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HomeMy WebLinkAboutSeptic As-Built Card , . c Commonwealth of Massachusetts °h=* ,0 Title 5 Official Inspection Form _= = ra Subsurface Sewage Disposal System Form - Not for Voluntary Assessments -E 6 Roads End Property Address I Dini Vigliano Owner Owner's Name information is S. Yarmouth MA 02664 3-6-2020 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view 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. Check one of the boxes below: D--- ce51po© i ® hand-sketch in the area below , fw;{14 50r ❑ drawing attached separately 3--‘-'?,0 1,0 FROt)T 111 i II A 11 21 �� //k ry k X'' 1 1 ,r I AB 1 1 l - 2 i31- 2 1 3 N• 2 23- , 3 - to1 yU 3 5:- . 6'S- 2__ ' 4 I 63- 2 (56- 10 J i I I t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 L Dr I mill'Col 4iRootlas.mvip LOT NO. _____ADDRESS. ti OWNERS NAME: \��� W-wr SEWAGE PERMIT NO. :S7-gr NEW: REPAIR: DATE ISSUED: '53- 77 DATE INSTALLED: q-)_7 INSTALLERS NAME: r r. r INSTALLATION OF: ( SCD `t c ca.((�ys 4-' ( WATER TABLE: FINAL INSPECTION BY: DRAWING OF INSTALLATION ON REVERSE SIDE: ��� 5006n SOTtC tRN� 47/ Gqi DIsTe L' 1 f O t (4) 4l'afiu.015 F12� Wf 3L'oC�1Z SID a - (go