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KEEPING YOU ORGANIZED
No. 12534
2-153LOR
FUSTAI
ORESTRY MIN.RECYCLED
INITIATIVE CONTENTIO%19
Certified Fiber Sourcing POST-CONSUMER
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SFW12W
MADE IN USA
1',F_T ORGANIZED AT SMEADMU
_< TOWN OF BARNSTABLE +
LOCATION ® C) /()d 0 bM C i r SEWAGE # �
VILLAGE fie ASSESSOR'S MAP &LOT16
INSTALLER'S NAME&PHONE NO. � -ti �s �7 S �� 1 G,_1
SEPTIC TANK CAPACITY C= w 1 U O y--
LEACHING FACILITY: (type) a �, ..� -=-�.kc�— (size) 'Q
NO.OF BEDROOMS :3
BUILDER OR OWNER � �7
PERMITDATE:I I�� I C1 W COMPLIANCE DATE: 1 / G
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Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility M, u4v eet
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 leachin facility k � � Feet
Furnished by {�i
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LO PERMIT U O.
ILL-AGE
INST E �'A E E
5UILDE 5 Q b, D DRE SS
D-LTE PERKA T ISSUED
D ATE COMPLI W ACE ISSUED : 44 _,1— 71
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