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/// S M E A D
KEEPING YOU ORGANIZED
No. 12534
2-153LOR
AE "" MIN.RECYCLED
INITIATIVE CONTENT1096
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MADE IN USA
GAT ORGMVEIAT SMEAn.Com
-/47",5 2 4-0*4 TOWN OF BARNSTABLE
LOCATION Fi RG .AeGl'lJ C.J SEWAGE # 2 3��
VILLAG ASSESSOR'S MAP &(�Ot
INSTALLER'S NAME&PHONE NO.�1 C�� qZ8;3 OR I— _
SEPTIC TANK CAPACITY 16®C_!UC
LEACHING FACILITY: (type) (size) /C �L
NO. OF BEDROOMS
BUILDER OR OWNER RA S / b _
PERMUDATE: Q .,C/ 7 COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table and 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 1 Ching facili ) ` / Feet
Furnished by � r�
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