Loading...
HomeMy WebLinkAboutSeptic As-Built Card Town of Yarmouth Subsurface Sewage Disposal System As-Built Information Street Address: 12 ..OrkLecifl Ra. Map: 33 Parcel: 10 1 Owner Name: �j� ►-�ci R $o —20--Z�� Permit Date installed: roots { ZG,'Zo New: Repair: / Installer Name: R 4 3 EXeo IJc- i O,/\ Installer Phone: ycil-OGS 3 Installation of(list all comporeM-newly Installed and existing to remain in use): Ekt5'DNG NEW QctsTIK1Cf Sc ic."I'oz x • Z - Lccm1„ 5 ZO Leach Capacity(gpd): Ground Water Depth(inches): Health Inspection by: tt R_L. 0272c.`2IJ As-built Diagram (Print Clearly in Black/Blue Ink.and Use Straight Edge) 1 O A 0 ©E- .. O Fror4 4111) FEB 2 8 2020 HEALTH DEPT. • A B C D E F G 1 $' tip' 2 12• II. 3 2.S. _ 4 30' 17• 5 6 .S1.\\. Commonwealth of Massachusetts -, ? Title 5 Official Inspection Form P Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 12 Dayton Road Property Address Kyle Hein , Owner Owner's Name information is South Yarmouth Ma 02664 2-26-2020 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑■ hand-sketch in the area below ❑ drawing attached separately Town of Yarmouth Subsurface Sewage Disposal System As-Built information Street Address: is ..._^ � Map._ Parcel.. Owner Name: t*L.c%1C i*-c.i rs Permit# C?- C 4 9 Date installed: cSR]o,.fit..( 2,4..-7c1 _ New: Repair: ,.,.--` installer Name: 13 4 B Lxc:,..vca.-I,®r,._ Installer Phone: '411-0653 Installation of(fist all components,both newly installed and existing to remain in use): 1^4 ttr. Tca.rNi,e.- ¶3'1c-1 . - '7 L...Cc4, 1. c);,-1 S } Leach Capacity(gpd): _ Ground Water Depth(inches): Health Inspection by: As-built Diagram (Print Clearly in Black/Blue Ink and Use Straight Edge) 0 A 0 Z I I 1 1 lS3 V.-1-c,(-t • K i I. A B 0 E .__ r- 1f( GF G _� — _ 2 i iZ• tr. 1.$' I 1.2 l I , __ „ _ j t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 16 of 18 - i 1 Town of Yarmouth Subsurface Sewage Disposal System As-Built Information Street Address: 12 S?rikr3orN R. Map: 33 Parcel: 10 j Owner Name Atc 1- city :o(+DC—20—2-9(497 Permit#: ZO- O q Date Installed: c..et oc: rC.( ZG Zo New: Repair: Installer Name: R .8 XCo vaA- O r • Installer Phone: y11-06S3 Installation of(list all compo etl wly installed and existing to remain in use): GX671NEW QClS11N� Gp,� ^ro"tai4-: M Box • 2. - Lcc h 5 T F42O 6. Leach Capacity(gpd): Ground•Water Depth pth(inches): Health Inspection by: ; ivt(Z.(... O212C,`2.C) As-built Diagram (Print Clearly in Black/Blue Ink and Use Straight Edge) I A O CJ NEW z Rua / •Q B Fro rc 11;) FEB 2 8 2020 HEALTH DEPT. • A BC D E F G 1 $ ' ib' 2 1Z' II' 3 2,S' 42' 4 ao' i-r