HomeMy WebLinkAboutInspection As-Built SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
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Property� r Address:1/9 9'a►f&er port y4.0.014j.(4 nt..
Owner: Lnwrenrr
Date of Inspection: sp.7.9 •7
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent references landmarks or benchmarks
locate all wells within 100'
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DEPTH TO GROUNDWATER Z1xcdi Ir M'e use.Nome uSedonly
Depth to groundwater: 3t feet wFQ. 3 moi►(h5 Ayer1�.
method of determination or approximation: i4114 A(4fR. 4o(L 9`sr 9Ibvnd U Pt4%' NOL*$ d.
Creviced 9/1S/95I 9