The URL can be used to link to this page

Home My WebLink About1060 CRAIGVILLE BEACH ROAD - Health 1060 Craigv lle Beadvi Road (Studio #4) j C"enterville A= 206 1 034 s 1� e i I o o fi 5 UPC 12534 iVo.2�3LOR ems '` HASTINGS,MN N: I —_ f i a ;j O 1 � � � �. � 1 to �- , � � � �� I P I� I!I i a 9 I ,;I i I �� a� `' Y i �' � 41 Yf 31 _ y a r p � 4 _ u Mtn• .._ r e_�,� � !� � Y � } � s , _ + , r e Commonwealth of Massachusetts (� =� Title 5 Official Inspection Form Ins 1 _- p Subsurface Sewage Disposal System Form - Not for Voluntary Assessments - . 1060 Craigville Beach rd Property Address ^ t� Juan Marichal Owner Owner's Name r information is ✓ require Centerville Ma 02632 6/5/2017 Revised 10/19/17 page. City/Town State Zip Code Date of Inspection' emu, Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information 5141 / S on the computer, use only the tab 1. Inspector: key to move your cursor-do not Michael DiBuono use the return Name of Inspector key. DiBuono Sewer and Drain C Company Name 8 Johns path Company Address _S Yarmouth MA 02664 Cityfrown State Zip Code 508-364-9587 SI 13522 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority Revised 10/19/17 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared system 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. ""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. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 17 g Commonwealth of Massachusetts ' W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments °M 1060 Craigville Beach rd Property Address Juan Marichal _ Owner Owner's Name information is required for every Centerville Ma 02632 6/5/2017 Revised 10/19/17 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 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: Inspection has been revised after Engineer Pete McEntee of engineering works an Donald Desmareis of the board of health have allowed the ground water seperation elevation to remain the same. The system contains a 1,500 gallon septic tank as well as a distribution box and 6 Flow diffusers with a calculated design flow of 770 Gpd B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1060 Craigville Beach rd Property Address Juan Marichal Owner Owner's Name information is required for every Centerville Ma 02632 6/5/2017 Revised 10/19/17 page. City(Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ 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 ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 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 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 4 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1060 Craigville Beach rd Property Address Juan Marichal Owner Owner's Name information is required for every Centerville Ma 02632 6/5/2017 Revised 10/19/17 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, perforrr�ed.at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of arnmonia 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: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool 0 ® 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 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ° 1060 Craigville Beach rd Property Address Juan Marichal Owner Owner's Name information is required for every Centerville Ma 02632 6/5/2017 Revised 10/19/17 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This sys.tem passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form F � { Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1060 Craigville Beach rd Property Address Juan Marichal Owner Owner's Name information is required for every Centerville Ma 02632 6/5/2017 Revised 10/19/17 page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: Existing information. For example, Ian at the Board of Health. ® ❑ 9 P � p ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 7 Number of bedrooms (actual): 7 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 770 t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1060 Craigville Beach rd Property Address Juan Marichal Owner Owner's Name information is Centerville Ma 02632 6/5/2017 Revised 10/19/17 required for every page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ® Yes ❑ No Seasonal use? ® Yes ❑ No Water meter readings, if available last 2 ears usage d 289 Gpd 9 ( Y 9 (gp ))� Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M ,• 1060 Craigville Beach rd Property Address Juan Marichal Owner Owner's Name information is required for every Centerville Ma 02632 6/5/2017 Revised 10/19/17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Not provided Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for um in : p P 9 Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1060 Craigville Beach rd Property Address Juan Marichal Owner Owner's Name information is required for every Centerville Ma 02632 6/5/2017 Revised 10/19/17 page. City[rown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 1990 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 1 feet Material of construction: ® cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): System is vented at the roof line Septic Tank(locate on site plan): 6" Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) 1500 If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: Sludge depth: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts ' Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1060 Craigville Beach rd Property Address Juan Marichal Owner Owner's Name information is required for every Centerville Ma 02632 6/5/2017 Revised 10/19/17 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 24" Scum thickness 3" Distance from top of scum to top of outlet tee or baffle 42" Distance from bottom of scum to bottom of outlet tee or baffle " Sludge stick How were dimensions determined? Tape Measure Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 � Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 1060 Craigville Beach rd Property Address Juan Marichal Owner Owner's Name information is required for every Centerville Ma 02632 6/5/2017 Revised 10/19/17 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1060 Craigville Beach rd Property Address Juan Marichal Owner Owner's Name information is required for every Centerville Ma 02632 6/5/2017 Revised 10/19/17 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Level and at normal level 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.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1060 Craigville Beach rd Property Address Juan Marichal Owner Owner's Name information is required for every Centerville Ma 02632 6/5/2017 Revised 10/19/17 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: — ❑ leaching chambers number: ® leaching galleries number: 6 ❑ 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.): Dug at both ends of the field and found clean dry native stone Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form r Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1060 Craigville Beach rd Property Address Juan Marichal Owner Owner's Name information is required for every Centerville Ma 02632 6/5/2017 Revised 10/19/17 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 � Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments , 1060 Craigville Beach rd Property Address Juan Marichal Owner Owner's Name information is required for every Centerville Ma 02632 6/5/2017 Revised 10/19/17 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form s .. " Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1060 Craigville Beach rd Property Address Juan Marichal Owner Owner's Name information is required for every Centerville Ma 02632 6/5/2017 Revised 10/19/17 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 63" feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 5/7/1990 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Visually. 8" of water in basement Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System°Page 16 of 17 r 11 M. �s, �� ri S a €+ 9 MAM .e 7 h � v �s - z +�yxh a ,z ..� �` z ✓ � �� "�"`' ate ��yf@� 7 a w�,�� .f'{ °yi„ "^ .vyA��*° ��'` * p. _ a s � ,; 3"r$9 ,"m� ✓y f.�zi'x ¢�-�'' �,:�'D,',�`�� h§'� �"' A� g sa°�'°R f a• z � `��d'z �� >'a�v"�, �.. �r Y �'` _g�r,�, fi 'k,.r�>` ry✓'``�t _�,,y,✓a✓' " :F o �..fi'" RP�tt's,�� s �' '�br.2s;z�iz•L.rsr, .},�, d �sP �.d �r'�Ny,"t t 1� -:.�r �� e� �,,��„gt,�?�•rt te \� 4'�-.t;. .sL e.,a r, � a. �x%7J^ F r'f+». 4'3" vav �' v `�" _ ,° ti r R .x"'r"F�`r r'° X+,n#d `� ^M�;�� ys',lnL'✓�j'�, �,�r� ,3<"`'' ��WAS �, 4M k % rkp v` ,w'z� �5° "Y � >y . `f�w `r d p ,�,� ✓'r s 9 a 4 ' `° .,°z s.✓ xzW'r.'e* sa�+tt sDL'.Odr ard �. . " ° "+e s. �\i �''"" r � �\"'�\�• a D aw KS�+,.�,3z t\s.,, •T�y.'° �.. �f��a''i4 c c� + 't2�t.':f"' D'�,�'< vRf�a i � ^e✓ 4,� r t r, 5 ,,•,��r {' v5`?< ,e-grb l; ?kekRt. k.• �(,. xns" Y 5 }� :y. �` °�'�. pr tie ,t3S }`, cO. 4. ? "": ats g Sy4°s"5✓a3t' 7 £ �f �' w.�`x�� ? ' 'a @ `:z',<'` r{J �x2 ax4� � z r•:� a }'` a: i\�' A gat '£ a " �<c � h ' .? e � �' } fir.x E �?4 f�� a�, i 1 tr`��? � rh r �K�� "`.�'. - `s?�a .. 4 .a�..> � � �.. w 'r��, ��v' ?�: 4� a� � ��£z $�', y� �''�` ��,'�'� ��` ,""k� 3 >r� '✓�s ;�v�.i 3�i',�,�`��tax��t��i�z''� � � tom, a s �\ , � �.\t \ s� � M�� .rrf ° '`�`€�•x j� �..��e c ��. �� > w sit � �<` '�: � F x jy..Z � s ..y�� n�"5.. �•`�� .e�� '� ,§x\\<�a ��ss,` S�z rA' �' �a .�^x '"'��2�� "�S �..i t e,� � yd'� i�r.e� i.'� &��a�` r ��xSz # S�.5-�� .. r� y5�'` S 'Dt23��' w� 5 i - � n �",�... �C`r> A7 M4 Z,\ f�>°''�u •'r, k. �' } � , t � 'f{.: Z. f.s��} �.� <�y��✓t,^<°'<�� g �^��*`` ?'"'. 3� a .2''.�� R``e �yiz Y��.'�.{"*��,, ?^t��>:r`<'v�k<ir ,2�3"?}r: yet r\,� D5q x. i,,, fSY..P ..x. Y5 ,r< \"JL.y,F�v'?tt' �+&t' ✓ x.3.�rti �� y2"$ ��' ��. t�a<;Y a�5 }a � �� Jj.. r T,)- `x ✓ c .� 3 €'�. ..J,, w .� ` �'€✓s� ,. ` z. >A�\ r yct g�^,�+'r�' vLs � ` O�3 �'��'kw s`y€.YK`` 'z �;'E�\�. _..- a S a ✓Y?...r� i^~�r^c �\ - h `S `��.. i '�`�.,e`r` L y✓ �"E `�.3y �i �'.°' ay. "��t�' M �'iz'� `t �a ? � Sa. €°t ,-.. �.. F A s ,j y.f ✓5 5 '3 \. <„�:n£� ✓ \" +,. ,.,{ d +�"�. `Y��+,,,,�7ya {7✓',� y `� \ ?w\'�(.✓�yzOy 5�+' €jy ,* l,+ ` c ..s, yi �'2 .� 2' ,.,.� if/ �i y<^•e:� FA�S:<:ny t - }1'✓` ...,�K\ �'z,,, �'��ti �� £' k�i fi�N. yvvan tr�a/rn'tzr Ora j3 ,� ll, a2T 9 ✓ J U>€._-il�i.0 �y b 4 v 'a'f" 1'C'<� .I- „`b \`fit.. ✓.µ✓ 5 .$.Y r a/ Y� � �' � Yx� � �`''~ �$Xt<` � k T�kj:h\. L��, '.'.� �� CM`\' 3 P'\ �-,�+a�a� f ✓ fx { ,r > cn", 3i ........^' , t, yR^7 <} �, '2r+"t>;y ^v� A,� 51 ,D\, kCY z<t rb� f `� v '£>z,�^�✓ eerx :e ✓ ✓ z >SSzJ v e }yr a a �„✓: n i5` t,. k` A,k Y.S v ti�.a � ;d� V A `''°C';� {3gy, A \ 5`� r ,. S ,. F✓, '1i yi D ✓ T e �} - ��_„ $ r � r3 u5z y iE�C�-:56/fe r v gy<a7.✓...✓x�✓�.r5 iX u¢i�o`} yysrz 5 z�r.z:n}-.y..">. t'✓l t `C'^-.e..r.�.Y rYst R�.Ss�'#...t.C2e`D-.. ..€h zs^a CX�'ta ca ceyvYE it��y.F yr'r<pL„xsr??31hv2',\H a�:,"'`��,�,�.;3'.�"CR^'�;°.'pk:,�'"`�2L3s`.aDZ,`c _h�'�\r�'Tsf c'L.S,,A�n^,,v`�k<£,��V ^ek,D A\``A+a.iz4 S\�aA; �N '✓� r x z z t e ' '-, % \5 b s '\ ua ". ✓.. . v, Ya^ .,, ~ S o\� ice' '�. v �I�t,a ? RK \3 11-1Ab K n ,!t ;✓c• ✓ -.f 1g S ,k r'd,,. ,O, $a,..,� A" ll-v €� I ✓ 5• 'T'ti rJ <^, r z r �r��`v 3 \'� �° d h'o `' �t z ✓ ,.l ' t >r;'`` i r xj 7-� �<,& � � �� t: yh -5 =r, y •z ✓l,,'.. v o Y'3r y,m'S. ".r kc ? .j arK�"y<,°.,.t...�3"v �E1� `�� '^,x� `\`�" �'i 2D�""''.\,.�'��`�r \x`biz„ \, 1\c�'a L2'3" i SF .✓ o x I `k : pk':^"`<w:.s u _ s c;a. tr v y � ♦,/T>t 7 •,�q e a .� a a`.�\"�'�i`a�i+� \" '`�<':�� a� \\ t e<v \ ti 5r. ;r i t , },{ �`y :�`� �ia `"Y�"a`+ ':u�'` 'q `, �7",y3",s,zg« rv'+ �z,v tdm, b. a,.ti..fl.'si�°�`\i+�. S<..\ c '•'s.�q p"� �5 fh ✓ r f 5'�5 5��^{.'`7 R -/3x4`�44�"gt`�? r^ Frft d<> 4`ukY4.sa. +d+'�' '�a.�'�$Rb A+, 'a,iy�A� ,� 'sCa t �z a i5 a".d z-"^^ r ✓ ✓r ✓< ✓a ; �' `�'ra $f e5 ✓.Y" ✓ 'x�a 2•z t :i�' l�.Si✓ F��t:., �d".�.�'�� `x✓�'£'! ..,�Lz v� ��...�cs �5.2� r��3�`2�'��. ~\�q��':� .�..,t\'vr�� \�\� 7j�\i` ✓ §e +.•c._ }} Zit' „ '''\ �'��. \�� \� ? ; y.+ a�aZ�t �. t ,� we A�t r h '�y`a i � ti�� "�`��"� ✓-. ✓. t :F. '-,ya. `�.s% �4 r ;<r .. `. r Air ems*+ s < A'� .'t�(v �<c•,z `a`s��fj"`A'M.Syd-�°nw �'.dR�Yaa �m>�"rir z4ia �sa�,k�S +✓'L>t'€€ �'� �;: ✓ ✓5 ^ S 4 ,�c as et"z` at z r, r r > ✓t v✓ 2 v G.,,,cy: ''<P"'v `o�: /. ✓ ✓ d r r' Rti9'X'vo'v ? e J. "%4 �+.�.. A '\ tQ i C3t' \ ;Xr v y �" r~; �'+� a�� ✓i2 +.5@ �' \7E wSz>� �" zz z ✓\,,\ \ gz j(°� �+z�: S `�4 Y- } r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 1060 Craigville Beach rd Property Address Juan Marichal Owner Owner's Name information is required for every Centerville Ma 02632 6/5/2017 Revised 10/19/17 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ❑ Inspection Summary: A, B, C, D, or E checked ❑ Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ❑ System Information—Estimated depth to high groundwater ❑ Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file l5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 Postal CERTIFIED o RECEIPT Ln Domestic Only For delivery information,visit our website at www.usps.cOmO; CO Certified Mail Fee Er Extra Services&Fees(check box,add tee as appropriate) `.�`i S, ❑Return Receipt(hardcopy) $ 0 ❑Return Receipt(electronic) $ �` Postmark []Certified Mail Restricted Delivery $ ' Here O ❑Adult Signature Required $ ❑Adult Signature Restricted Delivery$ r 1 3 to Postagea� r-1 Total Postage and Fees � u 1 Sent To r-q `n ::--- --�------- ---------------- / �t•,pdA�o., -P�jlllY.11�C�c`ui--Y__k.Ka<��r!.1.�..---- MIS City r.miT.T.Ti Inr r r rrr•r. Certified Mail service provides the following benefits: ■A receipt(this portion of the Certified Mail label). for an electronic return receipt,see a retail ■A unique identifier for your mailpiece. associate for assistance.To receive a duplicate ■Electronic verification of delivery or attempted t return receipt for no additional fee,present this delivery. USPS®-postmarked Certified Mail receipt to the ■A record of delivery(including the recipient's retail associate. signature)that is retained by the Postal Service- Restricted delivery service,which provides , for a specified period. delivery to the addressee specified by name,or to the addressee's authorized agent Important Reminders. Adult signature service,which requires the Iii You may purchase Certified Mail service with signee to be at least 21 years of age(not First-Class Mail®,First-Class Package Service®, available at retail). or Priority Mail®service. Adult signature restricted delivery service,which •Certified Mail service is notavailable for requires the signee to be at least 21 years of age international mail. and provides delivery to the addressee specified •Insurance coverage is notavailable for purchase by name,or to the addressee's authorized agent' with Certified Mail service.However,the purchase (not available at retail). of Certified Mail service does not change the •To ensure that your Certified Mail receipt is insurance coverage automatically included with accepted as legal proof of mailing,it should bear a certain Priority Mail items. USPS postmark If you would like a postmark on ■For an additional fee,and with a proper this Certified Mail receipt,please present your endorsement on the mailpiece,you may request Certified Mail item at a Post Office'for the following services: postmarking.If you don't need a postmark on this -Return receipt service,which provides a record Certified Mail receipt,detach the barooded portion. of delivery(including the recipient's signature). of this label,affix it to the mailpiece,apply You can request a hardcopy return receipt or an appropriate postage,and deposit the mailpiece. electronic version.For a hardcopy return receipt, complete PS Form 3811,Domestic Retum Receipt;attach PS Form 3811 to your mailpiece; IMPORTAMI:Save this receipt for your records. PS Form 3800,April 2015(Reverse)PSN 7530-02-000.9047 SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY ■ Complete items 1,2,and 3. A. Signatur ■ Print your name and address on the reverse X I Agent So that we can return the card to you. Addressee ■ Attach this card to the back of the mairpiece, B. Receiv y(Printed Name) CD ate of Delivery or on the front if-space permits. JZ G rI� 1:Article Addressed to: D —gyp D. Is deliveryaddress different from item 1? ❑"Yes V J n I, UZQ not 11\ If YES,enter delivery address below: ❑No -Tampa) FL 33(p13 II"III�I I'I I�I I II II I II I IIIII I I I'll II I I 0. Service Type O Priority Mall Express® O.Adult Signature ❑Registered MaIITM' ❑Adult Signature Restrtcted-Dewery ❑Registered Mali Restricted certified Mail® Delivery 9590 9402 1934 6123 0979 37 ❑Certified Mall Restricted Delivery tetum Recelptfor O Collect on Delivery Merchandise 2. A um rticle Nber(fransfer from seance/abel).v ❑Collect on Delivery Restricted Delivery O Signature Confirmation* III ❑Signature Confirmation 7 01`5 17 3 0' �'�01 '. 4967.`6155 it Restricted Delivery Restricted Delivery .PS Form 3811,July 2015.PSN 7530-02-000-9053 Domestic Return Receipt , i USPS TRACKING# First-Gass Mail Postage&Fees Paid USPS Permit No.G-10 9590 9402 1934 6123 0979 37 United States •Sender:Please print your name,address,and ZIP+4®in this box• Postal Service r)iVi'si°are ,200 Main --��an }�'iI'�`I"1f`:iI"1'�11�j'Jf�°.��ffFFP'III!(f7I7PIf.7lII1kFlFj��itlf7 'THE rti Town of Barnstable Barnstable kTATA ° Regulatory Services Department 1 erica j BARNSfABLE "� �m� Public Health Division m �iOrFp µAll A 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7015 1730 0001 4987 6155 June 6, 2017 SCOTT, SUZANNE TR 16902 CANDELEDA DEAVAILA TAMPA, FL 33613 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 i The septic system located at 1060 Craigville Beach Road, Centerville was inspected on 06/05/2017 by Michael DiBuono, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Any portion of the SAS, cesspool, or privy below high groundwater elevation. You are ordered to repair or replace the septic system within one (1)year from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BO OF HEALTH ThomaP0; n, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\1060 Craigville Beach Road Centerville.doc y ~ "w Town of Barnstable Regulatory Services Department Public Health Division 200 Main Street,Hyannis MA-02601 Office: 508-8624644 Richard Scali,Director FAX: 508-790-6304 Thomas A McKean,CHO Feb 6, 2007 Rev. 5111116 DEADLINES TO'REPAIR FAILED SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15,000) _ An"x"marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑Discharge or ponding of effluent to the surface of the ground 4 ' ❑Pumping more than 4 times during the last year not due to clogged or obstructed pipe. t ouse due to erloaded or clogged SAS or cesspool ONE (1)YEAR EADLINE CRITERIA ❑ Static liquid level in the distribution b ove outlet invert due to an overloaded or clogged SAS or cess o XAny portion of the SAS, cesspool, or privy below high groundwater elevation ❑ Any portion of the cesspool within a Zone 1 to a public well ❑Any portion of a cesspool within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO (2)YEAR DEADLINE CRITERIA q Single Cesspool- ❑Any"conditionally passed systems" (broken cover,relocation_ of a pipe,relocation of a driveway due to H-10 components, etc) ❑Leaching pit or cesspool with high liquid level, <12"below inlet(per Town Code §360-9.1) ❑Leaching facility with standing liquid level at or above the invert pipe (per Town Code §360-20 h) OTHER Repair deadline: Q:ISEPTICIDEADLINES TO REPAIR FAILED SYSTEMS.doc Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1060 Craigville Beach rd Property Address P+ Suzzane Scott Owner Owner's Name information is required for every Centerville kl Ma 02632 6/5/2017 page. City/town State Zip Code Date of Inspection h+� Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. General Information filling out forms �� 02 on the computer, use only the tab 1. Inspector: key to move your cursor-do not Michael DiBuono use the return Name of Inspector key. DiBuono Sewer and Drain QCompany Name 8 Johns path Company Address S Yarmouth MA 02664 Cityrrown State Zip Code 508-364-9587 SI 13522 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ❑ Passes ❑ Conditionally Passes ® Fails ❑ Needs Further Evaluation by the Local Approving Authority 6/5/2017 I pector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system 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. ****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. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 i Commonwealth of Massachusetts , Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M , 1060 Craigville Beach rd Property Address Suzzane Scott Owner Owner's Name information is required for every Centerville Ma 02632 6/5/2017 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Pag"e 2 of 17 f Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1060 Craigville Beach rd Property Address Suzzane Scott Owner Owner's Name information is required for every Centerville Ma 02632 6/5/2017 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ 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 ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 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 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 1060 Craigville Beach rd Property Address Suzzane Scott Owner Owner's Name information is required for every Centerville Ma 02632 6/5/2017 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a 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. I . ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters 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 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 1060 Craigville Beach rd Property Address Suzzane Scott Owner Owner's Name information is Centerville Ma 02632 6/5/2017 required for every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ® ❑ Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ® ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1060 Craigville Beach rd Property Address Suzzane Scott Owner Owner's Name information is required for every Centerville Ma 02632 6/5/2017 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No ❑ ® Pumping information was provided b the owner, occupant, or Board of Health Y P ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? Was the facility owner(and occupants if different from owner) provided with ❑ ® information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CM 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 6 Number of bedrooms (actual): 6 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 660 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1060 Craigville Beach rd Property Address Suzzane Scott Owner Owner's Name information is required for every Centerville Ma 02632 6/5/2017 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: System contains a 1,500 gallon Septic tank as well as a concrete distribution box and 6 concrete flo diffusers. Pipe exiting basement is only 63" above ground water. Bottom elevation of flo diffusers is 24" below pipe. For a seperation difference of only 39" and does not meet the required seperation of a minimum 48" " Eight inches of standing water in basement" Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ❑ No Water meter readings, if available last 2 ears usage d 289 Gpd 9 ( Y 9 (gp ))� Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: (Sins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1060 Craigville Beach rd Property Address Suzzane Scott Owner Owner's Name information is required for every Centerville Ma 02632 6/5/2017 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Not provided Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1060 Craigville Beach rd Property Address Suzzane Scott Owner Owner's Name information is Centerville Ma 02632 6/5/2017 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 1990 Were sewage odors detected when arriving at the site? El Yes ® No 9 9 Building Sewer(locate on site plan): Depth below grade: feet Material of construction: ® cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): System is vented at the roof line Septic Tank(locate on site plan): 6" Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) 1500 If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: Sludge depth: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1060 Craigville Beach rd Property Address Suzzane Scott Owner Owner's Name information is required for every Centerville Ma 02632 6/5/2017 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 24" Scum thickness 3" Distance from top of scum to top of outlet tee or baffle 42" Distance from bottom of scum to bottom of outlet tee or baffle " Sludge stick How were dimensions determined? Tape Measure Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts n Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 1060 Craigville Beach rd Property Address Suzzane Scott Owner Owner's Name information is Centerville Ma 02632 6/5/2017 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts a. W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1060 Craigville Beach rd Property Address Suzzane Scott Owner Owner's Name information is required for every Centerville Ma 02632 6/5/2017 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Level and at normal level 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.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No" Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1060 Craigville Beach rd Property Address Suzzane Scott Owner Owner's Name information is required for every Centerville Ma 02632 6/5/2017 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ® leaching galleries number: 6 EJ 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.): Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1060 Craigville Beach rd Property Address Suzzane Scott Owner Owner's Name information is required for every Centerville Ma 02632 6/5/2017 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1060 Craigville Beach rd Property Address Suzzane Scott Owner Owner's Name information is required for every Centerville Ma 02632 6/5/2017 page. CityrTown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth-of-Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 1060 Craigville Beach rd Property Address Suzzane Scott Owner Owner's Name information is required for every Centerville Ma 02632 6/5/2017 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 63"feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 5/7/1990 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Visually. 8" of water in basement Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 t• � } �i f b �Y f ��✓ � ` b � JJ '�f b 0 l 7g� � y E! j I Commonwealth of Massachusetts _ R W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1060 Craigville Beach rd Property Address Suzzane Scott Owner Owner's Name information is required for every Centerville Ma 02632 6/5/2017 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ❑ Inspection Summary: A, B, C, D, or E checked ❑ Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ❑ System Information— Estimated depth to high groundwater ❑ Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 C:% Cv _'",, Barnstable f Barnstable t�r Town o Regulatory Services Department AFAmedcaCity `"AS i639. �' Public Health Division � ♦0 m 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7015 1730 0001 4987 6155 June 6, 2017 SCOTT, SUZANNE TR 16902 CANDELEDA DEAVAILA TAMPA, FL 33613 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 1060 Craigville Beach Road, Centerville was inspected on 06/05/2017 by Michael DiBuono, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Any portion of the SAS, cesspool, or privy below high groundwater elevation. You are ordered to repair or replace the septic system within one (1)year from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH Thomas McKean, R.S., CHO Agent of the Board of Health I Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\1060 Craigville Beach Road Centerville.doc No................-...---- FEB....,£,, o..... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliratiun for Dispasal Works Tonotrurtiott 1hruti# Application is hereby made for a Permit to Construct ( ) or Repair (�an Individual Sewage Disposal System at: - --------------- - --•---------.....•--- - •-------•------------•-••-------•--..•--- cati° -Address or Lot No. ......... .:. -- ..................................... ........................................................... n /�ATd/d ess t J s ,a . -Ns± ------Sr(----------------------------------------------- ---- -- ----....-------•------------.....E.... .` Installer Address d _Type of Building -7 Size Lot............................Sq. feet U Dwelling—No. of Bedrooms_._._.-!__________________________Expansion Attic ( ) Garbage Grinder ( ) C14a Other—T e of Building No. of persons............................ Showers — Cafeteria Q' Other fixtures ---------------------------------•-•-- . w Design Flow........ '______________ _____gallons per person per day. Total daily flow.__._ __��.......................gallons. w Sep oral Trench No ity�S'gallons i ength___�_----- Width_..6`_...._ Diameter---------------- Depth................ Septic Tank Trench L id capac_ Width.._.P._........._ Total Length---�q!._.._. Total leaching area--------------------sq. ft. Seepage Pit No--------------------- Diameter.............._..... Depth below inlet-------------------- Total leaching area------------------sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed bY............................................................................ Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Gr4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 -----------------------------•-•--•---•---••-----•----•--------------........__..._......---•-------........................................................ 0 Description of Soil....................................................................------•--------•------------------•-------------------------------------------------.........._•--- x M •------------- U Nature of Repairs or Alterations—Answer_when applicable.�.VI-S1-161(.�.------'_�6r... c ........6..IF.� � �`�� s -....................-...................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b n issued b th�Vd lth. Sined ----- ------- ------------ _--- ------e -� Application Approved B ..................... Date Application Disapproved for the following reasons- --------------- ------------------------------------------------------------------------------------------------------------------ Dace Permit No. - ------ 2 7 j-- Issued ..............� .1 �7. ----------------- J - ' ..- t FEic THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE _ Appltrttttutt for Dtspuutti urks Tunutrur#tun r.erutt# Application is hereby made for a Permit to Construct ( ) or Repair ( -4'an Individual Sewage Disposal System at; tr"Ltx "'\�'c F V_C C �_ (2-2 - L catior((Address or Lot No. ..__.0...._................•-••-----•--•••--••............................ ......... .......��a ............ own Address w �__vE L►a __ar ........ ... ...... �•.�5 ....�11a �1,.a .......... Installer Address d Type'of Building � � Size Lot___________________________S q. feet V Dwelling—No. of Bedrooms___-.- . _----Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) Cafeteria ( ) dOther fixtures -----_---------_-------------------------------------------------------------------------------------------------------------------------------- w Design Flow........ _______________________gallons per person per day. Total daily flow..... -----_-------_.._.......gallons. WSeptic Tank 4 L id capacity/5 gallons Length_...7....... Width.... Diameter________________ Depth._..________._.. r, x Disposal Trench No. -� �._. Width..._-_____ ___. Total Length--- Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area...-..............sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ (Z4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------------------------ 9 -----------------------------•---------------------•----.....------------•-•-•-•........-----•---•-•......................................................... 0 Description of jSoil....................................................................................................................................................................... x vW ........................................:...................... ............... -_______-_________________-_________-_-_-_-___---.----._----____-_-__-_______---_____-.-_____---___------__--_______------___-____--___----------_-..-..-------- UNature-of Repairs or Alterations—Answer when -_-___%__ �T�.. Agreement: r' The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the 4oard of health. _.Signned----------- -----.....------ ....... ............................ Application Approved By .................. Due Application Disapproved for the following reasons- -------------------------------------------------------------------------------------------------------------------------............... -----------------------------------------'------------------------------------------------------------------------------------------. --------------------------...------............ .................................. Dale Permit No. --------- - - --- Issued ---------------------- -- --Y - Uate -t THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �, - TOWN OF BARNSTABLE THIS IS/TO G I T W' That the lVdividual Sewage Disposal System constructed ( ) or Repaired (�} by � �� a4t49 Sr(-�c "-------------........-............--...----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Installer at -f b(Q.o......C rc� v i� c -� - ..............---------------- ------------.. ----------------------------------------------------- has been installed in accordance with the provisions of TITLE 5 of lhe,Slate-fayiymental Code as d scribed in the application for Disposal Works Construction Permit No. ..........................v..................---- dated ....G.1-L-(/-yO............. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE..................-------/- �: ...."--� ~ Inspector .�1 > . .....r-...."'`� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 273 TOWN OF BARNSTABLE 3 QD_ No. ......:....... FEE....................... �►iu r u�t� Works Tuttu#rt ivit ami# Permission is hereby granted....... .......................................................................... to Construct ( ) or Repair e-Tan Individual Sewage Dis dsal System at No.... b G V --_------------------ Street ` . as shown on the application for Disposal Works Construction Permit No.�b....��?>Dated.. /..y.................. cz ----------------•------•------------------------...............................................Board of Health DATE................ l FORM 36508 HOBBS&WARREN.INC..PUBLISHERS l ~ LUG-' Jj e TOWN OFBARNST�ArBLE LOCATION 16C00 OYCO. r� Ui I(Q ?Yak SEWAGE # VILLAG N ' A SESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY4 LEACHING FACILITY:(type) TIT (size) ,d NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER _�aM BUILDER OR OWNER DATE PERMIT ISSUED: DATE COUPLIANCE ISSUED: M VARIANCE GRANTED: Yes No �/ I � ~ 18Co a j zoo 10 -----,- L.ou1S M Alp, RAJ� DkIEU,.! ' I t � �"Dlla►-� 4\z��(�b\ � �,1� � �CrAy[7!'lD-�'S 1 ! UT Ittt( �CV� �Elzl 3,PIPE QITG�f I')�f F�" FFJ?- �E( iG� I '� �vIK 4, DFh1,&,a 5, Pi96 lloiw's I-Abm �-taz,501ncrWr. cDr.1STRUG?lol4 0ETWL670 P.16 44.1 A4(loZD:lkll .c WN _ Maw Er'WtfzowJ A5N-T4kI DOVE 'TITLE J1., This r�1 eopocrosev wo04 C' �D G�IdU LD n107 TNT �E ��MaJ y%t7 to D►po�rJP-� \. . A� r> S,rl,yll� sfl��-ro �,�_��I:�T f I�U i�" I..IP'( "r0 Sc.dt,.E >✓�L�T-� �l`O ��1. �,2' `z ��A[-F�j v.1 G��..� �SO�.0 p, �' C Sri C6GI II•IG�9~ v o / Ll c_t - --' — py �% �� / _ DGC� 4� of �E o�✓ . �>hT Z' "LL?' of . . ., ,� / I�'wl�c C)� . .•,..�a��o �,� \;. , � 17-(So o�.•r��'-- ?�" (�"cl�', ,'�� op,.J►1 �-�v Fes,- /ram �..�A Ek: d-�>c►-• \'��-----_. ry '`t,y , . \ . . / l,.o-•c 4-7 I d— ��TIG Q,1� � ' Z� -` b�D� —' 3 s' 4C}� �Gl l..l I�f-PT1G 7et.;K 170 GPD ('-;-&L LC*,l 'TA*J K IL �%"i.�� ►2�C�. `0 ti�10 ( � o") ToTdL tvo'L.Gryo 7;7T`?- a r o o F �.�o►J� l`w F� 1� _ �T 1.d bO�LG��[\LAG ��c�Ll� �G.• �,1�rL.l>�� ) �i4,2z i.•;G. �"�. � EIr-T-S W,j2fN 7as &ze:o T� PyH �F MAjya( �\tN OF Mq�r\ X '';�' GF F. tF'T ryCGo .(�L1,��V �1�►.1 '7 ARNE d ARNE H. u` RE` .-Gr1�L�' L,L.rt' -JZ'3�3 T / OJALA1 OJALA 2fi348 ) 1' No.130L A u l ffi�tt CISTERE c�� o,�of .4�-Tt� �i `)-)a p iC" S/pHAI EN .� I 127E 6,4 YaeMoUT� 1"I OS0S '�- --�— _C1 ►-1�Ce =? p�, n. A Eu 17a-1'E