HomeMy WebLinkAboutSeptic As-Built Card, •
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Commonwealth of Massachusetts
= � Title 5 Official Inspection Form
a-,,,--_,- Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
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..4 49 Minnetuxet Way,Yarmouth Port, MA 02675
Property Address
Donald E Segal &Rise M Segal
Owner Owner's Name
information is Yarmouth Port
required for every MA 02675 03/06/2020
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:
hand-sketch in the area below
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