HomeMy WebLinkAbout0052 CAPTAIN LUMBERT LANE - Health 52 Captain Lumbert Lane
Centerville
A= 147-011-010
I
i
1
EN smE:A10
No.2-1153LOR
UPC 12534
smead.c®m • Made in USA
�J�RECYC�
AMP
CFMUOsdno "UefUm
OFUSH r aUe vrs�.S;::YSFFS$Du'"ie+1%tOW
- r -
' COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
—rob
TITLE 5
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS _
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address• 11� Mr`''.
Owner's Name:
Owner's Address:
Date of Inspection:
Name of Inspector.(please print) uv) �`` '�
Company Name: William E. Robinson Septic Service
Mailing Address: P O Box 1 089
Centerville, MA
Telephone Number. (5081 775-877-6-
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 see 15.340 of Title 5(3I0 ChIR I5.000)_ The system:
Passes
Conditionally Passes \
'Needs Further.Evaluation by the Local Approving Authority
Faits
,C:�, u--
Inspectoes Signature: Date: i Ca A7 ,r
The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Heatth Dr
DEP)within 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
DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approying
authority.
Notes and Comments
****This report only describes conditions at the time of inspection and under the conditions of use at that
tithe.This inspection does not address how the system will perform in the future under the same or different
conditions of use.
Title 5 Inspection Form 6/15/2000 page I
I� I �
Pagc 2 of I I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address:�5aoap'rtA�i>
Owner. YX CO-
Date of Inspection:
I
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all ofSeetion D
A. System sses:
L' l 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: f
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`knot 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 exfrltration or tank failure is imminent Syste
existing tank is replaced with a complying septic tank as approved by th m will pass inspection if the
e Board of Health.
.
'A metal septic tank will pass inspection if it is structurally sound,not leaking and ifa 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 aue to-broken or
Obstructed pipe(s)or due to a brokers,settled or uneven distribution box.System will pass inspection if with
approval of Board of Health): (
broken pipe(s)are replaced
Obstruction is rea 9ved
distribution box is leveled or replaced
ND explain:
The system required pumping more than 4 dimes a year due to broken or obsatxted pipc(s) .The
pass inspection if(with approval of the Board of Health): system will
broken pipe(s)are replaced
obstruction is srtnoved
ND explain:
Page 3 of I I
OFFICIAL INSPECTION FORM=NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: L4_^ 'y
Owner: Ea �X T-Z AF1 ii�u'1/n-,
Date of Inspection:
C. Further Evaluation is Required by the Board of Health: f
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(l)(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 front 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:
3
Page 4 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address:
C,�E,f
Owner: 1�-47Dt}v1z vk_
Date of Inspection:
D. System Failure Criteria applicable to all systems:
You must indicate"Yes"or"ne'to each of the following for all inspections:
Yes No
_ ackup,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 due to an overloaded or
clogged SAS or cesspool
_✓Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or
/cesspool
/ Liquid depth in cesspool is less than 6"below invert or.available volume is less than%day flow
_
Required pumping more than 4 times in the last year NOT due to dogged or obstructed pipe(s).Number
of times pumped
_✓ Any portion of the SAS,cesspool or privy is below high ground water elevation.
_✓Any portion of cesspool or privy is within 100feet 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.
3ty
y portion of a cesspool or privy is within So feet of a private water supply well.
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 or 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 faits.I have determined that one or more o[the above failure criteria exist as
described in 310 CMR 15.303.therefore the system faits.The system owner should contact the Board of
Health to determine what will be necessary to correct the failure.
E. Large Systems: i
To be considered a large system .he system must serve a facility with a design now 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 au
the system is within 400 feet of a surface drinking water supply
_ the system is within 100 feet of a tributary to a smrface 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
1 f you have answered"yes"to any question in Settinn E the system is considered a significant threat,or answered
"yes"in Section D above the large system has famed.Tlx o%mcr 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 oix-ner should contact the appropriate regional office oftlie 13cparunent.
4
Page S 9f I I
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SENVAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
( CHECKLIST
Property Address:52L o Luor\bet#-
Date of Inspection: ____
Check if the following have been done.You must indicate`yes"or"no"as to each of the following:
Y No
= Pumping information was provided by the owner,occupant,or Board of Health
Were any of the system components pumped out in the previous two weeks?
/ Has the system received normal flows in"the previous two week period?
✓f 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?
1z, 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)13 10 CMR 15.302(3)(b)J
5
Page 6 of 11
OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address5c�92iA -Ln L UCV\ky:!,.4 � --
Ccy yi kl4'O
Owner:
Date or Inspection: to I,a c
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design):.3 Number of bedrooms(actual): S
DESIGN flow based on 310 CMR 15103(for example: 110 gpd x#1 of bedrooms): �v
Number of current residents. !
Does residence have a garbage grinder(yes or no):
Is laundry on a separate sewage system(yes or no): v:. (if yes separate inspection required)
Laundry system inspected(yes or no): P��
Seasonal use:(yes or no):N4
Water meter readings,if available(last 2 years usage(gpd)):
Sump pump(yes or no):H,, L. t>c)O
Last date of occupancy: orr
COMM ERCIAL/iMUSTRIAL
Type of establishment:
Design flow(based on 310 CMR 15.203): gpd
Basis of design flow(seats/persons/sgS,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 as part of the inspection(yes or no): .NJ
If yes,volume pumped:__�allons—How was quantity pumped determined?
Reason for pumping:
TOF SYSTEM
_
Tptic 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):
Approximate age of all components,date installed(if known)and source of information:
Were sewage odors detected when arriving at the site(yes or no):
6
VagcM17 of I I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFOR LATION(continued)
Property Address.!5�2 pwic-, it:t.ruble t ��
�TAt,,,`V, t(Q_
Date of Inspection:
BUILDING SEVER(locate on site plan)
r
DcpUt below grade: f
Materials of construction._cast iron 140 PVC_oUtcr(explain):
Distance from private water supply well or suction lure:
Comments(on condition of joints,venting,evidence of leakage,ctc.):
,.a �..,.Ts n K. ✓v t t a bt'o�
SEPTIC TANK:%catc on site plan)
Dcpth below grade: 3
Material of construction: vncrete_metal fiberglass_yol}'etlnylene
_odtcr(cxplain)
If rank is metal list age:_ Is age confrnned-by a Certificate of Compliance(yes or no):_(attach a copy of
certificate)
Dimensions:
Sludge depth:
Distance Gom top of sludge to bottom of outict ice or battle: 3 a�
Scum thickness: ^-
Distance from top of scum to top of outlet tee or baffle: --
Distance Gorn bottom of scum to bottom of outict tee or baffle:
I lo%v were dimensions dctcnnincd: a �_ar Pc i� , S .6es. rx,,,,rri 1s
Comments(on pumping reeouunendattons,inlet and outie(tee or baflle eonditicn,sttuctwal integrity, liquid levels
as related11to outict invent,evidence of-leakage.etc-):
7 .
61 '1az3]�. L L i J lT� �l+►2:r t 1 c is
ova h; T SFrcy�lcl �ri
Gvtl 7* � �rs'.� s:a era>•rq-lerrl v«.
GREASE TRAP: .(toe#ti;Vn site plan)
Depth below grade:
Material of construction:_concrete_natal fiberglass__—tolycdtylene_other
(explain):
Dimensions:
Scum thickness:
Distance Gom top of scull,to Iop of outlet tee or baffle:
Distance from bottom of scum to bottom of outict tee or baffle:
Datc of last pumping:
Conuncnts(on pumping rccontnlcndations,inlet and outlet tce or bathe couditiunn,structural integrity, liquid levels
as related to oullcl dive t,cridcl,cc of leakage,cIc):
7
8 01 11
r
OFFICIAL INSPECTION FORIVI—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORh1ATION(con(inued)
?crty Add ress•�}D,
t of laspectlon:
:IIT or IIOLDING TANK:i J [ k"rust be purnpcd at time of inspection)(locate on site plan)
A below grade:
erial of construction:`concrete_metal fiberglass_polyethylene otlict(explain):
rcnsions:
lacity: �a40ns
ign Flow: gallons/day
nu present(yes or no):
rm level: Alan"in%vorking order(yes or no):
c of last pumping:
runcnts(condition of alann and float switches,ctc.):
STIUBUTION BOX:Z(if present must be opencd)(locate on site plan)
pill of liquid level above outlet invert:
nunents(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of
kagc into or out or box,ctc.):
YEA. r V A A-./AC. �A A' l f'1. .! 9 A f •y!
All'CHAMBER: <^1(l ate`vn site plan)
imps in working order(yes or no):—
!arms in working order(yes or no):—
munerrls(note condition of pump chamber,condition of pumps and apputienances,etc.):
Page 9.of I 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFO�R,M_ATION(continued)
Property Address: ; a.tr}
Owner
Date of Inspection: c::/a.:
SOIL ABSORPTION SYSTEM(SAS): ;(locate on site plan,excavation not required)
If SAS not located explain why:
Tyw
leaching 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,
etc.): i p
CESSPOOLS: fcAvool 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: IV(�datle 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
Page 10 of 1 I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION-FORM
PART C
SYSTEM INFORMATION(continued)
Property Address:�5a l kt ig�,n
Owner: Lfib&,4r C— L gv\Crrs.
P
Date of Inspection: 2 3, C c•
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.
~ y
PIT
v
i
A- 14 s K l!�) �
ia' i - ,S'Z •
A,
_G, - _5'*
" 5'6'
10
h
Pagel 1 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address:��`�-" ' ►(�LuA�er�Line
C'LAA.P �i 11
Owner. -Zcu(-b�,gr-a_
Date of Inspection: 21
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells
Estimated depth to ground water lo'l 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 propertylobservation 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: I
7/13
l ��p3:bw G� l3�GE. �e$ �1� 6,�9.1i� ,� '-'h::la:_�s �. Ac�•
i
i
�l
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
Ll
TITLE 5
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address: 52 Captain Lumbert .Lane
Centerville
Owner's Name: Barbara Gannon
Owner's Address:_S7 Captain T.nmbart T ane
Cent Date of Inspection �� .7 J -'-�?
Name of Inspector:(please print) Sean Jones
Company Name: William E. Robinson Septic Service
Mailing Address: P O Box 1 089
Centerville MA
Telephone Number, (5081 775-8 76
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,;ad maintenance of on site sewage disposal systems_1201 a DEP
approved system inspector pursuant to S lion 15340 of Title 5(3I0 CMR 15.000). The system:
Passes
Conditional
Needs F er Evalu ion by the Local Approving Authority
Fails
Inspector's Signature: /
Dsate:
The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Heatth•or
DEP)within 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 o frice of titp
DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and tfie appro "'
authority.
i c
Notes and Comments
This report only describes conditions at the time of inspection and tinder the conditions of use t that
c3
time_This inspection does not address how the system will perform in the future under the same or differenz rn
conditions of use
Title 5 inspection Form 6/15/2000 page 1
Page 2ofII
f
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued).
Property Address: 52 Captain Lumbert Lane
Centerville
Owner: Gannon
Date or inspection:
�7 -
Inspection Summary; Check A,B,C,D or E t ALyyAYS complete all of Section D
A. sy�stjpasses-
J[L ave not found any information which indicates that any of the failure criteria described in 3
15.303 or in 310 CMR 15.304 exist_Any failure criteria not evaluated are indicated below. I0 CMR
Comments:
B. System Conditionally Passes: l !�
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,Np) the explain. for the following statements. If`not determined"please
.__.._The septic tank is metal and over 20 e «existing
"sound,exhibits substantial infiltration or exfiltration or tank failure is imminent System will ass u
Years old*or the septic tank(whether metal or not)is structurally
existing tank is replaced with a complying'A metal septic tank wilt pass inspectionp�g septrc tank as approved by the Board of Health. P inspection if the
indicating that the if it is structurally sound,not leaking and if a Certificate of Compliance
Link is less than 20 years old is available.
ND explain:
______ Observation of sewage backup or break out or hi
obstructed pipe(s)or due to a broken,settled or uneven dsusbut torn box.ter will
box aue -
approval of Board of Health); broken or
Pass inspection if(with
broken PiPe(s)are replaced
obstruction is removed
distribution box is leveled or replaced
ND explain;
The system required pumping mores 4
ith approval of th
Pass inspection if(w e Board of H )e year duetoben or o
brntacted prpe(s).The system will
broken pipc(s)are replaced
obstrtiction its ismovod
ND explain:
Page 3 of l I
�T
OFFICIAL INSPECTION FORM=NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 52 Captain Lumbert Lane
Centerville
Owner.• Barbara Gannon
Date of Inspection: S / �
C. Further Evaluation is Required by the Board of Health: IV IA
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 front 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:
3
I'age 4 of I I
OFFICL4,]L,INSPECTION FORM—NOT }
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTIONYASSESSMENTS
FORM
PART A
CERTIFICATION(continued)
Property Address: 52 Captain Lumbert Lane
Centerville
Owner: Barbara
Ganno—n,�'
Date of faspection:
D• System Failure Criteria appiicoble to all systeini:
You must indicate'Yes"or"no"to each of the following for ail.inspections:
Yes No/
/Backup of sewage into facility or system cotriponent due t
✓/ Discharge or ponding of emuent to the surface of the
0 overloaded or clogged SAS or cesspool
dogged SAS or cesspool ground or surface waters due to an overloaded or
Static Liquid ievel in the distribution box above an
invert clue to an overloaded or
. `cesspool
___1/ Liquid depth in cesspool is less than 6*' clogged SAS or
Required below invert or.available volume is less than%,da
�afq Pumping more than 4 times in the fast year NOT due to clogged or obstructed i e s ,
times pumped y flow
�Y portion ofthe SAS,cesspool or privy
P P ( ) Nunibcr
MY portion of cesspool orprivy, P v}'is below high ground water elevation.
water supply. s within 100,feet of a surface water su
PP1Y or tributary--- Y Portion ofa cesspool or privy [o a surface
p �'y is within a Zone I ofa public well.
A. portion of a cesspool or privy is within 50 feet ofa private water supply well.
��// �Y Portion of a cesspool or privy is Bess than 100 feet but
supply well with no acceptable water quality analysis. greater than 5Q f th et from a Performed at a DEI certified laboratory, This sYstem passes if the welwate�r•analysis,
indicates that the well is free.from for coliform bacteria and volatile organic compounds
pollution from that
nitrogen and nitrate nitrogen is equal facility and the presence of ammonia
to or from
than 5
are triggered.A copy of the analysis must be attached of his for ;d that no other failure criteria
ram_(Yes/No)The system fa__iis.I have determined
described in 3 t0 fr t that one or more o[the above failure criteria exist as
CM! 15.3Q3,therefore the system faits.The s stem
Health to determine what will be necessaryY owner should contact the Board of
n ! to correct the failure.
E. Large Systems: v
To be considered a large sysi m the system must serve a facility with a deli ii B .
gpd• ors of 10,000 gpd to I5,000
You must indicate either')Ies"or"no"to each of the followi g:n
(Thc following criteria apply to large systems in addition to the criteria above)
Yes no
ate system is within 400 feet ofa surface drinking water supply
_ the System is within 200 feet ofa tributary to a sttrfacc drinking water supply
— _ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—i WPA)or a mapped
Zone It of a public water supply well
If you have answered"yes"to any question in
"yes"in Section D above the large system has fat ' ovt yst is c0midcred a sigrtifrcant threat,or answered
significant threat under Section E or failed under Section D shall upgrade the system in accordance with ed CMR
15.304,The System o«•ner should contact the appropriate re Iona!office of the system
system considered a
g
4
Page 5 of 1 I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 52 Captain Lumbert Lane
Centerville
Owner: -Centerville
rha T-a Gannon
Date of Inspection:— 77/ =7
Check if the followin have been done.You must indicate` s"or"na"as to each of the following
1 y No
_�P mping information was provided by the owner,occupant,or Board of Health
Were any of the system ys components pumped out in the previous two weeks?
Has the system received normal flows in-the previous two we
ek 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 'P signs of sewage back up?
Was the site inspected for signs of break out?
Were all system components,excluding the SAS,located on site 7
✓ `
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:
�'cs no
/ Existing information.For example,a plan at the Board of Health.
_ Determined in the field(if any of the failure criteria related to
is unacceptable)[310 CMR 15.302(3)(b)j Part C is at issue approximation of distance
5
Page 6 of I I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 52 Captain Lumbert Lane
Centerville
Owner: Barbara Gannon
Date of Inspection: 7
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design):. Number of bedrooms(actual): .
DESIGN flow based on 310 CNN 15.203(for example: 110 gpd x#of bedrooms): 33� ll
Number of current residents:I
Does residence have a garbage grinder(yes or no): mo
Is laundry on a separate sewage system(yes or no): u tj [if yes separate inspection required]
Laundry system inspected(yes or no):,&
Seasonal use:(yes or no): vb
Water meter readings,if available(last 2 years usage(gpd)): 2 0 0 6 - 3 5,0 0 0
Sump pump(yes or no): Nth _ 0
Last date of occupancy: Cvj%t� 'i '
COMMERCIAL/INDUSTRIAL /
Type of establishment:
Dcsign 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):
Pumping Records GENERAL INFORMATION
Source of information:
Was system pumped as part of the inspection(yes or no). ry)
If yes,volume pumped: `-"gallons-How was quantity pumped determined?
Reason for pumping:
TYA OF SYSTEM
✓/Septic tank,distribution box,soil absorption system
_Single cesspool
Overflow cesspool
Privy
Shared system(yes or no)(if yes,attach previous inspection records,if any)
Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be
obtained from system owner)
_Tigbt tank '—Attach a copy of the DEP approval
Other(describe):
Approximate age of all components,date installed(if known)and source of information:
19 � - Tc�-ems �t ��c3 i3ctl
Were sewage odors detected when arriving at the site(yes or no):
6
I
!'age 7 of I I
OFFICIAL INSPECTION I±ORAI—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SENVAGE DISPOSAL SYSTEM INSPECTION FORA-1
PART C
SYSTEM INFORMATION(continued)
Property Address: 52 Captain Lumbert Lane
en ervi e
Owner: Barbara Gannon
Dote of Inspection: 71,—�-oc,
BUILDING SEWER(locate on site plan)
Depth below grade: ��—
Materials of construction:_cast iron -- /40 PVC_outer(explain):
Distance from private water supply well or suction laic:
Commentsi(on condition of juints,venting,evidence of leakage,etc.)_
J "—'I. f3 C G-C — iv- dCa r t.
SEPTIC TANK: (locate on site plan)
Depth below grade:
Material of construction: ✓eveycrete meta{ fiberglass_j,o3}etlyylene
_otlycr(expiain} — —'
If tank is metal list age:____ Is age confiniied•bp a Certificate of Compliance oyes or nu):—(attach a copy of
certificate)
Dimensions: lcoo 6-kt(wts
Sludge depth: l.
Distance from top or sludge to buttoyn of outlet Ice of bank: Id
Sctun thickness: % >.
Distance from top of scum to top of oudct(cc or baffle: �0 t
Distance rrorn bottom of scull,to bottom of outlet ice or baffle: /a
Ilow were dimensions determined: oaAnlc� Ccavtrs
Comments(on pumping recommendations,inlet and outlet tee or bante conduit n,structural integrity, liquid levels
as relatte.1d-tol outlet invert,evidencce of leakage etc.): 1 )
�::..'J w7 �:%�T'/'�(.�. 7 st!ze a� C�•'e�'� c�. �iJJc/ �CY1 Gr G' _ J /�
z ,t
e e •ey
GREASE TRAP:/'(locate on site plan)
Dcpth below grade:_
Material of construction:_concrete_tnetal fiberglass�nolyetl,}Iene other
(explain): — --
Dimcnsions:
Scum thickness:
Distance Gom top of stun,to toln of outlet(cc or baffle:
Distance fro"'bottom of scum to bottom of outlet ice or ba c:
Date of last pumping:
Conulienis(on pumping recomruendalions, Wet and outlet ice or banle coitditiu:t,structural integrity, liquid levels
as related to outlet invul, evidence of leakage,etc.)-
7
'age 8 oC 11 F
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSUIU-ACC SEWAGE DISPOSAL SYSTL•'h1 INSPECTION FORA)
PART C
SYSTEM INFORMATION(contiaucd)
Property Address: 52 Captain Lumbert Lane
C erviTre
Owner, arbara Gannon
Duc of tospeclfoa: j 7 '7
TIGHT or HOLDING TANK;A/
(tank must be pumped at time of inspection)(locate on site plan)
Depth below grade;
Material of construction:`concretc_metal_fiberglass_____polyethylene 0111er(expla41).
Uinlcnsians:
Capacity: allons
Design Flow. gallons/day
/harm present(yes or no):
Alarm level: Alartn in%vorkirl order
Date of Iasi pumping: g {yes ur no):
Comments(condition oralanu and float Stivitchcs,etc.):
DISTiUUUTION BOX: (if present must be opcncd)(locate on site plan)
Dcpth of liquid level above outlet invert: 0
Conuncnts(note if box is level and disbribu6o11 to outicts equal,an •evidence of solids carryover,any cvidcrtcc of
Icakage into or out of box, ctc•); >
t`3n p `
,4
I�vr*�P cunntl3ie>E;:�'''
(locate on site plan)
Pumps in working order(yes or no);
Alarms if'working order(yes or no): _
Coruments(note condition of purn chamber,amber,cufidition of pui11pS and ahpurlcnanccs,etc,);
Page 9 of I I
OFFICIAL INSPECTION.FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 52 Captain Lumbert Lane
Centervi e
Owner Barbara Gannon
Date of Inspection:
SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation'not required)
If SAS not located explain why:
Type
1 leaching pits,numbe, it-if
leaching chambers,number:
leaching galleries,number:
leaching trenches,number,length:
leaching fields,number,dimensions:
overflow cesspool,number:
inn ovativeJalternative system Type/name of technology:
Comments(note condition of soil,signs of hydraulic failure,
etc.)* level of pondin„damp soil,condition of vegetation,
CLZ
c'i. ' .,j•/�tc�}t,s�.
�t'4Chr1, i,.�-tf� J t/a3
1 L,,e:r
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 pond ing,condition of vegetation,etc.):
PRIVY:,V � ...
• (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
Page 10 of 1 I
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 52 Captain Lumbert Lane
en ervi e
Owner: Barbara Gannon
Date of Inspection: �7
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 IOU feet.Locate where public water supply enters the building.
(9
7c�
i ANC
3u'd
i3-a W S�
pi h
3
10
---• "Y"viJ11G1Y111'1arkuII0lV FORM
PART C
SYSTEM INFORMATION(continued)
PriipertyAddress• 52 Captain Lumbert Lane
• Centervi e
Owner. Barbara Gannon
Date of Inspection: -713 7
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells
Estimated depth to ground water 5 feet
Please indicate(check)all methods used to determine the high ground water elevation:
Obtained from s ste y m design plans on record-If che
cked,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:
/1vz�
it
FRs......... .......THE COMMONWEA-LTH�OF MASSACHt9SET,T5 TO APP C1'11_
BOAR F H E � ,1 KJ JAB E CONSERVA T.!`�3
" C �d��v33Ssa��1
®d +v.........:.......OF... �/ ...........
, Itrat�arc fnxia1 ��k �n'g�r1�stltlt rruti
Application is hereby made for a Permit to Construct ) or Repa'r ( ) an Individual Sewage Disposal
S stem at• ,,d
Lae � � °'
.... ................. ..... .. .......... ........U......
................
� Installer Address G%/��
Type of Building Size Lot .......a_ __Sq. feet
Dwelling—No. of Bedrooms_________________________ ______._._Expansio Attic �K/p Garbage Grinder (yVf
Other—Type of Building ____________________________ No. of persons..... -.................. Showers (7_.� — Cafeteria ( )
0.' Other fixtures
W Design Flow................ ..._._._._._gallons per person per day. Total daily flow_________,j:47______________.____.gallons.
W Septic Tank—Liquid capacity� � gallons Length................ Width................ Diameter................ De nth ..............
n]E
x
Disposal Trench—No_____________________ Width.................... Total Length.................... Total leaching area. ..._eqvf. ' �'�/
Seepage Pit No--------------------- Diameter.........:.......... Depth below inlet.................... Total leaching area___ -------------
sq. ft.
Z Other Distribution box { ) Dosm ta� ( •
Percolation Test Results Performed by.... ___ _._....__ �'' !r_______ ............ Date___ .......
aTest Pit No. 1_' _ _.minutes per inch Depth of Test Pit___________________ Depth to ground water...........:___________.
Gz, Test Pit No. 2----------------minutes per inch Depth of Test Pit.................... Depth to ground water.......................
-
�.. .......
_ ...
_•---•-•••-......-----••---- ........
----------
O Description of Soil.___. ._, .._ '___... . . ?/P!�.. e '
_ ,
�d ✓ :. ------------------------------
x -------------------------------- 1,�• ----- =•••� 4 .VXV -----------� J. ---------------------------------
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 TITLZ 5 of the State Sanitary Code—The under ' ned further agrees not to place the system in
operation until a Certificate of Compliance has beF, d by the b of health.
Signed_._.. ---------------- -------•----_--------_--- �� -
Dat
Application Approved BY f�Z�p .....
Date
Application Disapproved for the following reasons----------------•------------•--•------------------------------•----------------------------•------._.......----
.................•--••----•--------•----.....------•-•-•-•--•-----•---•-------------.........---------------•-•--•--•--•---------------•-•---_..------•-------------•---••---------- -•------------
Date
PermitNo......................................................... Issued.......................................................
Date
•
No..... .3 J'
Fmc..............................
THE COMMONWEALTH OF MASSACqUSETT8
yABOAR H F E L /H.4.1i.................OF....... .. ............... .......... ........................................
Appliration -for Uhilimal Work onstrurtion thrutit
Application is hereby made for a Permit to Construct or Repa*r an Individual Sewage Disposal
System at:
X,E
....... ..... ...
Loca AZe
.... .... . ..
..........
.... ....... .. ................ ..............
.......... .........
I e r
es
..........-Y
................... .............. ... .......................... .......... ............................/2_1...............................
Installer Address ; "_
Type of Building Size Lot.A� ...Sq. feet
U
Dwelling—No..,of Bedrooms_________________________ Garbage Grinder...............................Expansiotj Attic V/):>
a
Other—Type of Building ............................ No. of persons____._&................. Showers Cafeteria
Otherfixtures ......................................................................................................................................................
Design Flow________________ ..gallons per person per day. Total daily flow...........33�...................gallons.
1:4 Septic Tank—Liquid capacity gallons Length________________ Width_..___.._._._... Diameter--..---_______:_ Dep 1. .......
otalleaching area. ----Sq.
Disposal Trench—No..................... Width.................... Total Length.................... T
Seepage Pit No_____________________ Diameter..______._....._____ Depth below inlet.................... Total leaching area_.__.............sq. ft.
Z 'Other Distribution box Dosing tank
0-4 �;,
Percolation Test Results Performed by.._...... ........... Date....
�--4 ..................... ------
'test Pit No. 1._!�2,_..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...____.._..__..__.__._.
9 ........... ----------------------
...........................................
.0 Description of Soil ........ -Z.......
.... ................
U. .......................................... . ........
.................................................... . ... ..�E/4 .......................e........
W --- ! /t .............. - ---------------------
54� ...... 7,,
U Nature of Repairs or Alterations—Answer wh'en applicable...............................................................................................
........................................................................................................................................................................................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
'5 of the State Sanitary Code— The ders* ned further agrees not to place the system in
the provisions of T1TIZ un
operation until a Certificate of Compliance has bee d by the b of health.
....... ..... Z,
Signed....... ..... ---_-------_-- ........................ .............
Date,-
Application Approved By........... . .. .. ...... - - -- ----------- ---*----------- ...... ...........
Date
Application Disapproved for the following reasons:...............................................................................................................
-------------------------------------7...................................................................................................................................................................
Date
PermitNo..................................... ............... Issued_.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD HEALTH
OF.... .... ......... 6--Za.............................
Trrfifirate of Tautpliattrr
THIS LCERTIFYI hat
.. ...
............. th /---n-d--ii�.idu...a.l...S.. e Disposal System constructed ...L./.....o..r....R...e.pair..e.d
by................... ...... . .............* .........
Installer
at- ................. .............
...................
has .been installed in accordance with the provisions of TIT 1j3 Z�_9f The State Sanitary Code as described in the
application for Disposal Works Construction Permit No........................f................. dated--_...._.....__
THE ISSU NCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE AS A GUARANTEE THAT THE
SYSTEM WILY/FUNCTION SATISFACTORY.
DATE.....Z, I.................................................. Inspector............ • ............................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOAR HEALTH
. .........OF..--- ................. .
......
No......................... FEE..2�.J.................
Permissionis h b_ y granted..............................................................................................................................................
to Construct or Repair n i vii u Isp sal System— f ys
t) anJ d'J ISewage D*Jr. ........................................
at No.......Z.- . .......................�d...
4�.........
Street
as shown on the application for Disposal Works Construction P_JAF"�t
7� .... N..o...........-.-.--.-.-.. ........... ..t.e..d.............................................
. ......
V ........................................
oadof Health
DATE---------- -----=---------------4................................................
FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS
LO CAT 10 SEWAGE PERMIT NO•�
-Lod -,r? (11 . k� -42-
VILLAGE
IN T LER'S NA Asir i ADDRESS
BUILDER OR OWNER
DATE PERMIT ISSUED
� f-
DATE COMPLIANCE -77
S 4
,
h. ' ^ -
.,.
i.
I.
,
_-- , ,._-. _...... .... --'lc-,
- ,- ,._._. --..-...,_._,...-_,....._-w�_.-.-.- ,.-. .,,. _. --, -.. -_ ._- „ _.._,_-,...._..,,....,.,,,....,^«.....-. „-�_,_�,____"� - __.,�.._,..,..,_,. _.,...,.. - - ,,.,.... r.._...,.--,.r.. .. ....-- ..- -- -- ._ .._., _ - --
_... .-....w..:_....--...- -.._..-. ...___,..__......--._.__...__.`. _., _,. .__ ,. a ..rn .,.«• - -•,.. :.,...-.,,.......__. ....«- ..._ ,...-_ ..,.�..- - �.. �_,�_..._.-�.,.._..,-..,.....- -....- w,,..,-- -.+.� _- . - ._.. ..
,��-..-"-,"4�IiII 1.--.�xr.-I..--�l-lI l,-.-lI�t";II�ii.�;1ii.t�9:i I.-O.,1..*",�.-I.�,'Il-�t,;I.-j-j.---.,.-I II--1,��
��I/,/.:%I.�.1�,,,\1
�'-/\\�--�"A1,.-1l\�'1,5\./II,I\.'—'-\\I��"-/.FeI�\I
�<y,;-1C'-/\-.�-�
1�'._�/,-\-!/1'"'\k e�,,7�-i--I,k"a."N/-I1,I'�,�I
r,��,---,-
,/
4'\—,.,,?A�1,'3
ol'��I3,"-�)
27
1,���I/'-r\--8�.%��I.-
-,C.%,'1,I\��
Ii�!11�I;..I*\t-."
t T `o``
tILI
-,/.—7'II�1�L I�.�:-:-.I��--I�:.
M
t
I.
-I I,,1-�-v.o,I,.6a-".,—.1
-_ a�J
f -
xc -
x + �,`
4 , /
- > t fi - t1 t -
/ * . !__
, Z$ /' F z
I 7,I I
�;/ 5,
. iI
I A�
IIIIi
t
O ' `}
f ( {� ;
\ t
�' `\
. I, ` A ? ;�
I _ \ _
C j/j )
1 _ . f y)t
,�; f Z j 1 p
_ - -r / - ! \ i c. j
,.•. ..__ ,
4r a
' .
i y `„
____....� it- V {
( -
J I_ 1•.' .. t,-. -`---..i. E-z:-�l ',-. iC,.J s G-�" f- \ / I ,. "; .� � I •� a, l \"
tl, ' I(%y�%e7j--.+ 31., LE--.1`:iG..-t 1_,i,_:-, h f -'--,i-i T-T' ) A ,f Y) ,I �", �'!� tl- i,:14 t\~- \ � Y � I
,) if \, k r; i f \ .�
:Iy /� r`• , i , I-! r { C_ - r--,, --- -_'--t-,t { i 1 \ / x Y, .r• L / `"` \ _-., ',.)l � \
_ \
/� r
,.
.
J / ,j �`' 27 1, �
l' a
'
-
Y
i a
j v� (
.> 1
�I,:��,,����,�.,,�..,I I—�,I�I-I,��`.I I.-�I..,4III
�,,:,.�1I-,�-,-,V--':7,,�'z,"�-:�,,,,��-P,.,,�,-;--,�-1 1""��.-.-.,�',,t5f�l�6�-%-�',t,�-�fIi,,-.,-�-",;,-_�w-,-,*-�,*,�,,1",--4.,�'�-:�.--.1'Il,,'.�--1.�-"'�1-..',-�l1.-.,,'---,,,�,.�-`,�--�,-�1"��,�:,,�i�,�-I,..F-';,"�'-1,n'l.I�-�,.-,
",, , _ ..
,. n w NA...
n W x �( j \�� r
j 1
.�,, - -\
t� `at
r' FF' `' �,� d- -- , ,
,
/' I ,\ . x
y
/ `1 �y%, 4 a-`^ \� �'' J �`` }yam l
_ - I is (`_< z,- \ "/✓ " 1
,c \ �� �t.)12 t- \ C > f t b�
)1-�6k l 11,3��,"\-,r'1-\-11.\.,,,�,-.(.1.,\—z:--\I:I��-�)�I—-�I.�7%,lI-.-I-I,�I1l//.�1\\1
�*I\�
-''
. , 1
1 }
__-
c - p ,. - '
"
' ; f J' 1
, !r
1
e /
. p
..
;,
_
n k Ywi Y+ .: , - 4 7 x / r /1 I /f/ •yam'(, ." -�«_,._- i4 -
r / (r/ !•
�i:
f ,
r
, .. r
a> - .
/ ,�
,1,.,-
- _.,
x _r„ ,
w ,, - _
. ` )j+
1. r- _...--.�..5+..,, ,.. 1 4 f } p I 3 j / I / •l.
r..,,
--
d" ' -" � ,
w + , '\' x
- Jc
y
R
x
, 8 y{1
n., \:.� I
! ^
'l )
- (
33( � e " '
I .. - f v ( /" ,
e ,' ,' -
I
~
i
,
r `
Y t V! { w
' t
i ,�
/3�• 7 M rP�. . ,N/O;`e : I F 7 N e -'.i,:r'f'7; " T4l, ; %f� U R
i _ -. !I
{ -__.. . . -{ ','�-) A' /l• /,^1%t-/c"_Z ,6r"7i.L-,:Al' 61F.'l,:?F',�aEl 4`-0 I
r 7 4/.,/ i %N'_ /,r -r zit E-li: /' {
I,, -wl ,f r,,,t ` , ``. 'O c. 7 h 70 f_J r'r C ,/•' . \4 n. Y^ y 7-t-- -'$ ,l e-A i
ti
1 ! f!:S/'�,1 'j E t= .' ^ ✓ . ;" s / R' t,�I`! �C)V ti','7' ��,"'f'/l'�L 1_ C•�' -.'.,"m" ? 1 P"-"' f•`1E'
j p . ly, !. 1) I
„�
t ».,
c . _r
„ u �. / -_ --- fV'X).lJ r
` .. _ _ J r.
' __
r
;rr 0 I... , , 3� Y- ~�✓..,4 �{ ,\� J Y ,4y.I,�.r ��� .,f_..1 1^'f�w�J, _ I.
z C _.�__."-� i
i
# r�
j . " �
+ ,{ r /I 1i /Ut>G- t�A � r 'a} r`- vr 31u ,« i
1 fl-I;ty PC r'r i i _._..,...._.- -. � i r y V' + ! 1, 4, " S:I jq/..1 -//'C ,sT&-11,F I
-N}
17
rl ,.�, i p• 1 ..5�f-' •i j C�.. 'a-.E .+.Mr rJ a ^ti,� { A w;: e
k
,(,4. T/•� f u4 r. A 4 ! 3 l .. T " ,
. ' r r :.: .'
r + ..____ -- _._. ...
_ ..Yt . - i i3 i ) r
1 G' 'ti
t7T` �;': (�C/� fY . ! 1/✓.vim+ C s1:3N �7/^�ll�
,
r, „4
M
.
, t3 �'••� _
t., .--..2"1 [
I 1�1 4. i x.
T� .
c ? t _. .t..a :;< P_, { 3 _.l>'`� ,.�.._i_'� i y.•«.. ! 1 "`.C-. . c_.y K._. f'ti:s.«4,.� {`+.i '-,�-... .�'w,+ i '` / !'�� 1
y . j ,. . �: -,_ ,. _ /G I •J f rG t: UE..._Ll-.. �r S l� Jt..+ cJ _
,
�fr��K i ��. { i . U; i I >. ` . 2- C i"/ lls4�, ? Q e'QLJ fV/U7 r' r _-" `` 'f .
-.._ .._.
_.
., f
II�I—I-�,.,1I.-I.I,�..I.--�I 3I 3;1'.-,'lT...,J�
,,
/... ,;: c%;x-'r .11.'i s-r -, t" 7 .'�9, Cam€ = J _ . 7:._. k._
{ 7 h �' PT �A�i`1G `i'� L' + K. " 7. /^ rs / /+-7% / (� �> t/U ' t,"?r i 7" `� .
/!/ y1" , r' 1 fK ..!y ! t/,* * G , /�i A/,. C°` - �io! L. V/r / ` ✓�S"y �AC Ae
e v i..
...,_-
/.of
1
I /,&1.4.<. , ,..J,S . 4 , ,' ni xm ,,,e, J �Ci,'r . .'�.; .. F4 ."': k"? ?"�'I � £ hF < ,._.-i, ,.`_x-, ,_:, __�..
1 x, , y c; 'v' ",*, r
i _ . ''
G1 C/ / Y i/ y n. y' ! t"y
__ _ y C yI
i /i'\ ., i s 'r ;. ' ti" ,.., - .--T j-/L .'•. -wr..-.a.".- /_; / 1z",e "C,! - , ,_ --'� ,J y 4-A-i'
F Y-
_. _ ,
j'+w . (le' •/G1/i/ E L v s j(-;,,,,,r /3 A)•_s !;�'f) t,j , 5 � _ i
L�,�? C/-�/.i'u(':- /-/ /
f
J ,, J�/.+fEnr,- a' 'l 'mil -T d A E l d
`t 11I o/4 -
- .`lCr>+a t /r x ICa �.�0 F-7-- �tiel -- �7!i?5r Y1T1 /�f N !a-. f d / t, r
, ,
r.�!/'ldJ :1/1- /r
. '••-'1 r'► -1,,<.r l ,,. t,:t!.:* , J'_ - F Q / .- a` a ? - - t
_ G' S - t — ---_-
1( J4 G � '✓%,:.> ',' 'I-, r-(.,,k'>,, ,)..3 S--, ;-'.." " " �r ,s J G. ,�'._ 'r•" ".. N''r `..? C' ,��:.
// I --,-
,"'` �;.. 4 YO ..• y ^`/ r ,7 R / �l,r" {� _. r�2 -.�F t/ I_✓.,�! T : '..i z' -r�' ,. ? 7 !%.� -,'. . � ! /."'"Gti /-1 / �.
--' --
.
i ,5 /.L, c.c.`:'/1 C'1'•J f's ,. .;./_ a.. 'i- /2- T 1-'-B"u x v t
z w /ZL-5''/a 17 A,,f J f— •', !V L� /�� / ' e�7f Q C If & I �r-�
i . •• r '
( ~
- i 2 y r `w.-/;�t., c.�s t y i,-', 7,;, k-kl t T r-1 FL� `� �l E L T .Gt . a
4 /\J •A a.q� '1: /' h .,.{T•]. , 4 '1 .J r/.�..O A�. )JV ,-_. ... " !!•..J , /, , ( /L7 /- 4I �' _ .. �/ �.Y L.. �`r� / i t.. / 1 . i .
�rJ,+.'SiC._'4"-"t'_ r''�.'/i '� »I'. f.,,� �Y::J !� ,,.^.'l C" -, ,y ` .: [�,'�jf/
II
itIII
:': � f r' C 1 Y n I,
W. 7 -,.. 1A;' r t .- f _d 9� RCvs ; C� . car . I c,. ,c,h 4* IiI
r
., r
»
Y'�? � c Af 1 JT s r'
.
r�/v
f t A 5 ` >V
• ,Yd't G✓"fa
�a' .� � r✓ ' y A
-' ,_J �.,LJ/``�I�-- I'� �• C.T L+'T.•�,.�i. f `, - ---- -. ._,..«. _ ,--..'. _,,._.._ ".. ..-.-.,. ,...._--.",... .,_,_......,,..-.—. ' ,.; ,.,.
'-' [y �y �r }
,x. t .,w �' , r 6 = 3
. / _ __._ _ .__.,.
-, : "- , - c - •• t 1.-�.r/`�,--.-, 'C,4'; G/V 67i klll�...1-; /t'.1c; C �/" e. �F'4"`^ '' `:,tit' I.
. y 3d� t �`ti
y t /1 / S L '
r,
�/ \
/ { s
8—
- -. ,. ,_> ,,..,--- _-.-,...._---•---4j----.-.,,.,,. -...,,...,_ ».__,_,_.,_ _"....-._ - ,,,•___....___,.._. .__ --'--'----- 2