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Home My WebLink About0094 LILLIAN DRIVE - Health 94 LILLIAN DRIVE, HYANNIS- A= 248 276' k -- t 'I I I f r e I I TOWN OF BARNSTABLE LuCATION SEWAGE# �- Z1l VILLAGE ZW9— %/_S ASSESSOR'S MAP&LOT f X INSTALLER'S NAME&PHONE NO...`� I �D �� 'ClP SEPTIC TANK CAPACITY /& Old 62�! ' bn e -TWe,16A , LEACHING FACILITY: (type) lid x 5< .1 (size) NO.OF BEDROOMS BUILDER OR OWNER kAA�g le e 07 5A,4 nna,7 PERMITDATE:� " �� -3Y COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 le 'ng�aci� _ . Feet Furnished by �� e F y. f" . X t ® � d - i � o No. 7 Fee / !D THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01pprication for &!5paat *pgtem Cow6truction 3permit Application is hereby made for a Permit to Construct( )or Repair(L,�an On-site Sewage Disposal System at: Location Address or Lot No. /�lis Owner's Name,Address and Tel.No. 1 Ll 1_-1 ' r�Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms 3 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 Description of Soil S AV'� Nature of Repairs or Alteration (Answer hen applicable) �I�- SYWA j Cy s� 12, K✓°- � o r�-rr�ta� � y�c a- 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 Co and n t to place the system in operation until a Certifi- cate of Compliance has been issued b this Bo Signe I Date Application Approved by Application Disapproved for the following reasons Permit No. I'lo a2 Date Issued ;h,t_ .7 _'+, r.:x.- ��"'" J'_..-•�'".. •.:t„ _ ..:�! F .�. .:t... ...x:i4w"��•..» .,>,S. � �,�.s." R+.-..;+�;.ak-�:..iX�,. rw4'.-:r+•A� -No. f e ,• Fee `/ .C/ ' THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS , 01pplicatiou for 13i5po$al *p,5tem. Con!5truction Permit— Application is hereby made for a Permit to Construct( )or Repair(V<an On-site Sewage Disposal System at: Location Address or Lot No. Owner's Name, Address and Tel.No. 6�2 Insta is Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: 3 e Dwelling No.of Bedrooms Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow _ gallons per day. Calculated daily flow O jCgallons. Plan Date Number of sheets Revision Date 7/ Title Description of Soil Nature of Repairs or Alteration (Answer hen applicable) .r s ►4 e,- � -1 too �`rr kx_ Date last inspected: Agreement: The undersigned agrees'to ensure the construction and maintenance of the afore described on-site sewage disposal system k in accordance with the provisions of Title 5 of the Environmental Co and not to place the system in operation until a Certifi- cate of Compliance has been issued b this Bo Signed Date Application Approved by ; A Application Disapproved for the following reasons Permit No. ' Date Issued a-1 —41 s; THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE. MASSACHUSETTS Certificate of Compliance T IS IS TO C�$1L11 r at the Swage Disposal System installed( )or repaired/replaced(l/�on .5 01 �to by /L r,CJ��-�� 5 for as q Lk i--i I lAs ok has been constructed in accordance y with the provisions of Title 5 and the for Disposal System Construction Permit No. �� dated �—.'7W Use of this system is conditioned on compliance with the provisions set fo ,tr" low: 1772 ----- No. / Fee ` U THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS lwigotar *pgtem Co(n5truction Permit Permission is hereby granted to to construct( )repair( an On-site Sewage System located at Lt ✓ 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. All construction must be completed within two years of the date below. Date: S 112.D `' �� Approved by CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS) hereby certify that the application for disposal works ' construction permit signed by me dated �� .� , concerning the property located at �`'� �F �w Dv+w2- I�meets all of the following criteria: There are no wetlands within 300 feet of the proposed septic system • There are no private wells within 150 feet of the proposed septic system �• The observed groundwater table is 14 feet or greater below the bottom of the leaching facility • There is no increase in flow and/or change in use proposed There are no variances requested or needed. SIGNED: / DATE: 5^c 6 LICENSED SEPTIC SY TEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER [Attach a sketch plan of the proposed system. Also if the licensed installer posesses a certified plot plan, this plan should be submitted]. L s. ;�� I Q ® (� ' � t y`: ' � � \ { �� , f ANTLANTIC ENVIRONMENTAL P.O.BOX 2384 MASHPEE,MA 02649 Attn: Commonwealth of Massachusetts Date: 02/29/96 Town of Barnstable Board of Health 367 Main Street Hyannis MA 02601 From : Mr Michael DeDecko Po Box 2384 Mashpee MA 02649 Dear Board of Health Official; I certify that I have personnally inspected the sewage disposal system at the following address : 94 Lillian Drive,Hyannnis Ma. The information reported is true, accurate and complete as of the time of the inspection. I have not found any information which indicates that the system fails to adequately protect the public health or the Environment. — If you have any questions regarding this inspection,please contact me at this number: (508)477-14-20. Thank you. Sincerely, Michael DeDecko phone 508 477-1420 :i Commonwealth of Massachusetts Executive of EnvironmentalAffairs �FCEI'.r�U - _ MAR 4 Iss Department of _ . ... � Environmental Protection SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 9 K L LUj►4 Kj Address of Owner: -K„trhLa,4(- ' kA-NAJoAj _ (if different) - _-- -___-- _--- Date of Inspectton`a X1 Name of Inspector: wl o Company Name, Address and Telephone nujpber: (�TGI f iL Vju✓190j"0-Z --- , "!>o 2- L( � CERTIFICATION STATEMENT i 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 site sewage disposal systems. The system _.X Passes -=-- Conditionafly Passes �-- Needs further evaluation by the local Approving Authority ---- Fails Inspector's Signature: I�I 10ate: a ;zpv l� The system Inspector shallf submit a copy of this inspection report to the Approving Authority 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 or the Department of Environmental Protection. µ The original should be sent to the system owner and copy sent to the buyer,.if applicable and the approving authority. ' ' r i 1k W ,�_M.`",+°''T":f++ r+�w�.�...a,,�riwv ;-,rm.,w*d,-".-snenmi_�,r*f,.!,.;. a".-. ,.., ;:; .- ,.: .:?' .`�•u" 5?.;'.:�;�. wc... w"''15... '"�wa«rz '."hy,'i+�...��?t..�n�,.N.,:�,'., r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A — CERTIFICATION (continued) Property Address: -6tLi -L% LL, __-- O wners: Ska, U Date of Inspection: INSPECTION SUMMARY: Check A,B,C,or D A)SYSTEM PASSES: • I have not found any information which indicates that the system violates any of the— failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below r,F B)SYSTEM CONDITIONALLY PASSES: ' T Jr ---- One or more system components need to be replaced or repaired. The system,upon completion of the replacement or repair,passes inspection. _ Indicate yes,no,or not determinate(Y,N,or ND). Describe basis of determination in all instances. If"not determinated",explain why not. ---- The septic tank is metal, cracked,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 conforming 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 ----- broken pipe(s)are,spaced ----• obstruction is removed distribution box is leveed or replaced. •--- The system required pumping more than four times a year due to broken or obstructed r pipe(s). The system will pass inspection-if(with approval of the Board of Health). ----- broken pipets)are replaced •---- obstruction is,removed s k 4 • , t; p S'Jy. 1.sf may. ' r J S ` ��g • - ,-erry R .1a ,u.,-za.-._....ice �`.Sa..,- a.. -.. „•,...e..� ., SUBSURFACE SELVAGE DISPOSAL SYSTEM INSPECTION FORM PART A - - CERTIFICATION (continued) Property Address: �y L, LL,Owner : Date of Inspection:akO.7 C) FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: -•- Conditions exist which require further evaluation by the Board of Health in order to de- termine if the system is failing to protect the public health, safety and the environ- ment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETYAND THE ENVIRONMENT: - --•- Cesspool or privy is within 50 feet of a surface of water ^ -•-• Cesspool ar privy is +Within 50 feet of a7 b"ordenng vegetated or a wetland small :marsh .- _.�._----- ------ --------— . 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUND - _ TIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT. •:•- The system has a septic tank and soil absorption system and is within 100 feet to a surface water supply or tributary to a surface water supply. •--- The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well. -•-- The system has a septic tank and soil absorption system.and is within 50 feet of a private water supply well ---- The system has a septic tank and soil absorption system and is less than 100 - feet but 50 feet or more from a private water supply well,unless a well water analy- sis 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 notrogen is equal to or less than 5 ppm. D)SYSTEM FAILS: _ I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The'basis for this dtermination is identified below. The Board of Health should be contacted to determine what will be necessary to cor rest the failure. . . -•-- Backup of sewage into facky or system component due to an overloaded or . or clogged SAS or cesspool. X 3ie. w 5^'�"Er*;��wt-e :.e» .,;s .,.o.._ Y.� r•-•'--**-^ '`.'1"Y'�` rt"- y g. -w.F.+.u^^,�z::� 4 ; "'�."r^_'^+t'.w..» ..r/- ,.:r4 "F '..�' } # h a�. :c,.r.-,+w�s<+#fi`-.'�an a\•::J.a .�"c.. a •,-.ay.�r-�l':,Ciin.+i,•.7,t,,.At_..r .w... r4•�•.d.: �.a..t•.f...:`yw,k..;,+A,%»+•+•Arw. .rxte3",W.+,.'::.'1.� +f•nj.Mw.7•.b,#wuYa:Sa'a+tw'.ku��'-' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION-FORM PART A - CERTIFICATION (continued) Property Address: �{ 11 ► 2 , Owner: Shp-NNdN Date of Inspection: 91"` D)SYSTEM FAILS (continued) --• 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 'over-- loaded or clogged SAS or cesspool. - --- Liquid depth in cesspool is less than 6"-belowa -invert or available--uolume is -- --- - _ - - --- less than 1 I2 day How.— 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 cesspool or privy is within 100 feet of a surface water supply ortributary 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_weU_with..no acceptable_water_quaNty--ana------ lysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for cofiform bacteria,vola9ttile organic compounds,ammonia nitrogen and nitrate nitrogen. l s R"`4 .'n',�S �k°s.R#•''•yj r t�L*#4*-�y S tx�. f , SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A - CERTIFICATION (continued) Property Address: _°I H b 1,1.E D _ Owner: 5�\o Nr erJ Date of Inspection: �a, l cl 6 E) LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria above The design flow of system is 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: •-- the -system is within 40.0 feet of 6'turf6ce 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 owner or operator of any such system shall bring the system and facility into full compli- ance with the groundwater treatment program requirements of 314 CM 5.00 and G.00. Please,consult the.local regional office of the Department for further information. .h Rr ¢k'1 r , 3n�0 +a� SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART B CHECKLIST Property Address: �I L4i prN Owner: SV\A1JN0#1J Date of Inspection: Check if the following have been done: Pumping information was requested of the owner ,occupant and Board of H ealth. - — -k-None of the system components have been pumped for at least two weeks - -- —----and the system has been receiving normal flow rates during the period. Large --- vok mes 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. The facility or dwelling was inspected for signs of sewage back-up. — t The system does not receive non-sanitary'or industrial waste flow. _ - 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 sep- _ tic-tank,was inspected for conditions of baffles or tees,material of construc- tion, dimensions,depth of liquid,depth`of sh�dge,depth of scum YLrh,�xtp,. The size and location of the Sol Absorption System on the site has been deter- mined based on existing information or approximated by non•intrusrve methods The facility owners and occupants if different from owner were provided with information •on'the proper maintenance of Subsurface Disposal System } . + may, 4 `` Y' .y. '•d P.. _ 5 Y . .. i , i .ff tad 4 yua 3 F I� � s- ..�....�...-..Q,«..,.,...:,..,,,.......�o.,-e.,..w... �` ,w.,�,.,�T. `- '- :�� r '•e {�'�5� .�ePGo�a "= i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C - SYSTEM INFORMATION Property Address: U LLB ji�►=► OL. Owner: 5�a4jnk►) Date of Inspection: RESIDENTIAL: Design flow: 33 o gallons Number of bedrooms : 03 Number of current residents: Garbage grinder (yes or no): Laundry connected to system(yes or noj Ll,� s Seasonal use(yes or no):v t. _: ..:..,..<. . - - - Water meter readings;if available:-N � Last date of occupancy COMMERCIALANDUSTRIAL: .-~- 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' uorrmation System pumped as part of inspection(yes or no):..... - if yes,volume pomped: . ................ giilions., ............ - x Reasonfor pumping:................................................................................................................ ..ci,q 'a id Ya✓.scars.�.rr...r3.`a4e...u...-vr....u........ .......w...w.r....r+n.+ard,.-'vt:'4+....n..s....✓..wsnw+..n•4•rv+-E-..s..^Pm.'wr.✓vtTMu.a.. '.+clams eY+�+n9�R^YY^.aWPRw�.4+�t4e9YMt.NV•P!f%nlf++vh%wYK.wtws. '... SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM _ PART C SYSTEM INFORMATION (continued) Property Address:. U L 4 Ro be- , Owner: She,-*-ornJ Date of inspection: TYPE OF SYSTEM --- Septic tank/distribution box/soil absorption system --- Single cesspool --- Overflow cesspool --- Privy --- Shared system s o (ifes,attach previous inspection records,if any] 'C-Other (explain... .r .. . . .... 1..:4za..UU.g,�¢., �.C "... /, APPROXIMAT F,AGE _of all components,date installed if knovun)and--- _source of information �z:.,.c�s.�..d.�'�--�:f-:.tN4�� .1. :22�....4.�xa.... r......Q-..i .....duini.. ........................... S ewage odors detected when arriving at the site: (yes or no)...... SEPTIC TANK: ...w... (locate on site plan) Depth below grade: .......... Material of construction: ....... concrete ......... metal........ FRP........ other(explain) .............................................................................. . Dimensions: .................. Y Sludge depth:............... . Distance from top of sludge to bottom of outlet tee or baffle:.............................. - 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:......................... Comments: (recommendation for pumping,condition of inlet and 6&let tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage,etc.)...................... ................................. ................................................ ............................................................. - • ..................... ........................................................ .............................. .......................... .... •........... ................ ..................................♦ ............................................ ............... •J - - 4 •v tom;' '9"arT"fv1' ; Ne SUBSURFACE SEWAGE DISPOSAL SYSTEM_INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: q U Lla rrr—j rL Owner: 5kP wJ01U Date of inspection: GREASE TRAP: - " -- -.................. (locate on site plan) Depth below grade: ............... Material of construction: ........concrete.........metal........FRP........other(explain).... .............. .......... . ............................................................................................................... Dimensions:............................... -Scum thickness,..................... _._Distance from.top of.scum to-_top of.outlet.tee_or,baffle --_Distance from bottom--scum-to-bottom-of-outlet-tee or_baffle- ... Comments: (Recommendation for pumping condition of inlet and outlet tees or baffles,depth-of liquid level in relation to outlet invert,structural integrity.' evidence of leakage;-etc.).. ..... ..... ........................................................................................................................................:........ TIGHT OR HOLDING TANKS:.............. (locate on site plan) _ _ r _ - Depth below grade:............... _ Material of construction:........concrete.........metal.........FRP..........other(explain).......... - . . . _ ...................................................................................... ..... ....................................................... _. _ - - .. .... _ Dimensions:...........:.:............... '' -. Capacity:....................gallons Design flow:...............gallons/day Alarm level.............................. Comments: (condition of inlet tee,condition of alarm and float switches,etc.) ................I....................... ....a...... .y.. .. ..................................... ............ .... ................................ ............................................ .� ...................... ................................. tat r � :�rt�' �.#.:�,.�,. r., _.7� ,.� .�v-� A_.t .-., ��Yw <� ,r�r4u?t�..r.�.r..;...p. �?,..sH�;•4'�r..ae�„A'�4.E.i_x.�.a -ttr..4.ra i�.�.Mt�r�:�,s��t7�r�;-*��h?d'"*sit: �:fb�?�.Y,15rT�k7"" lm�..t�..{awl .��'.... .,.. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM _ PART C SYSTEM INFORMATION (continued) Property Address: TA L W PIS Qom, - -_Owner: Date of inspection: DISTRIBUTION BOX:..Nd (locate on site plan) Depth of liquid level above outlet invert:................... Comment: (note if level and distribution equal evidence of solids carryover,evidence of leakage into orout of box,etc.). ................................................................................................................ ... ............................................................. ...... ............... ............. ... PUMP CHAMBER:..... (locate on the site) Pumps in working order: (yes or no)............... Comments: (note condition of pump chamber,condition of pumps and appurtenances,-etc.). ................ - ................................................................................................................................................ SOIL ABSORPTION SYSTEM (SAS):..`4..:e.�..... (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:.:.:...-: leaching galleries,number:........... leaching trenches,number ,length:.::............. .... leaching fields,number,di men ions:................... overflow cesspool,number...>., 6 jC ' Comments: yw, not nditIon of soil,signs of hydraulic fqHurg,level of ponding,condition of v geti tion, Stec. �.,..P.�Gr, . o...�J.�n�.:a�.. .4�R�! �. n a > <4' r7. � ,e" r` v' a16 -�M.c'.^_..2t'•dr�. :^ .^y. a n,'-r, r .,.d,;�..v^, At•Y�': L. ♦ ztn..,.0 ix4�."�',, '. -r2 XT-, - ett_Sn�. .,a+w z� _ _ .fir•'._..��..i 1v��.-,:_ SUBSURFACESEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property address: Q 4 G !-�-i'rJ JX-. Owner: 916NA 0 Date of inspection: 8.(2-7 I CESSP00LS:...y�S... . (locate on site plan) Number and configuration: ....i... ..4.P ............. Depth-top of,liquid to inlet invert: ..... G�................... Depth of solids layer: ....2........................................ Depth of scum layer: ...0........................................ Dimensions of cesspool: ...bK Materials of construction: ..�a:'�- -.?�� Indicator of ground water: 01 0-00"'d �q- �'� ��-�' �►�l -'- . inflow (cesspool must be pumped as part of inspection) Comments: (note condition of sol, signs of hydraulic failure,level of ponding, condition of vegetation, etc. - _ ..... ... d..l..a....s�..........��.... . .. . .,.. k.. ...1�d...'c�.?� ..ar. . .. C. c.l.0 .1..�!:L.�...P .. �...^� ...f.� ..o ...... }:.CONG��Ga►�- ........ . . ... . Of-- Ut j �f7wrj -No , N l=I 62J,'5e60 I s 6 i t:Z-cSSed PRIVY: ... . . (locate on the site) -; Material of construction: ................................... Dimensions: .. Depth of solids: ...............: _ via•-._ ' Comments: (note condition of soil,signs of hydraulic failure,level of pausing,condition of vegetation, etc.). ................................................................................................................................................. a�ya�'+�•^'s.=. -S•�"'?".'r+wx�,:`c,. .��.._ _.:c"_aw�-:rt""=� .,.,.r�_i-? !. '."?:�r�- •v'�- ��''a�'� .ems. F�'�•m`9 n'�;� _ � .^�.'4.��.�w+�«.�ii i.�n u,k.h ..._.,1 _ �- .^,+s>:ft,V_-at�a'�*S.�•"°. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 4i q t a" ti , Owner: 6KftAq*.- Date of inspection:a, - a SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate at wells within 100'. A\ 34 t DEPTH TO GROUNDWATER: z` Depth to groundwater: )A.: : feet Method of dgtermination or appraximative: F�. A C�ektclLct .�Ntr �vo&.�.. l:� S ' P ................................... °µ ..........• •.• • •..• ... •................... • ..................• •..................• . L.y . » + „ z - ,. ,sir :k:. .t ' :y/1/€ - '�•+,,y 'tt f,•r• r +" '�;,'r" 'sad »..ry `"s' - c�.� 'e.,tA -4��-Gt°,- ,�.a {.� V _ i i' r � ..`it�C r y 9 � � s {i. $S x � a�"�stx� •�y i`�`d s� ,.��5,��...# M