HomeMy WebLinkAboutSeptic As-Built Card Commonwealth of Massachusetts NVeDS
►� ` ►-p Title 5 Official Inspection Form X27
_ — p Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �V t'f�Uow 1
31A&31B Baxter Avenue Map 37 Parcel 14
Property Address
George Georgionis .
Owner Owner's Name
information is West Yarmouth Ma 02673 3/12/2020
required
page.
for every 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 b ilding.Check one of the boxes below:
ihand-sketch in the area below
0 drawing attached separately
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tbinsp.doc•rev.7/26/2018 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 16