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OFFICIAL L�!'SPECTION FORM—'�'OT Ff}R vOLUNTA,RY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(conrinued)
' Property Address: 149 MAIN STREET
' WEST YARMOUTH,MA 02673
Owner: LEWIS BAY RESORT
� Date of Inspection: MARCH 29,2004
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� SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or
� benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building.
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Title 5 Inspecaan Form 6�I5'^`+00 E
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