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TOWN OF BARNSTABLE
LOCATION 20 6`}_0u <-R658Q R0 SEWAGE# 2020
VILLAGE CC_0�`RSLST OR'S MAP&PARCEL 1q q -0 2(.
INSTALLER'S NAME&PHONE NO. R AN M o vD 1 L)M 4S 0
SEPTIC TANK CAPACITY `.TOO
LEACHING FACILITY:(type) Soo 541 Lpg,p,,ft&j S (size) _ .�O O f�
NO.OF BEDROOMS 091>ROa!
OWNER
PERMIT DATE: COMPLIANCE DATE: 2�
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 oN,o
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