Septic As-Built Card Town LSf Yarmouth
Subsurface Sewage Disposal System As-Built Information
Street Address:_# I . ,:._.0.t re. EA) Map: I IS_.Parcel: 17_
Owner Name: _e7 (� Permit#tf ' Z2' 8511
Date Installed: (,Q ) 4 ZZ New: Repair:
Installer Name: ��r-LCD . Installer Phone()* )477- x877
Installation of(list all components, both newly installed and existing to remain in use):
_alp 1500 s`&i. TSI , tA Z0Ll 3 -- -
(Z H70 500 T11. -S
Leach Capacity(gpd): ZZO Ground Water Depth (inches): Health Inspection by: _ 417"
As-built Diagram )
(Print Clearly in Black/Blue Ink and Use Straight Edge-Label Risers and Zabel Filter)
(-4+4 E 2 4ou.s C JJ
1r
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RECEIVED
3 JUIN 02 2o12
HEALTH DEPT
A B C D E F G
1 I1.9 13.3
2 14. .4 21. 2-
3 25.5 24.3
_ — 4 3Z•'l - Z41•3 –
5 3s. 7 24
cies/ • 24 ii. I
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cfo `t2, Z /•8
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