HomeMy WebLinkAbout0060 WIDGEON LANE - Health 60 WIDGEON L Ak JV C--::�- .
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Fire Department retains original application and issues duplicate as Permit.
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` j A P.PLICATI�Ok,uJ and„ PEI ,MI� 1 Fee: 2�.. 00;.p
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orage.-tam removal and transportation to approves tank disposal yard i(s:.accordance ',r ith,the prc-visions
G L': Chapter 148, Section.38A, 527 CMR 9.00, apl licatlon is hereb de by:
•
-Owner Name(please print) David Ross X
tpnemre fit aP.ytn9�ii
ress 60 Widgeon Way�i W r:est Bans_table, MA 02668 =
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Street c„
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a��,�„�o,a . n-si rnnm t _ Co of IndivlIual
ipany Name' Print ent a i
Prot
ress R Address _`
mt Print
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tature it applying for permit) Signature(if app�,iuig for permit) i
El IFCI Certified Other ❑ IFCI Certified �• ❑�''-SP # Other
ikLocatio,n 60 Widgeon Way,t WEst Barnstable, Mtn
¢E Sleet Address .
R.-Capacity(gallons) 1000 Substance Last Storer
Dimensions(diameter x Iength) .1
transportingwasteAdvanced'--Envirohmenta1 "StateLic, # MV508385610Q +,\ t K
ardous waste manifest# E.P.A. # w„
oved tank.disposaGyardJames' G.Grant 'Co . Tnc Tank yard rt 008 '
a t
ofrnertgas Tank yard address .walcott c ao=��•{ 11.9 ?4A ' - �
EST FIRE DISTRICT FDID# 01923 ��
r Town
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of,issue AUGUST •16 , 1999 " Date of expiration AUGUST; 19, 1 '3 9
fe approval number �1999330 Dig Safe Toll Free Tr;. Nur(jber-80 32'2 4844Y
ture/TitieIof Officer granting permitW RICRARD, LI EUTE t
ovals)send Form FP-29OR signed by Local Fire Dept. to UST Regulatory Compliance Unit, One A.vhburton Place,
310, Boston, MA 02108.1618,
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�ute $e�wece� uz,,�,t °�ale°State'
w - v RECEIPT OF DISPOSAL OF UNDERGROUND STEEL STORAGE TANK -14
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%ME AND ADDRESS iM—ROVkD TANK YARD 1 `-
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2R0VEQ TANK YARDNO #0�$ TankNard Ledger 502 CMR 3 03 t'4)INumber:
.:�. .,�. ' ..,i .�:; _ � .,.,..�a
h y oundsteel storagertank delivered'td'this approved tank yard by firm,'corparatlon or y
irtiry under, n ofaaw�l1 ave persohall examined the undergr ,r4
.., s l ..Prevention,Regulation 502 a � x
tnershi E�I(f///L�f snd accepted same in conformance with Massachusetts Fire
P ,.. . ;
''O.Proisions for} provfn-Underground Steel Storage Tank dismantling yards. A valid;permit was Issued by,LOCAL Head of Fire Department
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transportthls tank to this and
'} owner or owners authonzed representatlye
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ime and o f approved tank yard own `
TITLE f DATESIGNEM.
SIGNATUREe��
P � uant to 502 C R 3 00
is signed recei t of disposal must bbe'returned tb the local head of the fire de rtment FDID# purs
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\CH TANK MUST HAVE A RECEIPT OF DISPOSAL .. ,
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TANKREMOVED FROM FW
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o = d ' f #� ((1io and Street) y 3,
.'e a ��d� �` f� s:a t tf-i� ��,��ri v M1•s nJS�xc j - •1 ' t � �: .�.:.- tY�
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THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
iK/N_.__....-.oF......... 21V.STe -Tfc-J .................
Appl ration for Diipotiai Workti Tontrnrtion ramit
Application is hereby made for a Permit to Construct (..►rUr Repair ( ) an Individual Sewage Disposal
System a :
l ' � ------------------------------------------------------
•• Loc ion-Address or Lot No.
l/-1Ir �T 80;3 _I. rtt.AP -1 l..t ................ .....
Owner Address•-••_---•__-••------•- --
Installer Address` .�.
d Type of Building Size Lot.2 v-4;......._Sq. feet
U Dwelling—No. of Bedrooms.ZB&..*...D !`.._.....Expansion Attic ( ) Garbage Grinder ( )
'4 Other—T e of Building No. of persons............................ Showers — Cafeteria
a Other fixtures .................................
---------------------------------------------------------------
d Design Flow.........//0........................gallons pA! er day. Total daily flow......... "l4G_................_..._gallons.
i
WSeptic Tank—Liquid capacity/AP-.gallons Length.��..._. Width__ '0.... Diameter................ Depth..P"-Y.
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area............. ..__sq. ft.
Seepage Pit No Z._____---- Diameter.../OF'.. Depth below inlet...OP._.,F.r... Total leaching area- ,-.•` .---sq. ft.
Z Other Distribution box Dosing tank ( ) 10 . /
~' Percolation Test Results Performed by..2V,JK -p. ..... ................................. Date..2. ..............
aTest Pit No. 1--- _t...minutes per inch Depth of Test Pit___ Depth to ground water.....
(z, Test Pit No. 2._4.2......minutes per inch Depth of Test Pit----�400..... Depth to ground water........................
..............................--------------......... .-------•--
O Description of Soil_.0---&+ _4. °�,..-� ,��� rIBS!!�l } ��' �br T��i'�st prR ---..
- ----•--7..Q.!....'...................
VNature of Repairs or Alterations—Answer when applicable....:..........................................................................................
--------------------------•••---...------------•-------...-•-----------------•------•--•-----...._.......-•-•---•---------------•----•------•---------••-------•-••-•--••--•---•-•-•---•--..............
Agreement:
The undersigned agrees to install the aforedescribed Individt ewage Disposal System in accordance with
the provisions of iIT?IS 5 of the State Sanitary Code— The un ersi ned further agrees not to place the system in
operation until a Certificate of Compliance has b ' s ed ........................... ..............�...-------•--•.....-• ..........................
Application Approved By..... :-/-,C-.' ' /. ------ ---•--.. •....... ..... ...1�-// L.e f ....--------------•- --- ------'_.Date .._._...---•
Application Disapproved for the following reasons:...............................................................................................
_
-•-•-•----•--------------••--•--------....--------------•----------------•-•--•-••--------•-•---.......---•---•-•....--•------•--••------•-•-•-••--•--•-----•--•--------•-----•-------•-----•-----------
Date
PermitNo......................................................... Issued................:
Date
- r
• t[ r
No...5..... FEz.............................
THE COMMONWEALTH OF MASSACHUSETTS
•-A
BOARD OF HEALTH
YY ............OF........./... N.S..T..! TlLn...............
Appliration for Disposal Works Tonotrurtinn ramit
Application is hereby made for a Permit to Construct (--)—or Repair ( ) an Individual Sewage Disposal
Sy'ste�m/at:
.. :�v�t T......�_..17�..--•-•---.....•---•---......-••--•---•---•-----••••---
.:. .............. _•....
y ocation-Address or Lot No.
'.ram-------------------------- j f -------
Owner� .......................•.•.-----Address
!SLR•---._...�{�- •--- •-- I� •..........................................•- -...---.:.-- ----•-••-•-•-•-•--••-•--••-•--•-----------•
Installer Address .
d Type of Building Size Lot_11.29G..._...Sq. feet
aDwelling—No. of Bedrooms---ZL3f[__t-...D./Z.....Expansion Attic ( ) Garbage Grinder ( )
p, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
Other fixtures . ip y
P
W Design Flow-----IYd..............................gallons er day. Total dailyflow........ _ ---G....................gallons.
WSeptic Tank—Liquid capacity/;.$�.gallons Length.9 Width..,-,_. ?..... Diameter................ Depth..` .
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No......?-----------::Diameter...l0_e T.. Depth below inlet---4.F.f-... Total leaching area..5.71'...sq. ft.
Z Other Distribution box Dosing�tjnk ) /
'~ Percolation Test Results Performed by../!G:_ !.......f......P_. �........................ Date.._*71-1 _�`.._.__....
a �1 .. / Z..
,.a Test Pit No. 1................minutes per inch Depth of Test Pit-/G-�____.___ Depth to ground water.._J_j...__.........
Test Pit No. 2.... t=....minutes per inch Depth of Test Pit..l���._.. Depth to ground water........................
Ra' -------------------------------- .....---•--•-------•..._............................••••_.............................................................
D Description of Soi1..0.7 y.....e,.94 �t____.__. ......T!G�....t9 X n
w TAG t.:_tP.¢c_ .t�7 L°.l_! / 1.._..�rx >fT JI.AXW. .-02-------------------------------------------------------------------------
UNature of Repairs or Alterations—Answer when applicable...............................................................................................
----------------------------•-...............------------....-----------------------.....•••........-•-•----••----•------------•--•----•••-•-------•-------•-••-•-••••--•-•-------------..__._......---•
Agreement:
The undersigned agrees to install! the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITI-E 5 of the'State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of health.
X ,d. ..... ..................................................................
•-_.. ....................••••--
Sig � P' � DateApplication Approved By..... rr
--�- -•--g"- -� -•.................. - �--- ------Date--------------
APplication Disapproved for the following reasons------------------------------------------------------------------------...............................
---------------------------------------------------•-------:...:-----•----------•----------••-----------•---•--------------...._.....-•-----•-------•--•-----•--------•---••-----•-•---••------••••••••.
Date
PermitNo.............•---•--•......=----••......-••-•----••------ Issued.------------------- ------•-•••-••-•••......••••••.
Dattee
THE COMMONWEALTH OF MASSACHUSETTS
' BOARD O HEALT
C�ntif irate laf TI-Im tiFanrr
T S S T9.CE IFY, That the Individual Sewage Disposal System constructed ( r Repaired ( )
by ...._..... ._ •.... .............•--
at ... --- ---- --------------------------------------------------------------------------------
s sta
.........
has been installed in accordance with the provisions of T r f The State SanitaryCode as de ri d in the
application for Disposal Works Construction Permit N __ . {
•-- • --•---•--•------------- dated------ �, .:+.......
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE......•\ .-- -._ _... ./.`... ........:....... Inspector... = `f- ---...... .................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF FXALTH
`... ..... :O F................... ...........� .... ---•--••..................•......... "
N ................ FEE..................
Mops ko Tonstrnrtuan rranit
Permission reby granted_---- •---- --.. `•------..................................................-----------------------------••---••---•-------
to Con tr 5 oVRRaVi �( ) an Individual Sewage Disposal System `
_ f
at No.. p' � _t `� .. ' 9---- ---------PA •' '" ................
Street
as shown on the application for Disposal Works Construction Permit No•.__.._ `' ��_._ Dated
Board of Health
DATE........
FORM 1255 HOBBS & WARREN, INC., PUBLISHERS
........ FR$..............................
THE COMMONWEALTH OF MASSACHUSETTS
JC BOARD OF HEALTH
_. ..... .... ..................................................................................
Appliratiun -fur Mupu,ial Worko Cnunutrurtiun Prrulit
Application is hereby'made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
Y --------------------- .. ..--------------------------------------
or
LRc- -A �1/gs�s �y Lot No.
rtD net%a_!!L✓�`r� ' j r' aa�1 � ,__ uNY�i_.__. G
W •-----••--•- -----_.-- ---•------------------•---------------••-......
y _ ..PQ ...._3y. �-h �
staller Address
d Type of Building Size Lot____________________________Sq. feet
Dwelling—No. of Bedrooms..._A__..�............................EYpansion Attic ( ) Garbage Grinder ( ) 00"6
Other—Type of Building -___ No. of persons....__. ' . Showers .) Cafeteria (
Other fixtures •r= =W Design Flow.............. .._..................gallons per person per day. Total daily flow.... _-_____________._.____.gallons.
WSeptic Tank—Liquid'capacitvZ6�,e.gallons Length---------------- Width_-------------- Diameter---------------- Depth._.____.__._..-.
x Disposal Trench—No. Width.................... Total Length.................... Total leaching area--------------------sq. ft.
Seepage Pit No..... Diameter.................... Depth below inlet.................... Total leaching area..___._._-._-_____sq. ft.
z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed by----------- .............................................................. Date-_.------------------------------------
,� Test Pit No. 1----------------minutes per inch Depth of "Pest Pit-------------------- Depth to ground water-..____..____.______...-
f� Test Pit No. 2____--__--____minutes per inch Depth of Test Pit____________________ Depth to ground water........................
----------------------------------------------------------------------------------------------------.........................................................
0 Description of Soil........................................................................................................................................................................
x
----•---- - - -------- -------------------------------
w Ca�i�3E S1-u �b - / -�
UNature of Repairs or Alterations—Answer when applicable..---------------------------------------___-------------------------------------------------- .
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of heVIt
Signed--- --- - ----------------=--{------ '
Date
Application Approved By---- ---•--•---•---••----•--•---------•----•--•---•--•-••-•----•--•----
Date
Application Disapproved for the following reasons-----------------------------------------------------------------------------------------------------------------
---•-----------------------------•-------••-----------------•-••--•------------------•-••--•-•--•--•-----...--•---------•------------•---•••-------•-•-•-••-----------•---------------------------•------
`` Date
Permit No....4_' ,4---•-----------•----------------------- Issued...........- .__/.-Ye ..• •. ...
Date
.............. ..............................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
. .................OF ..............................................................
Appliration -for Diiqpwial Workii Towitrurtion Vanift
Application is hereby'made' for a Permit to Construct of, Repair an Individual Sewage Disposal
System at:
................
...........................A�K...............................................
zo�;_
le a;iCL-Ad.Os.Vs or Lot No.
............................. ...... - ------_
..........V...::5�_ _ - -
Owner Addrq$7
w
.......................................... .............................................................. ...........
--------�A�staller Address
-----------11�� AV
Type of Building Size Lot- -----------------------Sq. feet
;Dwelling—No. of Bedrooms_ _----_.---Expansion Attic
�/----------------------------- Garbage Grinder
P4 Other—Type of Building ce..."No. of.persons_-___ ----------------- Showers.(Z) — Cafeteria
04 0-- 1"
110---?11Z I&- ------Q -- -------------------
W Design fixtures
Design Flow.............,_()_....__...._......_.gallons.....................gallons per pet-son per day. Total daily flow....4,YtOP-------------------------gallons.
P4 Septic Tank—Liquid capacity/A!W-gallons Length________________ Width._............. Diameter_---_-------__ Depth_._._--_----...
Disposal Trench—No. -;I'_-K__rWidth-------------------- Total Length__-_-_----_______-- Total leaching -------Sq. ft.
Seepage Pit No-----A919---- Diameter.................... Depth below inlet_----------------- Total leaching-area--------------_--sq. f t.
Other Distribution box Dosing tank
Percolation Test Results Performed by--_---------------- ----------------------------------------------------- Date-----------`------------------t
Test Pit No. I----------------minutes per inch,, �Depth of Test Pit._.-._----_---____-. Depth to -round water__.._____-_-_---------
Gri Test Pit No. 2----------------minutes,per 'inch Depth of Test Pit._-.---..____-___-_ Depth to ground water--_.----_--__---._._._
-.----- ---•--•------------------------------------------•-------•-------------------------------------------------------------------------------------------
0 Description of Soil................................................................................... -----------------------------_--------------------I-----------------------------
------------------------------------
U ---------- r6..
11 . ........ ......................--------------------------------------------------
---------/,/
----------------- -----------1411'.n........................... .................................. ----------------------------------------------------- -- --------------------------
U U Nature of Repairs or,Alter',tioh' Answer
s-A when applicable_________________ ___ ____________________....__...._..__..._.__._..._._------------------
------------------------------------------------------------------------------------------------------------------I------------------------------------------------------------------------------------
Agreement: ,kl--
The undersigned agrees to install the aforedescribed Individual Sewage Disp, al System in accordance with
the provisions of Article XI of the State Sanitary Code— The undersigAed further agrees not to place the system in
operation until a Certificate of Compliance has be,ep,issued by the board of heal
lk
'74
Signd .......... -----------------
*------4_;4wo�A Date
Application Approved By......... ----------------------------------------- --------------------
Date
Application Disapproved for the following reasons:_----------------------_--- ---------------------------------------------------------------------------......
...................................................................................................................-------------------------------------------------------------------------------------
4/7 7�------•--
L7 t— 'Permit -------------------------------- Issued............ /..........t-m...............
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
........... ...... ..........OF.......
..........................................................
ITTrfifiratr of W"alImphaurr
THI,� 14 TO C4RTIFY, That the Individual Sewage Disposal System constructed or Repaired
b C- 4-Afee, 1/ 11
y------------ - --- ---------_--------r...................................I........... ............ ..........................................................................................
#101-11le J r-. fil 1 Installer
at.......... .... .............................................................Ate'.
-------------------------------------------------------------------------------------------------------------
has been installed in accordance with the provisions of.-Article XI of The State Sanitary Code as described in the
application for Disposal Works Construction
Permit (j.—, ...W. .................. dated..........&L..-A.- /4�
....................
THE ISSUANCE OF THIS CERTIRCATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
------------------�:....................
DATE-------- ...
------7--------_-------------------- Inspector------ -----------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF-.':WEALTH
......... .........OF......
No....6.0-i.k......... FEE.._
Bi-spaiial
Permissionis hereby granted--------45.. ........................../---------------------------------------- -----------------------------------------------
to Construct or Repair an Individual. Sewage Disposal System
.. !�, IYA e� - ...........
at No..................... ..........e�sr........ --------------------------------------------------
d. 7K -
IV. Street
as shown dn,.f.he application for Dis 6�4WorksConstru�tiq�- f6it NJ,0-4--------- Dated-_--_. _�...........
....................................................................................................
Board of Health
DATE............................ .. --------- ------------------------
FORM 1255 HoBes &'17A13REN. INC.. PUBLISHERS-:.
TOWN OF BARNSTABLE - UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION
MAP NO. 1 3 l-- PARCEL NO. -}
ADDRESS OF TANK: ! /'' .U�, r, . ; .14, VILLAGE:
Numb�r� gift 1^dwme!
MAILING ADDRESS ( IF DIFFERENT FROM ABOVE) :
OWNER NAME: PHONE:
INSTALLATION DATE: Ft BY:
I"!STALLER ADDRESS: CERT.NO.
*TANK LOCATION:
D6®QRiat TANK LOCATION WITH mKomCCT TO BUILDING)
CAPACITY 1000 TYPE OF TANK C AGE 10 YRS. FUEL/CHEMICAL 44 f--f
TESTING CERTIFICATION C ] PASS [ ] FAIL DATE
LEAK DETECTION [ ] CHECK IF N/A TYPE/BRAND
ZONE OF CONTRIBUTION [ ] YES C ] NO DATE TO BE REMOVED
FIRE DEPT. PERMIT ISSUED C ] YES C ] NO DATE
CONSERVATION C ] CHECK IF N/A DATE t
BOARD OF HEALTH TAG NO. [ ] DATE
/ t
* PLEASE PROVIDE A SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD
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— - NOTES.
.' 'TEST,
JN1lERrT EL�EVATION.5
DATE' OF SOIL TEST 1� INVERT AT DING
- a; FT. ALL WORKMANSHIP AND MATER?: L..
ice, ' _ SHALL:, CONFORM'
TO .DE.Q.E:
WITNESSED BY BY . �. INLET SEITIC ,-:TANK'
PERCOLAT{ON RATE.'?M{Nr/INCH
OUTLET 'SI�,PTJC ..l`ANK �• FT.
F., L-S
` ,
-
D THE TOWN , .O
-OBSERVATION HOLE " 1 OBSERVATION = HOLE 2 INLET 61s IBUTION eox F-r,
AND REGULATIONS :'FOR SUBSURFACE
OUTLET,-,,DISTRIBUTION BOX �>S" FT
ELEVATION = �. ELEVATION= sC• 3" DISPOSAL. OF SANITARY SEWAGE
o INLET LEACHING PITS;
BOTTOM . LEACHING PIT s�.o FT.
�✓ v s
DESI�N : ' CALCULATIONS
NUMBER OF BEDROOMS 3h/
: . . .
GARBAGE DISPOSAL UNIT... .
,yr � TOTAL' ESTIMATED -'FLOW //a GAL:/BR. DAY. - .1 I X_... BR.)... ALJDAY
REQUIRED ' SEPTIC TANK CAPACITY. ... . ..._ � '' GAL.
j,��,- s a,{ram ACTUAL SIZE OF SEPTIC TANK TO 8E INSTALLED... . Z 0�� GAL.
LEACHING 'AREA' REQUIREME TS
SIDE 'WALL "AREA 2.� GAL./S.F.
BOTTOM AREA GAL./S.F.
II Oc�ac .�-
LEACHING CAPACITY ('BOTTOM +SIDEWALL ).`. � SAL.
3.1 S"X Xl.r,t S.14st X It3
RESERVE LEACHING `CAPACITY..'. . . . ^AL.
i} TOP OF —
li FOUND.
f ELEV.- a-,o /o t-" '�;^' CONCRETE 4`� SCH. 40 CLEAN SAND
COVERS PVC PIPE I
Mlf�� PITCH CONCRETE
1/8 PER. `FT. COVER r
3 2°I !V!lf�l. PITCH jttOFM �tN Oi,y
12 MAX. .
FLOW LINE r--
N.— 2 LAYER OF I/8- 1/2 ; o`' �y ,�� RICHARDy :1
WASHED STONE, JAMEs o si
RICHARD Gv, JAMES
i n _L O Z / c o P o n it S O'HEARN O'HEARN y
4 CAST IRON 0 3/4- i I/2 No.691
PIPE- MIN. PITCH o , w �� WASHED .STONE �F��st£4� �yOC/sTf.��pQ`
+• 1I4 PER FT. DIST. a k �,L=- D D PRECAST LEACHING snnlTaR� SURE
e $Qi4 ne fl o BASIN OR EQUIV.
L n } {
n LL
W Z7 z
�2o GAL
SEPTIC
ar..; 177 T,4 MASS., {
TANK R. J. 0 HEARN` INC. RLS R3
191 MAIN 'ST. E 28 )
WEST DENNIS MASS .
E."d
PROFILE OF GROUND WATER . TABLE ` t `� '
SEWAGE DISPOSAL SYSTEM JOB No. I? �LIErT
NOT TO SCALE J A,
DATE /� .: , : SHEET OF Z.
lib
DATE SYM. REVISION RECORD DR. CK.
i
t.
4 6
8 NJ. - SG/KE SET .._. -:;:._... .• . . . _ ..:
Sor`
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L' KJ � - L ' 2 -T ' /' \ c-Tlnlc^ T,�c �l'✓EL L E� � /
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F' JPc�S= L PLOT �L Ni
`4 - yv/r "P"VE
a
SCALE: APPROVED BY ORAVM►1 BY
DATE / ?
StJF�y c ' �Spq+` .R1 DRAWING NUMBER
xYMADOM POsr ISAY-14E