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KEEPING YOU ORGANIZED
No. 12534
2-153LOR
SUSTAINABLE FORESTRY
MIN.RECYCLED
INITIATIVE CONTENT10%
CertifiedFihersourcing POST-CONSUMER
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wwwsfipmgmnLorg
SFl-01290
MADE IN USA
GET ORGANIZED AT SMEAD,COM
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TOWN OF BARNSTABLE
LOCATION IZ- 4,k/,�L/S (AII&I SEWAGE#
VILLAGE ASSESSOR'S MAP&PARCEL ZV
INSTALLERS NAME&PHONE NO.
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type) (size) J /17fU 9G llwl
NO.OF BEDROOMS
OWNER I�r1�L s I��hZ�v4�2 IZJ
PERMIT DATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility(If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
FURNISHED BY
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