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0099 EVANS STREET - Health
99 Evans Street )sterville P A = 142 099002 0 Fps. ✓..` ..`.............. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH --•....................................---OF........................................--... Apli iration for Disputia1 Works Tomitrnr#iun rrrutit Application is hereby made for a Permit to Construct (V"')' or Repair ( ) an Individual Sewage Disposal System at: Ck -----------------------------------------------------------------------------•...-..------------ Lpcation-Address or Lot No. ----- ......................_------------- ---- -•------••---•---------------•---•--------.. ..........----------._.....---- -•-...-------••----•----------------..... •�, COner Address • �---•...-•--------••--••........................•-•---•----------- •--......--•--•--..........................._.....--------•-•-._.................---...-•----..... Installer Address _ UType of Building Size Lot.....t. ..�.....Sq. feet Dwelling—No. of Bedrooms............3...........................Expansion Attic ( ) Garbage Grinder ( ) P4 Other—Type of Building 1,?.'1d.- w . No. of persons........... ............ Showers (Z ) — Cafeteria ( ) a' Other fixtures ------------------------•-------••••------•--- W Design Flow.._.._.... -_._-�?._S_...._...gallons per person per day. Total daily flow---____.1 . ......................gallons. WSeptic Tank—Liquid capacityALIM._gallons Length________________ Width................ Diameter-----------------Depth................ x Disposal Trench—No..................... Width..l._......._...... Total Length.........._ ....... Total leaching area.._3.`5.....sq. ft. Seepage. Pit No............f........ Diameter..... Depth below inlet....��__.......... Total leaching area..3. 0/.....sq. ft. Z Other Distribution box Dosing t nk ) Percolation Test Results k� Performed by.._ � r�__ _ _ .:�}a _1_!!J.�............... Date... _ _j ........._.. L45 minutes per inch Depth of Test Pit-_____2........... Depth to ground water.._._. _ __,.� Test Pit No. 1.._._�. �Q�.(�___- 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 1:4 •••---•-•••-•-•-•-----•••••-••••-•-•••-•••--•-•••-•••-••....-----•--------------•------...---_---•--.................................................... •---- 0 Description of Soil....................................................................................................................................-----------------................. x V ....----••-•----••-•-•-•-----•-••-------••--•--•....•--•--•._..._.....••------------•---.......••-------••-•••--•-----------•--•-----••---••--------•--••-•••.......................................... W VNature of Repairs or Alterations—Answer when applicable..........................................................:.................................... -------•---------------------------•------•-------------------•--------------------..........----•-----•-------------------------------------------------------------------------------------------.... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITL i� 5 of the State Sa 'tar d — T. ndersigned further agrees not to place the system in operation until a Certificate of Compliance ha be is ue y t e board of health. S .... ..... - ...................................................... ......... t - ApplicationApproved By... ---- •---•--•---- •.......................................................... Date Application Disapproved for e f wing reasons:............................................................................ ------------------------•------- .......••---------------------•-•--•-•.....--••••----•--•••••-••••-••-•--------...........-•---...........---•-••••.................................................................................... Date PermitNo......................................................... Issued....................................................... Date L No. y Z y' Fss .:.............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........................................O F............................._........ Appliratiun fur Disposal Works Tonotrur#ion ramit Application is hereby made for a Permit to Construct (PI") or Repair ( ) an Individual Sewage Disposal System at .1CTL.- _._._Z�.- .lY\`a:- '-----._...os' -•-- --•--••--------------•---••-------...--------- .................Z-••-•-------.....-•------ I�ocation-Address or Lot No. C �wner Address 8 ........................................................... . Installer w Address U Type of Building {4 `i, Size Lot___ 5_F6 G O .....Sq. feet Dwelling—No. of , edoms_______.___ ...........................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building�XSS' _. No. of persons..........Z.............. Showers (Z — Cafeteria ( ) Otherfixtures ------------------------------------•-----------------.--_----------•----------------------------------------------------------- W Design Flow......... .....'5__5.........gallons per person per day. Total daily flow-------.33_�.......................gallons. W Septic Tank—Liquid capacity_�9�.__gallons Length________________ Width................ Diameter__-__-_______-__ De th____________.__. x Disposal Trench—No_____________________ Width.................... Total Length.........__F___._... Total leaching area._.3q------sq. ft. 3 __ •-.... q Seepage Pit No----------I--------- Diameter....,(�z:_......... Depth below inlet___g_....._..... Total leachingarea.___.��' s . ft. Z Other Distribution box (l o►) Dosing.t nk ) aPercolation Test Res�uh wN Performed by l Y.� Q. iM 4�' ! _______________ Date__ __________. Test Pit No. 1L__. .....minutes per inch Depth of Test Pit....�_Z........... Depth to ground water_NO��.___. 4., Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a --------- -•-•---•------ -----•••-•-•••..... ------------------------ --...... •........... 0 Description of Soil---------------------------------------------•-----------•--•------------••------------------------------------------------------------------------------------=-_----. c.� -----------------------------------•--------------- ------------------------- -------------------------- -............... _-----------._.__------------------ ----------- •------------- ••-------------- ---------------- •-------------------------------------------------------------------------------------------------------------------------------------------------....--------------•-•-•••--•--•--•-- U Nature of Repairs or Alterations—Answer when applicable............................................................................................... ------------------------------------------------•----------•------...-----------------•-------.....------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TLITIL4 5 of the State Sa itar Coe Th ndersigned further agrees not to place the system in operation until a Certificate of Compliance h b- is ue t e board of health. S' ed' -••`• - ........................................................ ........... Application Approved By ------- -- ••-•-•-•••--••--•----•- ........... Date Application Disapproved for e f owing reasons-------------------------------------•--...------------------...--------------------------------------...._--•-•- --••---••-------------•---••••-•-•-•••-••.....---••-•----••...•-••------•--•----••---••--....•--••••••••---••-••-••••-••-•-•-----•-•-----••............................................................ Date PermitNo................................................... Issued-....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... Tutifirate of Tootplianrr T I� T CER IFY, That the Individual Sewage Disposal System constructed ( or Repaired ( ) by .._.-V------ ft .................... -••--•--•-•---••-•----• -------•-------•-------------------------------------------•-----........--•---••--•-•----•••-- _ 7 Installer at-••--•-••--••`. --------•------- ? ---•-------------------------- ------- -•-- ---------------------------------...---------�-f has been installed in accordance with the provisions of T�,�TIF 5 of e State Sanitary Co,eZ�r d in the application for Disposal Works Construction Permit No �/ �_�__ ___._...__. dated,r�, _______________ THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATIA �OY DATE.......... 1SA � -••-•••--- Inspector....... �`�•�-..................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ' ...........................................OF..................................................................................... No........:":.....�:_. FEE ............. Permission is he.eb rante ` ,,s Y g .•.---................................•---------------------......-------......__..._.........._.. to Construct (,.: Repair p I vtr1 wade Disposal System at No .r ... !.:.. = .......................................................................................................................... ' Street as shown on the application for Disposal Works Construction Perini F ...................... Dated.......................................... ................ .•.•-••-•-....-••...-- ---•-...................................................... r .Board of Health DATE................................................................................ FORM 1255 A. M. SULKIN. INC.. BOSTON i Low 4-3 Lo-r N vi vj F r 4iso is m 0 vj cQoG 3 5/°t 40 A .w 9314 -7 S qs 5 -7 3 7 . qq.5 T 12, L 9�t 15, s. F. � t i 2© F S, B I � �H of in' y ` '.vAaisQC.E Ca.(,A �aF EtJJ9 y f 208?4 O �; L .UM�! !l' .h(� 11 IL 3 4- n 4 PEJo- STS f" QW iJk--2 K.� 5 E LL'S i EFT' mil--•! L' . SVRv� EN EXISTING ' SPOT ELEVATION of CERTIFIED PLOT PLAN EXISTING .CONTOUR '--... .: _ _ _ ; 2 ��N M L.0 7` FINISHED SPOT ELEVATION,, U 7"-'l o , ,A R c �s T ' U` FINISHED GO N'TO U R ----' 0 ----- rx RSE v; APPROVED , BOARD OF HEALTW >`, 9 0`10951�Q DATE AGENT x SCALE' / = 30 DATE , i�-L Dti EDGE ENGINEERING. CQ. IN ------- -,,--- --- 04:I9NT _ 1 CERTIFY , THAT THE PROPOSED EGISTE�R REGISTEROt' '' �9 BUILDING SHOWN ON THIS PLAN JOH NG y�C/�IVIL LAND' ' 'CONFORMS TO THE ZONING LAWS ENGINEER URVEY 4 k DR,;BY� x; OF . BARNS:TABLE, MASS6.-4- I�c��i' ,4 E �.►o f 712 MA.I N S'TREET, H;. CH:BY� '�`• H YA.N N I, S, MA$S * `' PT - nE ne3T air i._.Alin Urvt%a ad F7' M/IV: /MOTE /F, EITNER 7`X�E S�PT/G TA.NK Ord? -,4C.Jr nrG' P/T ARE MORE T.yA.;✓ /2"BELOW /O f7t M/N: rRA®E, A 24'01AM.E7tzR COryCRETE: C-OYE•P .A S�,/ALL. E.E BROUG�/T T'O GRA.flE.�.r+;v .EXTRA. g'PVC 0/PE. CONCAAFTE tiE.4Yy CAST /RONSh'.4LG. C3E USED. EL 102.8. COVER5 M/N- O/TCN ,. /F/N ,t7R/VEN/A Y �8 pF�'FT Co A1C&E•TE a CO CLEAN SANG ar— G3l'•4oE VEf.' Z LAYER Lo-ol /RON P/PEGi4L.SEPTIC TAy;/ASH�FD ST27NEB /1� .314(8kt4 PST S c flWASNEO STP/?EG45• r • ® s • 1• Y io / x 5 6 .PTDR u ZS: S._S �Q � e • • s • r • / E9J/{/BMr, &LEY�AT/D-0NS �C Z : o 6 FT O/AM. l,VYER'7' AT OIl1LD/NG _FT. PST xE PcPPt �T( . '�� 8.(� (�/D w /Iti►�ET SEPTIC .TANK 9`7•_0'`FT ,.:., ' d Z FT ®/Ahr1 C(SEE TABUL.4TION�.,.- wT�ET sEF►Tie 7A-NX.. /A/lET D/STR18!/l/ON BOX GROUND itlATER TABLE_, - ouTtErD/sTR/evrio�tBOiX T SEw.�G� /SPAZ SY.STR/d! /JYLET LEACHlN40.�/T �13 OFT 7i�®Cl1�!'�!�/W , L EACH11Vf PIT v//bt /vsi ols/ �1 .3 DES/6M 'CRITERZA, z NtIMdE'R OF 8EOR04MS' 3 c,�R�+aGEolsPos�lt.`uw/T ��,�� • .SOIL -LOG- TdTAL E3T/M�'rE0 FLCrt/ 3$ U G.4L.�DAY; SO 14 TEST #/ SO/L TEST102 J�O/L,T�.�►T NUMBER L�.acXtNG PITS_ I �^gtz—Y. g4`f -EttrY. ,DATe ®F SOIL TEST 4 SIOF CACHING PER PIT Sf.� �T. " ' � REsutrs wlTnlEssgD BY �'�•�. JA��/ BOTTOM L6lC/E/NG PER P/T' I"l 3 $Q. FT PeRCOLAWOM A-4TE,*/ L.-C-37 M/N�//NCPd .33`1 L . � 4,._ TOTAL LZaCN//bG AREA S FT. `'�"`� Q C.+r•�. PAc. 7G .a 4-- PEN RA l2 m1M.JINCH .��SE�I�ELEAtN/N6AREA 339 SQ. FT. � r..����:� 1N®tf P��H OF J �r.° LUT �./ C—✓.�- "�s 5`F. AL J rn mow+ o� € �QR a951 O "�� f r ' EL OREDGE FNGI NXERING C® I NC. 2s�74 p !p �� p G/STEP \`ak fG Ey b?/.4 712 MA//Y ST ,.AlYAA/A/iS. M.9SJ, Fss/OMALEN� ® NGGROVN� LY,4reM ENCOUNTL�RSo CLIENT: toys DATE t �I GROU/NZ�_ I-VATER AT ELEI/. T3'rc..0 - .JOB /VO: E 3 i TO OF BARNSTABLE +;CATION SEWAGE # VILLAGE �� 1� y�`� ASSESSOR'S MAP& LOT��Z `` INSTALLER'S NAME&PHONE NO. I� SEPTIC TANK CAPACITY LEACHING FACILITY: (type 1 (size) NO.OF BEDROOMS BUILDER OR OWNER PERMTTDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the 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 O CATION SEWAGE PERMIT NO. VILLAGE CO %rX-1)t'l1c F-So I N S T A LLER'S NAME 6 ADDRESS � 0UILDER OR OWNER ��T S age A IUDTERMIT ATE P ISSUED �Apze DAT E COMPLIANCE ISSUED r y 4 3o as r COMMONWEALTH OF MASSA0HUSEITS. f EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS a DEPARTMENT OF ENVIRONMENTAL PROTECTION . Tow EP TITLES : NFo T&�'�Ns OFFICIAL INSPECTION FORM-NOT FOR.VOLUNTARY:ASSESSME SUBSURFACE SEWAGE,DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: �d Owner's Name: v Owner's Address: _ ,4 00col Date of Inspection:_ C�a - Name of Inspector: (please rint) Rod4-`, �(A)10` 6' MAP I7 t Company Namet�� ��j ' PARCEL Mailing Address: LOT Telephone Number: Q /. 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 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 ection 15.340 of Title 5(310 CMR 15.000). The system: n Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority F;k=Inspector's Signature: � -- rate: 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 or has a design flow of 10,000 a or greater,-the inspector and the system owner shall submit the report to the appropriate regional office of the DEP..The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. • <' L�LCyc�=•ry Notes and Comments <r4 `76 " e'� to ., rc —"***,*This report only describes conditions at-the-time of inspection and•under the conditions of use,at,that time.This inspection does not address how the system will perform in the future under the same or different. •�• . p y conditions of use. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of I 1 ' OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: QPY&A&, Owner: : �.. Date of Lnspection: Inspection`Summary; Check A,B,C,D or E/ALWAYS complete.all of Section D A.e(System Passes: y. I 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: 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 by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined"please explain. The septic=tank is metal and over 20 years old* or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or:.tank failure is imminent:System will pass inspection if the . existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: -Observation of sewage backup or breakout or high.static Water level,inthe 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 hoard of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping 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): broken pipe(s)are replaced obstruction is removed ND explain: 2 ` Page.") of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE.DI$POSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: Owner Date of inspection: a 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 public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the 4 system is not fun�-ctioning in a manner`which will protect public health,safety and theenvironcnent: r _ 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 Supplier,.if any).Aetermines that the system is functioning in a manner that protects the public health;safety and.environment: The system has a septic tank and soil absorption.system(SAS)and the SAS is within 100 feet of surface water supply or tribufary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone l of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply welt_ _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from.i private water.supply well". Method used to"determine distance "This system passes if the well water analysis,performed at a DEP certified.laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence�cif ainiiiania nitiogen'and_nitrate nitrogen is-equal'to or,ess than 5ppm;pfbo ided that no other failure criteria are,triggered.A copy of.the analysis must be attached to this form.. 3. Other: 3 Page 4 of I l OFFICIAL INSPECTION FORM-NOT FOR V LUNTARY ASSESSMENTS SUBSURFACE`SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: Owner: Ai a Date of inspection: �i Oda D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes N _ 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 die to an overloaded or _ Vclogged 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 ''/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 11 Any portion of the SAS,cesspool or privy is below high ground water elevation. 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. portion of a cesspool or privy is less than 100 feet but greater than 5.0 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 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.e.qual to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] 6 (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMJI 15.303,the 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 the.system must serve a facility-with a design flow of 10,000 gpd to 15,000 gPd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems.in addition to the criteria above) 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 a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. . 4 r Page 5 of I I OFFICIAL ][INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: Owner: Date nspection: 9j(ja 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? _ Z'Has the system received normal flows in the previous two week period? V Have large volumes of water been introduced to the system recently or as part of this inspection? _tZ-_ 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, 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: Yes no _ 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 15.3.02(3)(b)) 5 Page 6 of l l OFFICIAL INSPECTIONFORM—NOT FOR VOLUNTARY.,ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: P � Owner: ' Date of I spection: 00 a FLOW CONDITIONS RESIDENTIAL Number of bedrooms:(design): Number of bedrooms(actual): DESIGN flow based on 310 CMR V5,2 0.3 (for example: 11.0 gpd x#of bedrooms): Number of current residents: CD Does residence have a garbage grinder(yes or no):, 0 Is laundry on a separate sewage system (yes or noif yes separate inspection required] Laundry system inspected(ye .or noL" Seasonal use: (yes or no): Water meter readings, if availa le(last 2 years usag ( / l Sump pump(yes or no): Last date of occupancy: CA - �(� i✓ � �-+ C� + COMMERCIAL/INDUSTRIA.LL& Type of establishment:. . Design flow.(based on 310 CMR 15.203): . gpd Basis of design flow(seats/persons/sgft,etc.): _ 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/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Was system.pumped as4peolfthe ins tion(yes of no : If yes,volume pumped: gallons--How was quantity pumped determined? Reason for pumping: �t - TYF OF SYSTEM ptic 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) Tight tank _Attach a copyof the DEP approval _.Other(describe): proximate age of all components, date installed(if known) and source of information- Were'sewage odors detected when arriving at the site(yes or no)k_j(,O 6 Page 7 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM, .INFORMATION(continued) Property Address: � iy� A Owner: Date of nspection: X0 Q BUILDING SEWER(locate on site plan)/ j- Depth below.grade: Materials of construction:_cast iron _40 PVC other(explain): Distance from private water supply well or suction line: Comments(on condition,of joints,venting,evidence of leakage,etc.): SEPTIC TANK:_Z(�Io"clate on site plan) Depth below grade: Material of construction:_Vconcrete_metal fiberglass polyethylene _other(explain). If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) c�. Dimensions: c7 �' xJr Sludge depth: Distance.from top of sludge to bottom of outlet tee.or baffle: „(, Scum thickness: 0" Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: T/ How were dimensions determinei �,�e� p Comments(on pumping recommenoations,,mlet and outlet tee or baffle condition,structural integrity, liquid levels ass related to outlet invert evidence of leakage,etc): CL (20O GREASE TRAP`�cate on site plan) � P �c? Depth below grade:_ Material of construction:_concrete_metal_fb�--rglass_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(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid.levels as related to,outlet invert, evidence of leakage, etc.): . 7 Page 8 of 11 OFFICIAL:INSPECTION FORM—.NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTM INFORMATION(continued) Property Address: Owner: Date of Inspection: TIGHT or HOLDING TANK� `(tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material l of construction: concrete metal . fiberglass_polyethylene__other(explain): Dimensions` Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBiJTION BOX: V/1(if present must be open ed)(locate on site plan) Depth of liquid level above outlet invert: Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover,any evidence of leakage into or out of box, etc. : � � �v PUMP CHAMBE (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.): 8 I Page 9 of I I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARVASSESSMENTS SUBSURFACE SEWAGE DI SPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner: Date o nspection: SOIL ABSORPTION SYSTEM (SAS): (locate on site plan, excavation not required) If SAS not located explain why: ... P e aching pits,number: .-........: leaching chambers,number: leaching galleries,number: leaching trenches,number, length: leaching fields,number, dimensions: 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, CRJ CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and confi-uration: Depth'—top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of.groundwa.ter inflow(yes or no): Comments(note condition of soil, signs of hydraulic failure, level of pondirg,,condition of vegetation,etc.)-7, 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.): 9 1 ` Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM.INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: /1G�1 � klC Owner: Date of spection: GCI� SKETCH OF SEWAGE DISPOSAL SYSTEM Provide sketch 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. 1 1 �a 10 Page I 1 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner: Date of Inspection: a SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to'ground water feet Please indicate(check).all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked, date,of design plan reviewed: 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: You must describe how you established the high ground water elevation: Cn e° v &Yid" � s I 11 Perini' Number: Dane: ComPle-te-d by:. ;H C:--: GROUND-WATER LEVEI COMPUTATION Site Vocation: Lot N`e•- Jwner-: Contractor:�i—to G 14- i�ddress: Notes: S.I:G?'• 1 . Measure depth tLC' .watei- able. to nearestL.1.Ir0: Date _..................... ._..._..-. _ 1 month{day%year I S T LP 2 Usine.vvater Level.Range Zone i and In.de.x We'll-: .a.p:locate site-an.d•detern I'nd: O'Appr•o.priate.1ndexw.el9................__.... / .:._.. BWater level•-anae zone..._............................_...................... J: GP•;..�i:: U s i n a mo nth I-y.i. par•:4:"Current Water Resources- Conditions" I determine current de:pth-to water. I•evel forinde-z well ........ 6 Z ( ► mono/year i. ST-E? Usinc.T able.oa•1Nnier;l•evel Adjustments 77 for index well (STEP 2.4)_current depth' I l to weter'•1evel for•index wel.1 ('STEP 3�, andvua:er-level zone (STEP•21B) determr.ne.wage--level adjustment ............_.._._.._....._......_..._..-... .............................. S.IE : 5 =st'male-dept�, to:hfGh water _ by sUbtracti!lg th.e water level adjus rmant-(STEP 4) from measu.red,-depth +:d.water level•at sit.e.�S i tP 1}'. ......._.._...........................:..............................._................._._...........,_. '' i iCi�(v• iJ:"c�.1G�i'v�wi'7Iv'vhii l:-r7i�l:fillJii IJ LI is i s d _ M ° �� SV `E f i i i Commonwealth of Massachusetts Executive Office of Environmental Affairs Dept. of Environmental Protection One winter Street'Boston,Ma. 02108 John Grad D.E.P. Title V Septic Inspector P.U. Box 2119 Teaticke 02536 WILLIAM F.WELD Governor ARGEO PAUL CELLUCCI Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM YLO PART A CERTIFICATION Rp NOV 2 4 1998 i Property Address: 99 EV4NS ST.OSTERVILLE MAP 142 PAR 099 L41 Address of Owner: Date of Inspection: 11M2198 (if different) . s► AL1H A�v Name of Inspector: JOHN GRACI ROBERT STETSON;102 EAST ST.SH O .02067 I am a DEP approved system inspector pursuant to Section 15.340 of Title%(310 CMR 15.000) A ti Company Name,Address and Telephone Number: 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: x Passes This Inspection Is based on criteria dented In Title V Copsubmit Passes code310CMR16303.Myfindingsareofhowthesystemis performing at the time of the inspection.My inspection does - Ner Evaluation By the Local Approving Authority not Imply any warranty or guarantee of the longevity ofths F' septic system and any of Its components useful life. Inspector's Signature: Date: 11118199 - The System Inspector shacopy of this inspection report to the Approving Authority within thirty(30)days of completing this inspections. 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, 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 defined as in 310 CMR 15.303.,Any failure criteria not evaluated are indicated below. COMMENTS: B] SYSTEM CONDITIONALLY PASSES: One or more system'components need to be replaced or repaired. The system,upon completion of the replacement or repair,passes inspection. Indicate yes,no, or not determined(Y,.N, or ND). Describe basis of determination in all instances. If "not determined",explain why not. The septic tank is metal, unless the owne'or operator has provided the system inspector with a copy of a Certificate of Colhpllance(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 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. (revised 0412707) One Winter Street a Boston,Massachusetts 02108 • FAX(617)556-1049 a Telephone(617)292-5500 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 99 EVENS ST.OSTERVILLE MAP 142 PAR 099 L47 Owner: ROBERT STETSON;102 EAST ST.SHARON MA.02067 Date of Inspection:1111219E — Sewacle backup or,hreakout or hiah.static water level observed.in.the distribution box is due to a broken, or obstructed pipe(s)or due to broken,settled or uneven distribution box.The 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 THEBOARD 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 SUPPLIER,IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: — The system has a septic tank and soil absorption system and is within 100 feet to a surface of water supply or tributary to a surface water supply. — The system has a septic tank and soil absorption system and is within a Zone 1 of a public watersupply 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 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 presense of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method usedto determine distance (approximation not valid) 3)Other 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 in 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 cesspool. SAS is in hydraulic failure. (revised 0427197) e SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 99 EVENS ST.OSTERVILLE MAP 142 PAR 099 L41 Owner: ROBERT STETSON;102 EAST ST.SHARON MA.02007 Date of Inspection:11H2199 D]SYSTEM FAILS(continued) Yes No 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 4limes in the last year NOT due to clogged or obstructed pipe(s). Numbers 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 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. 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: 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 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. (revised 04127197) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECLIST Property Address: 99 EVENS ST.OSTERVILLE MAP 142 PAR 099 L41 Owner: ROBERT STETSON_;102 EAST ST.SHARON MA.02007 Date of Inspection:1111219E Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following: _c_ — Pumping information was requested of the owner, occupant,and Board of Health. x None of the system components have been pumped for at least two weeks and the and the system has 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. x _ 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. 1 x — All system components,,excluding the Soil Absorption System, have been located on the site. x 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. x — The size and location of the Soil Absorption System on the site has been determined based on The facility owner(and occupants, if different from owner)were'provided with information on the proper maintenance of Sub-Surface Disposal Systens. x Existing inform ation.'Ex. Plan at B.O.H. x Determined in the field(if any failure criteria related to Part C is at issue,approximation of distance is unacceptable)115.302(3)(b)1 (revised 04127)97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ' PART C SYSTEM INFORMATION Property Address: 99 EVENS ST.OSTERVILLE MAP 142 PAR 099 L41 Owner: ROBERT STETSON;102 EAST ST.SHARON MA.02067 Date of Inspection:1111219E FLOW CONDITIONS RESIDENTIAL Design flow: 33o g•p•d./bedroom for S.A.S. Number of bedrooms: $ Number of current residents: o Garbage grinder(yes or no): No �. Laundry connected to system(yes or no): Ye: Seasonal use(yes or no): No Water meter readings,if available:(last two(2)year usage(gpd): Na , Sump Pump(yes or no): No Last date of occupancy:3WEEKSAGO a COMMERCIAL/INDUSTRIAL ; Type of establishment: nIe Design flow:o gallons/day Grease trap present:(yes or no) No Industrial Waste Holding Tank present:(yes or no) No TI Non-sanitary waste discharged to the Title 5 system:(yes or rio) No 4.. Water meter readings,if available: Ne Last date of occupancy: Ne OTHER:(Describe) Na Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: System pumped as part of inspection: (yes or no)_No If yes,volume pumped:o gallons Reason for pumping: Ne TYPE OF SYSTEM x Septic tank/distribution box/soil absorptions 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.Information: SYSTEM WAS INSTALLED IN 1984 PERMIT 0 84.225 ' Sewage odors detected when arriving at the site: (yes or no) No (revlsed 04127187) C SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C . SYSTEM INFORMATION (continued) Property Address: 99 EVENS ST.OSTERVILLE MAP 142 PAR 099 L41 Owner: ROBERT STETSON;102 EAST ST.SHARON MA.02007 Date of Inspection:11112r98 SEPTIC TANK: x (locate on site plan) Depth below grade: 1' Material of construction:x concreate metal FRP Polyethylene_other(explain) If tank is metal, list age na . Is age confirmed by Certificate of Compliance No (Yes/No) Dimensions: Le'6^H5.7-W4't0" Sludge depth:r Distance from top of sludge to bottom of outlet tee or baffle: 33" Scum thickness:u Distance from top of scum to top of outlet tee or baffle:2' Distance form bottom of scum to bottom of outlet tee or baffle:o How dimensions were determined. MEASUSRED Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles, depth of liquid level in relation to 0utlef invert, structural integrity, evidence of leakage,etc.) SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND.RECOMMEND PUMPING SYSTEM EVERY TWO YEARS. GREASE TRAP: (locate on site plan) Depth below grade: rda Material of construction: —concrete—metal FRP Polyethylene_other(explain) Dimensions: rda Scum thickness:rda Distance from top of scum to top of outlet tee or baffle:rda Distance from bottom of scum to bottom of outlet tee or baffle: rva Date of last pumping;,ra 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.) rda BUILDING SEWER: (Locate on site plan) Depth below grade: v6, Material of construction:_cast iron x 40 PVC other(explain) Distance from private water supply well or suction line-.TOWN ' Diameter: rda Qmments: (conditions of joints,venting,evidence of leakage,etc.) (revised owV97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM. PART C SYSTEM INFORMATION (continued) Property Address: 99 EVENS ST.OSTERVILLE MAP 142 PAR 099 L41. Owner: ROBERT STETSON;102 EAST ST.SHARON MA.02007 Date of Inspection:11112/98 TIGHT OR HOLDING TANK: (locate on site plan) Depth below grade: Na Material of construction: concrete_metal_FRP Polyethylene_other(explain) Dimensions: nre Capacity: Na gallons Design flow: Na gallons/day Alarm level:_Na Alarm in woking order? Yes No ` Date of previous pumping: Comments: (condition of inlet tee,condition of alarm and float switches,etc.) ' Na DISTRIBUTION BOX: x , (locate on site plan) Depth of liquid level above outlet invert: LIQUID LEVEL WITH BOiTOMOFPIPE Comments: (note if level and distribution is equal, evidence of solids carryover,evidence of leakage into or out of box etc.) DISTRIBUTION BOX IS STRUCTURALLY SOUND PUMP CHAMBER: (locate on site plan) Pumps in working order.(yes or no)No Alarms in working order(yes or no)_ , Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) (revI9ed 0427J97) • r, SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C v SYSTEM INFORMATION (continued) I Property Address: 99 EVENS ST.OSTERVILLE MAP 142 PAR 099 L41 Owner: ROBERT STETSON;102 EAST ST.SHARON MA.Q067 Date of Inspection:11f1219s SOIL ABSORPTION SYSTEM (SAS):x (locate on site plan, if possible;excavation not required, but may be approximated by non-intrusive methods) If not determined to be present,explain: Na Type: leaching pits, number: 1000 GALLON LEACH FIT leaching chambers,number:-rde leaching galleries,number: rda leaching trenches, number,length: rda leaching fields,number, dimensions:rda overflow cesspool, number:n/a Alternate system: Na Name of Technology:_rda Comments: (note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.) THE LEACH PIT IS STRUCTURALLY SOUND AND FUNCTIONING PROPERLY.THE PIT WAS EMPTY AT THE TIME OF THE INSPECTION.PIT HAS NOT HAD MORE THAN 4'OF WATER IN IT. CESSPOOLS: (locate on site plan) Number and configuration: rda Depth-top of liquid to inlet invert: rJa Depth of solids layer: rda Depth of scum layer: rda Dimensions of cesspool: rda Materials of construction: rda Indication of groundwater: rda , inflow(cesspool must be pumped as part of inspection) rda Comments: (note condition of soil, signs of hydraulic failurejevel of ponding,condition of vegetation, etc.) rda PRIVY (locate on site plan) Materials of construction: rda Dimensions: rda Depth of solids: rda a Comments: (note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation,etc.) rda (revised 0427197), f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 99 EVENS ST.OSTERVILLE MAP 142 PAR 099 L41 ROBERT STETSON;102 EAST ST.SHARON MA.02067 11112198 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) A " AC iy AA ary� 1% ILb (revmed04127197} Fay ! of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 99 EVENS ST.OSTERVILLE MAP 142 PAR 099 L41 ROBERT STETSON;102 EAST ST.SHARON MA.02067 11112/98 Depth of groundwater 12« 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 ^' x Use USGS Data ° Describe in your own words how you established the High Groundwater Elevation.(MUST be completed) USGS MAPS AND CHARTS • t (revised04)27197j page 10 of 10