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HomeMy WebLinkAboutSeptic As-Built Card Commonwealth of Massachusetts - =ip Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments k, ., li ki4 011(4490 Cl/ 4,,, Property Address gf CC /N / Owner Owner's Name //�� informationeis AreVa / /g/ /1/4- Od b,?J5' as a O required for every it , N page. City/ own ir State Zip Code Date of Inspe.'on 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 orbnchmarks. Locate all wells within 100 feet. Locate where public water supply enters the buildin heck one of the boxes below: and-sketch in the area below ❑ drawing attached separately eA-C A/ \Ix A-- a - i . IcD ) © � �, (000 ,1- e2,C_ r' (rn llo.f 67(6 .5410/1.. AC)----/o), gc-,zo,,c Qitw �� 11 / - i3 R`" f1-'``Yf0 dy, 02� ,O cow,- 1 t5insp.doc•rev.7/26/2018 Title 5 Baal Irspecaon Form.Subs.Yace Sewage Disposal System•Page 16 of 18