Septic As-Built Card Town of Yarmouth
Subsurface Sewage Disposa.System As-Built Information
Street Address: L.04'. C K )11. S "e i ‘./.\;•--, Map: -:-.-›l 3 Parcel:
Owner Name: \---4‘,:___..D \ c\ \.1.2..3- J.- .‘,3-- Permit#:
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Date Installed: '1, .-_'_. _....) ) c New: Repair 1 .
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Installer Name: kt---,„ ,. .-.-*. ---,^^`-7-----/---- ,<-c...-A_ )257; , installer Phone:s•-z:Y?'-•M-60,53
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Installation of(list all components, both newly installed and existing to remain in use):
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Leach Capacity(gpd):3 S Ground Water Depth(inches): 7-1' .. Health Inspection by:-7\-1 ---.01, r' R- P-
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As-buift Diagram
(Print Clearly in Black/Blue Ink and U?Straight Edge)
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RECEIVED —
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APR 01 2022
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