HomeMy WebLinkAboutSeptic As-Built Card Commonwealth of Massach I
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. .=--iilit.-7- -7___-:=F Title 5 Official Inspection Form
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Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
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information is SOI•ADCKS0(4 A �' 4 � LC 5 3required for every ��
page. City/Town State Zip Code Date of Ins ectio
D. System Information (cont.)
14. Sketch Of Sewage Dispose em:
Provide a view of the age disposal system, including ties to at least two permanent reference
landmarks or b marks. Locate all wells within 100 feet. Locate where public water supply enters
the build' . heck one of the boxes below:
❑ hand-sketch in the area below
E drawing attached separately
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t6insp.doc•rev.7/26/2018 Title 5 Offrpsi inspection Form:Subsurface Sewage Disposal System•Page 16 of 18