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Home My WebLink About0045 NOB HILL ROAD - Health LOCATION SEWAGE PERMIT q0• s �r VILLAGE INSTA LLER'S NAME 6 ADDRESS v C BUILDER OR OWNER S rQ -�, DATE PERMIT ISSUED _ •Z� . q� J DAT E COMPLIANCE ISSUED � o r b �I Q �I !, 1 s....S.�.......... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ..........................................O F.........................----............ Xpliration for DhipmFal Works (foustrurfilaat Vamit Application is hereby made for a Permit to Construct ( ) or Repair. ( ) an Individual Sewage Disposal System at: av -- --------------............................................................................ Location-Address or Lot No. ......... _3-A.wu.....-----S-.:tv..-t-..........-............----------- ---------- ------------------------------------------ .-..-----•----.--- W Owner Address at ... ..... -..m.. _ Installer Address Q Type of Building Size Lot.................... .....Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) QOther fixtures ------------------------------------------------------•-•--•----••--•-----••-••-•........•------•-----•---••••----•••••-••......-•-•-....._......•... W Design 'Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter._.-- .......... Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter-------------------- Depth below inlet.................... Total leaching area..................sq. ft. Z 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•---_-__________..-_-_-. fZq Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ -------------------------------•--------------- ------------•-----=---------•-••-•---------.......................................................... 0 Description of Soil......-----•-•--••------•••-----••-------•------------•------------•._.....-••-----•-------•••-•--•-•------•••••-••---•-•-•-•••----•----•••-......----•---••--•-----... W U Nature of Repairs or Alterations—Answer when applicable__. ---- - C.V lc. !� cj� -------------------------------------••--••---------------------------------------....--•-------------------•-......---•••----•---- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITIS 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has en iss d by the board of health. Signed.. .-a &►M----•------------------------------ ......AJ&.1-.------- ate Application Approved By............ � •-----•----------•-- ....... . ... Date Application Disapproved for the following reasons-----------------------------------------------------------------------------------------------------------•---•- ................•••••---•-....•••..........•-•••-•---••-----•--•-••••••-•------..._...---------•-•----•.....-••-•---••......•-••-•-•-••••-•-•••-•-----------••-•-•••--•••-•-----••.••••••-----•••-•------ o Date , Permit No......................................................... Issued-....................................................... Date N ........f............ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH --------------------------------OF..........................._............... Allpliration for Dispoiial Works Tumaur#iort rruti# Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal S stem at .......... .................................................................................................. Location Addr ss or Lot No. ..... , ......... ..........................................•-..... .... ---------- (�� Owner �"` - ------Address Installer ......••.................. Address Type of Building Size Lot............................Sq. feet U Dwelling No. of Bedrooms.•..........................................Ex Expansion Attic a g— p ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures ------------------------•----...--•------------------......------------------•---------- ............................................................. W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length_............. Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total-Length.................... Total leaching area...............------sq. ft. i Seepage Pit No-_--------_------- Diameter.................... Depth below inlet.................... Total leaching,area..................sq. ft. z Other Distribution box ( ) Dosing tank ( ) ~' Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No. l................minutes.per inch Depth of Test Pit.................... Depth to ground water........................ t14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 ... •--------------------------------- ------------ •---------------- •------------- ---•••••------------ ----------- •--------------------------------•---......... O Description of Soil.........::........................ U ...........................-.................................................................................................................................................-----••-•-•-•--• ......... W ................... -- V Nature of Repairs or Alterations—Answer when applicable- --------o V s R.r. !j�..... •---------------------------•-------------------------•------•--•--•-------•---•---_..... ......... ...--•-- ----------•--- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TiTI,;,,. 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has n iss d by the board of health. P 4- Signed4 ................................... --- Application Approved By..........., . fie ` 1 ,�✓� y.v.._>_r._ ._:�..._•_ '%r ..................... .....,, �, ._........._._._ Date Application Disapproved for the following reasons--------------------------------------------------------•----•--------------------------------------....---•--... ..............•-•--•------------•--•-----...---•....--••--•----•----•-•--...-•--••---------------...----•-••------------•----•-•---•-------•-------••••--•-----••--•••----•---------•--......•-••••..... Date PermitNo........................................................- Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH, ............ ............................OF...... ............................... T rrtif iratr of ToutplWurr THIS_LS TO CERTIFY, That the. Individual Sewaw Disposal System constructed ( ) or Repaired ( . • Installer has been installed in accordance with the provisions of TITb of The State Sanitary Code as described in the application for Disposal Works Construction Permit No..__ ._J~. ....... dated-.... .......................................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE...............................•-............... � .. 1-.... Inspector.... -- �-�_` .i '. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH N FEE... ...•...•. Disposal Worksuttorttr#iari 'rrutif Permission is hereby granted-•--- ---' -•-••- ------•--•........................... to Construct ( ) or Re it ( an Individual Sewa��isposal System at No.----- -----r� . ---...... ......f.�w. �* '................ .. • .% .t�^ '�`-:?:Yy`sir.. .8:-....................................... Street as shown on the application for Disposal Works Construction Permit No..................... ................ Dated............._0............................. ---------------••---•-- Board of DATE.. ..__' FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS 7 l 9/7/21,10:46AM ShowAsbuilt(1700x2800) LOCATION SEWAGE PERMIT NO. VILLAGE / INSTALLER'S NAME & ADDRESS c h C°a s. BUILDER OR OWNED DATE PERMIT ISSUED q_ -2- DATE COMPLIANCE ISSUED z� �7 w https:/fitsq ldb.town.barnstable.ma.us:8431/Home/ShowAsbuilt?mp=288122&sq=1 1/2