HomeMy WebLinkAboutInspection Sketch Showing Line to be Replaced Commonwealth of Massachusetts
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. �, Title 5 Official Inspection Form
- Subsurface Sewage Disposal System Form-Not for Vokertary Assessments
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39 Crosby Rd.Extension
Property Address
Harvey B.Smith
Owner Owner's Name
information is
rogokoo for woof Yarmouth Ma. 02664 November 10,2014
paw. City/Town State rip Code Date of Inspection
D. System Information (cont.)
Sketch Of Sewage Disposal System:Provide a view of the sewage disposal system,induding ties to
at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet Locate
where public water supply enters the building.Check one of the boxes below:
® hand-sketch in the area below
0 drawing attached separately
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