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Home My WebLink About0043 TURTLEBACK ROAD - Health 43 TURTLEBACI � 0� A= 0) '7— C"T �sTo�S L lS f �p A I� I) 1 No. Fee 07 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE,, MASSACHUSETTS 01pphration for �Digo!5a[ *pgtem Con.5tru`ctton Vermtt 1 Application for a Permit to Construct( )Repair($1 Upgrade( )Abandon( ) O Complete System El Individual Components Location 43 Ad ss or Lot No. Owner's Name,Address and Tel.No. 1 Assessor's Map/Parcel Installer's�lamg�Address,�and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms _ Lot Size 76 sq. ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow a;a0 gallons per day. Calculated daily flow gallons. Plan Date J Number of sheets Revision Date Title Size of Septic Tank j 0 0 Type of S.A.S. Description of Soil Na u•e of Re airs or Alterations(Answer whe ,applicably �G' a Date last inspected: Agreement:. The undersigned agrees to en ure t e construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions f Title 5 of the Env' e 1 Code and not to place the system in operation until a Certifi- cate of Compliance has been issue by t s ' ''and o H t Signed Date "3 Application Approved by Date Application Disapproved for the ollowing reasons Permit No —7-a Date Issued i No. d..w.- f, Fee , THE COMMONWEALTH OF MASSACHUSETA, Entered in computer: VYes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZIppYication for Mi5ponl *pgtem Congtruttion Permit Application for a Permit to Construct( )Repair(^Upgrade( )Abandon( ) El Complete System El Individual Components Location Address or Lot No. LC 4 p�� /+�A Owner's Name,Addressl N Q and Teo. Assessor's Map/Parce�+�. M �- J40 NP ov - o7 `( Installer's Name Address and Tel.No. Designer's Name,Address and R 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 3 3n gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank 00 Type of S.A.S. _i negKmf� S Description of Soil Natu a of Repairs or Alterations(Answer wheq applicable 1A I / Date last inspected: Agreement: The undersigned agrees to en ure t e construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions f Title 5 of the Env' e 1 Code and not to place the system in operation until a Certifi- cate of Compliance has been issue by t s aid o e t , , ;y Signed Date 3 Application Approved by �" ° r Date • y—7— Application Disapproved for the llowing reasons Permit No. 'Z Date Issued y—3—9 THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO CERTIFY, that the On- to Sewage Disposal System Constructed( )Repaired(jj Upgraded s ( ) Abandoned( )b at has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. — 7 dated � Installer Designer The issuance of this permit shall not be con,trued as a guarantee that the system wA function •esigned. Date U Inspector � v --------------- �� No. / `�0 Fee J `� THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE} MASSACHUSETTS Pioozaf 6p5tem Construction Permit Permission is hereby granted to Construct ) pair( Upgrad )Abandon( ) 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. Provided:Construction must be completed within three years of the date of this it. Date: Approved by 1019/97 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 f r ' I, hereby certify that the application for disposal works construction permit signed by me dated — _ 9 ,concerning the property located at —A/ L _ 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 14 proposed leaching facility will p9I be located less than fourteen( )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: �'� G'�''�" DATE: — 3-IT IT LICENSED SEPTI 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 submi(ted). 9 :health folder:cent �� n ¢ ��Z I ��© .�-�� a I /___. i