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SMEAD
No.2453LY
UPC 12934
smead.com • Made in USA
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TOWN OF BARNSTABLE
LOCATION 3D C reS+y .e,0 G i t%c_\�' SEWAGE#
VILLAGEr� ASSESSOR'S MAP&PARCEL;Z
INSTALLERS NAME&PHONE NO. Z-S %r-f( o I I
SEPTIC TANK CAPACITY DO 6A),,
LEACHING FACILITY:(type) f1�ht..,4 CA Ayyiyi a (size) 1 X Z
NO. OF BEDROOMS .
OWNER A",
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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