HomeMy WebLinkAbout1995 - Septic System Info Request __ ,
QC
TOWN OF YARMOU
G 3 0 1995
reLI-A . y� 1146 ROUTE 28 SOUTH YARMOUTH MASSACHUSETTS 0244-44-6.1
lit-ALTH DEP r.
MATTACM6E5 Telephone(508)398-2231, Ext. 241 — Fax (508)398-2365
BOARD OF HEALTH
REQUEST FOR SEPTIC SYSTEM INFORMATION
(FORM MUST BE FULLY COMPLETED)
1. LOCATION OF INSPECTION: (i. / el 1-6 2,9yri f �r2r /I /Dant
2. TOWN ASSESSOR'S MAP # , /D , LOT # Ng)
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3. DATE HOUSE WAS BUILT: /gel
4. WELL ON PROPERTY, INCLUDING IRRIGATION WELLS? YES NO _/
(SHOW LOCATION ON SEPTIC INSPECTION FORM.) Kfe , �,k.,5. OTHER INFORMATION REQUESTED: i5/t1 On /4 /' iii
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or- Q/7 1/l roil/4 94 41,-- 4/.3 /ret Y'
The Health Department will provide:
1. Last four (4) years of-septic pumping history:
2. Septic system location "AS-BUILT" card, if on file;
3. Septic system description;
4. Copy of Septic Disposal Application;
5. Percolation card, if on file (New houses since 1980);
6. Review of engineered septic plan, if on file.
ALLOW TEN (10) BUSINESS DAYS FROM DATE OF SUBMITTAL FOR THE HEALTH DEPARTMENT
TO PROVIDE INFORMATION REQUESTED.
ON COMPLETED SEPTIC INSPECTION FORM, ATTACH "AS-BUILT" LOCATION CARD SUPPLIED
BY THE HEALTH DEPARTMENT.
NAME OF STATE CERTIFIED SEPTIC INSPECTOR: J( $epI Ai ` /111 Ctie I
ADDRESS: / 7 o✓✓K S/c/ b
42
g De nneS /71 r9—
TELPHONE NUMBER: ` (P--q3 j e
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FILING FEE OF $30.00 PAID ON: 'Pill 11111/
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03/31/95 L S Paper