Septic As-built Card Subsurface Sewage Disposal System As-Built Information
Street Address: igg C'apAyaf Scrw..,ll Rc Map:11 Parcel:
Owner Name: U.);11,c ii GhcS-i ry j4. Permit#: e)e,- 2-0
Date Installed: f0- I(,-2o03
New: Repair:
Installer Name: 3 i A EXC oc�.4i 01\ Installer Phone: 4' - 04,5 3
Installation of(list all components, both newly installed and existing to remain in use):
/000 cel s-r- P70..D Box - y 14 zo i-l;csk CQP.End'',' I
Leach Capacity(gpd): 3S I Ground Water Depth (inches): Health Inspection by:
As-built Diagram
(Print Clearly in Black/Blue Ink and Use Straight Edge)
1.111-0- 111.1 7-01\411-11
rnfIx
b` fi"ct- ec
A �3
OC1 1 Y ZU?U
HEALTH DEPT.
A g C D E F G
1 30 -32 it
2 33 ' 3S '
3 Vg/3 52,2„
4 3S'4 " (47. '1,0"
5
6