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0068 CHESTNUT STREET - Health
68 CHESTNUT ST., HYANNIS A _ TOWN OF BARNSTABLE LOCATION C��s> VN C5+rW �" SEWAGE # " 5*91 VILLAGE n is ASSESSOR'S MAP& LOT — f INSTALLER'S NAME&PHONE NO.W,t, d 06 i/150 1) 5 --n S-��b SEPTICo-TANK CAPACITY >� .LEACHING FACII.TTY: (type) 2 1� (size) ® �. NO:.OF BEDROOMS ;Z— BUILDER OR OWNER PERMTTDATE: -1D�99 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 Furnished by X� o ' ! O�� .,,.%No. 301 Fee $5 0 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZIppYtcation for �Bigo!gal *pgtem Con!truction Permit Application for a Permit to Construct( )Repair(X )Upgrade( )Abandon( ) ❑Complete System El Individual Components L cation Address or Lot No. Owner's Name,Address and Tel.No. a Chestnut St . , Hyannis, MA Louie Chesthie Assessor'sMap/Parcel 52 BeAch St . , Milford, MA 01757 Installer's Name,Address,and Tel.No. Designer's N e,Address and Tel.No. Wm. E. Robinson Septic Service PO Box 1089, Centerville , MA Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Sand Nature of Repairs or Alterations(Answer when applicable) Title-5 septic system. Tank; n-hay anri 2 ch-aanhers 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 Certifi- cate of Compliance has been issued by this Board of H�t ,SignedDate Application Approved by Date Application Disapproved for the following reaso ff--- V V on 0e:1 Permit No. --01 1 Date Issued NO. �. � . Fee $50 a.� `' THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION TOWN OF BARNSTABLE., MASSACHUSETTS r t 0(ppYication for Migpogal *pgtem Congtruction Permit Application for a Permit to Construct( )Repair(X )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components L cation Address or Lot No. IV Owner's Name,Address and Tel.No. Q Chestnut St. , Hyannis, MA Louie Chesthie Assessor'sMap/Parcel 52 BeAch St . , Milford, MA 01757 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. m. E. Robinson Septic Service '. PO Box 1089, Centerville, MA Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date.a Number of sheets Revision Date 4,Title' Size of Septic Tank Type of S.A,S ,. _ Description of Soil Sand. Nature of Repairs or Alterations(Answer when applicable) Title-5 septic system. ' Tankr h x and 2 a hare. `lLo—.n hen Date last inspected: w A + Agreement: The undersigned agrees to ensure the construction and maintenance of the af&e 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 Certifi- cate of Compliance has been issued by this Board of Heal p Signed Date—/j—/� Application Approved by k&M1J 2 Date Application Disapproved for the following reaso ez Permit No:' r` 'Date Issued '. *. THE COMMONWEALTH OF MASSACHUSETTS A Chesthie BARNSTABLE, MASSACHUSETTS , Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired (X )Upgraded( ) ., Abandoned( )by Wm. E . Robinson Septic Service at 68 Ches nu t. , yannls ham e constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer Wm. E. Robinson S r. Designer The issuance of this permit sha not-be construed as a guarantee that th s}� le will function as llesigne Date / � InspectorY? l A No. �'�" A ---------------------------Fee $50 _ THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Chesthie 1Wi9;poga1 *pgtem Conmructton Permit Permission is hereby r te�o B AN(S�Repair(X nJgrade( )Abandon( ) System located at tt55 riy I1 and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or'special conditions. i Provided:Construction rqAst bte�co pleted within three years of the date oft soeit.,,Date: fJ Approved byfl', '� r l/6/99 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. 3 © � C56�L CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS) I W i l l iarn E . Robinson,S,rltereby certify that the application for disposal works construction permit signed by me dated 7—/6 9 5 concerning the property located at 68 Chestnut St 14yannis , mA meets all of the following criteria: o The failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. a soil is classified as CLASS I and the percolation rate is less than or equal io 5 minutes per inch.anere are no wetlands within 100 feet of the proposed septic system V There are no private wells within 150 feet ofthe proposed septic system There is no increase in flow and/or change in use proposed 1 1 There are no variances requested or needed. V The bottom of the proposed leaching facility will not be located less than five feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor method when applicable] a If the S.A.S. will be located with 250 feet of any vegetated wetlands, the bottom of the proposed leaching facility will not be located less than fourteen(14)feet above the maximum adjusted groundwater table elevation, Please complete the following: A) Top of Ground Surface Elevation(using GIS information) B) G.W. Elevation +the MAX. High G.W. Adjustment . DIFFERENCE BETWEEN A and B — //i J� r SIGNED : „�—� DATE: �"�6 ''r 9 2— [Sketch proposed plan of system on back]. q:health folder:cert t b C• �- ?\p s COS INIO.N WEALTH OF MASSACHU SETTS =� ExECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS — dal DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE VZ\TER STREET. BOSTON TZA 02108 (617) 292-5500 TRUDY COaE Secretary ARGEO PAUL CELLUCCI DAVID B. STRUHS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Prop"Address:68 Chestnut St . , Hyannis. Name of OwnerjjmdzlCh n t h i e G Address of Owner:- K 2 B H S t . , M i - -er d. NIA Date of Inspection: ��--� ! . Name of Inspector:(Please Print) Wm. E . Robinson Sr. 01757 I am a DEP approved system-inspector pursuant to Sectiom15.340 of Title 5(310 CMR 15.000) CompanyName: wm. E. Robinson Septic Service Mailing Address: P 0 Box 1089, Centerville , MA Telephone Number: CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-sites sewage disposal systems. The system: i/Passes Conditionally Passes Needs Further Evaluation By the Local Approving Authority _ Fails 4 -ls 7 � Inspector's Signature: ° >� Date: . The System Inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or,DEP)within thirty (30)days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. NOTES AND COMMENTS OCT 15 1999 � TOWN OF BARNSTABLE HEALTH DEPT. N s C., revised 9/2/98 Page Iof11 �� Primed on Recycled Paper - SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM I PART A CERTIFICATION Icontinued) 'rop"Address: 68 Chestnut St . , Hyannis , MA awnef: Linda CGhesthie Date of Inspection: 7-)S-9 5 INSPECTION SUMMARY: Chec1"A_— C, o/ D; A. SYSTEM PASSES: 1 have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist. Any failure criteria not evaluated are indicated below. COMMENTS: B. YSTEM CONDITIONALLY PASSES: . One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Indicate ye , no, or not determined(Y, N, or ND). Describe basis of determination in all instances. If "not determined", explain why not. The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a.Certificate of Compliance(attached)indicating that the tank was installed within twenty (20)years prior to the date of the inspection; or the septic tank, whether or not metal,is :racked,structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health). broken pipe(s) are replaced obstruction is remove) distribution box is levelled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed revised 9/2/98 Page 2ofII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 68 Chestnut St . , Hyannis D`"ner= Linda Qhesthie Date of Inspection: I g D. SYSTEM FAILS: You mus indicate either "Yes" or "No to each of the following: I ave determined that one or more of the following failure conditions exist as described in 310 CMR 15.303. The basis for this d termination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No Backup of sewage into facility-or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped_. Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less-than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E. RGE SYSTEM FAILS: You m st indicate either "Yes" or "No" to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA) or a mapped Zone II of a public water supply well) The wner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional offic of the Department for further information. e revised 9/2/98 Page 4of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address:68 Chestnut St . , Hyannis 0- Linda hestnh' e ° Date of Inspection: I-/S 7 C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation ty the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 15.303(1)(b)THAT THE SYSTEM NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) S STEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF ANY)DETERMINES THAT THE SYSTEM IS NCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation not valid). 3) OTHER revised 9/2/98 Page 3of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Iroperty Address: 68 Chestnut St . , Hyannis Owner: Linda 'Chesthie Date of Inspection: FLOW CONDITIONS RESIDENTIAL: Design flow: 1SO g.p.d./bedroom. Number of bedrooms(design): 3 Number of bedrooms (actual): Total DESIGN flow so Number of current residents:3 Garbage grinder(yes or no):k O Laundry(separate system) (yes or no) 6; If yes, separate.inspection required Laundry system inspected (yes or no) Seasonal use (yes or no):JL d Water meter readings, if available (last two year's usage(gpd): 1999 87, 750 gal. Sump Pump(yes or no): O 1998 64,500 gal. Last date of occupancy: '%'ef COMMEI CIAL/INDUSTRIAL: Type of a tablishment: Design flo : gpd ( Based on 15.203) Basis of de ign flow Grease trap present: (yes or no)_ Industrial ste Holding Tank present: (yes or no) Non-sanitar waste discharged to the Title 5 system: (yes or no)_ Water mete readings,if available: Last date o occupancy: OTHER:( escribe) Last date o cupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: System pumped as part of inspection: (yes or no)_ If yes, volume pumped: gallons Reason for pumping: TYPE OF YSTEM Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes, attach previous inspection records,if any) I/A Technology etc. Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other r APPROXIMATE AGE of all components, date installed(if known)and source of information:' Sewage odors detected when arriving at the site: (yes or no)�� 73ir/�o rQ. �a f revised •9/2/98 Page 6of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Prop"Address:68 Chestnut St . , Hyannis owner: Linda Chesthir Date of Inspection: t;_/�f-9 2 Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Ye� No Pumping information was provided by the owner, occupant, or Board of Health. _V/ _ None of the system components have been pumped for at least two weeks and-the system has been receiving trormal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. ' _ As built plans have been obtained and examined. Note if they are not available with N/A. Y _ The facility or dwelling was inspected for signs of sewage back-up. V _ The system does not receive non-sanitary or industrial waste flow. V _ The site was inspected for signs of breakout. Z/ _ All system components, excluding the Soil Absorption System, have been located on the site. The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. The size and location of the Soil Absorption System on the site has been determined based on: _ Existing information. For example, Plan at B.O.H. _ Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) [15.302(3)(b)) - _ The facility owner(and occupants,if differeru from owner) were provided with information on the propermaintenaara-0f SubSurface Disposal Systems. revised 9/2/98 Page 5of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 'ropertyAddress: 68 Chestnut St . , Hyannis , O-ne': Linda Chesthie Date of Inspection: 9-65-9� BU ING SEWER: (Loca on site plan) Depth elow grade:_ Materi of construction:_cast iron_40 PVC_other(explain) Dista a from private water supply well or suction line Dia ter Co ments: (condition of joints, venting, evidence of leakage,-etc.) SEPTIC TANK: (locate on site plan) Depth below grade: _ .. Material of construction: Vironcrete_metal_Fiberglass _Polyethylene_other(explain) If tank is metal,list age_ .Is.age confirmed by Certificate of Compliance_(Yes/No) Dimensions: �c l a Sludge depth: 8 Distance from top osludge to bottom of outlet tee or-baffle: 8 Scum thickness: 0p�- Distance from top of scum to top of outlet tee or baffle: O J Distance from bottom of scum to bottom of outlet tee or baffle:_ How dimensions were determined: /-e w 'omments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to o�}tlet invert, structur mtegr evidence of leakage,etc.) O /1i a+'Vt/ 5 r y r�s GREA E TRAP: (locate on site plan) Depth b low grade:_ Material f construction:_concrete_metal_Fiberglass _Polyethylene_other(explain) Dimensio s: Scum thi knew. Distance rom top of scum to top of outlet tee or baffle: Distance rom bottom of scum to bottom of outlet tee or baffle: Date of I st pumping: Comme ts: (recom endation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, eviden a of leakage,etc.) revised 9/2/98 Page 7of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 1,roperty Address: 68 Chestnut St . , Hyannis Owner: Linda Chesthie Date of Inspection: p—f,s 5 TIGHT OR HOLDING TANK: (Tank must be pumped prior to, or at time of, inspection) Iloc to on site plan) Dept below grade:_ Mate al of construction:_concrete_metal_Fiberglass_Polyethylene_other(explain) Dimen ions: Capac y: gallons Desig flow: gallons/day Alarm present Alar level: Alarm in working order: Yes_ No_ Date of previous pumping: Com ents: (co ition of inlet tee, condition of alarm and float switches.etc.) DISTRIBUTION BOX:_L/ (locate on site plan) 'l Depth of liquid level above outlet invert: C� Comments: (note if level and distribution is equal, evidence of sglids carryover, evidence of leakage into or out of box, etc.) - PUMjcndition AMBER:_ (loc site plan) Pumworking order: (Yes or No) Alarworking order(Yes or No) Coms: (not of pump chamber, condition of pumps and appurtenances, etc.) revised 9/2/96 Page 8of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 'rop"Address:68 Chestnut St . , Hyannis Owner: Linda C�1hesthie Date of Inspection: 1 _/S f 9 SOIL ABSORPTION SYSTEM(SAS):_ (locate on site plan, if possible; excavation not required, location may be approximated by non-intrusive methods) If not located, explain: Type: leaching pits, number:_ leaching chambers,number: teaching galleries, number:_ leaching trenches, number, length: leaching fields, number, dimensions: overflow cesspool, number:_ Alternative system: Name of Technology: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, damp soib, condition of vegetation, etc.) CESSPOOLS:_ (locate on site plan) e Number and configuration: Depth-top of liquid to inlet invert. 1' ' Depth of solids layer: )epth of scum layer: v Dimensions of cesspool: Materials of construction: Indication of groundwater: inflow (cesspool must be pumped as part of inspection) Com ents: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRI _ floc to on site plan) ' ti terials of construction: Dimensions: epth of solids: omments: (n to condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) revised 9/2/98 Page 9of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(contirwed) '31rop"Address: 68 Chestnut St . , Hyannis )wner: Linda Chesthie Jate of Inspection: { Sr g SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) r 33, revised 9/2/98 Page 10of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) rop"Address: 68 Chestnut St . , Hyannis Owner: Date of Inspection: NRCS Report name Soil Type_ Typical depth to groundwater USGS Date website visited Observation Wells checked Groundwater depth: Shallow Moderate Deep SITE EXAM Slope Surface water Check Cellar Shallow wells 02 Estimated Depth to Groundwatera-o Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observed Site(Abutting property, observation hole, basement sump etc.) Determined from local conditions y Checked with local Board of health Checked FEMA Maps Checked pumping records Checked local excavators, installers Used USGS Data Describe AN you established the High Groundwater Elevation. (Must be completed) Y6 7-0 revised 9/2/98 Page ttof11 TOWN OF BARNSTABLE LOCATION fob C-1'1 eS+ng-� SEWAGE # VILLAGE nn 1S ASSESSOR'S MAP & LOT INSTALLER'S-NAME&PHONE NO.W,)f. &1b i nnin n 5 77S'O 7 7 SEPTIC TANK CAPACITY JSf -- LEACHING FACILITY: (type) LL�Bm Pl��/� (size) NO.OF BEDROOMS aZ' BUILDER OR OWNER tZ PERMITDATE: 9-40.99 COMPLIANCE DATE: Separation Distance Between the: i Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply We11 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 0 o '?S x� y