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0165 GREEN DUNES DRIVE - Health
jb5 &reen C.e (o-e v i l I-e, kJ5-- or3 - 001 S M E A D KEEPING YOU ORGANIZED No. 12534 2-153LOR 0SMANIM R5 MIN.RECYCLED INITIATIVE CO, ENTIO°!° CartifiedRberSourcing POST-CONSUMER xnvwsfipropranxwp Sfi012S0 MADE W USA CET©RGANW AT SMEAR= TOWN OF BARNSTABLE LOCA'iION /06 U6C DC,Irc SEWAGE # VILLAGE� ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO. OF BEDROOMS BUILDER OR OWNER h25 fie'aI n PERMITDATE: 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 ki ,pie`t° Mr-,- k44 6 leGcD piJ— sJ