Septic As-Built Card 404 Mk-th
Town of Yarmouth 0a l y
Subsurface Sewage Disposal System As-Built Information !l
Street Address: 63 terwit r faccIRCC Map: 1 Parcel: 4
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Owner Name: DP/4.5 Z`1i✓l�. 5r. Permit#: ] -
Date Installed: J0j241-//5 New: Repair: t
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Installer Name: � lM1•'r �-(.L Installer Phone: SS6,3
Installation of(list all components, both newly installed and existing to remain in use):
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Leach Capacity(gpd): 3.5-0•t Ground'UVater Depth(inches): LW Health Inspection by:
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As-built Diagram
(Print Clearly in Black/Blue Ink and Use Straight Edge)
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3 28,t s• 24,31'
2 12•4x' 25'7"
3 25*3r
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