HomeMy WebLinkAbout1575 IYANNOUGH ROAD - Health 515 &Te 13��� allnd��h b0
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LOCATIO —]
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VILLA (�nWO/C ASS S 'S &PARCEL �.5 lG1 (3 !R
IN T�A�LLE 'jN33AM PHONE NO,f,'
SEPTIL�TA CAPA T vilail.
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LEACHING FACILIT (type) (si
-NO.OF BE ROPMS
OWNER L I V 10, TFI/id—
PERMIT DATE: lJ 22 '/ COMPLIANCE DATE: C II 3 h 9-
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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LCi:: N7S R� SEWAGE # _
VILLAGE ASSESSOR'S MAP & LOT —0�'�00
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY -loop
LEACHING FACILITY: (type) (size) /000 , c
NO.OF BEDROOMS
BUILDER OR OWNER_ 2 ►nC 0 O v)0Ug A)
PERMITDATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility 41&, Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) g80 Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by
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