HomeMy WebLinkAbout0348 AMES WAY - Health 348 Ames Way
Centerville F/R
A = 170 057013
��� �� NO. 152 1/3 ORA
ajj
.(
V
Y
—1J
.�
V
63 -3 iC
No. Fee 5..�
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
01ppYtcation for MigosW Opgtem Con!Aruction Permit
Application for a Permit to Construct(pair Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No.3�,$ Owner's Name,Address and Tel.No. sOs-
Assessor's Map/Parcel 6CNP��v/`�r
I io - o57-013 e r lllve
Installer's Name,Address,and Tel.No. Designer's Name,Address d Tel.No.
/ aiyl rt?L Gr s S
Type of Building:
Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( )
Other Type of Building , No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) 4 ;
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issued by this Board of Health.
Signed Date
Application Approved by Date 0 U 7
Application Disapproved for the following reasons
Permit No. 20C)3-31fo Date Issued
2 ! �
6> � � Fee .
" No. _ _ V/
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
i Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS
f `
01pprication for Migogal *pgtem Congtruction Permit
Application for a Permit to Construct(z/; Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No._.y s /�f?�/� 5 , Owner's Name,Address and Tel.No. j'O,5-
Assessor's Map/Parcel ,
►-7o - o57-0%3 3f� >s �r✓, � G_ r=�^✓��/a_=
Installer's Name,Address,and Tel.No. Designer's Name,Address d Tel.No.
Type of Building:
Dwelling No.of Bedrooms ' 3 Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title --
Size of Septic Tank Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) /2 —a4 x
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code andnot to place the-system in operation until a Certifi-
cate of Compliance has been issued by this Board of Health.
Signed Date
Application Approved by Date 7
Application.Disapproved for the following reasons
Permit No. 2 0O 3— 3 ,o Date Issued 7 J
———————— ————————— ————————————————
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed(G.-)-Repaired( )Upgraded ( )
Abandoned( )by /r�s�o l]✓/� �^d^JS
at i=h%i fY/l� has been construct d in cc-ordance
with the provisions of Title 5 and the for Disposal System Construction Permit No.�3-31 b-. dated (-"
Installer .4s-e U�(`�>gr,-o5 Designer
The issuance of t-'s pe it shall not be construed as a guarantee that the system w' c ' as ed.
Date 7 Inspector
---------------------------
No.2cp 3— 31(0 Fee ...i/�
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS
lwigpogal *pgtem Construction Permit
Permission is hereby granted to Construct( v)'Repair( )Upgrade( )Abandon( )
System located at
and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to
comply with Title 5 and the following local provisions or special conditions.
Provided:Constuh ctio must be completed within three years of the date of this p i
Date:_- S 0 3 Approved by
TOWN OF BARNSTABLE
LOCATION l .S SEWAGE #
V LL,NGE Q ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE NO./�
SEPTIC TANK CAPACITY - I W ,
LEACHING FACILTFY: (type) (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 ����
IA
JA
c ! m �
s
V � C
3�6 o-p
fco
• �� i3 �
COMMONWEALTH OF MASSACHUSETTS RECEIVED
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIR
DEPARTMENT OF ENVIRONMENTAL PROTECTION JUL 15 2003
F
TOWN OF BARNST'ABLE
t o HEALTH DEPT.
TITLE 5
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION Property Address: 348 AMES WAY CENTERVILLE, MA 02632 IV057i
Owner's Name: MERRILL MORSE -'Cl COP
Owner's Address: 348 AMES WAY CENTERVILLE, MA 02632
Date of Inspection: 6/17/03
Name of Inspector: (please print) JOHN GRAC1, INC.
Company Name: SEPTIC INSPECTIONS
Mailing Address: P.O. BOX 2119 TEATICKET, MA. 02
536
Telephone Number: 508-564-6813 FAX 508-564-7270
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 Section 15.340 of Title 5(310 CMR 15.000). The system:
_ Passes �I 31 b
X Conditionally P s s
_ Needs Further uation by the Local Approving Authority
_ Fails
Inspector's Signature: Date: 6/17/03
The system inspector shall submit a copy this inspection report to the Approving Authority(Board of Health or DEP)within
30 days of completing this inspection. If t e 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 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
SYSTEM CONDITIONALLY PASSED TITLE V INSPECTION. RECOMMEND PUMPING EVERY TwO YEARS TO
PROLONG THE SYSTEM'S USEFUL LIFE. D-BOX IS STRUCTURALLY UNSOUND AND NEEDS TO BE
REPLACED.
****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 conditions of use.
TitIA 5 Incnrrtinn harm A/1 I
Page 2 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 348 AMES WAY CENTERVILLE,MA 02632
Owner: MERRILL MORSE
Date of Inspection: 6/17/03
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
A. System 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:
SYSTEM CONDITIONALLY PASSED TITLE V INSPECTION.RECOMMEND PUMPING EVERY TWO YEARS
TO PROLONG THE SYSTEM'S USEFUL LIFE. D-BOX IS STRUCTURALLY UNSOUND AND NEEDS TO BE
REPLACED.
B. System Conditionally Passes:
X 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.
n/a 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: n/a
n/a 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: n/a
n/a 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: n/a
n�
r
Page 3 of 11
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 348 AMES WAY CENTERVILLE,MA 02632
Owner: MERRILL MORSE
Date of Inspection: 6/17/03
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 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 n/a
"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:
n/a
i
Page 4 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 348 AMES WAY CENTERVILLE,MA 02632
Owner: MERRILL MORSE
Date of Inspection: 6/17/03
D. System Failure Criteria applicable to all systems:
You must indicate"yes"or"no"to each of the following for alLinspections:
Yes No
X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool
X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged
SAS or cesspool
X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool
X Liquid depth in cesspool is less than 6" below invert or available volume is less than 'h day flow
X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times
pumped SYSTEM LAST PUMPED AUGUST 2002..
_ X Any portion of the SAS,cesspool or privy is below high ground water elevation.
X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply.
X Any portion of a cesspool or privy is within a Zone 1 of a public well.
X Any portion of a cesspool or privy is within 50 feet of a private water supply well.
X 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 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.]
NO (Yes/No)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 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
X the system is within 400 feet of a surface drinking water supply
X the system is within 200 feet of a tributary to a surface drinking water supply
X the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped
Zone 11 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.
a
Page 5 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 348 AMES WAY CENTERVILLE,MA 02632
Owner: MERRILL MORSE
Date of Inspection: 6/17/03
Check if the following have been done. You must indicate "yes" or"no" as to each of the following:
Yes No
X _ Pumping information was provided by the owner, occupant, or Board of Health
X Were any of the system components pumped out in the previous two weeks?
X _ Has the system received normal flows in the previous two week period?
X Have large volumes of water been introduced to the system recently or as part of this inspection ?
X _ Were as built plans of the system obtained and examined?(If they were not available note as N/A)
X _ Was the facility or dwelling inspected for signs of sewage back up`?
X _ Was the site inspected for signs of break out?
X _ Were all system components, excluding the SAS, located on site`?
X _ 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 ?
X _ 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
X _ Existing information. For example,a plan at the Board of Health.
X _ 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(3)(b)]
5
i
Page 6 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 348 AMES WAY CENTERVILLE,MA 02632
Owner: MERRILL MORSE
Date of Inspection: 6/17/03
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design): 2 Number of bedrooms(actual): 2
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 220
Number of current residents: 4
Does.residence have a garbage grinder(yes or no): NO
Is laundry on a separate sewage system(yes or no): NO [if yes separate inspection required]
Laundry system inspected(yes or no): NO
Seasonal use: (yes or no): NO
Water meter readings, if available(last 2 years usage(gpd)): tip
Sump pump(yes or no): NO
Last date of occupancy: n/a
COMMERCIAL/INDUSTRIAL
Type of establishment: n/a
Design flow(based on 310 CMR 15.203): n/agpd
Basis of design flow(seats/persons/sgft,etc.): n/a
Grease trap present(yes or no): NO
Industrial waste holding tank present(yes or no): NO
Non-sanitary waste discharged to the Title 5 system(yes or no): NO
Water meter readings, if available: n/a
Last date of occupancy/use: n/a
OTHER(describe): n/a
GENERAL INFORMATION
Pumping Records
Source of information: SYSTEM LAST PUMPED AUGUST 2002.
Was system pumped as part of the inspection(yes or no): NO
If yes,volume pumped: n/agallons--How was quantity pumped determined? n/a
Reason for pumping: n/a
TYPE OF SYSTEM
X Septic tank,distribution box, soil absorption system
_Single cesspool
_Overflow cesspool
_Privy
_Shared system(yes or no)(if yes,attach previous inspection records, if any)
_Innovative/Alternative 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): n/a
Approximate age of all components,date installed(if known)and source of information:
20 YEARS BY OWNER
Were sewage odors detected when arriving at the site(yes or no): NO
h
Page I of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 348 AMES WAY CENTERVILLE,MA 02632
Owner: MERRILL MORSE
Date of Inspection: 6/17/03
BUILDING SEWER(locate on site plan)
Depth below grade: 0"
Materials of construction:_cast iron _40 PVC Xother(explain): 20 PVC
Distance from private water supply well or suction line: n/a
Comments(on condition of joints,venting,evidence of leakage,etc.):
TOWN WATER
SEPTIC TANK: X(locate on site plan)
Depth below grade: 0"
Material of construction: Xconcrete_metal_fiberglass_polyethylene other(explain)n/a
If tank is metal list age: n/a Is age confirmed by a Certificate of Compliance(yes or no): NO(attach a copy of certificate)
Dimensions: 1000 GALLONS"
Sludge depth: 1"
Distance from top of sludge to bottom of outlet tee or baffle: 33"
Scum thickness: 0"
Distance from top of scum to top of outlet tee or baffle: 6"
Distance from bottom of scum to bottom of outlet tee or baffle: 18"
How were dimensions determined: MEASURED
Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related
to outlet invert,evidence of leakage,etc.):
SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND AND FUNCTIONING PROPERLY.
RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE.
GREASE TRAP: _(locate on site plan)
Depth below grade: n/a
Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a
Dimensions: n/a
Scum thickness: n/a
Distance from top of scum to top of outlet tee or baffle: n/a
Distance from bottom of scum to bottom of outlet tee or baffle: n/a
Date of last pumping: n/a
Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related
to outlet invert,evidence of leakage, etc.):
n/a
7
i
Page 8 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 348 AMES WAY CENTERVILLE,MA 02632
Owner: MERRILL MORSE
Date of Inspection: 6/17/03
TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan)
Depth below grade: n/a
Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a
Dimensions: n/a
Capacity: n/a gallons
Design Flow: n/a gallons/day
Alarm present(yes or no): N/A
Alarm level: N/A Alarm in working order(yes or no): NO
Date of last pumping: n/a
Comments(condition of alarm and float switches,etc.):
n/a
DISTRIBUTION BOX: X(if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert: n/a
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.):
D-BOX IS STRUCTURALLY UNSOUND AND NEEDS TO BE REPLACED.
PUMP CHAMBER: _(locate on site plan)
Pumps in working order(yes or no): NO
Alarms in working order(yes or no):NO
Comments(note condition of pump chamber,condition of pumps and appurtenances, etc.):
n/a
R
I
Page 9 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 348 AMES WAY CENTERVILLE,MA 02632
Owner: MERRILL MORSE
Date of Inspection: 6/17/03
SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required)
If SAS not located explain why:
n/a
Type
1000 GAL 6' X 6' leaching pits, number: 1
n/a leaching chambers, number: n/a
n/a leaching galleries, number: n/a
n/a leaching trenches, number, length: n/a
n/a leaching fields, number: n/a
n/a overflow cesspool, number. n/a
n/a innovative/alternative system
Type/name of technology: n/a
Comments(note condition of soil, signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.):
LEACH PIT IS STRUCTURALLY SOUND AND FUNCTIONING PROPERLY. SYSTEM SHOWS NO SIGNS OF
FAILURE. PIT HAS F OF LEACHING LEFT IN IT. BOTTOM IS AT 8 FT.
CESSPOOLS: (cesspool must be pumped as part of inspection)(]ocate on site plan)
Number and configuration: n/a
Depth—top of liquid to inlet invert: n/a
Depth of solids layer: n/a
Depth of scum layer: n/a
Dimensions of cesspool: n/a
Materials of construction: n/a
Indication of groundwater inflow(yes or no): NO
Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation, etc.):
n/a
PRIVY: (locate on site plan)
Materials of construction: n/a
Dimensions: n/a
Depth of solids: n/a
Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, etc.):
n/a
4
i
Page 1 Q of 11 y'
OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 348 AMES WAY CENTERVILLE, MA 02632
Owner: MERRILL MORSE
Date of Inspection: 6/17/03
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a sketch of the sewage disposal system including ties to at least two permane:it reference landmarks or benchmarks.
Locate all wells within 100 feet. Locate where public water supply enters the building.
a,
C�
35�to
�1 0 3 �J
In
i
Page'11 of I 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 348 AMES WAY CENTERVILLE,MA 02632
Owner: MERRILL MORSE
Date of Inspection: 6/17/03
SITE EXAM
_Slope
_Surface water
_Check cellar
Shallow wells
Estimated depth to ground water 3 feet
Please indicate(check)all methods used to determine the high ground water elevation:
NO Obtained from system design plans on record- If checked, date of design plan reviewed: n/a
YES Observed site(abutting property/observation hole within 150 feet of SAS)
NO Checked with local Board of Health-explain: n/a
NO Checked with local excavators, installers-(attach documentation)
NO Accessed USGS database-explain: n/a
You must describe how you established the high ground water elevation:
HAND AUGER-3".
tt
FA-Ze
SHE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
70_U_>W...............OF........
Appliration for llhipasal Works Tonstrurtion Prrutit
Application is hereby made for a Permit to Construct ( 1-}"'or Repair an Individual Sewage Disposal
System at:
4-c-e ..........4�._r............elo......
'ati "I............. ...........................
. , /,/ ...........................
.......... ... . . ............ ........... ....... (..........
er Addrespri
-------- . . . .. .. .......................... ..................................................................................................
Installer Address
Type of Building Size Lot.15.10_Qd......Sq. feet
U
Dwelling—No. of Bedrooms............................................Expansion Attic Garbage Grinder (NO)
04 Other—Type of Building ............................ No. of persons....................._.._.._ Showers Cafeteria
P., Other fixtures ................... . ..
t� -----•--------- ---------------------------a---------------------**----------------------
W Design Flow......._...IZO......................gallons 1 e4a'y........Total ot'a"i daily flow....... ....;�L®...................gallons.
9 Septic Tank—Liquid capacity/4,00..gallons Length-16.-K-... Width.Z.;&-_ Diameter________________ Depth.5._"&..'.
Disposal Trench—No. .................... Width.....__............. Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No..... Diameter_&............ Depth below inldt...67............. Total leaching area&......sq. f t.
Z Other Distribution Dosing tank
Percolation Test Results Performed by.R.0&AGb----el...... 2 A ......... Date...
Test Pit No. I m'inutes per inch Depth of Test Pit...Lz�.......... Depth to ground water.Y-4- o.r.'I.j67.....
44 Test Pit No. 2................minutes per inch Depth of Test Pit_._............._... Depth to ground water.__................___..
.............................................................................................................................................................
0 Description of Soil.........0_7...xl..............4,4-4.1........4JW.,6........5V.11_wve�..................................................................
Cxj ................a_.O�_ • . . .
.........N:�.OAKW.�..........5A.*V.-D..............................................................................
---------------------------
fsl
........................................................................................................................................................................................................
U Nature of Repairs or Alterations—Answer when applicable...............................................................................................
................................................................................:.......................................................................................................................
Agreement:
The undersigned agrees to install the aforedescribed Ind' 'dual wage Disposal System in acp6rdan with
the provisions of TL I 1E 5 of the State SanitaryCo — h n ersiened further agrees not to plac, t e s stem in
operation until a Certificate of Compliance has n u th I bo of health. -7
............. ... ........
Date
Application Approved By..----. •.. .. .. ..... .. . . ............... -------7_77.....
Date
Application Disapproved for the following reasons:....................... .............. ...............................................
..........................................................................................................................................................------------------------------------------------
Date
PermitNo......................................................... ........................
Date I
K.w
Fra.............................
40XHE COMMONWEALTH OF MASSACHUSETTS
BOARD yOF HEALTH
.0-Lt.4j................OF........
1;��..f�.A3..� � .1646...............................
Appliralion for Disposal Works Tnnitrur#iun 11amit
Application isdhereby made for a Permit to Construct ( 11,1'or Repair ( ) an Individual Sewage Disposal
System at:
ocati res t+y�' r -
.. .......... . ..... -... --• ------------ -•---•.R , �% �. ......._........
.Z.1A.....
t
----••..............•-..Addres?
Insta Address
UType of Building Size Lot./ -0_12', ......Sq. feet
,., Dwelling—No. of Bedrooms......................::...................Expansion Attic ( ) Garbage Grinder (NO)
Other—T e of Building
a Other—Type g ...._....................... No. of persons........................... Showers ( ) — Cafeteria ( )
Other' fixtures --=--------------------------------- r taa - - ------- -•-----------
W Design Flow........../Zo......................gallons per er-soii pe day. Total daily flow._....Gam:r ._._:.._._._..........gallons.
WSeptic Tank—Liquid capacity14.P__....gallons Lengths:. "___ Width.rt.'; '`.... Diameter-_-_-- _ .Depth .".
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No...... .......... Diameter: ?'....._..._..... Depth below inlet._ .._....._..... Total leaching arear�.. 5.._..sq. ft. i
Z Other Distribution box Dosing tank ( )
aPercolation Test Results Performed by" 'ata_�4?.Ab ...�Q _..1 1l t j �. ......... Date.. U.4,
Test Pit No. 1. __Z:-_-_minutes per inch Depth of Test Pit.I.L.0........ Depth to ground water.No_Pu.e......
f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
W --••------------------------•--------•------------------.........-----._........._.........••----......--•--•-----•-••••-••-•---•...._........-••••---•.-----
O Description of Soil----_..�t.... -- ..... M........d4AJ.b------- -U&_.S"e /.4...•-----------•-•-------------------------------------------------
W .. .
U Nature of Repairs or Alterations—Answer when applicable.-............................................•........................._...._..............._..
••-•••-----------------------•••-----------------•---•------------••-----•----------------------•-••-----.....-----
Agreement:
The undersigned agrees to install the aforedescribed Individual S age Disposal System in accord ce ith
the provisions of TIT`. 5 of the State Sanitary Cod Th u rsi further agrees not to place t Sys min
operation until a Certificate of Compliance has eri ' ed b t oa• of health.
Sig ... .............................. .. ...... ....- e•-••_•-
Date
Application Approved By........ � •... !;
Date
Application Disapproved for the follow reasons:_..............••--- ............................................ a.t e..............
.................•--••-----...---......-------------•----•-------•--•---•-•------=---........----•---•------•-------.........--------•--------------------•--------------•----•-----------•------....._.
Date
PermitNo......................................................... Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
ti BOARD OF;, HEALTH
.... 46 .k!.............OF.......NAAR ,1;. .1 ?. ..........................
r Trrfifiratr of Toutpliatta
THIS IS TO CE IRfi E at the I V iduarS gage Disposal System constructed (�or Repaired ( )
by ,f I�-,A 1 L -- -----------------------------------------------------------------------------------------------
Installer
a'------ f .......................................
..............
been installed in accordance with the provisions of T ; ff.T e State Sanitary Code as described in the
application for Disposal Works Construction Permit No..-.....:____..._f rIV
PP P `�-- ------•-•--------- dated-- . -- ----7 ---------
THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE................................................................................ Inspector...................................................................................
e" ..
f'P
THE COMMONWEALTH OF MASSACHUSETTS
;i BOARD OF HEALTH `-
7
....-_rO.5- 7..A OF................ ....... t'.�.l.R.1a. .s.'rx.oz.�"�
No.. ..................... FEE.....::.................
laispn nr n �tr#ilan rrutit
Permission is hereby granted... ....----...-•-•.................•------......---...._-•••........---
to Construct ( or Repair ( ) an Individual Sewage Disposal System
at No........ !25kc.---..... -----:--&.1 '_f.....
Street
as shown on the application for Disposal Works Construction
c ( Per ' N __
...........................` r ...__.
7 13'oa'r'd of Health
DATE------ .........................................................
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
TOWN OF BARNSTABLE
LOCATION S E W A G
VIL: AGE ASSESSO 'S MAP/& LOT 05-9. 0 3
IMPEOU1,S NAME&PHONE NO. _ �o?,r, 0,/,
SEPTIC TANK CAPACITY 1600 J06011. Piai
.LEACHING FACILITY: (type) >�� L//e (size) /000 A'15E.&P
NO.OF BEDR
BUILDER O OWNE
PERMTTDATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by
r�t
1,,���lit/v �� ��� t
�v
(�
3�'
�5`
,�
y�� 0 3
b 9
BORTOLOTTI CONSTRUCTION,INC. REL
765 WAKEBY ROAD,MARSTONS MILLS, MA 02648 JUL 4 1997 N
508-771-9399 508-428-8926 FAX: 508-428-9399
TOWNOF INA .
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION HDLTHDEPT.
PART A
CERTIFICATION rb'
Property Address:(q
Date of Inspection: '7 Inspector's Na e:
O■ er's N e and Add qss: —] -
CERTIFICATION STATEMENT:
I certify that I have personally inspected the sewage disposal system at this address and that the informa-
tion reported below is true,accurate and complete as of the time of inspection.The inspection was per-
formed based on my training and experience in the proper function and maintenance of on-site sewage
dispo systems. The System:
Passes
Conditionally Passes
Needs Further Ev ation B t Local Aproving Authority
Fails
Inspector's Signature: Date: —715AP7
The System Inspector shall submit a copy of this inspection report to the Approving authority within thir-
ty(30)days of completing this inspection. If the system is a shared system or has a design flow of 10,000
gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional
office of the Department of Environmental Protection. The original should be sent to the system owner
and copies sent to the buyer, if applicable and the approving authority.
INSPECTION SUMMARY:
A)SYSTEM PASSES:
l/ I have not found any information which indicates that the system violates any of the failure
criteria as defined in 310 CNIR 15.303. Any failure criteria not evaluated are indicated
below.
B)SYSTEM CONDITIONALLY PASSES;
One or more system components need to be replaced or repaired. The system,upon comple-
tion of the replacement or repair,passes inspection.
Indicate,yes, nor,.or not determined(Y,N,OR ND). Describe basis of determination in all instances. If
not determined",explain why not.
The septic tank is metal,cracked, structurally unsound, shows substantial infiltration or .%
exfiltration,or tank failure is imminent. The system will pass inspection if the existing sep-
tic tank is replaced with a conforming septic tank as approved by The.Board of Health.
Sewage backkup or breakout or high static water level observed in the distribution box is due
to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. The
system will pass inspection if(with approval of The Board of Health):
' - 1 -
h
r i
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
t 1'a PART A
�* CERTIFICATION(continued)
.,ait ; 6 Broken iPe( )replaced
laced
P
'JrObstruction is removed
1� Distribution Box is levelled or replaced
�``+•.�")�rTh'e 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 ieirioved
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 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 FUNCTION-
ING IN kMANNER 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
water supply or tributary to a surface water supply.
The system has a septic tank and soil absorption system and is with a Zone I of a public
water supply well.
The system has a septic tank and soil absorption system and is within 50 Feet of a private
water supply well.
The system has a septic tank and soil absorption system and is less than 100 Feet but 50
Feet or more from a private water supply well,unless a well water analysis for coliform
bacteria and volatile organic compounds indicates that the well is free from pollution from
the facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less
than 5 ppm.
D)SYSTEM FAILS:
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.
Backup of sewage into facility or system component due to an overloaded or clogged SAS
or cesspool.
Discharge or ponding of efluent to the surface of the ground or surface waters due to an
oyerloaded or clogged SAS or cesspool.
Static liquid level in the distribution box above outlet invert due to an overloaded or clog-
ged SAS,or cesspool.
Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2
day flow.
Required pumping more than 4 times in the last year NOT due to clogged or obstructed
pipe(s). Number of times pumped
-2-
•
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater
elevation.
Any portion of a cesspool or privy is within 100 Feet of a surface water supply or tributary to
a surface water supply.
Any portion of a cesspool or privy is within a Zone I of a public well.
Any portion of a cesspool or privy is within 50 Feet of a private water.supply well.
Any portion of a cesspool or privy is less than 100 Feet but greater than 50 Feet from a private
water supply well with no acceptable water quality analysis. If the well has been analyzed
to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic
compounds,ammonia nitrogen and nitrate nitrogen.
E)LARGE SYSTEM FAILS:
The following criteria apply to a large system in addition to the criteria above:
The design flow of a system is 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:
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 11 of a public water supply well. ,f
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.
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Check if the following have been done:
_Pumping information was requested of the owner,occupant,and Board of Health.
None of the system components have been pumped for atleast two weeks 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.
1/As-built plans have been obtained and examined. Note if they.are not available with N/A.
The facility or dwelling was inspected for signs of sewage back-up.
ti The system does not receive non-sanitary or industrial waste flow.
The site was inspected for signs of breakout.
i/All system components,excluding the Soil Absorption System,have been located on site.
_ The septic.tank manholes were uncovered,opened,and the interior of the septic tank was in-
spected for condition of baffles or tees, material of construction,dimensions,depth of liquid,,
depth of sludge,depth of scum.
The size and location of the Soil Absorption System on the site has been determined based on
existing information or approximated by non-intrusive methods.
-3-
.,�.'- n emu. 1 � j��'a4,� .•id�:.
F
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST(continued)
The facility owner(and occupants, if different from owner)were provided with information on
the proper maintenance of Subsurface Disposal System
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
FLOW CONDITIONS
RESIDENTIAL
Design Flow: 330 gallons Number of Bedrooms: c9 Number of Current Residents:
Garbage,Grinder: Laundry Connected To System� Seasonal Use: ,r)d
Watei°Meter Reath i gs;if a ilable:
Last Date of Occupancy: o� -
i
COMMMERCLAIJINDUSTRIAL:Ak R;
Type of Establishment:
Design Flowyrf` gallons/day Grease Trap Present: (yes or no)
Industrial Waste Holding Tank Present:
Non-Sanitary Waste Discharged To The Title V System:
Water Meter Readings,If Available: Last Date of Occupancy: y
OTHER: Describe) .
Last Date of Occupancy:
GENERAL INFORMATION t
PUMPING RECORDS and source of information
System Pumped,as part of inspection:_ If yes,vol a pumped: gallons
>,eason for,puinping:
TYPE OF SYSTEM:
Septic Tank/Distribution Box/Soil Absorption System
Single Cesspool
_ i.
Ov4erflow Cesspool
Privy
Shared System(If yes,attach previous inspection records, if any) '
Other(explain):
PROXIMATE`AGE of all components,date installed(if known)and source of information:
Sew, gq odors detected when arriving at the site: ,w
-4-
v
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
GENERAL INFORMATION (continued)
SEPTIC TANK:
Depth below grade: Material of Construction: concrete metal FRP Other
(explain) -- _
Dimisions: s Y<�'X 5 ' Sludge Depth: Scum Thickness: /O "
Distance from top of sludge to bottom of outlet tee or baffle:
Distance from bottom of scum to bottom of.outlet tee or baffle: Z "
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. /O
? i
i� O.i
J,
GREASE TRAP:�� .
Depth,Below Grade: Material of Construction:—concrete metal_FRP_Other.
(explain)
Dimensions: Scum Thickness:
Distance from top of scum to top of outlet tee or baffle:
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.)
i
TIGHT OR HOLDING TANK:��
Depth Below Grade: Material of Construction:_concrete_metal_FRP_Other(explain)
Dimensions: Capacity: gallons Design Flow: gallonstday
Alarm Level:
Comments: (condition of inlet tee,condition of alarm and float switches,etc.)
DISTRIBUTION BOX:
Depth of liquid level above outlet invert:
Comments: (note if 1 1 and distribution is eq 1,evid c of solids carryover,evidence of leak a a into
or o of box,etc.)
PUMP CHAMBER:
Pump is in working order:
Comments: (note condition of pump chamber,condition of pumps and appurtenances,etc.)
-5-
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
SOIL ABSORPTION SYSTEM(SAS):
(Locate on site plan,if possible;excavation not required,but may be approximated by non-intrusive
methods) If not determined to be present,explain:
Type:
leaching pits;'number: Leaching chambers, number: Leaching galleries,number:
'Leaching trenches,number,length:
Leaching fields,number,dimensions:
Overflow cesspool,number:
Comments: (note condition of soil,signs of hydraulic failure level of ponding,condition of vegetation,
,rz
CESSP,OOLS:Ak
f
Number'and'configuration: Depth-top of liquid to inlet invert:
I'
Depth of solids layer: Depth of scum layer: Dimensions of Cesspool: a
Materials of construction: Indication of groundwater:
Inflow(cesspool must be pumped as part of inspection)
Comments: (note condition of soilk,signs of hydraulic failure, level of ponding,condition of vegetation,
etc.)
PRIVY:
Materials of wnstruction: Dimensions:
Depth of Solids:
Comments: (note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation,
etc.)
-6-
't.
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
SKETCH OF SEWAGE DISPOSAL SYSTEM:
Include ties to atleast two permanent references, landmarks or benchmarks.
Locate all wells within 100 Feet.
t�
-"2
►��, lu
.� IU
tk
L \,
a
DEPTH TO GROUNDWATER:
Depth to groundwater: / Feet
Meth of Determination or A proxi anon: 4 Im t'/fw' l ;am
-7-
f• ': ULY 13 l9 79 r
r `
LCYT 37
I /8+a Nut- ML)KRAy - .= 5PF-CTOR•
1a+c. L O T 4 / N
f L L Elf. 17. 4
LEACH
N 85 P/T
LOAM ANO
NEST O RE5ERVE ! SUBSOIL-
TES GIST, 5 0 i
17"" s�nnc 5' � �4 144 M EO10A SAND
` Q f TANK ak t
,!r-t 10' f9F9 �G4E f� 174S 23 i Q j
EXIST/N.VI
G -� !
/ FOUNDAVON1 ELEV. . 5.4
al 7
PKnP !i // Iv9 L a l�?T /Z C-NCOI-)N
L(a7 4.0. junl6 38. �� TOWN L�..��3TEk IS AYA; L A13Lt
AM ES ' WAY
s ETBAc (Pu%o rs {, SS,C,q L 40
T TZEt77E'
SE P T/C 5 y5 T•L.wl'.C'on/S T2 UG:T/O.N f <' � _� L3�D T2�c�,<<1 S
SNA [_L: GQNF02.,M a77 cT Ol3 "ASS
? - `• O4 S/G U•,
FO t ,C OOff 7 2r ,4 rEXIST/N&
M/
A/E<1LTN TZ��UL.�1 TiOn/S.
ToP of ✓020�o L- t� ��
's f` • . 'fir GOOF PE.A O.V�
MAAINOLE.t CO.V6E 2 TO. ,�X T�E^YZ.) 7"O /��•='l2✓IOIJS Co✓E�
WI.7W/A/ /� OF` C- 1c�A Dom. T. .`�2G ✓�.VT
j.. I �� , -- � � `1�, , .of/Cr7-5 � -� I DIST.- �• •.. . - � `.\ `,—o�/�` �,/�h,;•�.vIUM
!ton/ - ' -- - 3"MiN / -• _ _ p17-
;' CJM D/A.
1�/TGf/ FLOW Lin✓E - M N D�q_— `. _, f •'C L�.> i h, }Y�^�- L CF
FQOT /41, �4�IF0oT Mini njrc�i �_ r q'j i 3 l,z,.DiA.
_r_ H�1/ �� . �4../FOOT ``� a00
/10� , i ��V.45HEt7
I /NVE.2T G L._L O ( /N✓E2T
rA.vim l / �tic�
L�-� �!�/A T E,� 7'/G i/�' //V t/E2T __% -
/V VE'2T NO 3A e6AC T
9.8
TF- PL A A../ ,,PI�OPO
IN_ P, A_N
�1C � aT/ TAN L7✓ ;�L /T,' 7N '
f.3'7 Y
f t
NE-Y � lSTFR� � r j
T�� r:y .
T' CER?1F`` . Thy- rf�NDA-rYON :)40niN ON TH/5
PLAN /S EXIST/&& �N i � 6.�,01V p -A-S . ������ Q.4f
5Nf�/✓ N AN ` /! GC.jCf, COMPLY &-I/Tr'/ TiV�
1GEORGE
' `j'E` C tv i fi �� tow, ' -.
RAy S r'.srs�'
STf. Q� D� 7 4L _ �r