HomeMy WebLinkAboutSeptic As-Built Card Commonwealth of Massachusetts
} t Title 5 Official Inspection Form
w
411`- a Subsurface Sewage Disposal System Form-Not for Voluntary'61,— 244 Wood Road
Property Address
Cynthia Phippen
Owner Owner's Name
information is
required for every South Yarmouth Ma 02664 3/6/2020
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
PSI ZS A
61 .2'D'�
ill_ 3°'6
(3Z [ b � O \
A3 36 Z
B3 /s'6
Alf 3z 0 C1 3
6y z7 `I
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18