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Home My WebLink About0015 EDGEWOOD ROAD - Health (3) 15 Edgewood Road Hyannis i A= 248-125 i I 6, TOWN OF BARNSTABLE LOCATION / /� UG W0010 I SEWAGE # 3 r VILLAGE ter— ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. o��vim- SEPTIC TANK CAPACITY /5 R) LEACHING FACILITY: (type) (size) OZX�I �oZ NO.OF BEDROOMS BUILDER OR OWNER PERMTTDATE:� a-y �/ COMPLIANCE DATE: -a -2 9- 7-7 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 J �� , _ _ --.� b � N v � ..<. i 6' - x <�:. .. No. 7- k-5 Fee -1 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ier", PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01pphration for Migaar *pztem Comaructiou 3permit Application for a Permit to Construct( )Repair Grade( )Abandon( ) El Complete System ❑Individual Components Location Address or Lot No. SAS Owner's Name,Address and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. ` Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow -3-3 gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank SOD Type of S.A.S. Description of Soil S Nature of Repairs or Alterations(Answer when applicable) in CD v�'�e( `�-Z19�•.� ►�- �d� �{, l�+S.._�G�,.,�Gi�.��:LTv=..,�o�e5 iti� �\� STD 1�(t f 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 provisio�offfiitlethe Environmental Code nd not to place the system in operation until aCertifi- cate of Compliance has been iss Signed Date Application Approved by n'1 Date ,2 Application Disapproved for the following reasons Permit No. 7 s Date Issued - = 9 TOWN OF BARNSTABLE LOCATION % FnI�F L,ri�i✓� /� SEWAGE # VILLAGE_ /J02j ASSESSOR'S MAP & LOTS INSTALLER'S NAME&PHONE NO. SEPTIC.TANK CAPACITY LEACHING FACILITY: (type) —ri-K c riyt s (size) NO..OF BEDROOMS BUB.DER OR OWNER PERMTTDATE: '1 - 'a- !I % 7 COMPLIANCE DATE:= 'Z7, 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 F7e- 7' 17' d f No. +, s �'p. Fee ::Fl- THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS Zipprication for 3igpoml *pgtem Construction Permit Application for a Permit to Construct( )Repair( 'Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. / j A_t:� Owner's Name,Address and Tel.No. Assessor's Map/Parcel �,��,-a.�—• , Installer's Name,Address,and Tel.No. J Designer's Name,Address and Tel.No. OVA e Type of Building: Dwelling No.of Bedrooms �J Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 3 r3 D gallons per day. Calculated daily flow ✓" gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank 1 C1D Type of S.A.S. '�t Description of Soil AN VS Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal systPin in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by.,tl�i, o f iRealth. Signe_ /? Date �a Application Approved by 41 —Date�2 Application Disapproved for the following reasons Permit No. 7— J Date Issued ---------------------------- ----—f---—r)�'` THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERT F -tha he On-site S,e a Disposal System Constructed( ) Repaired( )Upgraded(1. Abandoned( )by o .. G• r �,r� —� at has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated. •a `-L= 9 2 . Installer Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date - �/� ' �f t Inspector } No. r Fee Sc� THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS lwigoal *pgtem Con$truction Permit Permission is hereby granted to Construct( )Repair( v Upgrade( )Abandon( ) System located at and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date: Approved by A NOTICE: This Form is to be used for the Repair of Failed Septic Systems Only CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLAN I, hereby certify that the application for disposal works construction permit signed by me dated , concerning the property located at -Zl 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: LICENSED SEPTIC SYSTEM 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]. jxert Town of Barnstable g Department of Health, Safety, and Environmental Services M Health Division 367 Main Street,Hyannis MA 02601 Installer Of�i�e 5 -7"-6263 T1�o�1►N A MctCan PAX: 508-775-3344 Dlredar dPut�lib Nald� TO: Mr. McCullough' (pate) January 13, 1997 15 Edgewood Road West Hyannisport, MA 02672 ORDER TO COMPLY WITH 310 CMR 15.00, THE STATE ENVIRONMENTAL CODE, TITLE 5. The septic system owned by you located at 15 Edgewood Road Avenue, Circle, Lane, Road, Street in the village of West Hyannisportwas inspected on Dec. -30;1996 by WerviRebinson Septic Massachusetts licensed septic inspector. The inspection of your septic system showed that your system has failed under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: Leaking pit in failure Septic system must be brought into compliance! You are directed to hire a licensed Town of Barnstable septic system installer to sketch a proposed system that will bring the septic system into compliance with 310 CMR 15.00, The State Environmental Code, Title 5 within(14) fourteen days of receipt of this notice. The septic system must be brought into compliance within thirty (30), sixty (60), ninety (90) days of your receipt of this letter. You are also directed to maintain the system by hiring a licensed septage hauler to pump the septic system to prevent discharge of sewage or effluent into the buildings, onto the surface of the ground, or in to surface waters. Any person aggrieved by any order issued by the local approval authority may appeal to any court of competent jurisdiction as provided for by the laws of the Commonwealth. PER ORDER OF THE B ARD OF HEALTH mas cKean, R.S., C.H.O. Agent of the Board of Health Town of Barnstable Ode 5(1) y Town of Barnstable e Department of health, Safety, And Environmental Services • NAM `�`a; ffiX Health Division 367 Main Street,Hyannis MA 02601 Installer oir :--5 08-790.6265 Dhdo o McKean 1:Ax: 508-775-3344 Director of Public Heshh TO: O)MX (Date) - 15 e�c� ORDER TO COMPLY WITH 310 CMR 15.00, THE STATE ENVIRONMENTAL CODE, TITLE 5. The septic system owned by you located at JS &QA�-a Avenue, Circle, Lane, Road, Street in the village of V4 thou as inspected on 6- 4 by Ala Massa usetts licensed septic inspector. The inspection of your septic system showed that your system has failed under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: Ag You are directed to hire a licensed Town of Barnstable septic system installer to sketch a proposed system that will bring the septic system into compliance with 310 CMR 15.00, The State Environmental Code, Title 5 within (14) fourteen days of receipt of this notice. The septic system must be brought into compliance within thirty (30), sixty (60), ninety (90) days of your receipt of this letter. You are also directed to maintain the system by hiring a licensed septage hauler to pump the septic system to prevent discharge of sewage or effluent into the buildings, onto the surface of the ground, or in to surface waters. Any person aggrieved by any order issued by the local approval authority may appeal to any court of competent jurisdiction as provided for by the laws of the Commonwealth. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean, R.S., C.H.O. Agent of the Board of Health Town of Barnstable title 5(1) Commonwealth of Massachusetts Executive Office of Environmental Affairs Department of Environmental Protection William F.Weld Trudy Coxe Governor Mary Argeo Paul Celluccl David B.Struhs, tl Gw.mor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A - CERTIFICATION property Address: 15 Edgewood Rd, W Hyannisport Address of Owner. McCullough Date of Inspection: 1 2.3 0—9 6 (If different) Name of Inspector. W.E. Robinson SR Company Name,Address and Telephone Number. ( 5 0 8 ) 7 7 5—8 7 7 6 W.E. Robinson Septic Service P.O. Box 1089 Centerville MA CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of 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: _ Passes _ Conditionally Passes _ Weds Further Evaluation By the Local Approving Authority Fails Inspector's Signature: <it, , Date: 1 o�,—3 0^07 4� t The System Inspector shall 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 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. IN ECTION SUMMARY: eck A, B, C,or D: A] STEM 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. B] STEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system,upon completion of the replacement or repair,passes inspection. to yes,no,or not determined(Y, N,or ND). Describe basis of determination in all instances. If"not determined",explain why not) The septic tank is metal,cracked, structurally unsound, shows substantial infiltration or enfltration,or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a Fonforming septic tank as approved by the Board of Health. (rev sed 11/03/95) 1 One Winter Street • Boston,Massachusetts 02108 • FAX(617)556-1049 • Telephone(617)292•SM i J Printed on Recycled Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 15 Edgewood Rd, W Hyannisport Owner. McCullough Date of Inspection: 1 2—3 0—9 6 B)SYSTEM CONDITIONALLY PASSES(continued) ' I 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 Health): broken pipe(s)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 pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed C] FUR ER 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) YSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A 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) YSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF APPROPRIATE) ETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND AFETY 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 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 5 ppm. S) THER (revised 11/03/95) 2 Z 548 6.59 990 Receipt for -95T Certified Mail No Insurance Coverage Provided cz� PORTED STATES Do not use for International Mail POSTAL SERVICE (See Revers ) Q) Je u St eat and N l6 � P. toe IP C d Postage !M E Certified Fee , )0 LL Special Delivery Fee Q`,s iRlfsttotodlDbtiVeryyFes: R�torrnReoeipttSTtowirirgt to Whom&Date Delivered Return Receipt Showing to Whom, Date,and Addressee's Address TOTAL Postage 1 &Fees $ �� Postma or D to I A. 6x STICK POSTAGE STAMPS TO ARTICLE TO COVER FIRST CLASS POSTAGE, CERTIFIED MAIL FEE,AND CHARGES FOR ANY SELECTED OPTIONAL SERVICES(see front). 1. If you want this receipt postmarked,stick the gummed stub to the right of the return address E2 leaving the receipt attached and present the article at a post office service window or hand it to your rural carrier(no extra charge). CC 2. If you do not want this receipt postmarked,stick the gummed stub to the right of the return address of the article,date,detach and retain the receipt,and mail the article. 3. If you want a return receipt,write the certified mail number and your name and address on a return receipt card;Form 3811,and attach it to the front of the article by means of the gummed Co ends if space permits.Otherwise,affix to back of article.Endorse front of article RETURN RECEIPT REQUESTED adjacent to the number. 00 4. If you want delivery restricted to the addressee, or to an authorized agent of the addressee, Cl endorse RESTRICTED DELIVERY on the front of the article. E . o 5. Enter fees for the services requested in the appropriate spaces on the front of this receipt.If return receipt is requested,check the applicable blocks in item 1 of Form 3811. to IL 6. Save this receipt and present it if you make inquiry. 105603-93-8-0216 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 15 Edgewood Rd, W Hyannisport Owner. McCullough Date of Inspection:_ 1 2—3 0—9 6 D)77M FAILS: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 16.303. 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. 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. El E SYSTEM FAILS: 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 and safety and the environment because one or more of the following conditions exist: 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 owns or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requireme is of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information.. I , (revised. 11/03/95) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST PropertyAddrew 15 Edgewood Rd, W Hyannisport Owner: McCullough Date of Inapeotion: 1 2—3 0—9 6 Check if the following have been done: Zpwmping information was requested of the owner,occupant,and Board of Health. None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates d ' that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. jZ t 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. ZThe system does not receive non-sanitary or industrial waste flow �e site was inspected for signs of breakout. All system components,excluding the Soil Absorption System, have been located on the site. JZThe 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. .""size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub- Surface Disposal System. (revised 11/03/95) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION PropertyAddresa; 15 Edgewood Rd, W Hyannisport Owner. McCullough Date of Inspection: 1 2—3 0—9 6 FLOW CONDITIONS RESIDENTIAI: Design flow:;33 y gallons Number of bedrooms: C-3 Number of current residents:�`'l Garbage grinder(yes or no): A-v Laundry connected to system(yes or no):.y Seasonal use(yes or no):_ Water meter readings,if available: 1 2/9 4 - 6/9 5 8, 0 0 0 a l s . 6/9 5 - 1 2-9 5 1 7 0 0 0 a l s . 12/95 - 6 96 3 , 000gals 6 96 - 12 96 - 13 . 000gals- Last date of occupancy: `` 6 — COMMERCIAL/INDUSTRIAL- Type of establishment: Design flow:_pflons/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 so of information: G System pumpeA as part of inspection: (yes or no) If yes,volume pumped: la o 10 gallons Reason for pumping: TYPE OF SYSTEM Septic tank/distribution box/soil absorption system cesspool Overflow cesspool Privy Shared system(yes or no) (if yes,attach previous inspection records,if any) Other(explain) APPROXIMATE AGE of all components,date installed(if known)and source of information: Q xn.S Sewage odors detected when arriving at the site: (yes or no) 2L O (revised 11/03/95) 5 • o SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 15 Edgewood Rd, W Hyannisport Owner. McCullough Date of Inspection: 1 2—3 0—9 6 8 TANK:_ (locate o site plan) Depth be w grade: Material f construction:_concrete_metal_FRP—other(explain) Duinensio Sludge Distance m top of sludge to bottom of outlet tee or baffle: Scum thi ess: Distan from top of scum to top of outlet tee or baffle: Distance m bottom of scum to bottom of outlet tee or baffle: Common (recommen ton for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity, evidence o leakage,etc.) I GREASE _ (locate on site plan) Depth bel w grade: Materjoconstruction:_concrete_metal_FRP_other(ezplain) DimenScum Distance From top of scum to top of outlet tee or baffle: Distan7m bottom of scum to bottom of outlet tee or bale: Comments: (reconqnendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert,structural integrity, evidet of leakage,etc. (revised 11/03/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 15 Edgewood Rd, W Hyannisport Owner. McCullough Date of Inspection: 1 2—3 0—9 6 TIGHT R HOLDING TANK:_ (locate on ' plan) Depth be grade: Material of nsteuction:_concrete_metal_FRP_other(explam) Dimensions Capacity: ons Design flo gallons/day Alarm 1 1: Common (condition of inlet tee,condition of alarm and float switches,etc.) DIS BUTION BOX:_ flocs on site plan) 30 Depth of ' uid level above outlet invert:___�2� Comments: (note if love and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) PUMP HAMBER (locate on 'te plan) Pumps in rking order:(yes or no) Comments: (note oon6 ' n of pump chamber,condition of pumps and appurtenances,etc.) (revised 11/03/95) 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 15 Edgewood Rd, W Hyannisport Owner. McCullough Date of Inspection: 1 2—3 0—9 6 / SOIL`ABSORPTION SYSTEM(SAS): til (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, dimenai overflow cesspool,number: ; Comments: (note condition of soil,signs of hydraulic failure, level of pond ing,condition of vegetation,etc.) CESSPOOLS:_ (locate on site plan) Number and configuration: Depth-top of liquid to inlet invgrt:�)' Depth of solids layer. air d ' Depth of scum layer: Dimensions of cesspool:_( /ZS cx—O Q a S Materials of construction:- o-c s Indication of groundwater: /L 40 inflow(cesspool must be pumped as part of inspection) Comments: (note condition of soil,signs of hydraulic fai,}mre,level of ponding,o1on tion of vegetation,etc.) /� 7/ �Ur w d d 1 P _ (locate on site plan) Mate of construction: Dimensions De of solids• Comma w(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) (revised 11/03/95) 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(oontinued) PropertyAddrees: 15 Edgewood Rd, W Hyannisport Owner. McCullough Date of Inspection: 1 2—3 0—9 6 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' i C DEPTH TO GROUNDWATER Depth to Vwndwater_L2.4 feet method of determination or approximation: 6 G� (revised 11/03/95) 9