HomeMy WebLinkAbout166GREATWESTERNRD SEPTIC APPLICATIONFee
$55.00
Commonwealth of Massachusetts
Board of Health, Yarmouth, MA.
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to: Repair-minor - Individual Component(s)
No.: BOHDC-14-0044
Location: 166 GREAT WESTERN RD, SOUTH YARMOUTH, MA
02664Map/Parcel#:
Lot#:
Owner
Name:
KARSON, DOUGLAS C
Address:
KARSON, JENNIFER C 166 GREAT WESTERN
RD
Phone:
Septic System Installer
Name:
ACCU SEPCHECK
Address:
17 NORTHSIDE DRIVE SOUTH
DENNIS, MA 02660
Phone:
5083855891
Type of Building: Dwelling Lot Size: 0.30 sq. ft.
Dwelling - No. of Bedrooms: 3 Garbage Grinder:
Other Type of Building: No. of persons: Showers: Cafeteria:
Other Fixtures:
Plan Date:
Title:Revision Date:
Number of Sheets:
Design Flow (min.required): gpd Design flow provided: gpdCalculated design flow: gpd
Description of Soils:
Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation:
DESCRIPTION OF REPAIRS OR ALTERATIONS: SEAL EXIST. 1000 GAL SEPTIC TANK PER 06/06/2014 INSPECTION
REPORT
The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions
of TITLE 5 and further agrees not to place in operation until a Certificate of Compliance has been issued by the Board of Health.
Inspections
Signed Date