HomeMy WebLinkAboutSeptic As-Built Card \ Commonwealth of Massachusetts
ii
Title 5 Official Inspection Form
Subsurface Sewa e Disposal System Form -No fo-Voluntary Assessments
-j a Milv1 � 2 `��GH 4-kr____________
ooe`y Aecress
: -:ve
ry _ �49., N 6`'fage. own =� __i ma's a`[n� 0
D. System information ;cart.;
t4. Sketch Of Sewage Disposai System:
Provide a view of the sewage cisbosal system, nciuc:ng ties to at;east two permanent-eferer:ce
landmarks or be^ hrnE-Ks. Locate all wells within: 100 feet. Locate where public water suppiy enters
the buildir. - L.reck one of the coxes below:
and-sce cb 'n the area oelcw
crawf-ic attached separately.
A•
g Acv
,.._
g
Gaiw
e'hV
pi
,r . -, -; -
l .. .�• �� - ram• r' Ci �j_ .
/ r x
cZi✓1//7lo�'S 64.�40v�
/14,1/ : 9� /b
1l )1366
la-016.4
"-3-- Yw, 9 IS- ��
insp.cc_-z..7: 2;,--.s
":e 3 J�'.c-a insoe:t=n-o.-.Soza.:ace S-ev2oe:-s?o5a-Sslec•..a-e 76 of 18