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L.(�CATION d",T U17P �26,4 SEWAGE #
VILLAGE ASSESSOR'S MAP & LOT
NAME&PHONE NO. • `—a L° "� Du
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) (size)
NO. OF BEDROOMS
OWNER
PERMITDATE: InMPLIANCE .DATE: 3�a7�Ql�
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the 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
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# 24
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LOCATION +Low SEWAGE #L06 - 00.5
`�.,uI-AGE F,1VrrR1&1 ASSESSOR'S MAP & LO
INSTALLER'S NAME&PHONE NO. � ��ihSD 3W r
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) _- (size) ---�--
NO. OF BEDROOMS fx
BUILDER OR OWNER
PERMUDATE: I Z- -Z) �� COMPLIANCE DATE: �'- �1�
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the 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
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;I MOWN OF BARNSTABLE
LOCATIO S OUMD VIEW 10-'y SEWAGE # 24' ' 1V
VILLAGE On A ASSESSOR'S MAP LOT
INSTALLER'S NAME PHONE NO.
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type) (size)
NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER ,
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No
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VILLAGE .
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Dt's,TE PERNAIT 15SUED
DATE COKAPLI W-aCE ISSUED: 'l Y`"' '��
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