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TOWN OF BARNSTABLE
LOCATION �99Jj 6 17CL .-7r�� SEWAGE #
VILLAGE
vXl�/1?l-S ASSESSOR'S MAP &LOT.?,e 7-X��
INSTALLER'S NAME&PHONE NO. �er Trd
SEPTIC TANK CAPACITY VZ 10// m1 reeg 6e; -re-919 6 -"
LEACHING FACILITY: (type);/..1',!/w S�aw&�P' (size) CC ,41Vsk7ez✓
NO.OF BEDROOMS
BUILDER(?R..O-*-ER R e.fA10066e$
PERMITDATE: l Il- COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility /Vl4 Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) /UJQ Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet� leaching facili ) iUJ9 Feet
Furnished by�-.�A l�� f" DW ,.
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