HomeMy WebLinkAboutSeptic As-Built Card Town of Yarmouth 66X' (..-05t-CO 01Q
Subsurface Sewage Disposal System As-Built Information
Street Address: Lig PO Qi)ice) S ! , (1 IYre b Ac) Map: tali Parcel:
Owner Name:LA0 TZ.L K cn ee v t-v1 l 1 O D qv Ls Permit#: / j`IgI�D`1� �-i e-i-007)( 4-
Date
4-
Date Installed: 'I} New: Repair:
Installer Name: R.0J•-2T 1J = OUR, CO C C Installer Phone: ](:) - SD.'
Installation of(list all components, both newly installed and existing to remain in use):
(9) 5OO 5(0 ,0 CiAlk 41,108c--S (c5 x f a J
Leach Capacity(gpd): 33 C)Ground°Water Depth(inches):/l,VIO Health Inspection by:
-no ) 38 06700 6700
As-built Diagram
(Print Clearly in Black/Blue Ink and Use Straight Edge)
111
31, 3
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5H g>i
j
sUr Lig
A B C D E F G
1 53
2 RECEIVED
Li? r�
351i 41, t a' U92019
4 —�
5 HEALTH DEPT
6