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No.:BOHDC-14-0738
` Commonwealth of Massachusetts F�
E55.00
Board of Health, Yarmouth, MA
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERNIIT
Application for a Permit to:Repair-minor-Individual Component(s)
Location: 8 WAGTAIL LN,WEST YARMOUTH, MA 02673 Owner:
Map/Parcel#: 076.125 HAUSER DORIS
HAiJSER HERBERT D
8 WAGTAIL LN
Phone:
Septic System Installer Designer
BEFORE SUNSET LLC
P.O. BOX 1466 HARWICH, MA 02645
Phone:
Type of Building:Dwelling Lo[Size:0.23 Acres
Dwelling-No.of Bedrooms: Garbage Grinder:
Other Type otBuilding: No.of persons: Showers:
Other Fixtures:
Plan Dah: Number of Sheets: Cafeteria:
Title: Revision Date:
Design Flow(min.required): gpd Calculated design flow: gpd Design flow provided: gpd
DescripHon of Soils:
Soil Evaluator Form No.: Name of Soil Evaluator: Date of Evaluation:
DESCRIPTION OF REPAIRS OR ALTERATIONS:REPAIR MINOR•REPLACE DBOX,TANK OUTLET TEE,AND BACKFILL
FAILED LEACH PIT PER INSPECTION REPORT DATED 11/12/2014
The undersigned agrees to install the above tlescribed Individual Sewage Diaposal System in aeeordanee withlhe provisions of
TITLE 5 and further aarees not to olate in ooerafion until a Certifitate of Comoliante has heen isaued hvlhe Hosrtl of Neakh.
Signed Date
Inspections
- Commonwealth of Massachusetts
Board of Health, Yarmouth, MA F�
DISPOSAL SYSTEM CONSTRUCTION PERMIT sss.00
Permission is herby granted to;
BEFORE SUNSET LLC, P.O. BOX 1466, HARWICH, MA 02645
To perform:Repair-minor an individual sewage disposal system.
Owner: HAUSER DORIS
HAUSER HERBERT D
�. 8 WAGTAIL LN
WEST YARMOUTH,MA 02673
Location:8 WAGTAIL LN, WEST YARMOUTH,MA 02673
Disposal System Construcrion Permit No.: BOHDC-140738,Dated: December 18,2014
. Provided:Construction shall be completed wi[hin six months of the da[e of this permit. All local conditions must be me[.
Cooditions
I 1. REPAIR MINOR-REPLACE DBOX, TANK OUTLET TEE,AND BACKFILL FAILED LEACH PIT
j PER INSPECTIONREPORT DATED 11/12/2014
��
Bruce G. iph , MP , R.S., CHO/Amy L.von Hone, R.S., CHO
.. Health Director/Assistant Health Director
The issuance of this permit shall not be construed as a guarantee that the system will function as designed.
I