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�j TOWN OF BARNSTABLE '
LOCATION /"t�� O� SEWAGE #
VILLAGE /C!/Jlll r P1// ASSESSOR'S MAP & LOT a 44
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..Ns Is
NAME&PHONE NO. 20, 4; 0s ul ��
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) &SS422A ��� (size) u 5-
NO.OF BEDROOMS
BUILDER OWNER ) d
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 fact ity)/ /`� Feet
Furnished by &Y �Di[�OriS��GcGi`On, Zhe. i f S'�
A.)T-
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