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Home My WebLink About0166 GREENWOOD AVENUE - Health 166 GREENWOOD AVE. HYANNIS A = 288 148 _ t t i i TOWN OFF B_ARNSTABLE LW' ON _I G Av,4b SEWAG # cg2 d VILLAGE_ Gin a j5 ASSESSOR'S MAP & LOT-7 ff Vr-N INSTALLER'S NAME&PHONE NO. ✓15 4 v g. -"7 IT v t-7JJZ SEPTIC TANK CAPACITY- 5 01 a I.. LEACHING FACILITY: (type) A 640(-5 (size) AS,fir /3.ac Ix NO. OF BEDROOMS_ A BUILDER OR OWNER C,0V 12-p1 A PERMITDATE: 46 e 13-® 1 COMPLIANCE DATE: 9"6-01 . 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 3 Q c2`F2 4 COMMONWEALTH OF MASSACHUSETT'S EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 166 Greenwood Ave. Hyannis Owner's Name: Murray Cohen Owner's Address: 1 7 6 He l i p s Dr #1 f15 Date of Inspection: — — Name of Inspector:(please print) Wi 1 1 i am E_ Robinson Sr. Company Name: William E. Robinson Septic Service Mailing Address: P O Box 1089 Centerville, MA Telephone Number: (5 0 8) 7 7 5-8 7 7 6 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 the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to Sec _ n 15.340 of Title 5(310 CMR 15.000). The system: 1 assw Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: i�q 11 ,/.Z Date: K—a— 0 I 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 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 DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments ****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. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued). Property Address: 1 6 6 Greenwood Ave. Hyannis Owner: Cohen Date of Inspection: Q Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. Sy em 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: LT L) s System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or rep ired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Ans er yes,no or not determined(Y,N,ND)in the for the following statements.If"not determined"please expla The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unso d,exhibits substantial infiltration or exfrltration or tank failure is imminent.System will pass inspection if the exist" g tank is replaced with a complying septic tank as approved by the Board of Health. *A etal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indi ating that the tank is less than 20 years old is available. N explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or structed 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 obstruction is removed distribution box is leveled or replaced explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will ass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 1 6 6 Greenwood Ave. Hyannis Owner: Cohen Date of Inspection: - r d 0 ) C. 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 fail g to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the ystem is not functioning in a manner which will protect public health,safety.and the environment: 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 2. ystem will fail unless the Board of Health(and Public Water Supplier,if any)determines that the syst in 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 rivate water supply well*".Method used to determine distance *"This system passes if the well water analysis,performed at a DEP certified laboratory,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,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: 3 Page 4 of 1 I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:166 Greenwood Ave. P Hyannis Owner: Cohen Date of Inspection: 9— — O D System Failure Criteria applicable to all systems:. Y 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 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''/z 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 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. [This system passes if the well water analysis, performed at a DEP certified laboratory,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,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] (Yes/No)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. E. Larg Systems: To be con idered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd- You must dicate either"yes"or"no"to each of the following: (The folio no ing criteria apply to large systems in addition to the criteria above) yes _ the system is within 400 feet of a surface drinking water supply _ the system is within 200 feet of a tributary.to a sm-face 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 If you hav answered"yes"to any question in Secdon E the system is considered a significant threat,or answered "yes"in S coon D above the large system has failed.The owner or operator of arty large system considered a significant hreat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. 4 -Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 1 6 6 Greenwood Ave. Hyannis Owner: Cohen Date of Inspection: " C Check if the following have been done You must indicate`yes"or"no"as to each of the following: Ycs No — Pumping information was provided by the owner,occupant,or Board of Health _ Y Were any of the system components pumped out in the previous two weeks? V Has the system received normal flows in the previous two week period? U 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 t/ Was the site inspected for signs of break out? . Were all system components,excluding the SAS,located on site :�7 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? 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: Yes no 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(3)(b)] - - 5 Page 6 of 1 l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 166 Greenwood Aye. Hyannis Owner: Cohen Date of Inspection: a —O FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 'y ? Number of current residents: "b Does residence have a garbage grinder(yes or no): / —0 Is laundry on a separate sewage system(yes or no):i6 [if yes separate inspection required] Laundry system inspected(yes or no):A, o Seasonal use: (yes or no):�.s Water meter readings, if available(last 2 years usage(gpd)): g g—9 n n 48,000 gal. Sump pump(yes or no):2-° 0 0—2 0 01 31 , 500 gal. Last date of occupancy: ;e. A C MERCIAL/INDUSTRIAL Type of establishment: Desi n flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Gre a trap present(yes or no): Indu trial waste holding tank present(yes or no): Non sanitary waste discharged to the Title 5 system(yes or no):_ Wa er meter readings,if available: Las date of occupancy/use: O ER(describe): GENERAL INFORMATION Pumping Records Source of information: &t IA Was system pumped as part of the inspection(yes or no): 'W'v If yes,volume pumped:_gallons--How was quantity pumped determined? Reason for'pumping: TYP 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) 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 or no): i D 6 Page 7of11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1 6 6 Greenwood Ave. Hyannis Owner: Cohen v� Date of Inspection: a5�- BUILDING WER(locate on site plan) Depth below gra e: Materials of con truction:_cast iron _40 PVC_other(explain): Distance from p vate water supply well or suction line: Comments(on ndition of joints,venting,evidence of leakage,etc.): SEPTIC TANK:_(locate on site plan) Depth below grade: j Material of construction:tz/Concrete_metal_fiberglass polyethylene —other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions:_(y °� L J(2 lg Sludge depth: 6 Distance from top of sludge to bottom of outlet tee or baffle: C)g Scum thickness: ® 7 Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: )17 How were dimensions determined: x,K Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of.leakage,etc.): GREAS TRAP:_(locate on site plan) Depth be ow grade:_ Material f construction:_concrete_metal_fiberglass_polyethylene_other (explain): Dimensio s: Scum thic kness: Distance om top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of 1 t pumping: Commen s(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): n 7 Page 8 of l l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 166 Greenwood .Ave. Hyannis Owner: Cohen Date of Inspection: TIGHT HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth belo ade: Material of c struction: concrete metal fiberglass polyethylene other(explain): Dimensions: Capacity: gallons Design Flowtyes gallons/day Alarm preser no):Alarm level: Alarm in working order(yes or no): Date of last : Comments( n of alarm and float switches,etc.): Ll if DISTRIBUTION BOX: (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: O 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.): Ili t�C�� PUMP HAMBER: (locate on site plan) Pumps i working order(yes or no): Alarms ' working order(yes or no): Comme is(note condition of pump chamber,condition of pumps and appurtenances,etc.): 8 Page 9of11 J( OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 16.6 Greenwood Ave. Hyannis Owner: Cohen I Date of Inspection: — `"o SOIL ABSORPTION SYSTEM(SAS): //(locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number:_ aching chambers,number:_ leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil,condition of vegetation, etc.): S -rd h L CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth—top of liquid to inlet idv rt- Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PR (locate on site plan) Ma erials of construction: Di ensions: De th of solids: Co ents(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): 9 Page 10 of 11 ` OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 16 6 Greenwood Ave. Hyannis Owner: Cohen Date of Inspection: e> SKETCH OF SEWAGE DISPOSAL SYSTEM system including ties to at least two permanent reference landmarks or Provide a sketch of the sewage disposal y g benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building. � _ a 10 Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 166 Greenwood Ave Hyannis Owner: Cohen Date of Inspection: $ -F—c'I SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water-a- feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: _E� 0, erved site(abutting property/observation hole within 150 feet of SAS) pecked with local Board of Health-explain: Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you establishe�;he hi h ground water elevation: K I1 s. 1�f No. ��3 G 9 Fee$5 0 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: �•/ Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 3pplicatton for 30igo5al bpotem Cotwtrurtion VCrmit Application for a Permit to Construct( )Repair(X)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. 166 Greenwood Ave. , Hyannis Murray Cohen Assessor's Map/Parcel 0 176 Helios Dr. , Jupiter, FL Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Wm. E. Robinson Septic Service P O Box 1089, Centerville Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Sand Nature of Repairs or Alterations(Answer when applicable) Title-5 septic system con— sisting of a 1 , 500 gal, tank, D-box and 2 precast leach chambers with stone all around Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been iss ed byth' o of tFiealth S' , L Date 0 Application Approved % Date Application Disapproved for the following reasons Permit No. Date Issued _i"`"N-r'"r`"x rL t e. ''i �+'z�"s�v�-.G,,,. .t 1"`'�' s t c•_'�. ''}' i+.'rc.'°' . �� ,y-�,,.•-- ^a �n �,� �. � k� vet �•t�,,� -.OWN OF BARNSTAB, E LOCATION L�b �t��11. �[>D� Avg SEWAG It VILLAGE (-{ _ SSOR'S MAP & LOT Z�� S A S t INSTALLER'S.NAME&PHONE NO. r► �'��2 x SEPTIC TANK`CAPA.CITY< A 1 - LEACHING FACILITY;.(typC) l►<�1 e,(—$ (size) -A:J NO. OF BEDROOMS ::BLIII DER OR OWNER: PERNiITbATE'. tfT"' 13't7.� cOMPLIANCE 'DATE: Separation Distance B'etween'the. ' Ivlaximum Adjusted Groundwater Table o the Bottom dteaching Facility Private Water Supply Well and,Leaching Facility. (If any wills:ezisi :: on site or within 200 feet of leaching facility) Feet t Edge of.Wet]and'and Leaching Fadi t (If any wetlands exist a within 300 feet of ieaehing facility) Feet Furmshed'.by 44 .:. _ 3 2 f 6,S o :. r -31/7 L $50 No. Fee THE COMMONWEALTH OF MASSACHUSETTS'- i+j t Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS 2pplication for Mis pozar *p!5tem Con.5truition Permit Application for a Permit to Construct( )Repair(X)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. 166 ;Greenwood Ave. , Hyannis Murray Cohen Assessor's'Map/Pazcel � 176 Helios Dr. , Jupiter, FL Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Wm. E. Robinson Septic Service r 6 O Box 1089, Centerville Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) OtherAEixtures Desig ow gallons per day. Calculated daily flow gallons. Plan Date i , Number of sheets Revision Date Titrollf�spti ; SizT nk Type of S.A.S. /Desriptiof Soil Sand_.. �� ✓ fx, A Naljjre of�Re airs or Alterations Answer when applicable) Title-5 septic system con- sisting ( PP ) sisting of a 1 , 500 gal. tank, D-box anda'02 precast leach Ehambers with stonelall around Date last inspected: �`P � 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 f Compli na ce has been issq ed by th' oar. of Health. S Date Application Approved y s Date 4<KeLl_ Application Disapproved or the following reasons t `J Permit No. Date Issued e —�_------- -------------- —�— ------- THE COMMONWEALTH OF MASSACHUS&TS BARNSTABLE, MASSACHUSETTS ohen - Certificate of (Compliance , THIS IS TO CERTIFY, that the On-sit//elewage Disposal System Constructed( )Repaired (X )Upgraded( ) Abandoned( )by Wm. R. t�inscA' Septic Service " at 166 Greenwood vet annis has been construe e }/ k dance with the provisions of Title 5 and.*• a for Disposal System Construction Permit No. _Z40 dated d Installer Wm. E. 1�;bitnlson Sr. Designer The issuance of this pe 't shaX not be construed as a guarantee that the syste 11 fu s �signe . Date Q 7 �/ Inspector _ 0 No. Fee Fee$5 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS litpoaf *pgtem Construction permit Permission is hereby granted to Construct( )Repair(X )Upgrade( )Abandon( ) System located at 166 Greenwood Ave. , Hyannis 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. Provided:Construction must be completed within three years of the date of this permit. Date: f r�� Approved b7I k C- ,0, uses�NOTILCF,:This Form Is To Be Used For the Repair Of Failed septic Systems only. - C1RTIItYCATION OF SKETCH AND APPLu',TION FOR A DLSFOSAL WORKS CO PER1 ff(WtTHODT DESIGNED PLANS) L William E. Robinson,S y certify dm do application fir disposal works caum- mou p�sigped by me datd � `'�"6j Z the prop"located at 166 Greenwood Ave. ,` Hyannis numts all of the following cariterk • The failed sysmiscoummiltoateddemddwdlipgonly. There arc uo eommc=m or bttmu= uses associated with the dwelling. The soil is daasift CLASS 1 and the peaxftd at roc is 1W than or equal to 5 uum mtes per inch f There arc no Wetlimft within 100 feet of the proposed srpuc by-Acm • There ICUO wells within 1fl0 Beet of the proposed septic.s}stem Thew is d in Saw=Afm td=W m mm pmpowd • 'there ant variances negnetted or needed. The of the pn r I ling bd%witi'-be lam less tham five feel abaft the mats9MG tote elmdon=(Adpm the Ummdvtater table using the Frimptor meth6dwhm apse! • if the S.A.&will be lotuad with 2W Seel of auy vgpaad wedands.the bottom of the propmod I=ching bdlky wtll as be rotated less than fauu=t 14)fast above the m uemam adjltstW gmundvater&able deviation. Maw aompkft the hdowiev A) Tap ofGround Su&m Ekwadon oming GIs ) 81 G.W.Elevation +the MAX. MO G.W.A4*un m DIFFERENCE BETWEEN A and 8 / v / SIGNED: DATE: [Slot►proposed plan of system on backI. .F n—fth fildW�,� ---___ A T ,� n �� ,.f;. . -�