HomeMy WebLinkAboutMiscellaneous - 503 Dale Street N
503 DALE STREET •
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1I �.
Address P -5 0.4V-CE- _5-7-
Title of File
P.age _ of
Date f=ile Open:
--—_-___ Date file Closed:—
Doc
Document/Action Title Date of
action Refer to other Purpose of DocunlE coon and nates
Document/ document/
Num. --
Action De artment
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Board of Appeals — Board of—Health Planniing Board Cons
ervatiion Commission — Building Department
SEPTIC SYSTEM INSPECTION FORM
ADDRESS `
DATE INSPECTED ,
PROPERLY FUNCTIONING? N
WEATHER CONDITIONS
COMMENTS :
WATER QUALITY ?TES T E:n
DYE TEST PERFORMED? Y N
DATE?
SKETCH:
Please forward us as much of the following information that is possible;
1. Type of system � �� ✓����L
C�.Q
7
2 . Age / 57/L4,
190
3. Locat ian,& U
4- Maintenance records and date of last pumping out
7
� Documentation of repairs and reconstruction
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6. Site conditions
7. Builder of system
8. Engineer who approved,
— Site
— System
9. Installation Procedure -_
10, Problems
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