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S M E,A D
KEEPING YOU ORGANIZED
No. 12534
2-153LOR
SUSTAINABLE MIN.RECYCLED
FORESTRY MIN.CONTENT104
CertifiedFibarSourcioo POST-CONSUMER
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SF INO
MADE IN USA
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TOWN OF BARNSTABLE
LOCATION 3'� ?_-,aeun SEWAGE# 20*61 �13y
VILLAGE Cen f1CA LA ��A ASSESSOR'S MAP&PARCEL o?U') _ 4 V
INSTALLERS NAME&PHONE NO. %]AA 4 A
SEPTIC TANK CAPACITY UnU 9c( k4 I b
LEACHING FACILITY:(type) q i u (size) 3 '6 S(j
NO.OF BEDROOMS
OWNER ' �L2�
PERMIT DATE:. ct -Z. - Z,nl COMPLIANCE DATE: �(�2 20,3
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Nv f t 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 C4A2�J; G vti t-r p f,s-) L L G
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