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Home My WebLink About0336 TURTLEBACK ROAD - Health 3-6-TOa r TOWN OF BARNSTABLE LOCATION 3 � 9 r� SEWAGE # s"?T VILLAGE p' � p ��:jQ ASSESSOR'S MAP & LOT q INSTALLER'S NAME&PHONE NO. flakTti SEPTIC TANK CAPACTI`Y `Sd LEACHING FACILITY: (type) (size) NO.OF BEDROOMS // BUILDER OR OWNER , Cahn PERMITDATE:' 747 COMPLIANCE DATE: II '.q '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 � 1 S 81-alL i No. / Fee _/ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: .� Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE. MASSACHUSETTS appuration for Migpogar *pwm Congtructton Vermtt Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ?;�Eomplete System ❑Individual Components Location Address or Lot No. t Owner's Name,Address and Tel.No. IM�Yv�t`�S Assessor's Map/Parcel ly_�_0L C Installer's Name,Address,and Tel.No. 1 0 Designer's Name,Address and Tel.No. C>—c,.A (?-e-.SepT� L rs i 6--,�S S� Type of Building: Dwelling No.of Bedrooms_q___ Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures j �- Design Flow —1 1 V gallons per day. Calculated daily flow ��j gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank 1'S0-D S�D`C�� Type of S.A.S. C 1-1 Description of Soil il� �CU Nature of Repairs or Alterations(Answer when applicable) c_ C LA-It U �t U ec1 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 En ' enta�Qodle place the system in operation until a Certifi- cate of Compliance has b sue y e ih. Signed Date Application Approved by Date - Application Disapproved for the following reason Permit No. - -?13 Date Issued �� / TOWN OF BARNSTABLE LOCATION �3� a��f K n SEWAGE # VILLAGE r � o�(� ASSESSOR'S MAP & LOT r7f i INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY /5�k f 1a I:( -I-)AX �.�, � -•a C t'`(�S ° k� LEACHING FACILITY:(type) (size) NO.OF BEDROOMS_/_ BUILDER OR OWNER s/�� Ics�i! cy PERMIT DATE: >��"I7�/ / 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 jwithin 300 feet of leaching facility) Feet. Furnished by f IN7 1 3 ..JUL � f No. Fee v THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ✓- Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLES MASSACHUSETTS ZIppYication for Migooar bpztem Construction 3permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) �omplete System ❑Individual Components Location Address or Lot No. 3��1/Y15AOC. C-6/1 Owner's Name,Address and Tel.No. Assessor's Map/Parcel ff""�^ \\b Y 1&j A 00—dL Installer's Name,Address,and Tel.No. Designeir's,Name,Address and Tel.No. PA%O-cY� fie_St-p 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 �� 0 gallons per day. Calculated daily flow �-��Ci gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank SiD`r\C2_KAL_� Type of S.A.S. Description of Soil V1'j �A �_ C o Nature of Repairs or Alterations(Answer when applicable) t 7576-D Sf(uu C_�t4c, U�/ 1ST 1-x 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 Envi a tal Code and et-to place the system in operation until a Certifi- cate of Compliance has bestzed"b'y`th ar ea Signed IeA _ Date /` Application Approved by Date �/ - Application Disapproved for the following reason Permit No. - 7-7 ? Date Issued //- - --------------------------------------- - THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance , THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired(- �)'Upgraded Abandoned( )by - at L 'M has been constructed in accordance with the provisions of Title 5 and the for Disposal SystemlConstruction Permit No. -'7 7 3 dated //-/ 7-.9 Installer �`�r Designer The issuance of this permit shall not be construed as a guarantee that the systerawill functio s esigne /� �. Date ��- 7-V - `�'� Inspector 2 --------------------------------------- No. 7 7-? Fee THE COMMONWEALTH OF MASSACHU�ETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS jBi!5pozar *paem Construction permit Permission is hereby granted to Construct( )Repair( )Upgrade( )Abandon( ) System located at =z :2 1?Q 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 cogmplleted within three years of the date of thi% �L r s Date: ,//-- / �- // Approved by /��" r y 1/6i99 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 DESIGNED PLANS) I, hereby certify that the application for disposal works construction permit signed by me dated — (--`i concerning the property located at meets all of the following criteria: V• The failed system is connected to a residential dwelling only. There are no commercial or business / uses associated with the dwelling. • The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. / There are no wetlands within 100 feet of the tic system proposed se P /There are no private wells within 150 feet of the proposed septic system /There is nc increase in flow and/or change in use proposed ✓• There are no variances requested or needed. / The bottom of the proposed leaching facility will not be located less than five feet above the maximtun adjusted groundwater table elevation. (Adjust the groundwater table using the Frimptor method when applicable] Zif the S.A.S. will be located with 250 feet of any vegetated wetlands, the bottom of the proposed leaching facility will not be located less than fourteen(14) feet above the maximum adjusted c roundwater table elevation, Please complete the following: A) Top of Ground Surface Elevation(using GIS information) ( / B) G.W. Elevation J(/!1/ =the vLa-C. High G.W. Adjustment .J 7 D117ERENCE BETWEEN A and B SIGi,MTI DATE: (Sketch proposed p�anf system on back1. q:health folder.crrt v/�` � ' � l O 7r C�