HomeMy WebLinkAboutInspection Report Sketch I � � Commonwealth of Massachusetts
� Title 5 Official Inspection Form
SubauAace Sewage Dispoaal System Fortn-Not for Voluntary Assessments
72 White Cedar Road
PmpeAy Address
Kristaff 2012 Exempt Family Trust-Brett C. Kristoff, Trustee
Oxmar . py��'s Name . .
inrom,auon� yy�t Yartnouth MA 02675 December 20,2013
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D. System Information (cont.)
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 af the boxes bebw:
� hand-sketch in the area below
� drawing attached separately
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