HomeMy WebLinkAboutSeptic As-Built Card •
Town of Yarmouth
Subsurface Sewage Disposal System As-Built Information
Street Address: :?:.25� �/14 �� kre
Map: (;,2 Parcel: 3‘c-1
Owner Name: CCDW f\ Permit#: 0 VL=)'q`"/1-42,
Date Installed: 7 /6, New: Repair:
Installer Name: ( ru C. C ('•)(-1e C+I Installer Phone: 6-C j
Installation of(list all components,both newly installed and existing to remain in use):
A i✓LA) TI1.Q ;i-1-11a- ,i M ,s v Ta , H av �S av w Q
f wy>r (.41..ea.L, 144 t I-hti'o V c3 �1 'ar1o � 4.n� ,, 1,
t A be 1-,A,eel).
Leach Capacity(god): 6/41/4,1 Ground Water Depth(inches): Ai/A Health Inspection by:
I certify that this s stern •.s be ins . -d in accordance with the provisions of 310 CMR 15,00 and all local
regulations. /�
Installer Signature
As-built ' agram
(Print Clearly in Black/Blue Ink and Use Str•ight Edge-Label Risers and •abel Filter)
A
11-41111 -
I 1 I
• JUL 1 i2022
HEALTH 'DEPT.
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A B C D E F G
1 all 3 -
2 37
3 t/3' 6 33.5,.
4 l07 ' r 63'
5 y
6