HomeMy WebLinkAboutSeptic As-Built Card o;WM11u sue 11 ea r rraUMISru
Subsurface Sewage Disposal System As-Bullt information
Street Address: 5g VLl I L-�f .j 2A Map: Parcel;
Owner Name: J® ) ?Et—t NI Permit 14-,per, -73- zdi
Date Installed: ( (3 0 23 New: Repair: v'
Installer Name; R- r (-3) • Dcke. C0 . installer Phonca( S')'417'7- S877
Installation of(list all components, both newly installed and existing to remain in use): -
_HI 0 Z, c eArn Port.-- 't'vt r=-r 1 oo Sci, • -rpri.•J /Puw►P° C--14- --n7.6€
1420 1)Z —4- _ 3 i-�Z� L.0 +el"�
Leach Capacity(gpd): 22.0 Ground Water Depth(inches): Health Inspection by;, &-
As-built Diagram
(Print Clearly in Black/Blue ink and Use Straight Edge Label Risers and Zabel Filter)
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jettr A JUL 0 6 2023
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` - HEALTH DEPT.
A B C b E F G
1 11.5 19
2 13 •L' 15
a 1te 13
4 1a _ 3(.6
5 _16. 8 31. 1
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