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S M E A D
KEEPING YOU ORGANIZED
No. 12134
2-153LGN
SUSTAINABLE FORESTRY MIN.RECYCLED
INITIATIVE CONTENT 10%
C.rtiBed Fiber Sourcing POST-CONSUMER®
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SFW 1290
MADE IN USA
GET ORGANIZED AT SMEAD.COM
TOWN OF BARNSTABLE
LOCATION'240 5W I lz� AVE SEWAGE #
VILLAGE ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) (size)
NO. OF BEDROOMS
BUILDER OR OWNER B YIZW C J-b 2-I &E Z MARTM SEM PO.S
PERMITDATE: 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 leaching facility) Feet
Furnished by
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B U I L D E R OR OWN ER
DATE PERMIT ISSUED
DAT E COMPLIANCE ISSUED �,� �
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