HomeMy WebLinkAbout0537 YARMOUTH ROAD - Health 537YARMOUTH RD., HYANNIS
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Parcel Lookup
Parcellnfo
IParcel ID 345-001 DeveloperLot
Location 1537 YARMOUTH ROAD I Pri Frontage 110b
Sec Road I Sec
Frontage
Village JHYANNIS I Fire District HYANNIS
Sewer Acct Road Index 1890
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Interactive ;
Map
aurt
Owner Info
Owner I DAVIS, LISA E TR I Co-Owner C/O GILBERT C WOOD
Streetl 1730 BEARSES WAY I Street2
city I HYANNIS I State EAJ zip 02601 Countryl"s
Land Info
Acres 10.11 Use AUTO S S&S MDL-94I zoning IB Nghbd CI04
Topography I Road
Utilities I Location
Construction Info
Building 1 of 1
Year 1920 Roof I Ext WOOD FRAME
Built Struct Wall
Effect 484 Roof fI AC INONE
Area Cover try— Type
Style Cottage I Int wall tI Rooms
Model Commercial Floor Carpet IntRooms
Bath
I Rooms 1 Full
Grade jAverage I Heat' Total F —i
Type- Rooms
http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=28553 4/27/2010
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Parcel Detail Page 3 of 3
15 1997 $20,500 $0 $0 $32,900
16 1996 $20,500 $0 $0 $32,900
17 1995 $20,500 $0 $0 $40,400
18 1994 $22,200 $0 $0 $42,400
19 1993 $22,200 $0 $0 $42,400
20 1992 $25,300 $0 $0 $47,200
21 1991 $41,700 $0 $0 $67,400 ;
22 1990 $41,700 $0 $0 $67,400
23 1989 $41,700 $0 $0 $67,400
24 1988 $32,300 $0 $0 $22,800
25 1987 $37,000 $0 $0 $22,800
26 1986 $37,000 $0 $0 $21,400
27 1985 $0 $0 $0 $0
Photos
MUTUAL
INANCNO A
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http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=28553 4/27/2010
a
Hazardous Materials Inventory Sheet Checklist
?Date
i (Physical Street Address-Check database to ensure it exists
/ Working Phone Number
Actual Amounts—(i.e.gas being used to fuel machines,thinner to
/clean brushes all count as hazardous materials)
Storage Information—location of storage,how long is storage for?
/ If none,note that.
Disposal Information—where and who? If none,note that.
Applicant Signature—understand what is listed and noted.
Staff Initial—any questions,know who to ask.
✓Vehicle Washing/Rinsing?—provide a vehicle washing policy and
✓6xplain it—note that it was given.
Attach the Business Certificate with your sign-off and comments.
**The Inventory form should explain what the business consists of and the procedures
they are doing Notes need to be left to explain what you discussed with them
Date: l.� / D1 /0p
TOWN OF BARNSTABLE
TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY
INAME OF BUSINESS: i'Y)V►Q AI rno Aor S
`BUSINESS LOCATION: 537 uh1 RM00kh R(� INVENTORY
MAILINGADDRESS: 53-i 4alZMOovh act TOTAL AMOUNT:
TELEPHONE NUMBER:
CONTACT PERSON: C- N e_[Fo
EMERGENCY CONTACT TELEPHONE NUMBER: a 9)S MSDS ON SITE?
TYPE OF BUSINESS: Used► Cw2S
INFORMATION/RECOMMENDATIONS: Fire District:
Waste Transportation: Last shipment of hazardous.waste:
Name of Hauler: Destination:
Waste Product: Licensed? Yes No
NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous materials use,
storage and disposal of 111 gallons or more a month requires a license from the Public Health Division.
LIST OF TOXIC AND HAZARDOUS MATERIALS
The Board of Health and the Public Health Division have determined that the following products exhibit toxic
or hazardous characteristics and must be registered regardless of volume.
Observed/Maximum Observed/Maximum
Antifreeze (for gasoline or coolant systems) _ Misc. Corrosive
NEW USED Cesspool cleaners
Automatic transmission fluid Disinfectants
Engine and radiator flushes Road Salts (Halite)
Hydraulic fluid (including brake fluid) Refrigerants
Motor Oils Pesticides
NEW USED (insecticides, herbicides, rodenticides)
Gasoline, Jet fuel, Aviation gas Photochemicals (Fixers)
Diesel Fuel, kerosene, #2 heating oil NEW USED
Misc. petroleum products: grease, Photochemicals (Developer)
lubricants, gear oil NEW USED
Degreasers for engines and metal Printing ink
Degreasers for driveways & garages Wood preservatives (creosote)
Caulk/Grout Swimming pool chlorine
Battery acid (electrolyte)/Batteries Lye or caustic soda
Rustproofers Misc. Combustible
Car wash detergents Leather dyes
Car waxes and polishes Fertilizers
Asphalt & roofing tar PCB's
Paints, varnishes, stains, dyes Other chlorinated hydrocarbons,
Lacquer thinners (inc. carbon tetrachloride)
NEW USED Any other products-with "poison"-labels- —
Paint &varnish removers, deglossers (including chloroform, formaldehyde,
Misc. Flammables hydrochloric acid, other acids)
Floor &furniture strippers Other products not listed which you feel
Metal polishes may be toxic or hazardous (please list):
Laundry soil & stain removers No 'Re Pc<i r W Or lc on
(including bleach) r e M ' e -_5 a ke OYlk
Spot removers &cleaning fluids
(dry cleaners)
Other cleaning solvents
Bug and tar removers
Windshield wash
WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS
TOWN OF BARNSTABLE gfPLIANCE: CLASS: 1.Marine,Gas Stations,Re air
sfactory 2.Printers
BOARD OF HEALTH 3.Auto Body Shops
��.�� unsatisfactory- 4.Manufacturers
COMPANY %li9A� ��/ O (see"Orders") 5.Retail Stores
6.Fuel Suppliers
ADDRESS 7 Class: 7•Miscellaneous
�1 � ITIES AND STORAGE (IN=indoors;OUT-outdoors)
MAJOR MATERIALS Case lots Drums Above Tanks Underground Tanks
IN OUT IN OUT IN OUT #&gallons Age Test
Fuels:
Gasoline,Jet Fuel (A)
Diesel, Kerosene, #2 (B)
Heavy Oils:
waste motor oil (C)
new motor oil (C)
transmission/hydraulic
Synthetic Organics:
degreasers
iscellan/�
DISPOSAIJRECLAMATION REMARKS:
1. Sanitary Sewage 2. Water Supply . Z 4 z zz A1,4 f
O Town Sewer Public
On-site Private
3. Indoor Floor Drains YES NO
O Holding tank: MDC
O Catch basin/Dry well _
O On-site system
4. Outdoor Surface drains:YES—ZNO ORDE S:
O Holding tank:MDC
O Catch basin/Dry well
O On-site system
5.Waste Transporter
Name of Hauler Destination Waste Product
YES NO
1. 6"
2.
7f5 Person(s) Interviewed Inspector Date
Date:
TOXIC AND HAZARDOUS MATERIAL REGISTRATION FORM
NAMEOFBUSINESS: /
BUSINESS LOCATION: Xgotjls 7Rq iq I
MAILINGADDRESS: Z."lylb 7 Mail To:
TELEPHONE NUMBER: a -0 0 Board of Health
Town of Barnstable
CONTACTPERSON: �SC� P.O. Box 534
EMERGENCY CONTACT TELEPHONE NU BER: 7 O"o;0 7 q
Hyannis, MA 02601
TYPEOFBUSINESS: d P
Does your firm store any of the toxic or hazardous materials listed below, either for sale or for you own
use? YES NO
This form must be returned to the Board of Health Y
a regardless of es or no answer. Use the enclosed
9
envelope for your convenience.
If you answered YES above, please indicate if the materials are stored at a site otherthan your mailing
address:
ADDRESS:
TELEPHONE:
LIST OF TOXIC AND HAZARDOUS MATERIALS
The Board of Health has determined that the following products exhibit toxic or hazardous character-
istics and must be registered regardless of volume. Please estimate the quantity beside the product that
you store. NOTE: LIST IN TOTAL LIQUID VOLUME OR POUNDS.
Quantity Quantity
Antifreeze(for gasoline or coolant systems) Drain cleaners .
NEW USED Cesspool cleaners
Automatic transmission fluid Disinfectants
Engine and radiator flushes Road Salt (Halite)
Hydraulic fluid (including brake fluid) Refrigerants
Motor oils Pesticides
NEW USED (insecticides, herbicides, rodenticides)
Gasoline, Jet Fuel Photochemicals (Fixers)
Diesel fuel, kerosene, #2 heating oil NEW USED
Other petroleum products: grease, Photochemicals (Developer)
lubricants, gear oil NEW USED
Degreasers for engines and metal Printing ink
Degreasers for driveways & garages Wood preservatives (creosote)
Battery acid (electrolyte) Swimming pool chlorine
Rustproofers Lye or caustic soda
Car wash detergents Jewelry cleaners
Car waxes and polishes Leather dyes
Asphalt & roofing tar Fertilizers
Paints, varnishes, stains, dyes PCB's
Lacquer thinners Other chlorinated hydrocarbons,
NEW USED (inc. carbon tetrachloride)
Paint & varnish removers, deglossers Any other products with "poison" labels
Paint brush cleaners (including chloroform, formaldehyde,
Floor& furniture strippers hydrochloric acid, other acids)
Metal polishes
Laundry soil & stain removers Other products not listed which you feel
(including bleach) may be toxic or hazardous (please list):
Spot removers & cleaning fluids
(dry cleaners)
Other cleaning solvents
Bug and tar removers
WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS
it
TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1. Marine,Gas Stations, Repair
Satisfactory 2.Printers
BOARD OF HEALTH 3.Auto Body Shops
Q unsatisfactory- 4.Manufacturers
� S �-QS (See"Orders") 5.Retail Stores
COMPANY RIA
6.Fuel Suppliers
ADDRESS '� �J 3D 1i-C N rzLb Class: 7.Miscellaneous
QUANTITIES AND STORAGE (IN= indoors; OUT=outdoors)
MAJOR MATERIALS Case lots Drums Above Tanks Underground
IN OUT IN OUT IN OUT #&gallons Age Test
Fuels:
Gasoline,Jet Fuel (A)
Diesel, Kerosene, #2 (B)
Heavy Oils:
waste motor oil (C)
new motor oil (C)
transmission/hydraulic
Synthetic Organics:
degreasers
Miscellaneous:
DISPOSALIRECI AMATION REMARKS:
1. Sanitary Sewage 2.Water Supply
O Town Sewer OPublic
O On-site OPrivate
3. Indoor Floor Drains YES NO
O Holding tank:MDC +�`
O Catch basin/Dry well
O On-site system
4. Outdoor Surface drains:YES NO ORDERS:
O Holding tank:MDC
O Catch basin/Dry well
O On-site system
5.Waste Transporter
Narne of Hauler Destination Waste Product
YES NO
1.
2.
Person W-rn-terviewod Inspector ate
_ TOWN OF BARNSTABLE ,
LOCATION 5 3-7 Yirmuilh R•CL SEWAGE #
ASSESSOR'S MAP& LOT.
VILLAGE
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) (size)
NO.OF BEDROOMS
BUILDER OR OWNER 5 ,
PERMTTDATE: `COMPLIANCE DATE' 7
,1 q
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 leaching facility) Feet
Furnished by l 7 /
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Wm. E. Rdbinsbn, Jr.
Septic Inspect ns
43 Tomahawk Drive
Centerville, MA 02632
(508) 775-7986
Pager 978-622-8700
Location
537 Yarmouth Rd.
Hyannis Ma.02601
S.M.T. Realty Trust
I0 39Vd 3611 QNVISI QNV 3dVO IIEZ06G80S 6Z:II 666I/60/Z0
Commonwealth of fvlossochusetts
Executive Office of Environmental Affars
Department of
I nviranmaatai Protection
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION
Map Number
Parcel Number
PROPERTY ADDRESS: 537 Yarmouth Rd.Hyannis Me. ADDRESS OF OWNER:
DATE OF INSPECTION: 1-7-99 S.M.T.Realty Trust
NAME OF INSPECTOR: William Robinson Hyannis Ma. 02601
I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 9310 CMR;15.000)
COMPANY NAME: W. E. Robinson Septic inspections
MAILING ADDRESS: 43 Tomahawk Drive Centerville, MA 02632
TELEPHONE NUMBER: (508)775-7986
CERTIFICATION STATEMENT
I certify that I have personally Inspected ft sewage disposal system at this address and that the information reported below Is tree,
arxurats and complete as of the time of inspection. The inspectton was performed based on my training and experience in the proper
function and maintenance of on-stte sewage disposal systems. The system:
X PASSES
CONDITIONALLY PASSES
NEEDS FURTHER EVALUATION BY THE LOCAL APPROVING AUTHORITY
FAILS , ,f
INSPECTORS SIGNATURE: W + ,LlA DATE: 1-7-99
The system Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of eotitpleting this
inspection. if the system is a shared system or has a design flow of 10.000 gpd or greater,the Inspector and the system:owner shall
submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be Sent to the
system owner and copies sent to the buyer,if applicable and the approving authority.
INSPECTION SUMMARY: Check A, ®, C,or D.-
A] SYSTEM PASSES:
X 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.
COMMENTS:
B SYSTEM CONDITIONALLY PASSES:
One or more system components as described in the*Conditional Pass"section need to be replaced or
repaired, The system, upon completion of the replacement or repair,as approved b the Board of Health,
will pass.
Indicate yes, no, or not determined(Y, N, or NO). Describe basis of determination in all instances. If'not
determined", explain why not)
The septic tank is metal, unless the owner or operator has provided the system inspector with a copy
T of a Certificate of Compliance(attached)indicating that the tank was installed within twenty(20)
years prior to the date of the inspection;or the septic tank,whether or not metal,is cracked,
structurally unsound,shows substantial infiltration or exfiltration, or tank is 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.
Page :I.of 10
(revleed 04/23/97)
DEP on the World Wide Web:h1tp7/www.magnet.state.ma.un/d
Z0 39Vd 3811 QNt1-1SI (INV 3cIV0 TTEZ06L809 6Z:TT 666T/E0/Z0
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(CONTINUED)
Property Addrm; 537 Yarmouth Rd.Hyannis Mo. 02601
Owner: S.M.T.Realty Trust
Date of Inspection: 1 7-99
B]SYSTEM CONDITIONALLY PASSES(continued)
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. TMe system will
pass inspection if(with approval of the Board of Health). Describe observations:
Broken pipe(s)are replaced
Obstruction is removed
Distribution box is leveled or replaced
The system required pumping more than four times a year due to broken or obstructed
pipe(s), The system will pass inspection if(with approval of the Board of Health):
broken pipe(s)are replaced
Obstruction is removed
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 failing to protect the public health,safety and the environment.
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
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) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER i
SUPPLIER,IF APPROPRIATE)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A
MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT:
The system has a septic tank and soil absorption system(SAS)and the:SAS is within
100 feet to a surface water supply or tributary to a surface water supply;
The system has a septic tank and soil absorption system and the SAS i$within a Zone
1 of a public water supply well.
The system has a septic tank and soil absorption system and the SAS is within 50 feet
of a private water supply well.
The system has a septic tank and soil absorption system and the SAS iS less than 100
feet but 50 feet or more from a private water supply well, unless a well water analysis
for coliform bacteria and volatile organic compounds indicates that the Drell is free
from pollution from that facility and the presence of ammonia nitrogen and nitrate
nitrogen and nitrate nitrogen Is equal to or less than 5 ppm. Method used to determine
distance (approximation not valid).
3) OTHER
(reviaed 04/25/97)
Page 2 of 10
E0 39Vd 3611 QNd-ISI (INd 3dVO TTEZ06L809 6Z:IT 666T/E0/Z0
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 637 Yarmouth Rd.Hyannis Ma. 02601
Owner: S.M.T.Realty Trust
Date of inspection: 1 7-99
D]SYSTEM FAILS:
You must indicate either"Yes"or`No-as to each of the following:
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 determination is Identified below. The Board of Health should
be contacted to determine what will be necessary to correct the failure.
Yes No
Backup of sewage into facility or system component due to an overloaded or clogged
SAS or cesspool.
Discharge or ponding of effluent to the surface of the ground or surface waters due to an over-
Loaded 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'A day flow
Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s)
Number of times pumped
Any portion of the Soil Absorption System, cesspool or privy is below the high grpundwater
Elevation.
Any portion of a cesspool or privy is within 100 feet of 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 frpm a private
Water supply well with no acceptable water quality analysis. If the well has beer]analyzed to
be acceptable; attach copy of well water analysis for coliform bacteria,volatile organic
compounds, ammonia nitrogen and nitrate nitrogen.
E)LARGE SYSTEM FAILS:
You must indicate either'Yes'or"No°as to each of the following:
The following criteria apply to large systems in addition to the criteria above:
The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a
significant threat to public health and safety and the environment because one or more of the following
conditions exist:
Yes No
the system is within 400 feet of a surface drinking water supply
the system is within 200 feet of a tributary to a surface drinking water supply
the system is located in a nitrogen sensitive area(Interim Wellhead Protection area-IWP'A)or
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 compliance with the
groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local rogional office of
the Department for further information.
(revised 04/25/97) Page 3 of 10
b0 39Vd 3811 QNV-lSI (INd 3dVO ITEZ06L809 6Z:Tl 666Z/60/Z0
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 537 Yarmouth Rd.Hyannis Ma. 02601
Owner: S.M.T.Realty Trust
Date of Inspection: 1-7-99
Check if the following have been done: You must indicate either"Yes`or'No'as to each of the follow:ing:
Yes No
X Pumping information was provided by the owner,occupant, or Board of Health.
X None of the system components have been pumped for at least two weeks and the system
X has not been receiving normal flow rates during that period. Large volumes of water have not
been introduced into the system recently or as part of this inspection.
N/A As built plans have been obtained and examined. Note if they are not available with N/A.
X The facility or dwelling was inspected for signs of sewage back-up,
X The system does not receive non-sanitary or industrial waste flow.
X The site was inspected for signs of breakout.
X Ail system components, including the Soil Absorption System, have been located on the site.
N/A The septic tank manholes were uncovered.,opened, and the interior of the septic;tank was
Inspected for condition of baffles or tees, material of construction,dimensions, depth of liquid
Depth of sludge,depth of scum.
The size and location of the Soil Absorption System on the site has been determined based on:
X The facility owner(and occupants, if different from owner)were provided with information on
the
X Proper maintenance of Sub-Surface Disposal System.
X Existing information. Ex, Plan at B.O.H.
Determined in the field(if any of the failure criteria related to Part C is at issue,approximation
of distance is unacceptable)[15.302(3)(b))
(revised 04/25/97)
Page 4 0£ 10
S0 39Vd 3NI1 QNVISI QNd 3dt/9 itEZ06L805 6Z:IZ 6661/E0/Z0
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 53T Yarmouth Rd.Hyannis Me. 02601
Owner: a.M.T.Realty Trust
Dale of Inspection: 1-7-"
FLOW CONDITIONS
RESIDENTIAL:
Design flow g.p,d./bedroom for S.A.S.
Number of bedrooms: 1
Number of current residents: 0
Garbage grinder(yes or no): No
Laundry connected to system(yes or no): No
Seasonal use(yes or no) No r�
Water meter readings, if available(last two(2)year usage(gpd):
Sump Pump(yes or no): No
COMMERCIAUINDUSTRIAL:
Type of establishment: Small office`
Design flow: 3OA0 gallons/day
Grease trap present. (yes or no): No
Industrial Waste Holding Tank present(yes or no) No
Non-sanitary waste discharged to the Title 6 system: (yes or no)
Water meter readings, if available:
Last date of occupancy: Unknown
OTHER:(Describe)
Last date of occupancy:
GENERAL INFORMATION
PUMPING RECORDS and source of information:
None T.O.S.
System pumped as part of inspection:(yes or no) No
If yes, volume pumped: Gallons
Reason for pumping
TYPE Or SYSTEM
Septic tank/dist6bution box/soil absorption system
Single cesspool
X Overflow cesspool
Privy
Shared system (yes or no) (if yes, attach previous inspection records, if any)
I/A Technology etc.Copy of up to date contract?
Other
APPROXIMATE AGE of all components, date installed(if known)and source of information:
30+ owner
Sewage odors detected when arriving at the site: (yes or no) No
(rvvlaed 04/23/97)
Page 5 of 10
90 39th1 3811 QNVISI (INV 3dVO ZIEZ06L809 6Z:L1 6661/E0/Z0
I
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: S37 Yarmouth Rd.Hyannis Ms. 02001
Owner: S.M.T.Realty Trust
Date of Inspection: 1 T-99
BUILDING SEWER:
(Locate on site plan)
Depth below grade: 28"
Material of construction X cast Iron 40 PVC other(explain)
Distance from private water supply well or suction line
Diameter
Comments: (condition of joints,venting,evidence of leakage, etc.)
SEPTIC TANK:none
(Locate on site plan)
Depth below grade:
Material of construction concrete _ metal Fiberglass Polyethylene other(explain)
If tank is metal, list age Is age confirmed by Certificate of Compliance ?(Yes/No)
Dimensions:
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:
How dimensions were determined
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.)
GREASE TRAP:none
(locate on site plan)
Depth below grade:
Material of construction concrete metal T Fiberglass Polyethylene i 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:
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.)
(revised 04/25/9))
Page 6 of 10
L0 39Vcl 38I1 (INV-1SI (INV 3dVO TIEZ06LB09 6Z:Tl 6661/E0/Z0
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 537 Yarmouth Rd.Hyannis Ma. 02601
Owner: S.M.T.Realty Trust
Date of Inspection: 1-7-99
TIGHT OR HOLDING TANK: none (Tank must be pumped prior to,or at time, of inspection):
(Locate on site plan)
Depth below grade:
Material of construction concrete _ metal Fiberglass Polyethylene other(explain)
Dimensions:
Capacity:
Design flow. gallons/day
Alarm level: Alarm in working order Yes; _ No
Date of previous pumping:
Comments:
(condition of inlet tee,condition of alarm and float switches, etc.)
DISTRIBUTION BOX:none
(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, aft,)
PUMP CHAMBER: none
(locate on site plan)
Pumps in working order: (Yes or No)
Alarms in working order(Yes or No) ;
Comments:
(note condition of pump chamber,condition of pumps and appurtenances, etc.)
(revised 04/25197)
page 7 of 10
80 39Vd 3NI1 QNVISI (INd 3dd9 TT6Z06L809 6Z:TT 666T/60/Z0
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 537 Yarmouth Rd.Hyannis Ma. 02801
Owner: S.M.T. Realty Trust
Date of Inspection: 1-7r09
SOIL ABSORPTION SYSTEM(SAS):
(locate on site plan, if possible,excavation not required, but may be approximated by non-intrusive rn'ethods)
If not determined to be present, explain:
Type:
leaching pits, number,
leaching chambers, number
leaching galleries, number
leaching trenches,number, length:
leaching fields, number, dimensions:
overflow cesspool, number, 1-6'xB'red brick
alternative system:
Name of Technology:
Comments:
(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, etc.)
Cesspool dry with no stain line at time of inspection.
CESSPOOLS,
(locate on site plan)
Number and configuration: 1
Depth-top of liquid to inlet invert: 56"
Depth of solids layer. Dry
Depth of scum layer: 0"
Dimensions of cesspool: 6'x8'
Materials of construction: Concrete block
Indication of groundwater. None
inflow(cesspool must be pumped as part of inspection) Dry at time of inspection.
Comments:-.
(note condition of soil, signs of hydraulic failure, , level of ponding, condition of vegetation, etc.)
block cesspool dry at time of inspection w/1.8'xB'block and red brick cesspool overflow.
PRIVY:none
(locate on site plan)none
Materials of construction: Dimensions:
Depth of solids:
Comments:
(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
(revised 04/25/91)
page a of 10
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SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 537 Yarmouth Rd.Hyannis Ma. 02001
Owner: S.M.T.Realty Trust
Date of Inspection: 1-7-99
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to tit least two permanent references landmarks or benchmarks
locate all wells within 100(locate where public water supply comes into house)
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(reviscd 0e/25/97)
Page 9 of 10
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SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 597 Yarmouth Rd.Hyannis Me. 02601
Owner: S.M.T.Realty Trust
Date of Inspection: 1-7-99
Depth.to groundwater 10+ feet
Please indicate all the methods used to determine High Groundwater Elevation:
Obtained fro Design Plans on record
X Observation of Site(Abutting property,observation hole, basement sump etc.)
Determine it from local conditions
Check with local Board of health
Check FEMA Maps
Check pumping records
Check local excavators,installers
Use U8GS Data
Describe in your own words how you established the High Groundwater Elevation. (Must be completed)
Hand auger hole at 10' (dry)
(reviaed 04/25/97)
Page 10 of 10
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COADIMONWEAIJ70H of MASSACHUSETTS
DEPARTMENTof ENVIRONMENTAL PROTECTION
BE T KNOWN THAT
Wifflam E. Robinson P . :fir'. p
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D
Has satisfied the Department's qualifications as required and is here �
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au D
thorized to use the title Z
CERTIFIED TITLE 5 SYSTEM INSPECTOR
as provided in 31 o I✓MR 15.340 and Section 13 of Chapter 2 I A of the m
General Laws. Issued by The Department of Environmental Protection.
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Acei Dixecroc of the Ur Wet"Pollution CoauoB
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Wm. E. RdbinsOn, Jr.
Septic Inspectlns
43 Tomahawk Drive
Centerville, MA 02632 8 9
(508) 775-7986 ^ .A
Pager 978-622-8700 �' F
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_ Location
537 Yarmouth Rd. g
Hyannis Ma.02601
S.M.T. Realty Trust
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I x Commonwealth of fviossachuseits
Execulive Office of Environmental Affairs
m►ep artment ®f
Enviarananantai Pot
SUBSURFACE SEWAGE DISPOSAL SYST INSPECTION F �VI
PART Akft
CERTIFICATION
Map Number
Parcel Number 4*
PROPERTY ADDRESS: 537 Yarmouth Rd. Hyannis Ma. ADDRE ti ER:
DATE OF INSPECTION: 1-7-99 S.M.T.Realty Trust
NAME OF INSPECTOR: William Robinson Hyannis Ma. 02601
I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 9310 CMR 15.0
COMPANY NAME: W. E. Robinson Septic Inspections
MAILING ADDRESS: 43 Tomahawk Drive Centerville, MA 02632
TELEPHONE NUMBER: (508)775-7986
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is t
accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the p
function and maintenance of on-site sewage disposal systems. The system:
X PASSES
CONDITIONALLY PASSES e
NEEDS FURTHER EVALUATION BY THE LOCAL APPROVING AUTHORITY
- FAILS
INSPECTORS SIGNATURE: DATE: 1-7-99
a_ The system Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing
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 s
submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to
system owner and copies sent to the buyer,if applicable and the approving authority.
INSPECTION SUMMARY: Check A, B, C, or D:
A] SYSTEM PASSES:
X I have not found any information which indicates that the system violates any of the failure criteria a
defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below.
COMMENTS:
B SYSTEM CONDITIONALLY PASSES:
One or more system components as described in the"Conditional Pass" section need to be replaced
repaired. The system, upon completion of the replacement or repair, as approved b the Board of He
will pass.
Indicate yes, no, or not determined (Y, N, or NO). Describe basis of determination.in all instances. If"not
determined", explain why not)
The septic tank is metal, unless the owner or operator has provided the system inspector with a
_ of a Certificate of Compliance(attached)indicating that the tank was installed within twenty(20)
years prior to the date of the inspection; or the septic tank, whether or not metal, is cracked,
structurally unsound, shows substantial infiltration or exfiltration, or tank is failure is imminent.
system will pass inspection if the existing septic tank is replaced with a conforming septic tank a
approved by the Board of Health.
Page 1 of 10
f � (revised 04/25/97)
= a� DEP on the World Wide Web:http://www.magnet.state.ma.un/d
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (CONTINUED)
Property Address: 537 Yarmouth Rd. Hyannis Ma. 02601
Owner: S.M.T. Realty Trust
Date of Inspection: 1-7-99
B]SYSTEM CONDITIONALLY PASSES(continued)
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 syste
pass inspection if(with approval of the Board of Health). Describe observations:
Broken pipe(s)are replaced
Obstruction is removed
Distribution box is leveled or replaced I
The system required pumping more than four times a year due to broken or obstructed
pipe(s). The system will pass inspection if(with approval of the Board of Health):
broken pipe(s) are replaced
Obstruction is removed
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 s
is failing to protect the public health, safety and the environment.
1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM
NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND
SAFETY AND THE ENVIRONMENT:
Cesspool or privy is within 50 feet of a surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt mar
2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER
SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN
MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMI
The system has a septic tank and soil absorption system(SAS)and the SAS is
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 the SAS is within
1 of a public water supply well.
The system has a septic tank and soil absorption system and the SAS is within
of a private water supply well.
<..- The system has a septic tank and soil absorption system and the SAS is less th
..� feet but 50 feet or-more from a private water supply well, unless a well water an
for coliform bacteria and volatile organic compounds indicates that the well is fr
from pollution from that facility and the presence of ammonia nitrogen and nitrat
nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to deb
distance (approximation not valid).
3) OTHER
�,z ,t�u' sue' .z••:
(revised 04/25/97)
Page 2 of 10
fw
l
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 537 Yarmouth Rd. Hyannis Ma. 02601
Owner: S.M.T. Realty Trust
Date of Inspection: 1-7-99
Dj SYSTEM FAILS:
You must indicate either"Yes"or"No" as to each of the following:
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 determination is identified below. The Board of Health should
be contacted to determine what will be necessary to correct the failure.
Yes No
Backup of sewage into facility or system component due to an overloaded or clogged
SAS or cesspool.
Discharge or ponding of effluent to the surface of the ground or surface waters due to an over-
Loaded or clogged SAS or cesspool.
Static liquid level in the distribution box above outlet invert due to an overloaded or clogged
SAS or cesspool.
Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/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 Soil Absorption System, cesspool or privy is below the high groundwater.
Elevation.
Any portion of a cesspool or privy is within 100 feet of 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. Q
Any portion of a cesspool or privy is within 50 feet of a private water supply well.
Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private
Water supply well with no acceptable water.quality analysis. If the well has been analyzed to
be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic
compounds, ammonia nitrogen and nitrate nitrogen.
E) LARGE SYSTEM FAILS:
You must indicate either"Yes" or"No" as to each of the following:
The following criteria apply to large systems in addition to the criteria above:
The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a
significant threat to public health and safety and the environment because one or more of the following
conditions exist:
Yes No
the system is within 400 feet of a surface drinking water supply
the system is within 200 feet of a tributary to a surface drinking water supply
the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or
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 compliance with the
groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of
the Department for further information.
i
(revised 04/25/97) Page 3 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 537 Yarmouth Rd. Hyannis Ma. 02601
Owner: S.M.T. Realty Trust
Date of Inspection: 1-7-99
Check if the following have been done: You must indicate either"Yes" or"No" as to each of the following:
Yes No
X Pumping information was provided by the owner, occupant, or Board of Health.
X None of the system components have been pumped for at least two weeks and the system
X has not been receiving normal flow rates during that period. Large volumes of water have not
been introduced into the system recently or as part of this inspection.
N/A As built plans have been obtained and examined. Note if they are not available with N/A.
X The facility or dwelling was inspected for signs of sewage back-up.
X The system does not receive non-sanitary or industrial waste flow.
X The site was inspected for signs of breakout.
X All system components, including the Soil Absorption System, have been located on the site.
N/A The septic tank manholes were uncovered, opened, and the interior of the septic tank was
Inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid
Depth of sludge, depth of scum.
The size and location of the Soil Absorption System on the site has beenrdetermined based on:
X The facility owner(and occupants, if different from owner)were provided with information on
the
X Proper maintenance of Sub-Surface Disposal System.
X Existing information. Ex. Plan at B.O.H.
Determined in the field (if any of the failure criteria related to Part C is at issue, approximation
of distance is unacceptable)[15.302(3)(b)]
(revised 04/25/97)
Page 4 of 10
r
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM .
PART C
I`
SYSTEM INFORMATION s
Property Address: 537 Yarmouth Rd. Hyannis Ma. 02601
Owner: S.M.T. Realty Trust
Date of Inspection: 1-7-99
FLOW CONDITIONS
RESIDENTIAL:
Design flow: - g.p.d./bedroom for S.A.S.
Number of bedrooms: 1
Number of current residents: 0
Garbage grinder(yes or no): No
Laundry connected to system es or no): No
Seasonal use.(yes or no) No
Water meter readings, if available(last two(2)year usage(gpd):
Sump Pump(yes or no): No
COMMERCIAL/INDUSTRIAL:
Type of establishment: Small office'
Design flow: 30-40 gallons/day
Grease trap present: (yes or no): No
Industrial Waste Holding Tank present: (yes or no) No
Non-sanitary waste discharged to the Title 5 system: (yes or no)
Water meter readings, if available:
Last date of occupancy: Unknown
OTHER: (Describe)
Last date of occupancy:
GENERAL INFORMATION
PUMPING RECORDS and source of information:
None T.O.B.
System pumped as part of inspection:(yes or no) No
If yes, volume pumped: Gallons
Reason for pumping
TYPE OF SYSTEM
Septic tank/distribution box/soil absorption system
Single cesspool
X Overflow cesspool
Privy
Shared system (yes or no) (if yes, attach previous inspection records, if any)
I/A Technology etc. Copy of up to date contract?
Other
APPROXIMATE AGE of all components, date installed (if known)and source of information:
30+ owner
Sewage odors detected when arriving at the site: (yes or no) No
;l
(revised 04/25/97)
Page 5 of 10
F.
5 s
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 537 Yarmouth Rd. Hyannis Ma. 02601
Owner: S.M.T. Realty Trust
Date of Inspection: 1-7-99
BUILDING SEWER:
(Locate on site plan)
Depth below grade: 2801
Material of construction X cast iron 40 PVC other(explain)
Distance from private water supply well or suction line
Diameter
Comments: (condition of joints, venting, evidence of leakage, etc.)
I
SEPTIC TANK: none
(Locate on site plan)
Depth below grade:
Material of construction concrete _ metal Fiberglass Polyethylene other(explain) '
If tank is metal, list age Is age confirmed by Certificate of Compliance (Yes/No)
Dimensions:
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:
How dimensions were determined
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.)
GREASE TRAP: none t
(locate on site plan)
Depth below grade:
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:
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.)
(revised 04/25/97)
Pace 6 of 10
:i
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 537 Yarmouth Rd. Hyannis Ma. 02601
Owner: S.M.T. Realty Trust
Date of Inspection: 1-7-99
TIGHT OR HOLDING TANK: none (Tank must be pumped prior to, or at time, of inspection)
(Locate on site plan)
Depth below grade:
Material of construction concrete _ metal Fiberglass Polyethylene other(explain)
Dimensions:
Capacity:
Design flow: gallons/day
Alarm level: Alarm in working order Yes; No
Date of previous pumping:
Comments:
(condition of inlet tee, condition of alarm and float switches, etc.) I
DISTRIBUTION BOX: none
(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 out of box, etc,)
PUMP CHAMBER: none
(locate on site plan)
Pumps in working order: (Yes or No)
Alarms in working order(Yes or No)
Comments:
(note condition of pump chamber, condition of pumps and appurtenances, etc.)
(revised 04/25/97)
Page 7 of 10 j
p
i
M1
i • J
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 537 Yarmouth Rd. Hyannis Ma. 02601
Owner: S.M.T. Realty Trust
Date of Inspection: 1-7-99
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:
leaching galleries, number:
leaching trenches, number, length:
leaching fields, number, dimensions:
overflow cesspool, number, 1-6'x8' red brick
alternative system:
Name of Technology:
Comments:
(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
Cesspool dry with no stain line at time of inspection.
CESSPOOLS:
(locate on site plan)
Number and configuration: 1
Depth-top of liquid to inlet invert: 56"
Depth of solids layer: Dry
Depth of scum layer: 0"
Dimensions of cesspool: 6'x8'
Materials of construction: Concrete block
Indication of groundwater: None
inflow(cesspool must be pumped as part of inspection) Dry at time of inspection.
Comments::
(note condition of soil, signs of hydraulic failure, , level of ponding, condition of vegetation, etc.)
1-6'x8' block cesspool dry at time of inspection w/ 1-6'x8' block and red brick cesspool overflow.
PRIVY:none
(locate on site plan) none
Materials of construction: Dimensions:
Depth of solids:
Comments:
(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
r
(revised 04/25/97) z
Page 8 of 10 j
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 537 Yarmouth Rd. Hyannis Ma. 02601
Owner: S.M.T. Realty Trust
Date of Inspection: 1-7-99
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent references landmarks or benchmarks
locate all wells within 100(locate where public water supply comes.into house)
YARmoah 1?d. I
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r ►
NOTE
5+ CeSSQoo1 S �': b`ng` $la�.cesgpeol
AT jimL of 101?"k4j wl -6Xg`
Block
(revised 04/25/97) I
Page 9 of 10
a
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 537 Yarmouth Rd. Hyannis Ma. 02601
Owner: S.M.T. Realty Trust
Date of Inspection: 1-7-99
Depth to groundwater 10+ feet
Please indicate all the methods used to determine High Groundwater Elevation:
Obtained fro Design Plans on record
X Observation of Site(Abutting property, observation hole, basement sump etc.)
Determine it from local conditions
Check with local Board of health
Check FEMA Maps
Check pumping records .
Check local excavators, installers
Use USGS Data
Describe in your own words how you established the High Groundwater Elevation. (Must be completed)
Hand auger hole at 10' (dry)
(revised 04/25/97)
Page 10 of 10
bey r�a�
MASSAC JSETT 3
THE COMMONWEALTH OF S -
{
DEPARTMENT OF ENVIRONMENTAL PROTECTION
BE IT KNOWN THAT
William E. Robinson, . :fir.
Has satisfied the Department's qualifications as required and is hereby
_ q y
authorized to use the title
CERTIFIED TITLE 5 SYSTEM INSPECTOR
as provided in 310 CMR 15.340 and Section 13 of Chapter 21 A of the
General Laws. Issued b The p
y Department of Environmental Protection.
April 20, 1995
Acting Director of the ' tun of Water Pollution Control
i � -