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TOWN OF BARNSTABLE
LOCATION So j`�j� 7R r� SEWAGE# 2= 1 39-,--'VILLAGE Ot,J �. q- ASSESSOR'S MAP&PARCEL
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY J C-00
LEACHING FACILITY. (type) 5 Ct!�,aM)cK_S Jsize) A;8)C I
NO.OF BEDROOMS
OWNER_-- r
PERMIT DATE: COMPLIANCE DATE: 2
. Separation Distance Between the: NO 61u)
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Fr_-r0Jr1W(j0----� Feet
Private Water Supply Well.and Leaching Facility(If any wells,exist on
site or within 200 feet of leaching facility) r. Feet
Edge of Wetland and Leaching Facility(If any wetlands exist within
300 feet of leaching facility) Feet
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