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HomeMy WebLinkAbout0010 ACORN DRIVE - Health to Ostervi.l.a'e A= 120-024 Commonwealth of Massachusetts, n Title 5 Official Inspection Form, COPY Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 10 Acorn Drive Osterville, MA 02655 Property Address Thomas Commito 269 Chestnut Hill Road Owner Owner's Name .information on for p on is required Montpelier VT 05602 June 10, 2010 every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: When filling out A. General Information - forms on the ' computer,use 1. Inspector: only the tab key to move your Patrick T. Sullivan cursor-do not Name of Inspector use the return key. Ready Rooter Inc. Company Name rsa P.O. Box 371 Company Address Sandwich MA 02563 rem City/Town State Zip Code 508-888-6055 Sl 12843 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to-Section 15.340 of Title 5(310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority --f � June 15, 2010 Inspector's Signature Date The system inspector shall submit a copy,of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing'this inspection. If the system is a shared system-o has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the' report to the appropriate regional office of the DEP. The original should be senfto'•the system owner and copies sent to the buyer, if applicable, and the approving authority. , d s ****This report only describes conditions at the time of inspection and under the coriditlons of use;. at that time.This inspection does not address how the system will perform in the futurLAnder the same or different conditions of use. La 15ins•09/06 Title 5 Official Inspection Form:Subsurface SewqDisp. at Sy tem• ag jlt Commonwealth of Massachusetts 11 Title 5 Official Inspection Form _ o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 10 Acorn Drive Osterville, MA 02655 Property Address Thomas Commito 269 Chestnut Hill Road Owner Owner's Name information is Montpelier VT 05602 June 10, 2010 required for p every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C;D or E/always complete all of Section D A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. - Comments: Property has been vacant for 5 years. B) System Conditionally Passes: ❑ One or more system components as described in th "Conditional Pass" section need to be replaced or repaired. The system,upon completio of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" ( , N, ND)for the following statements. If"not determined," please explain, •The septictank is metal and over 20 years old or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infil ation or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is re aced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspecti if it is structurally sound, not leaking and if a Certificate of. Compliance indicating that the tank is ess than 20 years old is available. ❑ Y ❑ N ❑ N (Explain below): t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 2 commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 10 Acorn Drive Osterville, MA 02655 Property Address Thomas Commito 269 Chestnut Hill Road Owner Owner's Name information is Montpelier VT 05602 June 10, 2010 required for State Zip Code Date of inspection every page. City/Town B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled�or uneven distribution box. System will pass inspection if(with approval of Board of Health):. ❑ broken pipes) are replaced ❑ ❑ N ❑ ND (Explain below): obstruction is removed A. Y ElN ❑' ND (Explain below): - ❑ distribution box is leveled or replaced ,f ❑ Y ❑ 'N ❑ ND (Explain below): r ❑ The system required pumpi more than 4 times a year due to broken or obstructed pipe(s). The system.will pass inspection if(with approval of the Board of Health):, E] broken pipe(s) are replaced ❑ Y. ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required b/tioning o Health: ❑ Conditions exist which require furth by the Board of Health in order to determine if the system is failing to protect publifety or the environment. 1. System will pass unless Boar determines in accordance with 310 CMR 15.303(1)(b)that the system is ning in a manner which will protect public health, safety.and the environment: Cesspool or privy is within , surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 3 t5ins-09/08 r Commonwealth of Massachusetts " Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 10 Acorn Drive Osterville, MA 02655 ' Property Address Thomas Commito 269 Chestnut Hill Road Owner Owner's Name information is Montpelier _ VT 05602 June 10, 2010 required for State Zip Code Date of Inspection every page. cityfrown B. Certification (cont.). 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a anner that protects the public health, safety and environment: ❑ The system has.a septic tank and soil bsorption system (SAS) and the SAS is within .100 feet of a surface water supply o ributary to a surface water supply. ❑ The system has a septic tank and AS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank d SAS and the SAS is within 50 feet of'a private water supply well. / ❑ The system has a s/t*no nd eIIS and the SAS is`less than 100 feet but 50 feet or more from a privately Method used to deta e: **This system passes iater analysis, performed at a DEP certified laboratory, for colifoofm bacteria indicates abseresence of ammonia nitrogen and nitrate nitrogen is equal to less than 5 ppm, providother failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other. D) System Failure Criteria Applicable to All.Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ Discharge or ponding of effluent to the surface of the ground or surface ® waters b due to an overloaded or clogged SAS or cesspool O ® 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 El ® than '/z day flow Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 4 t5ins•09/08 Commonwealth of Massachusetts _ H . Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 10 Acorn Drive Osterville, MA 02655 Property Address Thomas Commito 269 Chestnut Hill: Road Owner Owner's Name information is required for Montpelier VT 05602 June 10, 2010 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No El ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or, privy is below high ground water elevation. ❑ z Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply. well. ' ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This' system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system th system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or o"to each of the following, in addition to the questions in Section D. Yes No - ❑ ❑ the system is within 400 eet of a surface.drinking water supply f ❑ ❑ the system is within 2 10 feet of a tributary to a surface drinking water supply ❑ ❑ the system is locate in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a apped Zone 11 of a public water supply well If you have answered "yes"to any que tion in Section E the system is considered a significant threat, or answered "yes" in Section D abov the large system has failed. The owner or operator of any large system considered a significant thr t under Section E or failed under Section D shall upgrade the system in accordance with 310 Cr15.304. The system owner should contact the appropriate regional office of the Department./ t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 5 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 10 Acorn Drive Osterville, MA 02655 Property Address Thomas Commito 269 Chestnut Hill Road Owner Owner's Name information is Montpelier VT 05602 June 10, 2010 required for every page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate";yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? Have large volumes of water been introduced to the system recently or as part of El - this inspection? ® ❑. Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs.of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components,'excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, r dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site.has been determined based on: ® ❑ Existing information. For example, a plan at the.Board of Health.. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 GPD t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 6 Commonwealth of.Massachusetts Title 5 Official -Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments M 10 Acorn Drive Osterville, MA 02655 - Property Address. Thomas Commito 269 Chestnut Hill Road Owner Owner's Name information is required for Montpelier VT 05602 June 10, 2010 every page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents TO : Does residence have a garbage grinder? ❑ Yes 0 No. Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes Z No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ® Yes ❑ No No usage. Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Summer 2005 Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203)- Gallons per day(gpd)' Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Titl 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-09/08 ( Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 7 f Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 10 Acorn Drive Osterville, MA 02655 Property Address Thomas Commito 269 Chestnut Hill Road Owner Owner's Name information is required for Montpelier VT 05602 June 10,2010 every page. City/Town State Zip Code Date of Inspection D. System Information (cont:) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: No records found Was system pumped as-part of the inspection? ❑ Yes No If yes, volume pumped: gallons - How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) Innovative/Alternative technology. Attach`a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest = inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval._ Other(describe): t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 8 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 10 Acorn Drive Osterville, MA 02655 Property Address Thomas Commito 269 Chestnut Hill Road Owner Owner's Name information is required for Montpelier VT 05602 June 10, 2010 every page. City/Town - State Zip Code Date of Inspection D. System Information Cont. Approximate age of all components, date installed (if known) and source of information: System installed 04/18/1975. As-built and Certificate of Compliance on file at Board of Health. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): _ Depth below grade: 2 feet Material of construction' ❑ cast iron ® 40 PVC ❑.other(explain): Distance from private water supply well or suction line: N/A feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank (locate on site plan): Depth below grade: feet Material of construction: ® concrete El metal ❑ fiberglass ❑ polyethylene ❑ other(explain) ' If tank is metal, list age: years- Is age confirmed by a Certificate'of Compliance? (attach a copy of certificate) ❑ Yes ❑ No. Dimensions: 8'X 4.5'X 4.5' 1000 gallons Sludge depth: 1 i t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 9 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 10 Acorn Drive Osterville, MA 02655 Property Address Thomas Commito 269 Chestnut Hill Road Owner Owner's Name information is required for Montpelier VT 05602 June 10, 2010 --- every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) . Distance from top of sludge to bottom of outlet tee or baffle 36" 0" Scum thickness Distance from top of scum to top of outlet tee or.baffle 1 411 Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Tape measure and dip tube. Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): ` Inlet and outlet concrete baffles in place. Liquid level at outlet invert. No sign of leakage. Root intrusion into both inlet and outlet covers. Not effecting system.operation at this time. . Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fibe lass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to to/ttomof r baffle Distance from bottom of scum tet tee or baffle Date of last pumping: Date t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 10 r Commonwealth of Massachusetts Title 5 Official. Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 10 Acorn Drive Osterville, MA 02655 Property Address Thomas Commito 269 Chestnut Hill Road Owner Owner's Name information is required for Montpelier VT 05602 June 10, 2010 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑/ergs ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: / ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date r Comments (condition ofParm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 11 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 10 Acorn Drive Osterville,`MA 02655_ Property Address Thomas Commito 269 Chestnut Hill Road Owner Owner's Name information is required for Montpelier VT 05602 June 10, 2010 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) _ Distribution Box (if present must be opened) (locate on site plan): 0,1 Depth of liquid level above outlet invert comments (note if box is1evel and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): No D-box Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments (note condition of pump chamber, ondition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required):, If SAS not located, explain why: I . t5ins•09/08,. Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 12 Commonwealth of Massachusetts Title 5 Official Inspection Form - Subsurface Sewage Disposal System Form -Not for Voluntary Assessments_ �M .'" 10 Acorn Drive Osterville, MA 02655 Property Address Thomas Commito 269 Chestnut Hill Road Owner Owner's Name information is Montpelier VT 05602 June 10, 2010 required for p every page. City own State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1-6'X6'�w/stone ❑ leaching chambers number: ❑ leaching galleries number: leaching trenches number, length: ❑ leaching fields number, dimensions: - El overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding,damp soil, condition of vegetation, etc.): Octagon leach pit was dry at time of inspection. Clean stone visible through side walls. No sign of past hydraulic failure. Riser brings cover within 6" of grade. Cesspools (cesspool must be pumped as part of inspection) (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 ❑ Yes ❑ No t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 13 f— Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 10 Acorn Drive Osterville, MA 02655 Property Address Thomas Commito 269 Chestnut Hill Road Owner Owner's Name information is Montpelier VT 05602 June 10, 2010 required for p every page. City/Town State ' Zip Code Date of Inspection D. System Information (cont.) 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 hyd ulic failure, level of ponding, condition of vegetation, etc.): h t5ins-09/08. Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 14 Commonwealth of Massachusetts u Title 5 Official Inspection Fora - Subsurface Sewage Disposal System Form - Not for Voluntary Assessments wM 10 Acorn Drive Osterville, MA 02655 - Property Address Thomas Commito 269 Chestnut Hill Road ' Owner Owner's Name information is required for Montpelier VT 05602 June 10, 2010 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide-a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately i _ t i 5 • �> _ t5ins•09/08 Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 15 Commonwealth of Massachusetts' Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 10 Acorn Drive Osterville, MA 02655- Property Address Thomas Commito 269 Chestnut Hill Road Owner Owner's Name information is required for Montpelier VT 05602 June 10, 2010 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) -Site Exam: ❑ Check Slope ❑ Surface water ' ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: >2 - feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 1975 Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with-local excavators,'installers - (attach documentation) ® Accessed USGS database-explain:' ma.water.usgs.gov terraserver-usa.com You must describe how you established the high ground water elevation: No ground water found during system installation. Hand augered 2' below base of dry pit. No ground water after 1 hour.Accessed local ground water contours and topo mapping. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 16 r Commonwealth of Massachusetts H Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 10 Acorn Drive Osterville, MA 02655 Property Address Thomas Commito 269 Chestnut Hill Road Owner Owner's Name information is required for Montpelier VT 05602 June 10, 2010 every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information —Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file r t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 TOWN OF BARNSTABLE - .41 �.. LOCATION SEWAGE# VILLAGE ASSESSOR'S MAP&PARCEL iNS NAME&-PHONE:NO. r-S�s,� '�is Sig- pis SEPTIC TANK CAPACITY LEACHING FACILITY:(type) Lcr.ecJ--- V77 ®�'Z'�(size) NO.OFr#EDROOM8 OWNER � `. ,' vv�a� �c�y�..,,•��'G PERMITQDATE y'6(7 COMPLIANCE DATE:.. Separat ance'Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water'Supply,W,el1 and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) 3 Feet c We Edge of tland'and Leaching Facility(If'any wetlands exist s. within 300 feet of leaching facility) �1/ Feet g �) FURNISHED BY IT a ®; 3 � �o