HomeMy WebLinkAboutSeptic As-Built Card Town of Yarmouth
Subsurface Sewage Disposal System As-Built Information
Street Address: 2, c1 .61-.-oc..K.E-r (2. 1 ) IVIapli/3 parcel: / C'
Owner Name: \--- 0(-3 t. Permit#: Gq17(--2 - 2-1-11
Date Installed: I - -.) . New: Repair: 1,----'
Installer Name: C(4-(3e-- (......' Seri L'',..... Installer Phone; ---/ -, - i 1!.
Installation of(list all components,both newly installed and existing to remain in use):
II:- 1- /12 c ef2 ' 3 , 5-c,c,, 1.-/ 2c PO( u-L•tAS
2 9 ' A i O. f A 2..‘
Leach Capacity(gpd):36 g(4:" Ground Water Depth(inches): '1/4-111 Health Inspection by:
I certify that this system t.as -en in tale in accordance with the provisions of 310 OAR 15.00 and all local
regulations. i"---4 i X
Installer Signature
As-built Diagram I
(Print Clearly in Black/Blue Ink and Use Straight Edge-Label Risers and Zabel Filter)
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. 11111 INIF JAN 1 7 2024
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HEALTH DEPT.
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