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TOWN OF BARNSTABLE
LOCATION O a SEWAGE# qS- 7�aZ
VILLAGE ASSESSORS MAP&LOT M3/8- P y�S
INSTALLER'S NAME&PHONE# Jacques N.Morin(508)775-8822
SEPTIC TANK CAPACITY 1 LEACHING FACILITY: (type) ,C� ;r/ c�p (size) 3 ?;t 50a gd_
NO.OF BEDROOMS
BUILDER OR OWNER /V dI Ifl KIA�
PERMIT DATE: ^ a8_ 95 COMPLIANCE DATE: 11J/</1u
y Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility ov Feet
Private Water Supply Well and Leaching Facility (If any well exists
on site or within Meet of leaching facility. Feet
.' Edge of Wetland and Leaching Facility (If any wetlands exist
within 300 feet of leaching facility. Feet
Furnished by Jacques N.Morin
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