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Commonwealth of Massachusetts &XX "i1 1
_' -O, Title 5 Official Inspection Form
_.= - Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
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4—,. 73 Willow St.
Property Address
David &Margarite Ganshaw
Owner Owner's Name
information red fo is Yarmouth port Ma. 02675 10-1-20
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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:
® hand-sketch in the area below
❑ drawing attached separately
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t5insp.doc•rev.7/26/2018 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18