HomeMy WebLinkAboutSeptic As-Built Card ,
Commonwealth of Massachusetts
''. 7-7.1z = Title 5 Official Inspection Form
SII,- Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
' •: 84 Route 6A
Property Address
Benton Bodamer Mailing address, 2108 East Broad Street, Bexley OH 43209
Owner Owner's Name
infonnation is
required for every Yarmouthport, MA 02675 3-14-2020
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:
0 hand-sketch in the area below
® drawing attached separately
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