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HomeMy WebLinkAboutSeptic As-Built Card • • Commonwealth of Massachusetts Title 5 Official Inspection Form =+a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 7 Lily Pond Dr. Property Address LUDORF DOROTHY E TR Omer Owner's Name information is S.Yamouth MA 02664 3/1120 required tar every page. City/Twin 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 (*;4 f 0 A 1 c pi14114 aci tS ap.doc•rev.712612018 MrSandal inapectlenfonn:subswfaoe Sewage Deposal System•Page leaf 16