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0052 COMPASS CIRCLE - Health
/ ,ass C i. ;flymnnis Y ill LO CAT ION SEWAGE PERMIT NO. "j VILLAGE P IL CL g✓1 i'3 INSTA LLER'S NAME i ADDRESS BUILDER OR OWNER Ted "Iceas pccacs 1 ra.s/ DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED `�2_7 , .. -r-- �,''� _� � - �, ,� m �� �� 0 �s � � s. G \ �� �.[- .� `�� � �� • ........ Fps... THE-COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF......BA RN S T AB L E ............. ..... - - ---- --------------------------------------------------- Appliration for Elhgpaaaal Works Cnolna uurtion Vamit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: 13 COMPASS CIRCLE gyannis , Ma. .....-- - .&-................••-•...---....._ ._....... .............. tion-A dr s - r Lot No. W SPERO THE014�`RI-DIS SoutTi yar6ou 4s Ma . Installer Address a QType of Building Size Lot...l Q._t.�.........Sq. feet UDwelling—No. of Bedrooms...........3_---•_.---_•._-_-•-__.___-_-Expansion Attic ( ) Garbage Grinder ( ) p, Other—Type of Building __D"_j.j jg n _-- No. of persons.....__.6................. Showers ( ) — Cafeteria ( ) C4Other fixtures ----------------------------------------• --•----•------------•-•---•----------------- -------••----•--••---•--•••••--•-••-•----•-••••---••••-••-••- 5 5.........................----gallons per person per day. Total daily flow........._._.__3 3Q. gallons. W Design Flow--------------- - g P P P Y• Y ------------------------� . WSeptic Tank—Liquid capacity10 0.0__gallons Length.8_I..611.... Width.4-1,A.,!1.... Diameter---------------- Depth................ x Disposal Trench—No..................... Width.............._..... Total Length.................... Total leaching area.................. sq. ft. Seepage Pit No..................... Diameter.....p _ Depth below inlet_&.'.G. Total leaching area.. Z Other Distribution box ( ) Dosing tank ( ) �4 Percolation Test Results Performed by..-•.Norman Grossman......................... Date.___......1 d,-.5_-. 8 � Test Pit No. 1____, `'.. ..minutes per inch Depth of Test Pit Depth to ground water......................... fi Test Pit No. 2................minutes per inch Depth of Test Pit ........••1 Depth to ground water. -------------------------------------------•---------------•--------•--•••...---•--......•---................................................................ Description of Soil...............Me.dium--to_•_co•arse.-hand._ - x --•••----•-•---••-•-•-•------•-••-•••--•----••--------------------------- V ----------------------- •......... •.......... •------------------ •----------------------------------------------------------------------------------------- --•----- ----- --- - - ------------•---------------------------------............---------•-----•-------------•----------------•---------------------•---------------•-----------....._.....--•- U Nature 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 TITLL 5 of the State Sanitary Co e— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee _sued by the board o alth. _ o Signed-- ----,� ••.... / ... ...:��..-i ................................ Date ApplicationApproved By................. •--...-------.- .......s................................................. ........ Date Application Disapproved for the following easons.................. --- --------•••••••-••-•----•--•-••-•---••--••••---•---•----••••-••••-•-•---•--•-•--••••......-•-••----•--••.... ..-----•-------------------•---------•--....-•----•------•------.............•-••--••--•••••-•-......--••--••-----•-----••-•--••••-•---•---------•--------------------------------------•------•--•••--- Date PermitNo......................................................... Issued_-.....•.l- Date Fss ......... ......... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH 1 TO` ...................oF.....EARNSTARLE--------------------------------..-.------..-------- '` . ppliration for Diiputial Works Tnntrnrtinn ami# Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: -�J3: COMPASS .CIRCLE ;` Hyannis ,, Ma. _ ... ---...•---...-- -----••---_. . ....-••-.•.............. ........•- ;,rs ,r cation-Add s or Lot No. w Address w SPE40 THE0101DIS South Yarmouth_�t._Ma. ..................................................------•.....-• ---•._.........._..... Installer Address Q Type of Building Size Lot. _ __ Sq. feet v Dwelling—`No. of Bedrooms.._......3................................ p ( ) �I'bage Grinder ( ) Ex Expansion Attic a Other—Type of Building ----- Dw No. of persons.......6................... Showers ( ) — Cafeteria ( )i•Yi�g Other fixtures ................................. Design Flow...........SS...........................gallons per person per day. Total daily flow-------------- 30 gallons. 9- .' Septic Tank—Liquid capaci400_0---gallons Lengtl t.6**...... Widtl . ....... Diameter________________ Depth................ W " Disposal Trench—No..:.................. Width__- g g - -- q • 4 x Seepage Pit No......1............ Diameter_... Depth below n n et_61.611-__--_ Total leaching area._ . .. t z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed b .-_ __ Date_...._... y No�ean---6res-srran------------------------ - 1.0--- Test Pit No. 1___, �__minutes per inch Depth of Test Pit.................... Depth to ground water.._.... ._...._________. fTq Test Pit No. 2..............._minutes per inch Depth of Test Pit____________________ Depth to ground water.,A/0_._•_--____ ODescription of Soil............ ---------------------------------------------------------------------------------------------- . x W ------------------------------ •.......... VNature 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 TITLE: 5 of the.Ztate Sanitary Code—The undersignee urther agrees not to place the system in operation until a Certificate of ComlSliance has been issued by the board of health. I �Y.;:. Signed...........•-------------------------------------•----------••-----••......-••-••••-- Application Approved B Date Application Disapproved for the f o lowing reasons:---...----'•----------------•-----------•-------------------........--------------------. ._.......---- ......_....-•--••--••---•...----•.......................................•---•--•........--••-•----=--------•••-••--••---•--•-•--••-- Date Permit No.......... Issued..................••f.......-----• Date......•---- s THE COMMONWEALTH OF N ISSACHU9'&TS , BOARD OF H I i A,E'tH'r ........... O F.:.. `. :........ TOWN................ NARKSTAR�LET..... ClEntif i6t of fl-mlifia�t THIS IS TO CERTIFY, That the Individual Sewage Disposal System eonstruo'ted ) or Repaired ( ) by....... Spr..r0...Thsnharidis------•--•----• . .. r........................ / Installer *1 41 at-. C-Ompass---.Circl.e------...-./--`3-------------------...---------------------=----------_-, ;�.---------------------------- ------ h: tlled in accordance with the provisions of TI` 5 of Th6State Sa> Itary Code. as described in the application for Disposal Works Construction Permit No.._ _. ........... dated d. __ :" _7-0-_______---. THE ISSUANCE OF THIS CERTIFICATE SHALL OT BE CONSTRUED AS A GUALIANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. � � _ 1 j 4 DATE -• ........ Insp.ector ............... ,:. - ----- .......................................... THE COMMONWEALTH OF MASSACHUSETTS -BOARD OF HEALTH ...................... ...;t:OF....... ••--------............ No FEE `5 ... Disposal Vorks 0-Fnntr inn ranfit Permission is hereby granted......... 'Theo COriS tTllCtlOri COmariy to Construct ( X) or Repair ( ) an Individual Sewage Disposal System kr at No.............. ------ ----- -------- -------- -------- -••----. .........• £plit �S S �31 G e ' �d Street as shown on the application for Disposal Works Construction Permit No._.____ l� ------- -- Dated.._ oar of eah J DATE.. ....... ..... - - •-.................................. FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS f Town of Barnstable " Inspectional Services Department BA MASS. Public Health Division 039.'°rFc rug" 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7015 1730 0001 4987 7671 June 12, 2020 LAGARDE, JOHN A & KATHLEEN F 52 COMPASS CIR HYANNIS, MA 02601 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE,TITLE 5 The septic system located at 52 Compass Circle, Hyannis, MA was inspected on 05/22/2020 by Michael T Bisienere, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic.system showed that the system "Fails" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: Static liquid level in the distribution box is above the outlet invert due to an overloaded or clogged SAS or cesspool. You are ordered to repair or replace the septic system within one(1)year from the date you receive this notification. - Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF T BOARD OF HEALTH omas McKean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\52 Compass Circle Hyannis.doc " Town of Barnstable NsrrABM Inspectional Services Department rfp M1A'�A Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 FAX: 508-790-6304 > Thomas A.McKean,CHO Feb 6, 2007 Rev. 4/26/19 DEADLINES TO REPAIR FAILED SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15.000) An"x" marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑ Discharge or ponding of effluent to the surface of the ground ❑ Pumping more than 4 times during the last year not due to clogged or obstructed pipe. ❑ Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ❑ Structurally unsound septic tank or SAS O E 1 YEAR DEADLINE CRITERIA tatic liquid level in the distribution box is above the outlet invert due to an overloaded or clogged SAS or cesspool ❑ A portion of the SAS, cesspool, or privy is below the high groundwater elevation ❑ A portion of the cesspool is located within a Zone 1 to a public well ❑ A portion of the cesspool is located within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO (2) YEAR DEADLINE CRITERIA ❑ Single Cesspool ❑ Any "conditionally passed systems" (broken cover, relocation of a pipe, relocation of a driveway due to H-10 components, etc) ❑ Leaching facility with standing liquid level at or above the invert pipe (per Town Code §360-20 h) OTHER El Repair deadline: Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc Commonwealth of Massachusetts SO— 0/9 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments f . 52 Compass Circle Property Address John and Kathleen Lagarde r Owner Owner's Name/ information is Hyannis ,/ MA 02601 05/22/2020 required for every -- page. City/Town State Zip Code Date of Inspection Lij Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. Inspector Information on the computer, use only the tab Michael T Bisienere key to move your Name of Inspector cursor-do not Cape Septic Inspections use the return Company Name key. Co Rivers End Road � Company Address Teaticket Ma. 02536 City/Town State Zip Code 508-280-3356 S13938 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.060); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined that the system: 1. ❑ Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ® Fails e <5705-24-2020 ` 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 30 days of completing this inspection. If the system 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 DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 52 Compass Circle Property Address John and Kathleen Lagarde Owner Owner's Name information is required for every Hyannis MA 02601 05/22/2020 a e. City/Town State Zip Code Date of Inspection P9 P P C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: 2) System Conditionally Passes: t ❑ 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. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 I i Commonwealth of Massachusetts n Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 52 Compass Circle Property Address John and Kathleen Lagarde Owner Owner's Name information is required for every Hyannis MA 02601 05/22/2020 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 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 ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments V!% 52 Compass Circle Property Address John and Kathleen Lagarde Owner Owner's Name information is Hyannis MA 02601 05/22/2020 required for every y page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and 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 SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ® ❑ Backup of sewage into facility or system component due to 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 52 Compass Circle Property Address John and Kathleen Lagarde Owner Owner's Name information is required for every Hyannis MA 02601 05/22/2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ® ❑ 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 Y2 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 SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of 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 1 of a public water supply 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. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd: ® ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section CA. 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form A Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 52 Compass Circle Property Address John and Kathleen Lagarde Owner Owner's Name information is Hyannis MA 02601 05/22/2020 required for every y page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes"to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no"for each of the following for all inspections: Yes No ® ❑ Pumping information was provided by the owner,'occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ' ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® El Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form � Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 52 Compass Circle Property Address John and Kathleen Lagarde Owner Owner's Name information is required for every Hyannis annis MA 02601 05/22/2020 - page. CityrFown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 1.5.203(for example: 110 gpd x#of bedrooms): 330 plus GPD Description: Number of current residents: 1 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy.: occupied Date t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form t Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 52 Compass Circle Property Address John and Kathleen Lagarde Owner Owner's Name information is required for every Hyannis MA 02601 05/22/2020, page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8'of 18 c , Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 52 Compass Circle Property Address John and Kathleen Lagarde Owner Owner's Name information is required for every Hyannis MA 02601 05/22/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) c 4. Type of System: ® 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) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): 2111 Depth below grade: feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: Town water feet Comments (on condition of joints, venting, evidence of leakage, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 52 Compass Circle Property Address John and Kathleen Lagarde Owner Owner's Name information is required for every Hyannis MA 02601 05/22/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): 12" Depth below grade: feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) i If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: Standard H-10 1000 gallon Sludge depth: 3" Distance from top of sludge to bottom of outlet tee or baffle 33" lit Scum thickness 511 Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 12" How were dimensions determined? sludge judge 0 Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as-related to outlet invert, evidence of leakage, etc.): I'recommend the new owner put the septic tank on a maint. plan with a local septic pumping co. based on the future use of the home. At the time of inspection the liquid level was at working level and the tee's were in place. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 Commonwealth of Massachusetts �n = Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 52 Compass Circle Property Address John and Kathleen Lagarde Owner Owner's Name information is required for every Hyannis MA 02601 05/22/2020 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): . I 8. .Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 52 Compass Circle Property Address John and Kathleen Lagarde Owner Owner's Name information is required for every Hyannis MA 02601 05/22/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 1 Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): At the time of the inspection the liquid level was appx. 1 inch above the outflow pipe. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 52 Compass Circle Property Address John and Kathleen Lagarde Owner Owner's Name information is required for every Hyannis MA 02601 05/22/2020 - page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order,.system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ® leaching pits number: one El leaching chambers number: r ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 18 Commonwealth of Massachusetts p Title 5 Official Inspection Form X Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 52 Compass Circle Property Address John and Kathleen Lagarde Owner Owner's Name information is required for every Hyannis MA 02601 05/22/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): At the time of the inspection the liquid level was above the inlet pipe. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): I , t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,Lu 52 Compass Circle Property Address John and Kathleen Lagarde Owner Owner's Name information is Hyannis MA 02601 05/22/2020 required for every y page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 13. Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 52 Compass Circle Property Address John and Kathleen Lagarde Owner Owner's Name information is required for every Hyannis MA 02601 05/22/2020 page. Citylrown State Zip Code, Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: hand-sketch in the area below ❑ drawing attached separately 13 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 f LOC TION 5� SEWAGE PERMIT NO. VILLAGE u INSTA LLER'S NAME & ADDRESS R ea ILaAr, B U I,L D E R OR OWNER a�S (f YQ DATE PERMIT ISSUED DATE COMPLIANCE ISSUED k S iRE-;57- � f Commonwealth of Massachusetts Title 5 Official Inspection Form <I; Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;V 52 Compass Circle Property Address John and Kathleen Lagarde Owner Owner's Name information is required for every Hyannis MA 02601 05/22/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: Failed system I did not find ground water. Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Failed system engineered plans required to upgrade the leaching. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 18 0 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 52 Compass Circle Property Address John and Kathleen Lagarde Owner Owner's Name information is Hyannis MA 02601 05/22/2020 required for every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist) completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included M II t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 • S O d"O s SorctFport'2rrc. - 3�iuter�lar6or��'� Commonwealth of Massachusetts MA 02066 Executive Office of Environmental Affairs Department of 0 9 r Environmental Protection ° oNs1�199� WWlarn F.Weld Pl N dorm« Argo Paul Celluccl Trudy x LL Gomm s s SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A , n CERTIFICATION Property Address: Date of Inspection: /6 — C/ 7 Address of Owner. Name of Inspector. N � (If different) Com y Name, ass and Telephone Number. Fk�E' '&� 6°� Rd! 5 c.;Tv���,�� , o 24) - 6i7 5-y-5-- 6-3 �-55 CERTIFICATION S ATEMENT 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 es maintenance of on-site se disposalpenance the Proper function and systems. The system: Passes Conditionally Passes Needs Further Eval ti B the Local pproving Authority ._ Fails Inspector's Signature: Date: �7 The System Inspector shall submit a copy of this inspection report to the Approving Authority within days P inspection. If the system is a shared system or has a design flow,of 10,000 thirty the da of completing this report to fhe a gpd or greater,the inspector and the system owner shall submit the P° 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. INSPECTION SUMMARY: Check A,B, C,or D: A) SYS PASSES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 C1dR 15.303. Any failure criteria not evaluated are indicated below. B) SYSTEM CONDITIONALLY P ES: One or more system components be replaced or repaired. The upon completion of the replacement or repair, pis e inspection. Indicate yes, no,or not determined(Y, N, or ND). Describe is of rmination in all instances. If"not determined hy The septic tank is metal, cracked, structurall d,shows substantial infiltration or ezfil explaintration,.or teak ail f fail not) ure is iTMTM;*+pnt. The system will pass inspect if the septic tank is replaced with a Ponforming septic tank as approved by the Board of Health. (revised 11/03/95) 1 One Winter Street • Boston,Massachusetts 02108 • FAX(617)SS6-1 • Telephone(617)292-MM - iJ Printed on Recycled Paper S ' R'1 southp^ DW. 361nnerHarborRd Scituate, MA 02066 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (oontinued) Property Address: e "w Owner. Date of Inspeotion: / —16 q 7 BI SYSTEM CONDITIONALLY ES(continued) Sewage backup or reakout or high static water level observed in the distribution box is due broken or obstructed pipe(s) or due to a broken, or uneven distribution box. The system will pass inspection if approval of the Board of Health): broken pipe(s)are replaced obstruction is removed tion box is levelled or replaced The system required pumping m than four times a year due to broken or o pipe(s). The system will pass inspection if(with approval of the of Health): broken ipe(s)are replaced obstructi is removed CI FURTHER EVALUATION IS REQUIRED BY THE BO OF HEAL Conditions exist which require further evaluation by the of H th 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 D INES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface ter — Cesspool or privy is within 50 feet of a bo vegetated or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD HEALTH(AND PUB WATER SUPPLIER,IF APPROPRIATE) DETERAE[NES THAT THE SYSTEM IS ONING IN A MANNER T PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank soil absorption system and is within 100 to a surface water supply or tributary to a surface water supply. The system has a septic and soil absorption system and is within a Zone f a public water supply well. The system has a septic and soil absorption system and is within 60 feet of rivate water supply well. The system has a se • tank and soil absorption system and is less than 100 feet 50 feet or more from a private water supply well,unless water analysis for coliform bacteria and volatile organic indicates that the well is free from pollution fro that facility and the presence of ammonia nitrogen and nitrate ai is equal to or less than 5 ppm. 3) OTHER (revised 11/03/95) 2 90f Southport, lix- 36 Inner Harbor Rd Scituate, MA 02066 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(oontinued) Property Address: Owner. Date of Inspection: r• D) SYSTEM FAILS: �j I have determined that the system violates one or more of the following failure criteria in 310 CMR 15.303. The basis for this determination is atified below. The Board of Health should be contacted to failure. what will be necessary to correct the — Backup of se into facility or system component due to an aver r clogged SAS or cesspool. — Discharge or Pon of effluent to the surface of the ground or waters due to an overloaded or,clogged SAS or cesspool. — Static liquid level in the bution box above outlet invert due an overloaded or clogged SAS or cesspool. — Liquid depth in cesspool is 1 than 6"below invert or a volume is less than 1/2 day flow. — Required Pumping more than 4 ' as in the last year NO due to clogged or obstructed pipe(s). Number of times pumped _. Any portion of the Soil Absorption m, cesspool privy is below the high groundwater elevation. — Any portion of a cesspool or privy is wi 100 f t of a surface water supply or tributary to a surface water supply — Any Portion of a cesspool or privy is wit a ne I of a public well. — Any portion of a cesspool or privy is writ ' 5 feet of a private water supply well. _. Any portion of a cesspool or privy is 1 than 1 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If a well has analysed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic pounds, nitrogen and nitrate nitrogen. El LARGE SYSTEM FAILS: The following criteria apply to large ms in addition to the trite above: The system serves a facility with design flow of 10,000 gpd or greater System)and the system is a significant threat to public health and safety and the en ' nt because one or more of the folio ' conditions exist: the system is wi 400 feet of a surface drinking water supply — the system is 200 feet of a tributary to a surface drinking wate supply — the system ' located in a nitrogen sensitive area(Interim Wellhead P n Area(IWPA)or a mapped Zone II of a public water su ly well) The owner or operator of y such system shall bring the system and facility into fall compliaacs with the requirements of 314 C 5.00 and 6.00. Please consult the local regional office of the De partruen for further information. (revised 11/03/ ) 3 36 2wxrHarborRd Scituate, MA 02066 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: Owner. Date of Inspection: t7// �7 Check if the fo}]owing have been done: Pumping information was requested of the owner,occupant,and Board of Health. one of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates that period. Large vohunes of water have not been introduced into the system recently or as part of this inspection. 0' As built Plans have been obtained and examined. Note if_ P they are not available with NIA- V411. facility or dwelling was inspected for signs of sewage back-up. YTh mdoes not receive non or industrialsyste -salutary waste flow II The site was inspected for signs of breakout. ,`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 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 rptw yste determined based on existing information or approximated by non-intrusive methods. _The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of Sub- Surface Disposal System. (revised 11/03/95) 4 • A � , Sotl*ort, 1= 36 Inner Harbor Rd Scituate, MA 02066 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C C SYSTEM INFORMATION Property Address: Owner. i�/ Date of Inspection; RESIDENTIAL: FLOW CONDITIONS Design flow ns Number of bedrooms- 3-Number of current ream rAs:-3 Garbage grinder(yes or no):_Sr Laundry connected to system or no):_ G� Seasonal use(yes or no): Water meter readings,if available: /y Last date of occupancy: COMMERCIAL/INDUSTRIAL. Type of establishment: Design flow: gallons/day Grease trap present: (yes or no)_ Industrial Waste Holding Tank present: (yes or no)_ Non-sanitary waste discharged to the Title 5 system: (yes or no)_ Water meter readings, if available: Last date of occupancy: OTHER:(Describe) Last date of occupancy: 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 SYSTEM Septic tauWdistrt`bution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes,attach previous inspection records,if any) Other(explain) APPROXIMATE AGE of all components, date installed(if known)and source of information 4/t / �///�/yl✓ /-�>fT/[ s Sewage odors detected when arriving at the site: (yes or no) (revised 11/03/95) 6 '40.7. 1 Southport, 1= 36 Inner Harbor Rd Scituate, MA 02066 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 5- G o M P S5 `4? Owner. J / 5 Date of Inspecdon: SEPTIC TAN&_ (locate on site plan) Depth below grad-s:1 Material of construction: metal_FRP_other(ezplain) Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness:t Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or tile: Comments: (recommendation for pumping, conditio of inlet and putlet tees or baffles,depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage,etc.) X2 ©H GREASE TRAP: c (locate on site plan) Depth below grade: Material of construction:_concrete_metal_FRP other(ezplain) Dimensions: Scum thirle,..�a• Distance from top of scum to top of outlet tee or bane: Distance from bottom of scum to bottom of outlet tee or baffle: Comments: (reoommendation for pumping,condition of inlet and outlet tees r baffles,de of liquid level in relation to outlet invert,strucbn l integrity, evidence of leakage,etc.) a (revised 11/03/95) 6 Southport, im 36 Inner Harbor Rd Scituate, MA 02066 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFF�ORMATION(continued) Property Address: J /� Date of Inspection: /"/ /r5h'e'q TIGHT OR HOLDING TAN& (locate on site plan) Depth below Fade: Material of construction:_concrete_metal FRP_other(explain Dimensions: Capacity. gallons Design flow: day Alarm level: Comments: (condition of inlet tee, condition of alarm and:6atswitches,etc.) DISTRIBUTION BOX_ (locate on site plan) Depth of liquid level above outlet invert: Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box, etc.) PUMP CHAMBER:_ (locate on site plan) Pumps in working o:der.(yes or no) Comments: (note condition of pump chamber, condition of Lpampmandp ) (revised 11/03/95) 7 /90ri Southport, Inc. 361 nner Harbor Rd Scituate, MA 02066 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Addreax Owner. Date of Inspection: 9 SOIL ABSORPTION SYSTEM (SAS): (locate on site plan,if possible;excavation not required,but may be approximated by non-intrusive methods) If not determined to be present,explain: Type: leaching pits, number- leaching chambers,number._ Ong galleries, number- leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number. Comments: (note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation etc.) CESSPOOLS:_ (locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: - Depth of solids layer: Depth of scum layer- Dimensions of cesspool: Materials of construction: Indication of groundwater. inflow(cesspool must be pumped as part of inspection Comments:(note condition of soil,signs of hydraulic fail ,level of pon ' condition of vegetation,etc.) PRIVY:_ (locate on site plan) Materials of construction: Dimensions Depth of solids: Comments:(note condition of soil, of hydraulic failure,level of ponding,condition of vegetatio etcJ (revised 11/03/95) 8 fl01 ,S01it ort, 7= 36 Inner Harbor Rd Scituate, MA 02066 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(oontinued) Property Address: ����� Owner. rl 55 Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' N G P� DEPTH TO GROUNDWATER Depth to Voundwater. L /L L feet method of determination or approximation: (revised 11/03/95) 9 FINISH G'QADf s .,y•::i r- I �_.--.------.---="--' I _ 1 N lSM G'IQA'C�E F'►tiiS`H GSA DGs - —--- -- - f O vEK TANK = ` s OVEi2 101'T TO P 0 F r4i Q At , - �(� cvv 4"c. z• IV a,09CACA'114 — G Fil .I?-""_. --TT-- . Ta .4L✓, • / ,/ x'ta J �_ . = 47 O O ° d�_T& a z CELLA R F-� 6At• O o� ? / I ► j �� �, fcw 4:�5 0 4 to + {j :PE/N fb�GE,D CON(,• ; D I S T. V' O X i? i ' 3 17 / / G eus yti S'ra.vE --To C3E EVES. % : S•EPTt G -rAJV K A r n 51rA84E ` sys T-.51V 714 IL i /YO- of .t3FDRUo MS � " • GAL- �E.e Dig y = �..� � � A,, " s/+CLr VIA E L lZe rA O'�;3X � _ "�c'1 d � i' I �-it-J'J' - -- �-- -, .18 1v � `� '� -:�. � /�roc• I sT PPJpj�i :no IrZ 47 1I `Isarg- I 13� N I I I 5 1 P _ [7 r +r /.VSp�G TfD ray . /�iK1UL /{nZ/e&/ Z,4,ev, do, /h,ly[, rt / PE�C• .C'ArE G S'CALF'_.i �w _.. Pf?nE 'A GFw /off ` •P ti �1� P3GfiMR, y ri NOAYAN i � -�.... ._-__ _.__._._.--- __ ___ __ .- ---._...._.,...._._.__,..__._...•... _ QilOR3MtAiV E t � 109eMp1f 6�R'OSSMAIV R , 22d. A6044y• POIM" kXZ . ,�' j�_,,,a`�f' ti� Sure` GENT&R V/LLB.