HomeMy WebLinkAboutSeptic As-Built Card Town of Yarmouth
Subsurface Sewage Disposal System As-Built Information
Street Address: 3 5 H s t N a_ AVC: Map:7 Cit, Parcel: .`Y
Owner Name: 1-431 5 SIZEIUG S NA- Permit#: /f-/22/6OWDC''13-322_
Date installed: 47 ` 3 - 2 t (9 New: Repair:_
S o£
Installer Name: r4PCt,.31:0E �3c�R i t ut'Z Installer Phone: q 1 Z- '2 7'7
Installation of(list all components, both newly installed and existing to remain in use):
SIv 5-r-c.t._ N tl,J 14- (v 'p-13 0Y- W OK)C..\/
Leach Capacity(gpd): Ground Water Depth (inches): Health Inspection by: i
As-built Diagram
(Print Clearly in Black/Blue Ink and Use Straight Edge-Label Risers and Zabel Filter)
A 6
o
0
C ■ 7-
3
JUN 0 5 2019
HEALTH DEPT.
A
41 , 111
2 y9•S ' 34.41'
3 1-1 7.1 3q `
4
5 ___
6
•
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
SYSTEM INFORMATION continued
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent references landmarks or benchmarks
locate all wells within 100 '
8/,k Ic
•
va
Avg/
DEPTH TO GROUNDWATER
depth to groundwater
method of determination of approximation:
}SAND -.3,F -fo /544 t rlrph,0-77/L /,r J0 ,
15 'To 14,177;,- (S'vt/R c . d°1:1)/n i �`,,� - 1-/3. 29