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TOWN OF BARNSTABLE
LOCATION Ln /Q9' JV/W1 ft P—VC- SEWAGE # 9G—J'y
VILLAGE C.e? a V.��C, ASSESSOR'S MAP &LOTJfJ
INSTALLER'S NAME&PHONE NO. l ElC C 0044SM- (20 .
SEPTIC TANK CAPACITY I , S-0 O
LEACHING FACILITY: (type) (size) X-L
NO.OF BEDROOMS 3
BUILDER O� t
PERMITDATE: 1— COMPLIANCE DATE: iN n9l�
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility lye' 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) MI/ Feet
Furnished by
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