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� � Commonwealth of Massachuse#!s ���
� Title 5 Official Inspection For�n �"F�°��
Subsarface Se�rage Disporal System Fom�-Nat tvr Voluo#ary Assessments
8A�8B Ros�mary Ln West Yarmouffi MA
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+ N�cy L Johnson TR clo West Yarmouth Serie.s Fouf LLC PO Box 342
�� Owner Owners Name
�"�°rt"�tO�� HYANNIS AAA 02601 1i28J2016
cequired for every CitylTown Sia� ZiP Code Da��.Inspec�on
Pa9e-
D. Sys#em Information (cont.)
Sketch Of�rage Disposal System: Provide a view of the sewage disposal system, including ties to
at least tv�ro permanent refenence landrnarks or benc�tmarks_Locate a{i wells witftin 1 UO feet. Locate
' where publ�water supply etrters the buitding.Ct�edc one csf the boxes Eielow:
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� hand-�ketch ir�the area beiow
❑ drawing atlached separabe{y
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