HomeMy WebLinkAboutSeptic As-Built Card Commonwealth of Massachusetts 0 i"L.J OKA L_L-
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t_r., Title 5 Official Inspection Form � Sg ;- i. 1...-=. ',
— Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
k,., - 12 Wadsworth Ln. - _ -
Property Address
Richard &Nancy Lamed
Owner Owner's Name
information is Yarmouthport Ma. 02675 3-9-23
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: L'al•—.;LsU V LgLJ
® hand-sketch in the area below APR 1 0 2023
❑ drawing attached separately
HEALTH DEPT
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t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18
Town of Yarmouth
�''Subsurface Sewage Disposal System As-Built Information
Street Address: l a WQaSt 5 G1l p Xprirotti4 Pack- iViap: 10 7— Parcel: /'
Owner Name: An e hrize) _Permit#: 0 —5115—
Date installed: /4'A®P3
New: Repair: V.
Installer Name: eg6! 13 i C6- Installer Phone: 96 r 7 8 7
installation of(list all components, both newly installed and existing to remain in use):
4/15/117 /000 1/07/ IC vZn/t -to Ct. Nem) 1000 botlongimp in r4-lust-147 bP-6.0X.
Agylitje. A04 fifl °L �a
Leach Capacity(gpd): 336 Ground Water Depth (inches):,,/4 Health Inspection by:,
I certify that this system has been installed in ac o an 8 with he p ovisions of 010 CMR 15.00 and all local
regulations. <
Inst er Signature
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JUN 1 5 2023
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