HomeMy WebLinkAboutSeptic As-Built Card c Commonwealth of Massachusetts
*='i, ,1 Title 5 Official Inspection Form
=-1— Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
1
29 Reflection Way
Property Address
Marcus Guerrero
Owner Owner's Name
information is South Yarmouth Ma 02664 3-18-2020
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:
❑■ hand-sketch in the area below
❑ drawing attached separately
No .Aro*'"Dc--tic.-83Z Bi-E5 Bi—E5E:;}CGI'1V7�1"1l100
FEE iss.00
ie-- COMMONWI ALTA Or MASSAC.IHUSETTS ctz-4- 413-
Board of re=alis+. YA1•M04.7ni. MA.
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission is h,,cula,granted in,, Construct( ) Repair( ) Upgrade( ) Abandon( ).an individual sewage disposal system
at fX r�J{�{-{{?t{'{rJt-y \/•,% �/j� as described in the application for
Disposal System Comstrucdon Permit No./44 -?Zp, dat:cti i-"' ,r'"v,•
Provided: Construction shall be completed n'Ylt'ffp •Z.-
,� +,, P rs oFt'the date of this pertna. t local Cu,.itiona must be met. (
. .4-74:ass wase A.M.soda ca.Ct a aeta Date •)---C7 C+ Board of Health C _ a��1".
a
NAP NO. qp
LOT NO. : .3A. ADDRESS. i
2.9 RvA-Ic.c.-1:on_ cJcic{
OWNERS NAME: aVF-.% ; li....„,ft
SEWAGE PERMIT NO. : /6-Zed NEW: REPAIR:
DATE ISSUED:Z.S-./L DATE INSTALLED: 2-24-1G"
INSTALLERS NAME: sC 4a egco,j,A;c.,a,.J
INSTALLATION OF:'Cm„t,,.K.. o.s- Zn4".:I4r -1or.S
WATER TABLE: FINAL INSPECTION BY:
DRAWING OF INSTALLATION ON REVERSE SIDE:
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t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 16 of 18
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