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Home My WebLink About2299 MAIN ST./RTE 6A(BARN.) - Health -2299 Main Street/Rte 6A (Baiq Barnstable P 237 046 p � q a a - o U i a ° ASSESSOR'S MAP NO. —PARCEL— q/ p LOCATION SEWAGE PERMT No. YIL L,,Z . �A-(4�- R , z37 0 4 INSTALLER'S NAME i ADDRESS i ® U I L D E R OR OWNER DA T E PERMIT ISSU E D DATE COMPLIANCE ISSUED 14 v m_ .rS� ii J �v _ a No .... .. THE COMMONWEALTH OF MASSACHUSETTS r D BOARD O HEALTH 3 ti..__.... oF........ . ............... tttion -fur 43W.Voiittl Worko Tomitrurtion Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Indlvldual Sewage Disposal System at: ---!C'"......� .................... .....tLA.-------- ------------------------"------"--------------------.........-----.. Location"Address or Lot No W Owner Address Installer Address Q Type of Building/ Size Lot----------------------------Sq. feet Dwelling No. of Bedrooms.-._--_- -------------------------------Expansion Attic ( ) Garbage Grinder (� J� aOther—Type of Building ---------------------------- No. of persons............................ Showers ( ) — Cafeteria ) Q' Other xt es ------------------------------------------------------- W Design Flow. _____._. _. Mons per person per day. Total daily flow..... gallon. ------ WSeptic Tank Liquid capacity�i"-"----gallons Length................ Width---------------- lliameter---------------- Deptll-------------... x Disposal Trench—No. .................... Width.- _.. _ . _ Total Length.................... Total leaching area.---_.-----_.-_----_sq. ft. Seepage Pit No...._.._�._._______. Diameter. � _. .°Depth below i et...... ........ Total leaching area.-.-----_-_-.----sq. ft. z Other Distribution box ( )�.�� / ®sin tank ( ) (��-� �G -- l.2 *�� W Percolation Test Results Pei ~oorcA Date. Test Pit No. 1----------------minutes per inch Depth of "Pest Pit.................... Depth to ground water---------.--..-..------- �14 Test Pit No. 2................minutes per inch Depth of Test Pit--------------------- Depth to ground water------------------------ P4 ............ . ...............................l_-- . `- ---------- ------ ----=--- O Description of Soil------. `� ---- ........ ------------------------------- ------ --- - ------ ---- V - 9 - ! - >---------------------------------------------------- W x ----------- ---------------- - ------------------------------------------------------------------------------------- ----------------------------- ----------------------------------------------------- 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 Article NI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been ' ued by the boar of health. Signe = --------------- ----------------------- Date Application Approved By---- �-- - -- ------ -- -- - -- ------- - ..... D e4--------- Application Disapproved for the.f ollowing reasons:.................................. -•--•--•---.............-••---------------------........--------------_...-- ---------------•--••----------------------------------------------------------------------•------------------------ ................................... ------------------------------------------------ Date PermitNo......................................................... Issued................----- .................................. Date No. ":................. ` Fps... ..�i ............... THE COMMONWEALTH OF MASSACHUSETTS BOARD O HEALTH /. .. ... ....... ----OF......... ....G . ............._.. ....................... J Appliration -fur Uhipwial Workii Towitrurtion Vinmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ----------- -------- ------ Location-Address or Lot No. ---••--•------•-----------------------•----•------------------------•--------••-•--------•••------ ...•--•--•----------------•--•••-••--•.....-•---........---------••-............--.......••----•-- Owner Address W Installer Address QType of Building/ Size Lot----------------------------Sq. feet U Dwelling 1-7No. of Bedrooms--.------._;_--__-_-•---.................. -Expansion Attic ( ) Garbage Grinder ( �'-a4 Other—Type of Building ---------------------------- No. of persons............................ Showers ( ) — Cafeteria ( ) Q' fixt.Other >ares ............... d ---------------------------------------____.................................................... W Design Flow........... y��allons per person per day. Total daily flow........_. .. gallons. - -----•--- 04 Septic Tcuik/-Liquid capacity___________gallons Length________________ Width_... ------.-.. Diameter____- Depth...---_-_.----- xDisposal Trench—Np. .................... .Xi�jth.................... Total Length.................... Total leaching area--------------.-----sq. ft. Seepage Pit No--------------------- DiaXrleter.l. .19... _-Depth below i let...... _ Total leaching area.................sq. It. z Other Distribution box ( )r 11c.�,. Rosing tank � Z Percolation Test Results 3 Pertor�ey` a Date..... a Test Pit No. 1................minutes per inch Depth of Test Pit-------------------- Depth to ground water...___.-.-.____--.-..._. 44 Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water_.._-._.______.__.-_.... P4 / ----------- ---- f� - O Description of Soil v..` - ---------�`=--'^��--- � _ . - U -------------------------- --• --------------------------------------------- W UNature 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 Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board,of health. e� f --= --•--•----------------�- ----•-•-•-•-----•---..__ ._._...---"Date ------•--•-- �/ ---------- r ' Application Approved BY-------�-- - - - ----------�-- !�-��----��7-------------•>---- —.��- ,� -D7 Application Disapproved for the following reasons:----•----------•------------------------------------------------•-----------------•----------•-------------•---- -_--_-•------------------------------------------------------------------•----•-•-----------------------_.--- Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD HEALTH :..... .........OF.. g4��.......................................... Trrtifirate of (ItUmphaure T. -S TO CE. TI Y, That the Individual Sewage Disposal System constructed or Repaired ( ) by �• %} ------------------------------------------------ 1 Instal�fx4,i has been installed in accordance wif/El the provisions of Ar 'cle XI of The State Sanitary Code as described in the application for Disposal Works Construction Permit N��,:, ,.. dated /l TIDE ISSUANCE: OF THIS CERTIFICATE SHALE. NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.A zr� _1 ....: ` � Inspector - r -' .............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD 19f, HEALTH ..........................................OF .. Al . //n ---- No......................... FEE.r. .............. Permission is ereby granted-------- .,.f--- --- --------- .._. .__ to Constr t ( ) or Repair ar Individ f Se�ag ,,sposaKSy tem at No. tF' 7 ----.------ ----------- - -•---- Street as shown on the application for Disposal Works Constructioi f�mit N .... ....., __ Dated__-_//_-_-2.-.76......:..... �i f (--•-••• . --• ---- 1/f .,C ---•----------------•--- r Board of Health DATE-- ... G FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS •.ram - b K XG$� ir 144 z t a •3 •S ,tiR e 'E'K 2it� �+��yT�V�j. s j o k M1zm •` F 4,Affi�x L y t -Ic F t ,,p A AC ` -COO—T/FY 77"oP7- TiAIE aW1_z)/.VG +sAk ?dry V r < y xxa (jr. +C�RIitJ� '/ti5 ` � pRPeaGP r y' ONT✓ " n SO4>W .1 O.V r" SSAP", /S 40Cs9 4.SNOWA/ H �AZ) TNF7' /T '. CONFC>AeA-1 TO TN SO�c//.t/�r r o T'NE 71OWit./ of � :1VA/s:'aV CONSTBGIC TE D. at P- +� Irt G ciViL Eft/6/A/EEBS / _ qg ikf 204' 4 bP }# COMMONWEALTH OF MASSACHUSETTS RECEIVED EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT Olt' ENVIRONMENTAL PROTECTION - AUG 2 4 2004 TOWN OF BARNSTABLE MAP Zs - HEALTH DEPT. PARCEL;fLOT • TITLE 5 (7), OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS ? SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM �' PART A X a CERTIFICATION Property Address: �nsr^bl i{ Od.66� " Owner's Name: o✓l •q, � Owner's Address: a1 Date of Inspection: a a p RZ Name of Inspector:(please print) a r'k" P/e`/ Company Name: i O — EC Mailing Address: flo off( $ve Telephone Number — t f 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 finiction and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to 15.340 of Title 5(310 CMR 15.000). The system: Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: !" Date: / 01 The system inspector shall sub t 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 10,00o 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 sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection pection and under the conditions of use at that time.This ins pection does not address how the system will perform in the future under the same or different conditions of use. f Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: � n v r rats q � D�C� Owner: C, Date of Ins 'on• ,?d Inspection Summary: Check Al1,CDorE/ALWAY complete all of Section D A. Sy Passes: 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: & Sy m Conditionally Passes: A7One 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. Theseptic 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 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 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: I page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: /� 9+ Owner: Date of Insp oa: C. Further Evaluation is Required by the Board of Health: /v• Conditions exist which require further evaluation by the Board of Health in order to determine if the system rs farlu�g 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 system is not functioning in a manner which will protect public health,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 any)determines 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 a surface water supply or tributary to a surface water supply. _ The system has a septic tank and SAS and the SAS is within a Zone 1 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 well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a 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 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 must be attached to this form. 3. Other. f page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 7 Jrt iv►s c�i� Owner: G Date of Inspection: D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No/ f/ "ckup of sewage into facility or system component due to overloaded or clogged SAS or cesspool gg spo _ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or /clogged SAS or cesspool (/ tatic liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool quid 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 9T due to clogged or obstructed pipe(s).Number 4,6f times pumped . 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. Z/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. _L 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 N 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 equal 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.] (Yes/No)The system Ws.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 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) ynostem is within 400 feet of a surface drinlang water supply' stem is within200 feet of a tributary to a surface drinking water supply stem is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped 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. Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: as 9 9 b"A l Date of Inspection: o?d 0 Check if the following have been done.You mast indicate es"or"no"as to each of the following: Yes-Ao — 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 mi the previous two week period �/ Have large volumes of water been introduced to the system recently or as part of 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 ba$Ies 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 L/ sting information.For example,a plan at the Board of Health. Determined in the field(if any of the faihme criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)) page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C � ` Q SYSTEM INFORMATION Property Address• v� / Owner: Date of Ins on: ZALt OW CONDITIONS - RESIDENTIAL 2 Number of bedrooms(design): Number of bedrooms(actual): DESIGN flow based on 310 Cl 15.203(for example: 110 gpd x#of bedrooms): Number of current residents: Does residence have a garbage grinder(yes or no): Is laundry on a separate sewage system"or no): elif yes separate inspection required] Laundry system inspected(yes or no):_ Seasonal use:(yes or no): Water meter readings,if available(last 2 years usage(gpd)): Sump pump(yes or no):�/1 Last date of occupancy: GtiIe� , COMMERCIAUINDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203) ppd Basis of design flaw(seats/persons/sgftetc.): 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: �� 0 w�✓ Was system pumped as part of the inspection(yes or no):11-0 If yes,volume pumped:melons—How was quantity pumped determined? Reason for pumping TIPCOF SYSTEM v Septic tank,distribution box, soil absorption system Single cesspool Overflow cesspool Pnvy Shared system(yes or no)(if yes,attach previous inspection records,if any) Innovative/Altemative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight tank _Attach a copy of the DEP approval _Other(describe): Approximate age of all components,date installedn(if %?nd source of information: Were sewage odors detected when arriving at the site(yes or no): /v� f page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM . PART C SYSTEM INFORMATION(continued) Property Address: as 9 9 A f C/� �1 Gles a�v+ �j InA Owner. Date of Ins 'on• old AV BUELDING SEWER(locate p site plan) Depth below Materials of constriction: cast iron _` 1 PVC other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK:_(locate on site plan) Depth below grade: �� Material of construction:_k''con _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) Dimensions: Sludge depth y"` Distance from top of to to bottom of outlet tee or baffle: Scum thickness: // n Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle:Z� How were dimensions determined: o a R A s I Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as rela to outlet invert,evince of leakage,etc.):` t r N v�ic r Ae5aIr /90 #7Bed R Trt �r '"gyp. TOO a d vr O GREASE TRAP:LI(locate on site plan) Depth below grade:_ Material of construction:_concrete_metal_fiberglass_polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Adds: a� Owner: A7 a 0 / Date of Insp Lion• ott TIGHT or HOLDING TANK:Z(tank must be pumped attune of mspecUon)(locate on site plan) •. Depth below grade: Material of construction: concrete metal fiberglass_polyethylene other (explain): Dimensions: Capacity: gallons Design Flow: gallonstday Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping r Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX:&(if present must be opened)pocate on site plan) Depth of liquid level above outlet invert: Commends(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.): 1/ / ifiOrn 0�! �S bui•�T. .SNal•�oC �•�d ��• arc/, PUMP CHAMBER (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.): f Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM //INFORMATION(continued) Property Address: �`� Owner: a✓i Date of Ins 'on• at4 0 SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: CX leaching pits,number: CPS�N � , leaching chambers,number: leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow.cesspool,number: innovativelalternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): // ,a .X c �► �-.i 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 or no): Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY:_Aocate 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.): Page 10 of 11 OFFICIAL INSPECTION FORM-NOT FOR.VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: a2t)91 Owner. Gv► Date of Inspections MAAY SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a.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. W 10o��h V �\ Aa CY f Pap 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Pr opeerty Address: Q rr► Owner: A10 h Date of Inspection SSUE lope EXAMM �v Surface water Check cellar OLG� Shallow wells -� Estimated depth to ground water 2 feet Please indicate(check)all methods used to determine the high Bound water elevation: To? Obtained from system design plans on record-1f checked,date of design Plan reviewed: Observed site(abutting property/observation hole thin 150 feet of SAS) t, Checked with local Board of Health cplain A�f Checked with local excavators,installers-(attach docume�ationj Accessed USGS database-explain: You mast de;ri you established the hr�h ground water elevation: A .0 wN aA"—, JeB (f /'G► V � ° `r OGOO io, J 'V �