HomeMy WebLinkAbout0019 CAPTAIN BAKER ROAD - Health (2) NOW
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LOCATION Z C-Pe6xi0l, 6861- Q-0182 SEWAGE #
VILLAGE ('1 A a5i7JS M;115 ASSESSOR'S MAP & LOT`9G1,03L
INSTALLER'S NAME&PHONE NO. t l,%®h) SAIL 772-2-7 2(-
SEPTIC TANK CAPACITY i 000 GJA L S --
LEACHING FACILITY: (type) (a 4Q1 2 r 5 � (size) f 6bb
NO.OF BEDROOMS ?i
R OR OWNER 27--r,OMGJP22� =.5
PERMIT DATE: I bc _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 leachJng facility) Feet
Furnished by 2!? -✓"6/V
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