HomeMy WebLinkAbout1030 PUTNAM AVENUE - Health (2) r
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LOCATION /® d ctT fl /cl SEWAGE #
VILLAGE _ASSESSOR'S MAPP& LOT M�
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INSTALLER'S NAME&PHONE NO. -5 FPHFiy ��d O I dU/� 150
SEPTIC TANK CAPACITY Z5220 STr
LEACHING FACILITY: (type) /YF/Ci4�oeS (size)
NO.OF BEDROOMS
BUILDER OR OWNER 4fd'r'--1r,111 A,4ezz,
PERMTTDATE: COMPLIANCE DATE: v '02« e9 Z
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Ak ej e- Feet
Private Water Supply Well and Leaching Facility (If any wells exist yy,�
on site or within 200 feet of leaching facility) /'/0 Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet_
Furnished by lrfld 6�ll,' — ,S''.�PIlyplt! A40 T�C4 l/
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