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0069 EMERSON WAY - Health
:NN 69 Emerson Way. LCenterville A = 188 - 023 ® II 5 M E A D No.2-153LOR UPC 12534 emead.com • Made in USA � y !�WT jOF1 OM fllERUS®NiFLSPAODUCTIlERPItO SGRAM NCI�RFlA@7IS WWWSFVWGPAKOW _ i �� ����� �� i U. A-C,E-P_E.R-NUS tit O. l- ja7 DIJ►TE-P-E-R-t�1T 155UED '- �=�� 7� - D ATE-C.ONA-P-L-I-At�l r f : ,y. 90 o ��N No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 21pplitation for Misposal �6pstem Construction Vermit Application for a Permit to Construct( ) Repair(Q Upgrade( ) Abandon( ) ❑Complete System Z Individual Components Location Address or Lot No.69 4521(6C.560 c44 Owner's Name,Address,and Tel.No. Assessor's Map/Parcel QZSp&,) CQ— ✓e Lc'E Installer's Name,Address,and Tel.No. . 7_$�'(-� Designer's NamAddress,and Tel.No. Type of Building: Dwelling No.of Bedrooms /y Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) tygpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) 6-1k)E Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date ` o`3_a b13 Application Approved by Date - 3 - ,;�o13 Application Disapproved by Date for the following reasons Permit No. ad l Date Issued 3 �C) No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: - PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes 1, 2pplication for Vsposal 6petem Construction Permit Application for a Permit to Construct( ) Repair K) Upgrade( ) Abandon( ) ❑Complete System K Individual Components Location Address or Lot No.69 6. ffa(SbN U-44 Owner's Name,Address,and Tel.No. doer ILW MAQZA c N Assessor's Map/Parcel t asr 3 69 Eer6XS0Xj wxY �6l�Te_�VILC.� Installer's Name,Address,and Tel.No.SOS- 77_$&'l-y Designer's Nam�ddress,and Tel.No. � C�Qc-»t p[� CX1T2l�i�ISc-3 (,c.G r • S4o� Type of Building: Dwelling No.of Bedrooms /t/ Lot Size aJ-- sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided N gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) t Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date -"3 %�P13 Application Approved by Date t - 3 -- avl3 Application Disapproved by Date for the following reasons Permit No. �/' Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(A) Upgraded( ) Abandoned( )by ( Qr=wt pvc—!:a I 2f at A) (q�t4�l has been constructed in accordance with the provisions of�Title 5 and the for Disposal System Construction Permit No.1�oi 3- 39'4- dated /0-3 ` 3 Installer de &-)u( 0A �. Designer N #bedrooms Approved design flow / ' gpd The issuance of this permit shall not be construed as a guarantee that the system will fu ctitmflas-designed. Date Inspector AA(. -----No.--------------------------------------------------------------------------------------------------------Fee------------------- THE COMMONWEALTH OF MASSACHUSETTS 16-0 PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Misposal 6pstem Construction Permit Permission is hereby granted to Construct( ) Repair(x) Upgrade( ) Abandon( ) System located at (oq Eo4 Ep spa (.F)A\-/ Ul L4_C and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local'provisions or special conditions. _ CProvided:Construction must be completed within three years of the date of this permit. Date 1 6 — 3 ^(?j Approved by 7 06 13 09:58p P.1 ■ ■ �■ Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 69 Emerson Way Property Address Maria Watson Owner Owner's Name information is required for every Centerville MA 02632 10-3-13 page. Cityrrown State Zip Code Dale of Inspection 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:out forms A. General Information filling out forms `\�p�uuurrq�rr�r on the computer, ������ t'�OF/b{ use only the tab 1. Inspector: (� � �� aqc�% key to move your .�` �j ,J A M E S CP cursor-do not ,James D.Sears � �✓ � '� "' use the return key. Name of Inspector = -� CapewideEnterprises LLC - Company Name -' 'tfTI?r�'T 153 Commercial St. �,, 5•I N SP� `,`\��� Company Address x► Mashpee MA 02 02649 City/Town State Zip Code 508-477-8877 S1623 Telephone Number License Number B. Certification 1 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 16.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 10-3-13 ^' G(nspectors Signature Date w The system inspector shall submit a copy of this inspection report to the A p going Authority((,BBOrd :. of Health or DEP)within 30 days of completing this inspection. If the system'sa sharedlsyste T-bor has a design flow of 10,000 gpd or greater,the inspector and the system owner shall sdtimit tfie; report to the appropriate regional office of the DEP. The original should be se At to the system orner and copies sent to the buyer, if applicable, and the approving authority. iy w ""This report only descnbes conditions at the time of inspection and under1#he eondiflonsi f 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•3113 Tale 5 Ofirael hs. pection'Fo�mrymn:U�suRaoe Sewage Disposal System-Page 1 of 17 I� Oct 06 13 09:59p p 2 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 69 Emerson Way Property Address Maria Watson Owner Owner's Name information is Centerville required for every MA 02632 10-3-13 page. Citylrown State Zip Code Date of Inspection B. Certification (cost.) 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 Q N ❑ ND(Explain below): l5 ns 3/13 TWO 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Oct 06 13 09:59p p 3 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 69 Emerson Way Property Address Maria Watson Owner Owner's Name information is required for every Centerville MA 02632 10-3-13 page. City/Town State Zip Code Date of Inspection B. Certification (cunt.) ❑ Pump Chamber pumpsialarms not operational_ System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes(coat.): ❑ 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 i p pe(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): i 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. I. 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 }Sins•3113 Tine 5 official Inspection Form:Subsurface sewage avow}Syatem-Page 3 of 17 Oct 0613 09:59p p.4 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 69 Emerson Way Property Address Maria Watson Owner Owner's Marne information is required for every Centerville MA 02632 10-3-13 page. Cityfrown state Zip Code Date of Inspection B. Certification (cunt.) 2_ System will fail unless the Board of Health(and Public Water Supplier,if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: This system passes if the well water analysis, performed at a DEP certified laboratory, for 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 dogged SAS or cesspool ❑ ® Liquid depth in cell is less than 6"below invert or available volume is less than%day flow /�.T' 15ins•3M 3 - Title 5 Official Inspection Form Subtantaoe Sewage Disposal System-Pape 4 d.17 ,Oct 06 13 10:00p p 5 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 69 Emerson Way Property Address Maria Watson Owner Owner's Name information is Centerville MA 02632 10-3-13 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.- El ® 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.] ❑ 0 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 Departrnent 15ins•3113 Title 5 Ofidal Inspection Forth:SuDsuAaca Sewage Disposal System•Page 5 of 17 Oct 06 13 10:00p p 6 Commonwealth of Massachusetts Title 5 Official Inspection Form ' Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 0 90- 69 Emerson Way Property Address Maria Watson Owner Owner's Name information is required for every Centerville MA 02632 10-3-13 page. CityfTown 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 NIA) ® ❑ 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 bees, 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 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 2 Number of bedrooms(actual): 2 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 220 t5ins-U13 Title 5 Official Mpaction Form:Subsurface Sewage Disposal System-Page 6 of 17 Oct 06 13 10:00p p.7 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 69 Emerson Way Property Address Maria Watson Owner owner's Name information is required for every Centerville MA 02632 10-3-13 page. Citylrown State Zip Code Date of Inspection D. System Information Description: The system is a 1000 Gal. tank and Pit. Number of current residents: 1 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 2011-35,000Gais g ( y g (gPd))' 2012-38,000GaI s Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Present P Date CommerciallIndustrial 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: 15ins•3113 TiUe 5 Ofidel I nspectiw Fomx subsurface Serage Disppsal System•Pege 7 of 17 Oct 06 13 10:01 p 0.8 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Forth -Not for Voluntary Assessments 69 Emerson Way Property Address Maria Watson Owner Owner's Name information required for every Centerville MA 02632 10-3-13 page. Cityfrown State Zip Code Date of tnspedion D. System Information (cunt.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: 12118/08 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•W13 Tide 5 01fiaial Inspection Form:Subsurface Sewage OlsposeI System.Pape 8 of 17 Oct 06 13 10:01 p p 9 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 69 Emerson Way Property Address Maria Watson Owner Owner's Name information is required for every Centerville MA 02632 10-3-13 page. Citylrown State Zip Code Date of Inspection D. System Information (cost.) Approximate age of all components,date installed (if known)and source of information: 1975 Permit #75-324 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 18" 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.): Pipeing is 4" PVC SCH 40. Note: New line tank to pit Septic Tank(locate on site plan): Depth below grade: 4" feet Material of construction: ®concrete ❑ metal ❑fiberglass g El polyethylene El other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 Gal. Precast Sludge depth: 2" i5ins•3113 TAte 5 Official hrpec ion Form:Subsafaoa Sewage Disposal System•Page 9 of 17 Oct 06 13 10:01 p p.10 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 69 Emerson Way Property Address Maria Watson Owner Owner's Name information required for every Centerville MA 02632 10-3-13 page. Cityrrowm State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cunt) Distance from top of sludge to bottom of outlet tee or baffle 28" Scum thickness 2" Distance from top of scum to top of outlet tee or baffle 12" Distance from bottom of scum to bottom of outlet tee or baffle 16" How were dimensions determined? Asbuilt-Tape Sludge Judge Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage,etc.): Tank at working level. Tank and cover's at 4"below grade. In and out let baffles. No sign of leakage or over loading. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: El 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.3Y1 3 Title 6 Official Inspection Form:subsurface sewage Disposal system•Pepe io of 17 Oct 06 13 10:02p p.11 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Fonm -Not for Voluntary Assessments 69 Emerson Way Property Address Maria Watson Owner Owner's Name - information f0 a Centerville MA 02632 10-3-13 required for every page. CityrTown 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 F,] 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 !Sins 4 W13 T-1118 5 ORiasl]"SPO On Form:SWsurieee Semege Dispo5el System•Page 7 S of 17 Oct 06 13 10:02p p.12 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 69 Emerson Way Property Address Maria Watson Owner Owner's Name information is required for every Centerville MA 02632 10-3-13 page. Cttyrrown State Zip Code Date of Inspection D. System Information (cons.) Distribution Box (if present must be opened) (locate an site plan): Depth of liquid level above outlet invert Comments (note if box is level and distribution to outlets equal,any evidence of solids carryover, any evidence of leakage into or out of box, etc.): 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•.3r13 Title 5 Of&jal Inspemnn Form:Subsurface Sewage Disposal System-Page 12 of 17 Oct 06 13 10:02p p.13 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 69 Emerson Way Property Address Maria Watson Owner Owner's Name information required for every Centerville MA 02632 10-3-13 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number. 1 ❑ 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.): Leaching is one 1000 Gal.Precast Pit. Pit and cover at 1' below grade. I'water in pit w/stain line at 18". No sign of over loading or solid carry over. 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 Ofridat ins pection Fonrc SuDsurteoe Sewage Disposal System-Page 13 of 17 r Oct 06 13 10:03p p.14 Commonwealth of Massachusetts Title 5 Official, Inspection Form b Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 69 Emerson Way Property Address Maria Watson Owner Owners Name information is required for every Centerville MA 02632 10-3-13 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.): 151ns•3/13 Title 5 Dttiaal Inspection Form:Subsurfew sewage Disposal system•Page 14 0117 t Oct 06 13 10:03p p.15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 69 Emerson Way Property Address Maria Watson Owner Owner's Name information is Centerville MA 02632 10-3-13 required for every page. Citylrown 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 A -a=37-3 �" 13-;2- =37- 4z A FEAR a � 0 i i o 15ins-W13 Title 5 Official Inspection Form;Subsurface Sewage Disposal System-Pago 15 of 17 Oct 06 13 10:03p p.16 Commonwealth of Massachusetts fingram Title 5 Official Inspection Form t Subsurface Sewage Disposal System Forth -Not for Voluntary Assessments 69 Emerson Way Property Address Maria Watson Owner Owners Name information is Centerville MA 02632 10-3-13 required for every page. c4rrown State Zip Code Date of Inspection D. System Information (cost.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells N� Estimated depth tCF71gh ground water. 124 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: 9-2-75 Date ❑ Observed site(abutting propertylobservation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: 1 ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: T.H_ 9-2-75 No G.W. at 12'. Bottom of pit at 7' below grade. Bottom of pit at 5'above T H Depth Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins.3M3 Tile 5 Official Inspection Forth:Subsurfaw Sewage Olspoaat Sytem-Page 16 of 17 Oct 06 13 10:04p p.17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 69 Emerson Way Property Address Maria Watson Owner Owner's Name information is required For every Centerville MA 02632 10-3-13 require 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-3l13 Tide 5 0Mdal kspection Form:Subsurface Sewage Disposal System-Page 17 0117 I Health Master Detail Page Page 1 of 1 as{ icr�L9} wn M pia y k'v g ' flcsel�frCa —de .a aas Logged In As: TOWN\miorandd Health Master Detail Wednesday, December 10 2014 Application Center Parcel Lookup Selection Items Parcel Septic Perc Well I Fuel Tank Parcel: 188-023 Location: 69 EMERSON WAY,CENTERVILLE Owner: WATSON, MAR)A Business name: — � Business phone: Rental property: ❑ Deed restricted: ❑ Number of bedrooms : Oj Contaminant released: ❑ Fuel storage tank permit: ❑ Save Parcel Changes Return to Lookup Parcel Info Parcel ID: 188-023 Developer lot:LOT 52 Location:69 EMERSON WAY Primary frontage: 100 Secondary road: Secondary frontage: Village:CENTERVILLE Fire district:C-O-MM Town sewer exists at this address: No Road index:0502 Interactive map Town zone of contribution:AP (Aquifer Protection Overlay District) State zone of contribution:OUT Owner Info Owner: WATSON, MARIA Co-Owner: Streeti:69 EMERSON WAY Street2: City:CENTERVILLE State:MA Zip: 02632 Country: Deed date:6/4/1997 Deed reference:C144677 Land Info Acres: 0.38 use: Single Fam MDL-01 Zoning:RD-1 Neighborhood: 0106 Topography:Level Road:Paved utilities:Public Water,Gas,Septic Location: Construction Info Building No ear Buil Gross Area Living Area Bedrooms Bathrooms 1 1975 4128 1232 2 Bedrooms 1 Full + 1H Buildings value:$112,600.00 Extra features: $35,200.00 Land value: $133,000.00 http://issgl2/intranet/healthMaster/HealthMasterDetail.aspx?ID=188023 12/10/2014 R CERTIFIED SEPTIC SYSTEM REPORT �� 12 ,,0 1 10. 41 wav oggb LOCATION ,vL 69 EMERSON WAY CENTERVILLE, MA MAP 188 PARCEL 023 LOT 52 PREPARED FOR SELLER MR. & MRS . ROY J . FARROW 25 BUTTARO RD. WOBURN , MA 01801 BUYER MS . CLAUDIA MCCLURE P .O . BOX 1167 OSTERVILLE, MA 02655 PREPARED BY HILLIARD HILLER, JR. P .O . BOX 250 CENTERVILLE, MA 02632 508-778-1472 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Address of property G9. owner' s name Gov J, �sfe�PD�r/ Date of Inspection GAad zs PART A CHECKLIST Check if the following have been done: 1,/ Pumping information was requested of the owner, occupant, and Board of Health. r/ None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. r/ As built plans have been obtained and examined. Note if they are not available with N/A. 4/ The facility or dwelling was inspected for signs of sewage back-up. The site was inspected for signs of breakout. 1/ A11 system components, 0*cluding the SAS, have been located on the site . The septic tank manholes were uncovered, .opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. The size and location of the SAS on the site has been determined based on existing information or approximated by non-intrusive methods. The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of SSDS. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION FLOW CONDITIONS If residential o- number of bedrooms -I- number of current residents . 'AS garbage grinder, yes or no %fS laundry connected to system, yes or no seasonal use, yes or no /1/-*" If nonresidential, calculated flow: / y ly oao G9L I�j3 S,S oao G i9 G Water meter readings, if available: PI2J'SEI-11-L % Last date of occupancy GENERAL INFORMATION Pumping records and source of information: Peg 61 System pumped as part of inspection, yes or no if yes, volume pumped Reason for pumping: Type of system 1/ Septic tank/ /soil absorption system Single cesspool Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) Other (explain) Approximate age of all components. Date installed, if known. Source of information: Ny Sewage odors detected when arriving at the site, yes or no SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued SEPTIC TANK: </ (locate on site plan) depth below grade: 8" ,fr /,��XT o? /97- material of construction: 4-- concrete metal FRP other(explain) dimensions: B �� r X 4e"Y' �0,0� /� O��'D ! 6✓16 T; 9; ,S sludge depth distance from top of sludge to- bottom of outlet tee or baffle —2 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 Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, recommendations for repairs, etc. ) TI-IMI 44,y /S DISTRIBUTION BOX: (locate on site plan) depth of liquid level above outlet invert Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, recommendation for repairs, etc. ) PUMP CHAMBER: (locate on site plan) pumps in working order, yes or no Comments: (note condition of pump chamber, condition of pumps and appurtenances, recommendations for maintenance or repairs,etc. ) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued, SOIL ABSORPTION SYSTEM (SAS) : y (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to. be present, explain: Type leaching pits and number / C� leaching chambers and number leaching galleries and number leaching trenches, number, length leaching fields, number, dimensions overflow cesspool , number Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, recommendations for maintenance or repairs, etc. ) 4-V S/liJ p! /-f�//�/�Z /d/T % L/Qr//O_ �vr/Gp .�O% /1_�' /"t"A-X/ji 6"� /S A 14i01'F&>x 1 h11 rC G Y G t o'! To7`'f c. .O'CeT,y= G ' CESSPOOLS (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 (cesspool must be pumped as part of inspection) Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, recommendations for maintenance or repairs, 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, recommendations for maintenance or repairs, etc. ) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100 ' /9G Ar I i DEPTH TO GROUNDWATER depth to groundwater method of determination or approximation: ,(3AX1--Kr,4,6G,f G/S 5 AT 3/ ' Ll"-"-g ez'o 4 7/ b Zc� O�/ a v !I h�(i UA vtJ Of � r 4o f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C FAILURE CRITERIA Indicate yes, no, or not determined (Y, N, or ND) . Describe basis of determination in all instances. If "not determined" , explain why not) AJb Backup of sewage into facility? Discharge or ponding of effluent to the surface of the ground or surface waters? Static liquid level in the distribution box above outlet invert? A114 Liquid depth in cesspool <6" below invert or available volume< 1/2 day flow? Required pumping 4 times or more in the last year? number of times pumped Septic tank is metal? cracked? structurally unsound? substantial infiltration? substantial exfiltration? tank failure imminent? Is any portion of the SAS, cesspool or privy: below the high groundwater elevation? _ within 50 feet of a surface water? within. 100 feet of a surface water supply or tributary to a surface water supply? within a Zone I of a public well? 'W within 50 feet of a bordering vegetated wetland or salt marsh (cesspools and privies only, not the SAS) ? within 50 feet of a private water supply well? less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis? If the well has been analyzed to be acceptable, attach copy of well water analysi for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. �-----z -.---- -. -------- TOWN OF ,3.1 BOARD OF HEALTH- -----------—_ SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART D - CERTIFICATION -TYPE OR PRINT CLEARLY- PROPERTY INSPECTED STREET ADDRESS -f ,F'/j?ER.So/U ASSESSORS MAP,_ BLOCK AND PARCEL # OWNER' s NAME _ �ZiQ, ltyeS jfe2y J__ j=�9�i?DLy PART D - CERTIFICATION NAME OF INSPECTOR COMPANY NAME — COMPANY ADDRESS Street Town or City State ZIP COMPANY TELEPHONE ( S'�PF) 778 - �t�?� FAX CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported is true , accurate , and complete as of the time of inspection . The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems . Check one : C,-, System PASSED The inspection which I have conducted has" not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR 15 . 303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form. System FAILED* The inspection which I have conducted has found that the system fails to protect the public health and the environment in accordance with Title 5 , 310 CMR 15 . 303 , and as specifically noted on PART C - FAILURE CRITERIA of this inspection form. Inspector Signature �e Date c One copy of this certification must be provided to the OWNER, the BUYER ( where applicable ) and the BOARD OF HEALTH. * If the inspection FAILED, the owner or operator shall upgrade the system within one year of the date of the inspection, unless allowed or required otherwise as provided in 310 CMR 15 . 305 . partd.doc f SEWQCaE PERMIT MO. iW.5TQLLER 5 ► WE � ADDRESS 5UILD.ER S Q ANME ADDRESS -- QATE PERNAVT ISSUED D ATE COKAPLI &MCE--: ISSUED : —0 3 -7 C f • L��' ��� off/ 8 .r' KEY NUMBER <5056 > NAME <FARROW, ROY J > B-C 1 B-C 2 B-C 3 B-C 4 STREET 25 BUTTARO ROAD CITY WOBURN ST MA ZIP 01801-3619 REF 1 REF 2 PHONE ( 617 ) 933-5040 REF 3 REF 4 METER NO. < 4702> DATE READING CONS STREET <EMERSON WY NO. 69> 06/30/95 104 9 _ CITY CEN K L51 ST LOC 12/31/94 95 8 PHONE (508) 771-3953 06/30/'94 87 6- 12/31/93 81 23 - ROUTE NUMBER 31 06/30/93 58 32_ SERVICE DATE 10/01/75 12/31/92 26 7 METER DATE 04/01/9' 06/30/92 19 3_ CAPACITY 7 12/31/91 16 12 STYLE T10 SIZE 1 RATE SCHEDULE KEY PIT PLASTIC NOTE RR RIGHT SIDE ADDITIONAL CONS 0 ALTERNATE MIN 0 i - \ i ------ / ✓� I is i — \ : lk t 1 r , 1 1 1 1 11 £me.gal� y� � I J �� �P �� ��� , i �/!'i) C�� p _,1— � /Il�f���•.dacC , {�M4�T� �� TOWN OF BARNSTABLE LOCATION `1 F.t%. g;noV G.//7 k SEWAGE # 7,5=3-,-?Y VILLAGE ASSESSOR'S MAP & LOT AW caU3 57.2 t INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY /ca7U <SitL `LEACHING FACILITY: (type) 1 6f}L AIr (size) NO.OF BEDROOMS o� BUILDER OR OWNER /9/.ter XaY PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility �'• ` Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) — Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leachin facility) � '/ //L3 � Feet Furnished by ' i✓ _' G/d/�9s 6 C�9G/C t qry i i i Old No...J -Y....... Finc............................. THE COMMONWEALTH OF MASSACHUSETTS BO ARD HE, LTH OF......... ... . ........... ........................ Appliration -for Dhipmat Works Tatuarurtion Prrutit Application is hereby*made for a Permit to Construct or Repair an Individual Sewage Disposal System at: ..................................................................... ... ......................................................................................... tion-Address or Lot No. -------------La-N-Jr--------------------------------------- ............................................ ................................................... wner _f Address ..............6 ----------------------------------- .. ...................... Installer Address Type of Bu1ld1jl&,,— Size Lot........../-----------------Sq. feet U �No. of Bedrooms-----------Dwelling _Z_�_-------------Expansion Attic (No GaFbage Grinder ( ) Other—Type of Building ............................ No. of persons..--_-_---------__-----_---- Showers Cafeteria ( ) Othu-fixtures ..... ------------------------------------------------ ---------------------------------------------------------------------------------------------- Design Flow... L_4............................gallons per person per day. Total daily flow........... ............... ...gallons. P4 Septic Tmik—Liquid capacitv-k((;..gallons Length................ Width.............--. Diameter_..........._.. Depth_.-.__-__.-.--. x Disposal Trench—No. .................... Width-------------------- Total Length-------------------- Total leaching area--------------------sq. f t. Seepage Pit No--------------------- Diameter.................... Depth below inlet---------_----__---_ Tot.Ll leaching area------------------sq. ft. Other Distribution box ( ) Dosing tank ( ) q- 2,- 7-5 , Percolation Test Results Performed by------ ------------------------------------------------------------------- Date---------------------------------------- Test Pit No. I----------------minutes per inch Depth of Test Pit.................... Depth to ground water_---------------- (14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-..--._.--_._--.---_-. - O . ------------- . .. ............................. ---------- ---- --------------------------------- ---- -------z ..... -- ------ ------------------------ escrptonoSoil--------_-40 V! A---------- U ---------------------- .1(------------------------------------ ----------_--- ......V--V- U NaturVof Pepi s or Alterations—Answer when applicable------------------------------------------------------------------------------------------------ --------------I-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Agreement: The undersigned agrees to install the aforcdescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b en issued by the board of health Sig . ..............................k_ ..... ------------------------------ Date Application Approved By------ . ... ........ . ...A"4,,-" 4 —---------- - - -- --- - Date Application Disapproved for the following reasons:---------- -------V-_�------------------------------------------------------------------------------------- ................................................................................................................................................................. -------------------------------------- Date PermitNo.I....................................................... Issued-- ............................................ Date .S No.. F�$. Q.................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �.. '...-........OF.........&f-tA ! . Appliration -fur Uiiivagal Works Tonstrnrtiun Vrrniit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ---•- �� -------- -2----------------------------------------------------------- p Location-Address or Lot No. Owner Address ._ _,r_�............R t v. .. ... �.✓?_ S ►A 6...... . ----------------------- -- - Installer Address UType of Build Size Lot...___:_. ......Sq. feet -, Dwelling—No. of Bedrooms._.____.... _______________Expansion Attic Vv) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons.--------------------------- Showers ( ) — Cafeteria ( ) P4Oth fixtures ------------------------------------------------------ W Design Flow___ _ ________________ _____________gallons per person per day. Total daily flow......._.-Cam_._.--_-___..___..gallons. WSeptic I'- —Liquid capacityl��_-_gallons Len th Width_........_...--. Diameter_____...._..___ Depth._.._____._._--. 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 ( ) I - ? - 7 :> . Percolation Test Results Performed bY.................. ....................................................... Date........................................ ,� Test Pit No. 1----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water.._-___.__..-..__.----- f14 Test Pit No. 2----------------minutes per inch Depth of Test Pit____________________ Depth to ground water__.-..-___.___-__-__-._. P4 -----------------------------------------?�...........................................................................Z------------------------------- O Description of Soil_ =•--f--- -� - / -- -- -- --------------- ---------- U ----r-------�-- -- S / ' ------•----• ( .......... ---- � ./�r'r /---- ,•-••-:;----•-- - ----- -`--- U Nature of Repairs or Alterations—Answer when applicable.................................._..._._..._._........_.._.._.........._...._...__......._... . ------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----- ---------------------. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bLeen issued by the board of health 34 Signed. �-,-,, ,,�s-r. -••--•,-{ ------ ----- . ................................ Date Application Approved BY......................... . ��.... .p_. _`� - --------------------------• � ---`r-` --- ---------------- Date Application Disapproved for the following reasons:----•.----------- •�-------------------------------------------------------------------------------------- •---------------•---------------•---•---------------•----•----•-•-•---------•---•---•---------------•----------------------•----•-•----------------------------•---•-----------•---••-----•------------- Date PermitNo......................................................... Issued----------------------........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH l .......OF....,.P� �..f.�.'�!J. .. . .... ........... ...:.......................... (1:11rrtifirnte of 0,11mpliaurr THTSIS TO CERVVFY, That the Individual Sewage Disposal System constructed or Repaired ( ) ., by - .� a__j ---- --- f, Installer � -•--------•---•--•----------------------------------•--------•----- has been installed in accordance with the provisio of d : rtic�e XI of T e State Sanitary Code as described in the application for Disposal Works Construction Permit N 7s...____ _` ___________ date _'91-__ _ .-.. � ........... THE ISSUANCE OF THIS CERTIFICATE SHALL. NOT BE C RIgRE A A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATI ACTORY. DATE. --------•--•--•-•---•------- Inspector----------- -------------------...................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD SJF No H ,� ................OF. ......`�r :sx, :.................. FEE Diner ti l orkii Lf vn rurtion "rrmit Permission i hereby granted__ / �c..t., ��' -----------------------•----____--___----•- to Cons tr V(�' ) or Repa• ,( ) an Individual ewage D's sal stem "j at No: lz`- --`�--�� --- _ --.�-----� ----7.......� . . -------- _ ! treet as shown on the application for Disposal Works Con ruction Perp-rip No.._n_____________ Dated-..,,9-._a_.-.!. 1. -----••-• -f�--vet 't'Z_4 ------------------------------------- J/� Board of :ea thr DATE-- ll/ �.. ✓ -----• ---------------- ..................... FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS i ` +- ds"^3t " a ...r :si�.' s .x ,= 5 „ _ �� e� q..a•€2 y ::,4 - - 3 - 0 .11 1 it -!}�, .: "� �xF t fir= F r _ } € e Air .� ,s s - _ 4 , Y+. -e c - F c s i } 11,� } n 3` {{ � $ � i 33 a �, r. k 5 = - _ I- K , , -, {/� `tt// .../� � �i 4 is `� at. � _, ... . __ �, ... - - .... Y _ I'll�1� "... r `w1 d{_ r 0.0. 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