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HomeMy WebLinkAbout0033 GERALDINE ROAD - Health 33 GERALDINE ROAD, COTUIT A=040 018 i ®4 P - No.. '_ e Fmc.. .r. APPROVED THE COMMONWEALTH OF MASSACHUSETTS n to Conserve BOARD OF HEALTH 75 9 TOWN OF BARNSTABLE AV firalwit for Bi-nVi1iitt1 Work.6 Tattitrnr#inn ramit Application is hereby made for a Permit to Construct ( ) or Repair Cl<an Individual Sewage Disposal systeq,a �A/ �j� ^ Lora i-Address � Lot No. y +---- ----- ------ ..------............... Ownev\�y�—LL/ ess � C � -•� ... `.................... ......•............................... .- .:..._... ��3 ._..:...........' Installer Address UType of Building =^� Size Lot............................Sq. feet Dwelling—No. of Bedrooms-------------�?------__________-__-__-_Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures ................................... W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. R: Septic Tank—Liquid capacity........____gallons - Length________________ Width---------------- Diameter---.------------ Depth................ W Disposal Trench—No. .................... Width-------------------- Total Length.................... Total leaching area....................sq. ft. x Seepage Pit No._.___. .-____. Diameter____________________ Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date--------------......................... Test Pit No. I________________minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth,to ground water........................ ---------------------------------- --------------------------------------------------------•-•••---------•-•-------------•---------•---.-•--.------------••- ----••-•••••.... r. O Description of Soil •----------- =----------------------------------------------------------------------•••••............-•--- x �'St . x --- t ...... t _. >� _ U n Ner wh nNat licable.___ � ^ k `of Re airsaAlterat' si (� r Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Envi ental Code—The undersigned further agrees not to place the system in operation until a Certificate of Co piiari e ha been issued the oard of health. _ Signed ........ ...- . ------- �` Date Application Approved By .............r�! ui --------- ��-------- -....... ......................................... ...�5....11.eat. q� -------------- De Application Disapproved for the following reasonr- ------------------------------------------------------------------------------------------------------- Q..................................................... . ........ ... . ............................ .--------------------------------------------------------------- ...` �t D ."-- t'---------- are Permit No. l�~ Issued �.� - - .�................... ---------.............__.....----------------............._ ..----'--------- Date MA J4 oL0 P No..�.:C....�'`A42:5 T Gc� Fxs.SO , THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH � /TOWN OF BARNSTABLE A hratiou for Dig nitt�� � 1 Wurkii Tumitrurtio n r.ermtt Application is hereby made for a Permit to Construct ( ) or Repair 4"1 an Individual Sewage Disposal Sys..jA " Local-g ess G t n•Addr S. or Lo No. .r .. L.c[�-� . --.................. - -------------•----------------------------- ----------------------- ..............�-=....... -------- ................ Owner v '� Ad cress �,�.. ems , : _ 5� w\GsV •-----^*-- r------4r'.'.-------\------------------•-•-•-----------•--•------ ..................................................•--.----•-------......------r ......... Installer� Address UType of Building Size Lot............................Sq. feet ,., Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) a Other fixtures ------------------------------------------------------ W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length---------------- Width---------------- Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage•,Pit No...................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by....................•---------------...-----------------------------..____ Date........................................ Test Pit No. I----------------minutes per inch Depth of Test Pit.................... Depth to ground water........................ G14 Test Pit No. 2................minutes per inch Depth of Test Pit--------_......:.... Depth to ground water........................ P4 -----•-••-••----------------••-•-•.......................................................................................................................... xDescription of Soil--------------- =------------------------------------------....----------------------------------------------••------•----- V ------------------------------------- ------------------------- ------------------------------------------------------- ---------------------- •-----------------------------------.------------------- UW ...•-••---••----------------- . --.. ----- Nature of Repairs Alteratiaarks— 'nswer wh n a, plicable.__._. cS •_. _.__�.-_� -......0 's- .` �" ....... 1� _S:........... YJ J 4,,......��i�p... -_---•-•----���U� rJ , Gi �....--•--•......1000rC..:..........._+ 1 \Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Corl pliance has beenissued by the board of health. _ Signed�....(,L.�-�l� �---- l a �1 .................. ` -�� •� �_ �to l Application Approved By Date Application Disapproved for the following rearons: ............................... -------------------------------------------------------------------------- --- --- r�. Permit No. ------------------f-------------------------- Issued �� ........... - Dace THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Ter#ifictt#E of ComlatiancE THI8 IS TO CE TIFY, That t e Individual Sewage is osal System constructed ( ) or Repaired 4 ) y car ; c�� b (-------- �' `------------------\� e_.�"�......_x - ` m,:lu i�w c - Co-� . at ---------------------------............. � r � c . ........__. ... ....---------- has been installed in accordance with the provisions of TITI. 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. Fr` --- '---;P77..,O-------. dated.,, .'" THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE--------�---`.''3..-^--C1-----r--------- ----------------------- ------------ Inspector ^..n2. t/z / - __... ' THE COMMONWEALTH OF MASSACHUSETTS �� ( D jry)tq BOARD OF HEALTH TOWN OF BARNSTABLE '1 No........................ FEE Permission is hereby granted_______, . � wc. r . to Construct ( ) or Repair (�a an Individual Sewage Dis op sal System i atNo.... 2� - -- .y `��`` �- .....�--- ----------•---------------------------------------------- Streetl f as shown on the application for Disposal Works Construction Permit��o�''�_4_ /& Dated.-�5___.-._'e.7'�-,-.............. Board of Health / DATE........5... -.:..�.�................................................... 36508 HOBBS 6 WARREN.INC..PUBLISHERS . . - TOWN OF BARNSTABLE LOCATION SEWAGE # VILLAGE Co ASSESSOR'S MAP &.LOT t INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY it LEACHING FACILITY: (type) ( iP 1 (size) 1000 S f� NO.OF BEDROOMS S- BUILDER OR OWNER PERMTTDATE: 2 2 �rjZ,_COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and ZU ( Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) fJ 1 Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility)__ Feet Furnished by - -¢-�-�-t� j 3a z t 37 ' �3 Al ' wr , Ltd, Y + �i TOWN OF BARNSTABLESl c LOCATION �L ����9 e -.gVyr �, SEWAGE . 6 VILLAGE - 00+ ASSESSOR'S MAP & LOT%I LO INSTALLER'S NAME & PHONE NO. �1�,,, SEPTIC TANK CAPACITY ® LEACHING FACILITY:(type) 4 Pa�- (size) G4600, NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER W �� r sli ® r DATE PERMIT ISSUED: 1 DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No GL A7 B 4® r 1 E \ COMMONWEALTH OF IVIASSACHL•SETTS EXECUTIVE OFFICE OF DNviRONMENTAL AFFAIR ^ a 9 _ DEPART�IE�T OF EN-VIRONMENTAL PROTE \ �.. ONE WINTER STREET. 80570N. DtA 02105 61 _81998.. U ILLIAM F.WELD �TRL D i Goverac _ ,.. a ARGEO PAU1 CELLUCCl _ . .. TRL'Y. Lt.Govcrnor SUBSURFACE SEWAGE DI SPOSAL SAL SYSTEM INSPECTION CTION FORM� mmissiorr. M 1P P O Lk C) PART A CERTIFICATION Property Address; �"1L�.1 loae.r I Cvi v4 l Address of Owner: h11 �•Q��-� �- ��d� Date of Inspection: dl IZZ M. "(If different) Name of Inspector: lt'i✓.(C�a o 40 ►I E3)&-Ce� COTS:_l< <`t✓� am a DEP ap roved system inspector pursuant to Section 15.340 of Title S (310 CMR 15.000) U2� 3 S . Company Name: , 4 g4-e c En Ap'i+j., 0-4 p M Mailing Address: R o C-32!!4 H 19-©... �F-C/ Telephone Number: r.S-et;2 C6.$';- �4 7 vim_ CERTIFICATION STATEMENT - I certii that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and comolete as of the time of inspec-oo•-. The inspection was performed baser on my training and experience in the proper function and maintenance of on-sae sewage disposa; systems. The system: Passes m _ Concitionaii% Passes _ Neecs Further Evaluation By the Local-Approving Autnorin Fa.-s Inspector's Signature. Date: 5 T;,e Svste^ Ins:+ezo• sha!' submit a cop\ of this inspection report to the Approving Authority within them, (30) days of completing this inspection. If She system is a shared s%-stem o• has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the repoi to the appropriate regional office of the Depanment of Environmenta' Protection.. The orig!na! should be sent to the system ovine and copes s-n;to the buyer, if applicable, and the approving authorit\::. INSPECTIO, SUMMARY:.. Check A, B, C, or D: Al SYSTEM PASSES: Y I have not found any information which indicates that the system violates any+aof the failure criteria as defined in 310 CMR.15, 303. Any failure criteria not evaluated are indicated below. COMMENTS: BI SYSTEM CONDITIONALLY PASSES: One or more system components as described in the 'Conditional Pass" section need to be replaced or repaired. The system, upol completion of the replacement or repair, as approved by the Board of Health, will pass. Indicate yes, no, or not determined (Y, N. or NDi. .Describe basis of determination in all instances. If'not determined",explain why not. The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance (attached) indicating that the tank was installed within twenty (20) years prior to the date of the,inspection; o- the septic tank, whether or not metal, is 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. (revined 04/2S!17) ^Page I of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A : . CERTIFICATION (continued) Property Addcgss: Owner:", �� + _ _ " r. _ .t• gip•t; 1 ,� Date of Inspection: . } V, B] SYSTEM CONDITIONALLY PASSES icont.nr-d Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed e� rP.pets) or due to a broken• settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Healthl.. Describe observations: broken pipe( are replaced obstruction is removed distribution box is levelled or replaced _ The system required pumping more than four times a year due to broken or obstructed pipCs). The system will pass inspection if twith approval of the Board of Health): - - - broken pipets; are replaces obstruction is removed - :- - - - C] FURTHER EVALUATION 15 REQUIRED BY THE BOARD OF HEALTH: __.,_.._.. Conditions exist which require furthe•evaluation by the Board of Health in order to determine if the system is failing to protect the public health• safer•and the environment., 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM 15 NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or pr,%-, is within 50 fee: of a surface water Cesspool or prn-� 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 SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONItiG 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 is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than S ppm. Method used to determine distance (approximation not valid). 3) _.OTHER I (revised OV25/371 Page 2 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A 1. . I , CERTIFICATION (continued) S Property Address: Owner: Date of Inspection: DI 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 overloaded or clogged SAS or cesspool. , Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped — Any portion of the Soil Absorption System, cesspool'or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100,feet of a surface water supply or tributary to a surface water supply.. Any portion of a cesspool or privy is within.a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet-but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E LARGE SYSTEM FAILS: You must indicat e either "Yes" or "No" as to each of the following: Y .. 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 �y - the system is within 400 feet of a surface drinking water supply - - the system is within 200 feet of a tributary to a surface drinking water supply " the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area -IWPA) or a mapped Zone II of a public water supply well) The 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. f. i (revised 04/25/97) Page 3 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM CTION FORM PART B CHECKLIST Property Address: 33 &a AR i N Owner: J_sk(-',VQj Date of Inspection:V 22 i5 Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Yes No _ Pumping information was provided by the owner, occupant, or Board of Health. _ None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rate., during that period. Large volumes of water have not been introduced into the system recently or as pan 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. _ 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 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 proper maintenance of Sub Surface Disposal System. -=1� 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 04/2S/n Page 4 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: `33 Gleem' .rye. Owner: Solvr- Date of Inspection: I�f FLOW CONDITIONS RESIDENTIAL: Design (low: $$O Q.p.d./bedroom for S.A.S. ; s' Number of bedrooms: OS Number of current residents: Garbage grinder (yes or no):_N-�k Laundry connected to system (yes or no): ;.. Seasonal use (yes or no): fJ Water meter readings, if available (last two (2) year usage (gpd): iV Sump Pump (yes or no): PJ Last date of occupancy: COMMERCIAL/INDUSTRIAL: „ v Type of establishment. Design flow:_ allons/day z 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 INTFORMATION PUMPING RECORDS and source of information: System pumped as part of inspection: (yes or no),4p,I(j If yes, volume pumped: Gallons Reason for pumping: TYPE OF SYSTEM X, Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) I/A Technology etc. Copy of up to date,contract? Other APPROXIMATE AGE of all components, date•.installed (if known) and source of information..- Sewage odors detected when arriving at the site: (yes or no) No (revised OVISroB Page S of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 3 Owner: Date of Inspection: 'Z�I y BUELDING SEWER: (Locate on site plan) Depth below grade: Material of construction: _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: ,,L` (locate on site plan) Depth below grade: y I tO b Material of construction: Aconcrete _metal _Fiberglass _Polyethylene —other(explain) If tank is metal. list are _ Is age confirmed by Certificate of Compliance _(Yes/No) Dimensions: 1 Soo Ci» 1 Sludge depth: %`J 3�� 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: F Comments: (recommendation for pumping. condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert. structural integriq. evid cc of leakage. etc.) � tit., t 11-11 r GREASE TRA.P:_� (locate on site plan) Depth below grade: Material of construction: _concrete _meta) _Fiberglass _Polyethylene —other(explain) Dimensions: Scum thickness: DisLmce 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) P2ge 6 Of 10 f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM . PART C' SYSTEM INFORMATION (continued) Property Address: 3 &vc P14 r&.I� Owner: Date of Inspection: D TIGHT OR HOLDING TANK:, (Tank must be pumped prior to, or at time, of inspection) f' (locate on site plan) s Depth below grade: Material of construction: _concrete _metal _Fiberglass .._Polyethylene _other(explain) Dimensions: - Capacity: gallons u Design flow: gallons/day Alarm level: Alarm in working order Yes: No Date of previous pumping: A Comments: (condition of inlet tee. condition of alarm and float switches. etc.) ►ISTRIBUTION BOX: S (locate on site.plan) Depth of liquid level above outlet invert: M T V/wV-gxj- Comments: (note if 1 vel and distrib ion is equal, evidence of solids carryover, idence of leakage into or ou of box, etc.) - '16G i 10U 01'..l S PUMP CHAMBER:JL1% (locate on site plan) Pumps in working order: (Yes or No) ry Alarms in.working order (Yes or No) Comments: r (note condition of pump chamber, condition of pumps and appurtenances, etc.) t (revised MUM) Page 7 of to .a� SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 33(4ciu I&Lo Owner: t a�q ve d: Date of Inspection: —1(AI1(;6 SOIL ABSORPTION SYSTEM (SAS):,*5 (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: i A L leaching chambers, number:_ leaching galleries, number: leaching trenches. number.length: leaching fields. number, dimensions: overflow cesspool, number: Alternative system: Name of Technology: Comments: (note condition of soilsigns of hydraulic failure, level of ponding, condition of e n n, etc.) C Iry �. CESSPOOLS:._LJU (locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater: inflow (cesspool must be pumped as part of inspection) Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY: (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) (mvised 04125/97) Page 8 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Owner: (.E• vti2e . Date of Inspection: 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)33 , .l a HU 4 a (revised 03/2S/97) Page 9 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECT ION FORM PART C SYSTEM INFORMATION (continued) Property Address: �3 GwicA�(,,jAe— Owner: Date of Inspection:�l �S� Depth to Groundwater Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record 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) U,S.�a(a9�cet.5> �,�.vc,�L, l,-��c�.�,lo��`c ��v�T,5 ►a'1a"'S r-(,Fl • ��Z.. VV i 3ILk (revised 01/2S/97) Page 10 of 10