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TOWN OF BARNSTABLE
LOCATION 7 114 Cam— S-P SEWAGE #
VILLAGE S "` ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE NO. _
SEPTIC TANK CAPACITY 07a, Ir
LEACHING FACILITY: (type) �B c'G� P' (size)
NO.OF BEDROOMS
BUILDER OR OWNER G�- S
PERMITDATE: COMPLIANCE DATE:
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 60N f,&a�u^a^'� Z ^2 G —01 7
17/
p 35
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' � ,�c C K ._ •2 n� �c.Ov'Z i I
' /,9,q L5�V
LO•CAT ION SEWAGE PERMIT NO.
24, rr'�+Jig) 12) o�prc=-
VILLAGE
a
INSTALLER'S NAME It ADDRESS
BUILDER OR OWNER
DATE PERMIT ISSUED
DAT E COMPLIANCE ISSUED ��.
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