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TOWN OF BARNSTABLE
LOCATION 79 SEWAGE#
VILLAGE _ ASSESSOR'S MAP&PARCELg 6U�n
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY '
LEACHING FACILITY.(type) (size)
NO.OF BEDROOMS
OWNER
V W
PERMIT DATE: 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 NO feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist within
300 feet of leaching facility) Feet
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