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KEEPING YOU ORGANIZED
No. 12534
2-153LOR
OFORESTRr" MIN.RECYCLED
INITIATIVE CONTENT 10
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MADE W USA
CST ORGANIZED AT SSAEA IZU
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TOWN OF BARNSTABLE
LOCATION e-t -_�7 tkt SEWAGE# . CI®(B -CF!Z ""
VILLAGE '�� ' r ASSESSOR'S MAP&PARCEL IV56-FA
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY L
LEACHING FACILITY:(type) (size) j 3 x_/4!X
NO.OF BEDROOMS - - c0 k-A Le-
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OWNER 1 L.
PERMIT DATE: J-30—16 COMPLIANCE DATE: 3 1 h
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility f`j Feet
Private Water Supply Well and Leaching Facility(If any wells exist on
site or within 200 feet of leaching facility) k— Feet
Edge of Wetland and Leaching Facility(If any wetlands exist within
300 feet of leaching facility) /G® Feet
FURNISHED BY ��caisJ ! t�JQ' ri1t,°�r�•-iy i
NHq 3�
r TOWN OF BARNSTABLE
LOCATION 30 ,k-1 La SEWAGE#
VILLAGE C&41r7_L1Z_LAi t e c_-ASSESSOR'S MAP&PARCEL y f_/, - $4
INSTALLER'S NAME&PHONE NO. AE'•6• ( - a1-�—
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type) �I (size)
NO.OF BEDROOMS f 1 t.1 t LTt2 ►'"�P—�
OWNER LA p-t�I n C
PERMIT DATE: 4 1=�n- I( ' COMPLIANCE DATE:
Separation Distance Befween 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) t o3 Feet
FURNISHED BY Z2 w
Y16
LOCATION ` AGE PERMIT NO.
VILLAGE
i I N S T A LLER S NAME i ADDRESS
Job IF ga/t
BUILDER OR OWNER
9-
DATE PERMITISSUED
DAT E COMPLIANCE ISSUED , _ �l-a�"/
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