HomeMy WebLinkAbout0114 VICTORIA STREET - Health (2) ley Jut I'CA
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LOCATION 4r Q�JQ Y a . SEWAGE#• " 00
VILLAGE k ASSESSOR'S MAP&t1PjARCEL
INSTALLER'S NAME&PHONE NO. d E YOp p - 1
SEPTIC TANK CAPACITY -/a
LEACHING FACILITY:(type) 41 !e, (size) 0
NO.OF BEDR O S
OWNER �Qcdaler
PERMIT DATE: 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
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