Loading...
HomeMy WebLinkAboutSeptic As-Built Card I Commonwealth of Massachusetts k ,_,p Title 5 Official Inspection Form pSubsurface Sewage Disposal System Form -Not for Voluntary Assessments 111 North Main St. Property Address Amy Adamaitis and Shawn Gartner Owner Owner's Name information is S. Yarmouth, Ma 02664 4/4/2024 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 LgecJ k- '641 t f 1 1 1 l c 0 0 • jei_ . - t I - 1 $7 _ (di�ni9 ( k" yvc� A B 1 ii 7-g -1,?-6- . • 2 _,'3_0 3 6-7- 3 I( 3g 36--8 4 Cf 7_1( .."y75 5. 6 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18