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TOWN OF BARNSTABLE
LOCATION_ (� SEWAGE#
VILLAGE ASSESSOR'S MAP&PARCELa7a C70.2-007 7
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY
LEACHING FACILITY.(type) (size)
NO.OF BEDROOMS �* FWER
OWNER'
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 200 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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