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SMEAD
KEEPING YOU ORGANIZED
No. 12134
2-153LGN
Owam MIN.RECYCIlD
INMATME CONTENT10%®
CortifiedRbarSoureinp pOST-CONSUMER
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SM12M
MADE IN USA
GET ORGANIZED AT SMEAD.CAM
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OWN OF BARNSTABLE
i LOCATI N ® SEWAGE # 'ZOO Q:`
�`'LLAGE
INSTALLER'S
SEPTIC TANK CAPACITY 6,0
LEACHING FACILITY: (type)` ITO 'A-)J dflfsize)
NO.OF BEDROOMS
BUILDER OR OWNS '
PERMITDATE: 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 _ 'I
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