HomeMy WebLinkAbout0078 THIRD AVENUE (HYANNIS) - Health 78 Third Avenue
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TOWN OF BARNSTABLE
LOCATION �® yye49'?ISEWAGE#d 040'—
VILLAGE 'J/JAG OOZ--- ASSESSOR'S MAP&PARCEL
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY,12`0�1e' 16-0® 6r4 Z
LEACHING FACILITY: e ®' ' (size)
NO. OF BEDROOMS
OWNER
PERMIT DATE: �� �����` COMPLIANCE DATE:
Separation Distance Between the: a
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
FURNISHED BY
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No. d `? Fee j�JU
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer•
Yes
PUBLIC .HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
Zipplitation for his sa' 6pstem (Construction permit
Application for a Permit to Construct( ) Repair. Upgrade( ) Abandon( ) L; mplete System ❑Individual Components
Location Address or Lot No.,>& Owner's Name,Address,and Tel.No.
Assessor's Map/Parcel
Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No.
Type of Building:
Dwelling No.of Bedrooms ` Lot Size sq.ft. Garbage Grinder( )
Other Type of Building j!:;t G° �- No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) S-® gpd Design flow provided gpd
Plan Date %� J —�� Number of sheets J Revision Date
Title
Size of Septic Tank d✓�"d� S�® �"d 1 Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of h. ,+
Signe Date ,� //a g�
'Application Approved by iA Date / 7
Application Disapproved by Date
for the following reasons
Permit No. 0 I Date Issued (l
No. a .a Fee tl}U
Entered in computer
THE COMMONWE, LTH OF MASSACHUSETTS Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
0�pYicatiou for his oral *pstem Construction Permit
Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) PC/,mplete System ❑Individual Components
Location Address or Lot No.,>,& �y�v ode' Owner's Name,Address,and Tel.
/No.
Assessor's Map/Parcel a-1 s/o!�' — � q yQ�ia� z:�P,4,A-e
Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No.
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building ,p_ No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) gpd Design flow provided gpd
Plan Date J J / , —/Si Number of sheets / Revision Date s
Title +
y Size of Septic Tank -*A-cs`Ly /So a 6:W 1, Type of S.A.S. of'G aze,7w` G
Description of Soil
t`s
Nature of Repairs or Alterations(Answer when applicable)
e.
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title-5-of the Environmental Code and not to place the system in operation until a Certificate of
' Compliance has been issued by this Board of th.
Signe Date
Application Approved by / , � Date I 1 — / 7-
Application Disapproved by Date
for the following reasons
Permit No. CG Date Issued
TIi E COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( Repaired( ) Upgraded
Abandoned( )by ,;r!
at 0' e&OV OPA47_ has been consttrllucteerd in accordance
i-o with the provisions of Title 5 and the for Disposal System Construction Permit No. (� Y! / dated 71/ 7
Installer (7' ,�W e kM,4-`G,oK_ Designer 4eapl o 6, -;I,4 -Pe—P
#bedrooms f- Approved design .ow �y gpd
The issuance of this ermit s '11 not be construed as a guarantee that the system wion,as esidjl
gned.
Date / Inspector /i�i/ s9 "/70
-----No.-------(-------------- ---------------------------------------------------------- --------=--- - Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION —BARNSTABLE,MASSACHUSETTS
]Disposal 6pstem Construction Permit
Permission is hereby granted to Construct( &I" Repair( ) Upgrade( �ll Abandon( )
System located at > CP �i��/�c a� ,/Gr- J/�IPl/'Z
and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with
Title 5 and the following local provisions or special conditions.
Provided:Construction must be com leted within three years of the date of this permit.
Date /4 — l �) I Approved by
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Town of Barnstable P#
'. Department of Regulatory Services
M Public Health Division A"IDate
e�;� ♦ 200 Main Street,Hyannis MA 02601
rEn A IJ
Date Scheduled_ b V;r Time Fee pd.
Soil Suitability �D.sse meat fog- 5' e Di
Performed By: Witnessed By:
]LOC TIOhT& GE INFORMATION
Location Address -' �/1����®��/ Owner's Name
—- i5y emu'
Address
Assessor's Map/Parcel:Ma //
p �r r d�✓ Engineer's Name�''� °� ���f'✓��
NEW CONSTRUCTION REPAIR Telephone#
Land Use Slopes(96) Surface Stones
Distances from: Open Water Body ft Possible Wet Area ft Drinking Water Well ft.
Drainage Way ft Property Line ft Other ft
SKETCH:(street name,dimensions of lot,exact locations of test holes&pert tests,locate wetlands fn proximity to holes)
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Parent material(geologic) Depth to Bedrock
Depth to Groundwater. Standing Water in Hole: Weeping from Pit Fnce
Estimated Seasonal High Groundwater
DETER-NE RNAXION-EOR SEASONAL HIGH-WA-TER TABLE
Method Used:
Depth Observed standing in obs.hole: In, Depth to soil mottles:
Depth to weeping from side of obs.hole: in, Groundwater Adjustment fr.
Index Well# Reading Date: Index We111eNel Adj.factor 4 Adj.Groundwater level v
,} PrpRCOLATION TEST Date- Time
Observation `1. I
Hole# -N Time at 9" e
Depth of Penc Time at 6" _-
Start Pre-soak Time @ 11S3
Time(9"6")End Pre-soakRake Min./inchSite Suitability Assessment: Site Passeded: Additional Testing Needed(YIN)
Original: Public Health Division Observation Hole Data To Be Completed on Back-----------
***If percolation test is to be conducted within 100' of wetland,you must first notify the.
Barnstable Conservation Division at least one(1) week prior to beginning.
Q:X.S EPTIC\PERCFORM.DOC
1
DEEP-OBSERVATION HOLE LOG Hole#
Depth from _ Soil Horizon Soil Texture .Soil Color Soil - ther
Surface(in.) (USDA) (Munselq Mottling (Stnucture,Stones;Boulders.
onsiltency %Gravel)
J /b3 /
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DEEP OBSERVATION HOLE LOG Dole# L
Depth from Soil Horizon Soil Texture Soil Color Soil the
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency,%Gravel)
C1
Gi
DEEP OBSERVATION HOLE LOG Dole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistencv.%Oravell
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency,
nc Rate Ma
Flood
Insurance at :
Above 500 year flood boundary No___ Yes
within 500 year boundary NO Yes
Within 100 year flood boundary No— Yes
Depth of Naturally Occurring Pervious Material
Does at least four feet of naturally occurring pervi s m A terial exist in all areas observed throughout the
area proposed for the soil absorption system?
If not,what is the depth of n urally occurring pery ous material? M
Ceatification
I certify that on 11 (date)I have passed the soil evaluator examination approved by the
Department of Envir nmental Protection and that the above analysis was perfor ed by me consistent with .
the requir aining,expe 'se e p ience described in 310 CMR 15.017.
Signature J Date �! ��
Q:\S.EIyrICVERCFORM.DOC
NOV/19/20 A/WED 07:59 AM FAX No, P, 001/001
Town of Barnstable
Regulatory Services
Richard V. Seali,Interim Director
KAFA� suuvsrnat,�, �
Public Health Division
rpbMAya Thomas McKean,Director
200 Main Street,Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304
Installer&Designer Certification Form
Date: I�—/���� Sewage Permit#')C7/* ",-Assessor's MaplParcel
Designer: ��Y� lnq_- COP -�/ Installer: � 7 M Ca �
Address: 'T' � •40d'19f, Address:
On Lze'DWF, —was issued a permit to insta11.a
(date) (installer) }}
septic system at ��}W a'S`' E �1,"_7 based on a design drawn by
address)
WL�5b"Jdated 11 1 601
designer)
certify that the septic system referenced above was installed substantially according to
the design, which may include minor approved changes such as lateral .relocation of the
distribution box and/or septic tank. Strip out (if required) was inspected and the soils
were found satisfactory. .
I certify that the septic system referenced above was installed with major changes (i.e.
F greater than 10' lateral relocation of the SAS or any vertical relocation of any component
of the septic system)but in accordance with,State &Local Regulations. Plan revision or
certified as-built by designer to follow. Strip out(if required)was inspected and the soils
were found satisfactory.
I certify that the system referenced above was constructed ' nee with the terms
of the I1A approval letters (if applicable) OF 41
DAVO
g. \
to ler's Fgxiature) MASON rrn
�crs•r��`�`
(Desig r s Signature) (Affix Desi P Here)
PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE
OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-
BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC. HEALTH DIVISION.
THANK YOU. •
QASeptic\Desiper Certification Form Fev 8-14-0.doc
f
Commonwealth of Massachusetts
Ll
100210481
Asbestos Notification Form ANF-001 Asbestos Project#
❑ Project Revision
Project Cancellation
A. Asbestos Abatement Description
1.Facility Location:
PAUL CHAMBRE 78 THIRD AVE.
Name of Facility Street Address
Instructions 1.All HYANNIS MA 02672 2392460328
sections of this form City/Town State Zip Code Telephone
must be completed in PAUL CHAMBRE HOMEOWNER
order to comply with
MassDEP notification Facility Contact Person Name Facility Contact Person Title
requirements of 310 Worksite Location: BASEMENT/1 ST FLOOR12ND FLOOR
CMR 7.15 and
Department of Labor Building Name,Wing,Floor,Room,etc.
Standards(DLS) 2. Is the facility occupied? r Yes r--J No
notification
requirements of 453
CMR6.12 3. Is this a fee exempt notification (city, town, district, municipal housing authority, state facility, or
. owner-occupied residential property of four units or less)? r Yes ❑ No
MassDEP Use Only 4.Blanket Permit Project Approval,if applicable:
Date Received Approval ID#
5.Non-Traditional Asbestos Abatement Work Practice Approval,
2.Submit Original if applicable: Approval ID#
Form To:
Commonwealth of 6.Asbestos Contractor:
Massachusetts NEW ENGLAND SURFACE MAINTENANCE 850 WASHINGTON STREET
Asbestos Program
P.O.Box 120087 Name Address
Boston,MA 02112- WEYMOUTH MA 02189 7813372117
0087
City/Town State Zip Code Telephone
A0000196 Contract Type: FJ Written r7l Verbal
DLS License#
7. JOSE VILLALTA AS061825
Name of Contractor's On-Site Supervisor/Foreman DLS Certification#
$, JEFF HILL AM000203
Name of Project Monitor DLS Certification#
9. ENVIROTEST LABORATORY INC. AA000128
Name of Asbestos Analytical Lab DLS Certification#
10. 11/12/2014 11/12/2014
Project Start Date'(MM/DD/YYYY) End Date(MM/DD/YYYY)
8-4 N/A
Work Hours-Monday Through Friday Work Hours-Saturday&Sunday
11.What type of project is this?
Demolition r7i Renovation Repair ❑ Other-Please Specify:
Revised: 11/13/2013 Page 1 of 4
v .
Commonwealth of Massachusetts 100210481 —�
Asbestos Notification Form ANF-001
Asbestos Project#
Proect Revision
Project Cancellation
A.Asbestos Abatement Description: (cont.)
12.Abatement procedures(check all that apply):
Glove Bag ❑ Encapsulation ❑ Enclosure � Disposal Only � Cleanup Full Containment
Other-Please Specify:
13.Job is being conducted: Indoors ❑ Outdoors
14.Total amount of each type of asbestos Containing materials(ACM)to be removed,enclosed,or
encapsulated:
120 500
Linear Feet(Lin.Ft.) Square Feet(Sq.Ft.)
Boiler,Breaching,Duct, Transite Pipe
Tank Surface Coatings Lin.Ft. Sq.Ft Lin.Ft Sq.Ft
Pipe Insulation 120 Transite Shingles 200
Lin.Ft Sq.Ft. Lin.Ft. Sq.Ft
Spray-On Fireproofing Transite Panels
Lin.Ft. Sq.Ft. Lin.Ft. Sq.Ft.
Cloths,Woven Fabrics Other-Please Specify:
Lin.Ft. Sq.Ft.
Insulating Cement LINOLEUM 300
Lin.Ft. Sq.Ft. Lin.Ft. Sq.Ft.
15.Describe the decontamination system(s)to be used:
AS REQUIRED
16.Describe the containerization/disposal methods to comply with 310 CMR 7.15 and 453 CMR 6.14(2)(g):
AS REQUIRED
17.For Emergency Asbestos Operations,the MassDEP and DLS officials who evaluated the emergency:
Name of MassDEP Official Title of MassDEP Official
Date of Authorization(MM/DDNYYY) Waiver#
Name of DLS Official Title of DLS Official
Date of Authorization(MM/DD/YYYY) Waiver#
18.Do prevailing wage rates as per M.G.L.c. 149, §26,27 or 27A—F apply to this ❑ yes ry—j No
proj ect?
Revised: 11/13/2013 Page 2 of 4
- Commonwealth of Massachusetts 100210481
Asbestos Notification Form ANF-001 Asbestos Project#
Proect Revision
Project Cancellation
B. Facility Description
1.Current or prior use of facility: RESIDENCE
2.Is the facility owner-occupied residential with 4 units or less? r Yes [!—�j No
3.PAUL CHAMBRE 78 THIRD AVE.
Facility Owner Name Address
HYANNIS MA 02672 23,92460328
City/Town State Zip Code Telephone
4.X X
Name of Facility Owner's On-Site Manager Address
i
X MA 02672 0000000000
City/Town State Zip Code Telephone
5.X X
Name of General Contractor Address
X MA 02672 0000000000
City/Town State Zip Code Telephone
Note:Temporary X
storage of Asbestos
containing waste Contractor's Worker's Compensation Insurer
material is only X 1/1/2015
allowed at the place Policy# Expiration Date(MM/DD/YYYY)
of business of a DLS
licensed Asbestos 6.What is the size of this facility? 2000 2
contractor or a transfer
station that is
permitted by Square Feet #of Floors
MassDEP and C. Asbestos Transportation & Disposal
operated in
compliance with Solid
Waste Regulations 1.Transporter of asbestos-containing waste material from site of generation:
310 CMR 19.000
Directly to Landfill or ly—j, To Temporary Storage Location/Transfer Station
NEW ENGLAND SURFACE MAINTENANCE,LLP 850 WASHINGTON STREET
Name of Transporter Address
WEYMOUTH MA 02189 7813372117
City/Town State Zip Code Telephone
2.If a temporary storage location/transfer station is used,list name of transporter of asbestos containing
waste material from temporary storage location/transfer station to final disposal site:
RED TECHNOLOGIES 10 NORTHWOOD DRIVE
Name of Transporter Address
BLOOMFIELD CT 06002 8602182428
City/Town State Zip Code Telephone
Revised: 11/13/2013 Page 3 of 4
r
Commonwealth of Massachusetts 100210481
Asbestos Notification Form ANF-001 Asbestos Project#
Project Revision
(j Project Cancellation
Noce:contractor must C.Asbestos Transportation&Disposal: (cont.)
sign this form for DLS
notification purposes 3.Name and address of temporary storage location/transfer station for the asbestos containing waste
material:
RED TECHNOLOGIES 203 PICKERING STREET
Temporary Storage Location Name Address
PORTLAND CT 06480 8603421022
City/Town State Zip Code Telephone
4.Name and location of final disposal site(asbestos landfill):
MINERVA ENTERPRISES MINERVA
Final Disposal Site Name Final Disposal Site Owner Name
9000 MINERVA ROAD
Address
WAYNESBURG OH 44688 3308663435
City/Town State Zip Code Telephone
D. Certification
"I certify that I have personally
examined the foregoing and am KEN FURTNEY KEN FURTNEY
familiar with the information Name Authorized Signature
contained in this document and PARTNER 10/30/2014
all attachments and that,based
on my inquiry of those Position/Title Date(MM/DD/YYYY)
individuals immediately 7813372117 NESM,LLP
responsible for obtaining the Telephone Representing
information, I believe that the 850 WASHINGTON STREET WEYMOUTH
information is true,accurate,and Address City/Town
complete.I am aware that there MA 02189
are significant penalties for
submitting false information, State Zip Code
including possible fines and
imprisonment.The undersigned
hereby states that I have read the
Commonwealth of
Massachusetts regulations
governing asbestos abatement
(453 CMR 6.00 promulgated by
the Department of Labor
Standards and 310 CMR 7.15
promulgated by the Department
of Environmental Protection),
and that I am aware that this
permit application or notification
shall not be deemed valid
unless payment of the
applicable fee is made."
Revised: 11/13/2013 Page 4 of 4
NEW ENGLAND LAND SURVEY MORTGAGE INSPECTION PLAN
_ Proteeslonal Lead E,.—yom NAME PAUL CHAMBRE
25 SUTTON AVENUE
Oxford, MA 01540 LOCATION 78 THIRD AVENUE
PHONE: (508) 987-0025 HYANNIS. MA
.- WINDOW SLSNE.DULE FAR: (500) 234-7723
SCALE t"=40' DATE 9/78/2014
REGISTRY[tARNBTABLE `-'- —
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General Notes:
I.All work to be performed in accordance with Massachusetts State Building Code,780 CMR,
Eighth Edition,IBC 1009,and applicable codes included by reference.Framing to be in
accordance with the American Wood Council Wood Frame Construction Manual,110 MPII
Zone.All work to be as approved or directed by local authorities having jurisdiction.
2.Contractor to secure all permits,and to arrange for inspections by local authorities having
jurisdiction,as may be required. ._REyt" p,J..12-10-14
I, 3.Work to be left in clean condition,ready for use and occupancy.All debris to be disposed off AndTejs R.all l]tls
site in a legal mawu.
Architect
85 River View tare,Centerville,MA 02632-Tcleplwae:(508)79o.,W
4.Contractor to install or upgrade all plumbing,electrical,heating and venting systems as
required,per code.Install and upgrade all fire protection systems per applicable codes,or as may - Floor Plan with New Addition
be required by loud authorities having jurisdiction,including smoke and carbon monoxide -- '-- --
detectors. 11 3rd Avenue,West Hyann(spgrt MA Al
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85 Rh-V Lmq CauavillS MA 02632-Telephone:(508)79"920
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�- -��--.Q��.)_L_)L BS Aiwr View lane,Cenkrville,,MA 02632-Teleph(506)79t1-0920
Sections and Details
78 3rtl Avenue,West Hyannisport,MA A3
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Architect
85 Alvu Vies lam.Cnnerviila MA 02632•T4gftm:(SOB)790-0920
!� Existing Floor Plans
78 3'Avenue,West Hyannisport,MA; X 1
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Andrejs R.Strikis
Arclritecc
87 River View lem Cm—iu MA 02672-T :(SM)7904920
Existing Elevatious:
78 3rd Avenue,West Hyarinisport-MA X2
r,�l'•o' 12-o4-1i A�
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ASSESSORS MAP :
------ ------ - TEST HOLE LOGS
PARCEL : 8c - l) The installation shall cornp� with Title V and Town of�j�l;�uard of.
FLOOD ZONE: �C7,UL/G. 6 SOIL EVALUATOR: 1 1 lealth Regulations.
---- ---------- WITNESS : I �gu 2) The installer shall verify the location of utilities, sewer inverts and septic
REFERENCE: � � / 2792, _ �i DATE: _ I ('�I components prior to installation and setting base elevations.
71� PERCOLATION RATE_ —' 2 3) All gravity septic piping to be 4 inch Sch 40 PVC at 1/8" per foot. The first
Z� ��2 two feet out of the d-box to the ieaching shall be level.
�� _ DL�_ l�7 ��� £ �7� TH- I TH-�`�E 4) This plan is not to be utilized for property line determination nor any other
-_-- _ purpose other than the proposed system installation.
A to /� 1A 5) All septic components must meet Title V specifications.
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S11 3 6) Parking shall not be constructed over H10 septic components.
7) The property is bounded by property corners and property lines.
8) The property owner shall review design considerations to approve of total
LOCATION MAP �� � 11 ` design flow and number of bedrooms to be considered for design. Receipt
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` � _ 1"l � � of payment for the plan and installation based on the plan shall be deemed
1" approval of the design flow by the owner.
�D �� 9) The existing leaching or cesspools shall be pumped and filled with material
per Title V abandonment procedures. Those within the proposed SAS shall
be removed along with contaminated soil and replaced with clean sand per
Title V specs.
� �' !!nQ vo 10)System components to be 10 feet from water line. Sewer lines crossing the
water line shall be sleeved with 4 inch SCf 140 PVC with ends grouted if
00 �� ,, i applicable. The proposed SAS is being installed below the water service
line. The line is to be sleeved as aforementioned and maintained in place.
SEPTIC SYSTEM DESIGN I I) If a garbage grinder exists it is to be removed and is the responsibility of the
owner to ensure such.
FLOW ESTIMATE 12)The installer is to take caution in excavation around the gas line if such
10L exists.
M► , O 5_BEDROOMS AT GAL/DAY/BEDROOM - aGAL/DAY 13)The installer shall verify the location, quantity and elevation of the sewer
lines exitin? the dwelling prior to the installation.
O \ ��) SEPTIC TANK 14)This plan is representative only that a system can fit on a property meeting
Title V requirements.
SOGAL/DAY x 2 DAYS - GAL
�� USE I ,�OQ;ALLOSEPTIC TANK
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_ \ SOIL ABSORPTION SYSTEM
o U,E 44
SIDE AREA: +I2,^� XZX D,1 . I�Z.Z9
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BOTTOM AREA: - . r �( x ,7 MASON ', ,
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SEPTIC ' SYSTEM SECTION
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I�OD GAL lZ Z�'��
SEPTIC TANK 2
SITE AND SEWAGE PLAN
LOCATION : 1 N112 1 .
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PREPARED FOR : -Z-)M uEA2p6jF 6
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SCALE: l
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W DAV I D B . MASON R5 DATE: I I 0
Z DBC ENVIRONMENPAL DESIGNS
EAST SANDWICH . MA
3 DATE HEALTH AGENT ( 508 ) 833- 2 1 77
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