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Subsurface Sewage Disposal System As-Built Information
Ci Street Address: 19 TE [6.-/ LA Map: Parcel;
Owner Name:_EVE L'J Q�, L Permit# ONDC - Z3 -3<4 40
Date Installed: 1 New: Repair: ✓ ,
Installer Name: (2_06C- Vc--'-I— • OCAQ_ CO • installer Phone;608) 4/7'6B77
Installation of(list all components, both newly installed and existing to remain in use):
1JEGJ ; 1410 I SOO J. `T,-.-/i< r }/Zd 7j,133
(2) 1O 5b 0 cal• CHA-, B��.5
Leach Capacity(glad); 27 e3 Ground Water Depth (inches); health Inspection by:ILEZ�/r✓�
As-built Diagram
(Print Clearly in Black/Blue Ink and Use Straight Edge-Label Risers and ZabelFilter)
No
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if
A
dt
JUN 2 0 2023 2.
HEALTH DEPT. Mill
1.211 •
E LI ev- .
A l C CD E F
15.2 44(0
2 ZI. 3 11.3 -
3 zl. 1 45.
4 Z5. S 19.3
5 z5 3/.1
6