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SMEAD
No.2-1531LY
UDC 12934
smead.com • Made in USA
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SUSTAINABLE
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Certified Fiber QoumbW
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TOWN OF BARNSTABLEy Z
LOCATION 1l$S �• Rele 151- 6y9el-rlZ°Q,oP EWAGE #
VILLAGE C'IV AfI2111le ASSESSOR'S MAP & LOT 2LW-1 oo'e,j
INSTALLER'S NAME&PHONE NO.Af/OiW1
SEPTIC TANK CAPACITY
LEACHING FACILrrY: (type) (size)
NO.OF BEDROOMS //��
BUILDER OR OWNE 4,04I
PERMITDATE: 14.Z?J COMPLIANCE DATE: A _ l T- �fr
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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