HomeMy WebLinkAboutSeptic As-Built Card I®w 1 et Yirmoi tIh
Subsurface Sewage Disposal System As-Built information
Street Address: 42 POW,3O40 ` -_— Map: l3/-1 Parcel:N3 _
Owner Name: AV,I tel Jat ck VviAki �t (4 Permit#: 23- k
Date Installed: (21(ft11023 New: Repair:
Installer Name: i`O\04.,{1( ? Ou( Co. Installer Phone: 50 L(11 'B 1-1
Installation of(list all components, both newly installed and enisting to remain in use):
Usac e,�ttlfiw1 f two aU i -6Akr, -tb vt/AA\ -2o 1)165 citsfr.bvhevt. box AiArc-c. N-20
500 q(�.l�l.Jwt Cl'litmbcl� (�i-1� S-oric. eer ?keg%
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Leach Capacity(gpd): 455,'L Ground Water Depth(inches):_ Mon 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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