Construct( ) Repairx) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components ` Location Address or Lot No. f4o,/fi — a j Owner's Name,Address,and Tel.No. Assessor's Map/Parcel Q _/TM ['•e� ��''v/ /'lU�•�( Installer's Name,Address,and Tel.No.��w��-✓/v�'/A' Designer's Name,Address and Tel.No. 0_,-f4. ,5�y�rrh�t r.,A 0.'2C01 Type of Building: R Dwelling No.of Bedrooms _Lot Size sq. ft. Garbage Grinder ( ) Other Type of Building 'No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) i gpd Design flow provided gpd 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 applicable) �� f AIn.l Date last inspected: Agreement: The undersigned agrees to ensure the construction and main na ce o t e of-re de d on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental de nd no t p c s operation,until a Certificate of Compliance has been issued by this Board of Health. Signed �-�� Date y/r'/� Application Approved by V Date q—/ Z-o 7 Application Disapproved by: Date for the following reasons Permit No. ;-6o7— i S)�— Date Issued '4— t V—7 , THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance 1� THIS IS TO CERTIFY,that the On-site Sewage Di s osal System Constructed ( ) Repaired Upgraded ( ) Abandoned( )by s � at ` jUhas�be- Instructed in accordance with the provisions of Title 5 and the for Disposal System•Construction Permit No. dated Installer Designer #bedrooms Approved design flow I lie and The issuance oft is permi shall not be construed as a guarantee that the system w• function as de 'gned, 9"45k) Date Inspector 1';// 0 ks + ti ------/—J —C-------------------—-------/-- f—�j—� !--- Fee / THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS lwizpozal *p!gtem Construction Permit Permission is hereby granted to Construct ( ) Repair (/'�. Upgrade ( ) Abandon ( ) -System located at 4 and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this permit. Date ' ( '��` a� Approved by �--, No...sl. ..... Ficx. ....................._ THE COMMONWEALTH OF MASSACHUSETTS BOARD F H ALTH & L........... .O F..... 4�.. .. . Appliratinn for igifiposal Workii Tons#rnrtiun Prrutit Application is hereby made fora Permit to Construct ( ) or Repair ( ) an Individual -Sew:{ge sposal Sy;str a ......./4 -•' 7 L z�ti n-Address ...................•---or Lot No. Own Address v a � Fatal er Address Q Type of Building Size Lot............................Sq. feet U Dwelling ( ) g ( }No. of Bedrooms,...... Expansion Attic Garbage Grinder Other—T e of Building .............. No. of persons............................ Showers — Cafeteria a1 Other fixtures ...................•----•--•--.... . . . W Design Flow...................... ' ...........gallons per person per day. Total daily flow__........ ._ ...._._gallons. WSeptic Tank—Liquid capacityjons Length................ Width................ Diameter................ Depth................ Trench—No..................... Width.............. ... Total Length.................... Total leaching area...... .....sq. ft. x Seepage Pit No.___/............. Diameter ' .1 .. Depth below inlet e.............. Total leaching area: +� ''.sq. ft. 7 Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed bY.......................................................................... Date.............................-•••------ Test Pit No, 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ f� Test Pit No. 2................minutes per inch Depth of Test Pit................... Depth to ground water....................... O ----- . ....................................................................... Description of Soil .-A. -. :;�. .... -�, ��'y�L''x --------------------•................................ ...................... .......-••-•••-••••••-•--•--•--•--------•------•---......••---•.............•-•-•-..........----••-•--•-•-•-•-•----..............-•--•-••---•... W U Nature 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 NI of the State Sanitary,Co&— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee`h­i`ssued by the board of health. Sign ........ •--•--• -- ----- .---- f Application Approved By.....� ���' `. ±- � '' * Da e .X Application Disapproved for the following reasons:_............................................................................................................... ...............................................--•---------..........----------......-•----..................--------------•--•.....--•--•---•-•• -•----....••• -•--•----•---•-••-......•---......... Date .r Permit No.... Issued...., . - -- - Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH . ....OF............&4:�� .................. �rr�ifitn�$ rrf �nn��linnrp THI IS �CERTIF , That<.t e dtvidual Sewage Disposal System constructed ( ) or Repaired ( ) by . !.u'�....... � ... s................ ... ar Insriu . at... . 4V has been installed in accordance with the provisions of Article XI of The State Sanitary Code a, describ d in the application for Disposal Works Construction Perinit No.............a �_._._......... dated.----- :. -- -. .......... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. t DATE........................................... •..•--••-----••......-•............ Inspector........ .--• .: b... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH01 . ...::.......OF........ a ..� _ No.. . �" FEE.. F.-:.... fit � VIUM's -ft ermif Permission is,hereby ranted......... to Constru duel sewage D osal stern 1 at No..., . ..... .....:.. ...... f. t.�,� ....... _.. `.. "..#e;;4 ... .. '... Street � as shown on the application for Disposal `Works Construction lit N }rA. ,, . Dated..... sj,�U� ""' Loard of health DATE............................................................................... FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS