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KEEPING YOU ORGANIZED
No. 12134
2-153LGN
SUSTSTRY
AINABIE MIN.RECYCLED
FORE
INITIATIVE CONTENT 1096
Cordfad Fiber
Sourcing POST�CONSUMER
www4fipropram.orp
SFW12Pd
MADE IN USA
GET ORGANIZED AT SMEAD.COM
TOWN OF BARNSTABLE Dvrc_ Lf�Duf
LOCATION!>v 411&;n-A SEWAGE # /a-��`�
VILLAGE 0s er-i /c. ASSESSOR'S MAP & LOT
INSTALLER'S NAME & PHONE NO.
SEPTIC TANK CAPACITY J,50 ® 09-1��,
LEACHING FACILITY:(type) (size)
NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER
DATE PERMIT ISSUED: /'U
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes k No
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VJ 14 n B STABLE— 0
LOCATION SEWAGE #
VILLAGE ASSESSOR'S MAP&LOT
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY ryA''e
LEACHING FACILITY: (type) ? �lpG� Cef 5400la (size)
NO.OF BEDROOMS
BUILDER OR OWNER
Au Aid
PERMUDATE: 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 I to 'Cfa,cl R s
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