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F" MEAD
No.2.153LY
UPC 12934
smead.com • Made In USA
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INITIATIVE
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TOWN OF BARNSTABLE
LOCATION ��(� (�}-�aa Q `cti SEWAGE#
VILLAGE ( #n fer dt I t ASSESSOR'S MAP&PARCEL J 29 //F
INSTALLERS NAME&PHONE NO. C' ritr! vt y2$ y0 2 P
SEPTIC TANK CAPACITY ISo U I'f 10
LEACHING FACILITY.(type) i U Qu,,cLc Y (size) 3Y
NO.OF BEDROOMS 3
OWNER LindA A/dr-A]Ap
PERMIT DATE: 2P7,L 2.®0$ 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 c40� f�c �u �i�S e} (,�,c
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