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TOWN OF BARNSTABLE
LOCATION SS Q►cca►.sa�n� garR AvF SEWAGE# 7019 o Z!C.
'VILLAGE ASSESSOR'SMMAP&PARCEL 7-49-04Z100Z
INSTALLER'S NAME&PHONE NO. L3 E X cQUaA i o n t4 n0. OL S3
SEPTIC TANK CAPACITY f S00 90-d
LEACHING FACILITY:(type) sue) L�� 'Z� " (size) 13x ZSx Z
NO.OF BEDROOMS
OWNER CX i //
PERMIT DATE: G-11.19 COMPLIANCE DATE: to
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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ASSESSOR'S MAP NO. 1 PARCEL i q 7 _
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L0CAT1O075 SEWAGE PERMIT NO.
14, PL E,4 s,4,or p.4t a A✓c Lar zA PG = 3 A �L
(2,fVILLAGE
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I4INSTA LLER'S NAME i ADDRESS
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�R UILDE R OR OWNER
DATE PERMIT ISSUED l
DAT M PL I A N 1 SUED
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