HomeMy WebLinkAboutSeptic As-Built Card Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
'.� 37 Standish Way
Property Address
Karen Richards
Owner Owner's Name
required fo is every
West Yarmouth
required for eve MA 02673 03-19-2020
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
0 drawing attached separately
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t5insp.doc•rev.7/26/2018
Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18