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Septic As-Built Card
Town of Yarmouth /� Subsurface Sewage Disposal System As-Built Information Street Address: LV? S T a r L.l ri« c; h -� 1 /r 1'141 L y Map:!I -S Parcel:" P' Owner Name: r Permit#: - / .S it Date Installed: 3 New: Repair: Installer Name: 1-(75-.. /I it ref 714 KS Co el s it Installer Phone:5 0 3- 3 6.;,1' Com 3, Installation of(list all components,both newly installed and existing to remain in use): Xi 5 TiA16- /o 611 - Tic- 7✓i,t:' hti CAP aN - 13OX 14 " !© rL c'k_ 66 X 1'Z1 s,=-, Lc'.Rcl-1 C 5'rhr.c5 nycL:17 Leach Capacity(gpd):---- Ground Water Depth (inches): I �`t y Health Inspection by:i&-) ( C� �� fr int S Zc-) EA e1L-- 3f As-built Diagram (Print Clearly in Black/Blue Ink and Use Straight Edge—Label Risers and Zabel Filter) STA-n.f3,}ck< ten/ _ dl o MAN 23 LULL HEALTH DEPT. • A B C D E F G 1 (a.` 2 . 417 ' 3 37H A•3 4 3�.(# ] 1 ' 5 6