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HomeMy WebLinkAbout0039 POND VIEW DRIVE - Health 39 Pond View Drive - Centerville A = 229 - 020 S M E A D No.2-153LOR UPC 12534 emead.com • Made in USA OIRCFM SFIPROfiRANI a�ae�s YYWYYSFVROGRAAIIORG �p n TOWN OF BARNSTABLE LOCATION Q �P*1V6gy)V40C SEWAGE# VILLAGE Cp �y�Le,. �Mq ASSESSOR'S MAP&PARCELZZ INSTALLER'S NAME&PHONE NO. ry�PIgabUIC SEPTIC TANK CAPACITY I, LEACHING FACILITY:(type) PQ5!3(o (size) R BC>�+Mr)642,5 NO.OF BEDROOMS 2- OWNER Gx;,r PERMIT DATE: SIN I l COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching f cility) A� Feet FURNISHED B Of _ 3 A-2. Z I� 3 qo3 �� a �4 4A2- rvl : *4 60 ?ZL �� TOWN OF BARNSTABLE �i'• SEWAGE 4` �/��Ile,. 1 e F,.SSESSOR'S LAGER, M.Ap�i LOTS STAr.LLER'S NAME&PHONE NO. Is PUC TANK CAPACITY LEAMNG ACli�.i!ry- (type) (size) ;...., N0.O�E1I?k?.00NLS._;..'3 : -•-,• PE IT�A'X` ..., c()1�1Q'�lily qa IDA, ..».. Ih Sepnraeton R'.��5t�tc4$�turcen the Maximum AdjldWid Gi' l' itet Table to the l�ottorn dLenhi4 VAdility �euti Peiv�@ 'd'JfiY41 auppiy lcii eei i, acl n�VaAity Cf.WY Vic s cxtst Aa »ito oe�ltbsn 200 feet of l6achitig fnciliYy) . .. ..,,_-..:. eea Ecln;�:cy� .la .t9 aid 1.cacliw acilily(if withisa 30:0 feet of iec+ewng,fici4q) �'�e �GK s. � G i � 6 �; A - �- ��� �, j� JOHN T.REGAN 80 KEARSAGE P.O.BOX 82 WEST HYANNISPORT,MA 979-595-6171 jr6gan@arch.tamu.edu 09 October 2014 Timothy B. O'Connell, R.S. Health Inspector Town of Barnstable 200 Main Street Hyannis, MA 02601 Dear Mr. O'Connell: Thank you for meeting with me on October 9, 2014 regarding the completion of de- leading the house on 39 Pond View Drive, Centerville, MA. As we discussed, I assume that the certification by Prior Environmental Services through the report that I submitted to you that is in compliance with the Regulations for Lead Poisoning Prevention,and Control completes my obligation in this matter. As you explained, if there are further actions required by me you will contact.me by phone. After we met, I received an additional note from Prior Environmental Services that a page was not included in the report that she sent to me; therefore, please add the attached page to the packet of information that I submitted to you today. , .t Thank you again for your careful guidance to me during this process. Regards,. { Jrhngan ATTACHMENT The Commonwealth of Massachusetts _ Executive Office of Health and Human Services �r Department of Public Health Bureau of Environmental Health Childhood Lead Poisoning Prevention Program DEVAL L.PATRICK th GOVERNOR 250 Washington St. 7 floor TIMOTHY P.MURRAY Boston, MA 02108-4619 LIEUTENANT GOVERNOR CLPPP Toll Free: 1-800-532-95 7 JUDYANN BIGBY,MD SECRETARY JOHN AUERBACH COMMISSIONER Fact Sheet on Maintaining Full Compliance Massachusetts law does not require the deleading of all paint, plaster or putty containing dangerous levels of lead. After a Letter of Full Initial or Full Deleading Compliance has been issued,there may still be paint or other material containing dangerous levels of lead present. For example,walls, exterior siding and surfaces above five feet.may still have intact lead paint remaining on them. The owner of any residential property is not strictly liable for damages associated with a case of childhood lead poisoning as long as the dwelling unit and any associated common areas has a valid Letter of Full Compliance. The owner remains under a duty of reasonable care to avoid liability. In other words,owners must keep their properties in good repair, free of defective lead paint, plaster,or putty,to protect themselves from liability. Letters of Compliance do not"expire"after any given period of time, and the Childhood Lead Poisoning Prevention Program(CLPPP)does not require letters of compliance to be routinely updated.However,property owners should visually assess the property for compliance on a regular basis, and any time occupants report loose paint,plaster or putty, and/or detached coverings. In addition, owners may choose to update their letters of compliance to certify that the property is still free of lead hazards. In order to do this,the owner must hire a lead inspector to perform a Post- Compliance Assessment Determination, or"PCAD." Directions for performing a post-compliance assessment and for correcting hazards are contained in Appendices A and B of the document CLP-10A,Maintenance of Full or Interim Control Compliance Status,available from CLPPP upon request at(800) 532-9571. The directions in these documents must be strictly followed,to protect the person doing the work and any occupants from lead exposure, and to protect the owner from liability. It is critical that the property owner maintain all documents associated with the compliance status of the property together in a safe place. The owner will need these documents in order to perform routine maintenance or post-compliance work, as well as to fulfill the reporting requirements associated with the Property Transfer Notification and Tenant Notification regulations. These documents include: ✓ The comprehensive initial inspection report ✓ The Letter of Full Compliance ✓ A reinspection report, completed on the initial lead inspection report,when deleading was done.Do not loose this document it is your guide to how each surface was deleaded ✓ Dust sample results,when deleading was done ✓ Deleading notifications,when deleading was done ✓ Deleading invoices from the authorized persons who did deleading work, when deleading was done ✓ Any post-compliance assessment determination reports ✓ Any Certification of Maintained Compliance or Certification of Restored Compliance ✓ Any waivers issued by CLPPP or by the Division of Occupational Safety pertaining to the property CLP-1 OB Revised 1/09,7/l/04 Pagel of] I va r� 7 Paula Prior paujaepr.i. com. Compliance documents October 9, 2014 4:21 PM Hi John It looked like this page was missing from the previous email. Thank you, Pa4e4 VM" Prior Environmental Services Lead Paint Testing and Training Offices in Mansfield and Mashpee Serving Southeastern Massachusetts, Cape Cod and the Islands 95 River Rd, Mashpee, MA 02649 PHONE: (508) 963-2323 FAX: (508)796-2322 J Town of Barnstable P# 0¢15W �y'. �►•� Department of Regulatory Services y. M,A M : Public Health Division Date 1439 200 Main Street,Hyannis MA 02601 /spy a-- Date Scheduled_ Time Fee Pd. Soil Suitability Assessment for Sewage Disposal Performed By: %, ��y� Witnessed By:jX6 00/ � Location Address LOCATION& GENERAL INFORMATION 3 9 A/4 f lee Owner's Name /,{f/GL/ G'v�,✓�y n l y t Address 94blco/ h h1/1—LS, A Y lO ✓-0/ Assessor's Map/Parcel: �� 2 / P/��� O Z Engineer's Name, D D}�—6' /1 SSo Cl 7CS NEW CONSTRUCTION REPAIR VZ Telephone# -51�0,? 3 Land Use Jl t/YL E y xg- Q, Slopes(%) IA2 Z, Surface Stones N *—ft Distances from: Open Wa[er Body ©® ft Possible WcLArea D Qft Drinking Water Well Drainage Way�ft Property Line 2 0 ft Other ft SIMTCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) %Seq D o 2- — � - -- - - T?-/ N e w Parent material(geologic) SWA1,A Depth to Bedrock AldAl f' Depth to Groundwater. Standing Water in Hole: /1/ Weeping from Pit Face &0 Al--- Estimated Seasonal High Groundwater �LY� %�1 PeA DETERMINATION FOR SEASONAL'HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: _ In. Depth to soil mottles: ►n, Depth to weeping from side of obs.hole: in, Groundwater Adjustment __ _.� _ ft. Index Welt# Reading Date: Index Well level Adj.factor_ Adj,Groundwater Level PERCOLATION TEST butt 23/-3rime /o•4-1 Observation ' Hole# 7P" Time at 4"%D.'' / 'o 3 ► Depth of Perc Z�! Y-7 Time at 6"/0:2 5,1/✓U Start Pre-soak Time @ /fir d3:O D Time(911•6") End Pre-soak Rate Min./Inch Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the. Barnstable Conservation Division at least one(1) week prior to beginning. Q:\SEPTI0PERCFORM.D0C DlEEP.OBSERVATION HOLE LOG Mole# .TP-/ Depth from Soil Horizon Soil Texture .Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Stnucture,Stones,Boulders. onsistency.%Gravell Q`'- 7'' /� 9�y LD/,�iv/ 2,sy� �/.3 ��206 r_r 129`-120 c ,✓,0` S7A '�� DEEP OBSERVATION HOLE LOG Hole# 2- Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,% rav _/23` coA 2 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stories,Boulders, Consistency. .r Flood Insurance Rate Man: Above 500 year flood boundary No_ Yes. t Within 500 year boundary No Y Yes Within 100 year flood boundary No.—.I Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? yrss If not,what is the depth of naturally occurring pervious material? __�_�_ Certification I certify that on (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with . the required trai 'ng,expertise and experience described in�10 CMR 15.017. Signature Date Q:\sL4P-nCNPERCFORM.DOC r JOHN T.REGAN 80 KEARSAGE P.O. BOX 82 WEST HYANNISPORT,MA 979-595-6171 jregan@arch.tamu.edu 22 October 2014 Timothy B. O'Connell, R.S. Health Inspector Town of Barnstable 200 Main Street Hyannis, MA 02601 Dear Mr. O'Connell Regarding the de-leading of the house that I own at 39 Pond View Lane, Centerville, MA, at our meeting on 09 October 2014 1 delivered all documents required necessary to certify that the de-leading of this house has been completed. Prior Environmental Services certified compliance with the lead-free requirements as noted in their report I submitted to you at our 09 October 2014 meeting. A copy of this certification, dated 09 October 2014, is attached. During our meeting you noted that the Prior report seemed to complete my requirements'to resolve the code violations, but that you would contact State authorities to make certain that no additional action on my part was required. I appreciate your thoroughness in resolving this matter. To date, I have not been informed that there are additional de-leading requirements, so I assume that the property is in compliance with the codes regarding lead. As you know, I received a letter on 04 August 2014 from Thomas A. McKean, R.S., CHO, Director of Public Health for the Town of Barnstable, copy attached, indicating that the house at 39 Pond View was in violation of the State Sanitary Code and the Lead Law. His letter outlined the steps to be taken to resolve these problems and the need to "obtain a Letter of Full Compliance..." after the code violations were corrected. For my records, I request a "Letter of Full Compliance" from the Public Health Division of the Town of Barnstable indicating that the house at 39 Pond View is in compliance with both the State Sanitary Code and the Lead Law. Thank you again for your careful guidance on this issue. Regards, h JnRegan Regan Mr. Thomas A. McKean, Director of Public Health ATTACHMENTS i � Y PRI.GR' Environmental Services Serving Southeastern Massachusetts, Cape Cod and the Isllands 95 River Rd, Mashpee, MA 02649 Phone: (508) 963-2323 Fax: (508) 796-2322 LETTER OF FULL DELEADING COMPLIANCE John T Regan PO Box 82 West Hyannisport, MA 02672 Dear John T Regan: This letter is to certify that on 10/06/14 I re-inspected your property located at 39 Pond View Dr,Unit None,and relevant interior and exterior common areas, in the City/Town of Centerville. On that date,those surfaces cited in the initial inspection report by Paula Prior conducted on 08/06/14 as being in violation of Massachusetts General Laws,Chapter 111, Section 197,and 105 CMR 460.000: Regulations for Lead Poisoning Prevention and Control,were determined to be in current compliance with those same laws. Dust samples were taken and found to be within acceptable limits. Massachusetts law does not require the abatement or containment of all residential lead paint. The residential premises or dwelling unit and relevant common areas shall remain in compliance with the requirements of the Lead Laws referenced above only as long as there continues to be no peeling, chipping or flaking lead paint or other accessible leaded materials as long as coverings and/or encapsulants forming an effective barrier over such paint or other leaded materials remain in place and as long as surfaces reversed to correct lead hazards remain reversed and securely in place The law grants you a 30-day maintenance period to repair deteriorated lead paint or detached coverings over such paint,and to clean up,during which time this Letter remains valid.. The second page or reverse side of this letter indentifies the authorized person(s)who performed deleading on the property and a general summary of the methods used to achieve compliance with the Lead Laws. A complete Reinspection Report is attached to this letter,which specifies how and on what date each surface was brought into compliance. To the best of my knowledge,the cost of the legally required deleading is$10,500.00. The CLPPP authorized serial number for this Letter of Full Deleading Compliance is 45463985100914-39. This number is tracked and unique to this address and unit. DO NOT LOSE THESE DOCUMENTS. If The documents are lost you will be required to have additional private inspector services that may cost you significant amounts of money.This Letter of Full Deleading Compliance is only for the address and unit noted above. If you change the street address, unit number or any other identifying information pertaining to the residential premises referred to in this Letter of Full Deleading Compliance,this Compliance Letter may be considered null and void by the Department of Public Health and/or a municipal health office. Do not alter this document in any way.Altering this document is fraudulent and may endanger the health and safety of a child which may result in significant legal consequences. In addition to any potential civil liability which may arise as the result of the alteration of this Letter of Compliance,the Massachusetts Department of Public Health's Childhood Lead Poisoning Prevention program may seek criminal prosecution of any person who alters this document after it is originally issued. Sincerely, , Paula Priot✓ f�( 3985 10/09/14 Inspector License# Date Questions?Call the Department of Public Health at 1-800-532-9571. DO NOT LOSE THESE DOCUMENTS L0FDC--rev01i12 Page 1 of ADDRESS: 39 Pond View Dr,Centerville, MA 02632 Serial Number: 45463985100914-39 Inspection and Deleading History Comprehensive Initial Inspection done on 08/06/14 by Paula Prior License#: 3985 Reoccupancy Reinspection, if needed,done on by License#: Final Deleading Reinspection done on 10/06/14 by Paula Prior License#: 3985 Deleading Contractor John P Lyons License#: © DC 001912 Exp.Date 08/06/15 ❑ DS Deleading Methods: ❑ Scraping ❑ Demolition ❑ Power Sanding ❑ Caustics ❑ Heat Gun ❑x Replacement O Covering O Making Intact ❑ Liquid Encapsulation ❑ Other Work was done in the following rooms: See Report Work was done on the following components: See Report Start Date: 09/23/14 Finish Date: 10/01/14 Cost: $10,500.00 Authorization# MR- RRP w/additional Moderate Risk Training Issuance Date: Authorization# -❑OM ❑AM Moderate Risk Deleader(owner/agent) Issuance Date: Deleading Methods: ❑ Replacement ❑ Making Intact(interior) ❑ Capping Baseboards ❑ Covering ❑ Making Intact(exterior) ❑ Liquid Encapsulation Work was done in the following rooms: Work was done on the following components: Start Date: Finish Date: Cost: Low Risk Deleader(owner/agent) Authorization# - ❑ OL ❑ AL Issuance Date: ❑ OE ❑ AE ❑ OB ❑ AB Deleading Methods: ❑ Covering ❑ Liquid Encapsulation ❑ Capping Baseboards ❑ Replacement (ONLY doors,cabinet doors,shutters,shelves not affixed,drawers,windows on hinges) Work was done in the following rooms: Work was done on the following components: Start Date: Finish Date: Cost: LOFDC—rev 01/12 Page 2 of 2 SNE Town of Barnstable Barnstable T�Y,�, Regulatory Services Department "' g Public Health Division 039. �. 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F. Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL #7012 1010 0000 2850 9149 May 28, 2013 William Gurney 64 Davids Way Bedford Hills, NY10507 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 39 Pond View Drive, Centerville, MA was last inspected on 4/24/2013 by Shawn Mcelroy, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails" under the guidelines of the 1995 TITLE 5 (310 CMR 15.00) due to the following: • Blocks in the cesspool were corroded and falling. • Stain lines above outlet invert in cesspool. You are ordered to repair or replace the septic system within sixty (60) days i 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 BOARD OF HEALTH Tho as McKean, R.S. CHO Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures or Future Eval\39 Pond View Rd Cent May 2013.doc A Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 39 Pond View Dr Property Address William Gurney Owner Owner's Name information is required for every Centerville MA 02632 4-24-13 page. City/Town State Zip Code Date 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. A. General Information 1. Inspector: Shawn Mcelroy Name of Inspector Upper Cape Septic Services Company Name 10 Victors Ln Company Address E. Falmouth MA 02536 City/Town State Zip Code 1-508-495-0905 S13971 Telephone Number License Number 1 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. -Tbe in�*Ction was performed based on my training and experience in the proper function and maintenance of gsite sewage disposal systems. I am a DEP approved system inspector pursuant to Sectiolt- 5.3Sof Title 5 (310 CMR 16.000).The system: ❑ Passes ❑ Conditionally Passes ® Fails ❑ Needs Further Evaluation by the Local Approving Authority 4-24-13 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-3f13 Title 5 Official Inspect' F :Subsurface Sewage Disposal System e 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 39 Pond View Dr Property Address William Gurney Owner Owner's Name information is required for every Centerville MA 02632 4-24-13 page. Cityfrown 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: t 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 (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 r 39 Pond View Dr Property Address William Gurney Owner Owner's Name information is required for every Centerville MA 02632 4-24-13 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): i ❑ 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): 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. 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 Title 5 Official Inspection Form "s Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 39 Pond View Dr Property Address William Gurney Owner Owner's Name information is required for every Centerville MA 02632 4-24-13 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, 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 99 P ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool 99 P ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y2 day flow t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 39 Pond View Dr Property Address William Gurney Owner Owner's Name information is required for every Centerville MA 02632 4-24-13 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 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M s 39 Pond View Dr Property Address William Gurney Owner Owner's Name information is required for every Centerville MA 02632 4-24-13 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 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, 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): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 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 „ 39 Pond View Dr Property Address William Gurney Owner Owner's Name information is required for every Centerville MA 02632 4-24-13 page. Cfty/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 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 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: 4-2013 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-3113 Tide 5 Official Inspection Form:Subsurface Sewage Disposal p g System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official- Inspection -Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 39 Pond View Dr Property Address William Gurney Owner Owner's Name information is required for every Centerville MA 02632 4-24-13 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: N/A 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): Cesspool with leach line. t5ins-3113 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 39 Pond View Dr Property Address William Gurney Owner Owner's Name information is required for every Centerville MA 02632 4-24-13 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: 1970's Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: See Comments feet Material of construction: ® cast iron ❑ 40 PVC Orangeburg ® other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Sewer line is at 12" at house, and drops to 72" at cesspool. Septic Tank(locate on site plan): Depth below grade: See Cesspool page 13 feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ 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: Sludge depth: t5ins-3113 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form e Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 39 Pond View Dr Property Address William Gurney Owner Owner's Name information is required for every Centerville MA 02632 4-24-13 page. City/Town 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 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 How were dimensions determined? 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 39 Pond View Dr Property Address William Gurney Owner Owner's Name information is required for every Centerville MA 02632 4-24-13 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 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 39 Pond View Dr Property Address William Gurney Owner Owner's Name information is required for every Centerville MA 02632 4-24-13 page. CitylTown 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 N/A Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): 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-W3 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments . M 39 Pond View Dr Property Address William Gurney Owner Owner's Name information is required for,every Centerville MA 02632 4-24-13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ® leaching trenches number, length: 1-20' ❑ 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.): Leach line out of cesspool has stain lines above the oulet invert in the cesspool. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration 1 Depth—top of liquid to inlet invert N/A Depth of solids layer N/A Depth of scum layer N/A Dimensions of cesspool 6x6 Materials of construction Block 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 39 Pond View Dr Property Address William Gurney Owner Owner's Name information is required for every Centerville MA 02632 4-24-13 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.): Cesspool was empty at inspection. Blocks in the tank were corroded and falling. Stain line above outlet invert for the leach line going out. 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 Title 5 Official Inspection Form t Subsurface Sewage Disposal System Form -Not for Voluntary Assessments „ 39 Pond View Dr Property Address William Gurney Owner Owner's Name information is required for every Centerville MA 02632 4-24-13 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 Nf t � S A _ rB�-C M j t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ' M '~ 39 Pond View Dr Property Address William Gurney Owner Owner's Name information is required for every Centerville MA 02632 4-24-13 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: 20 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 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: USGS and town maps show groundwater at greater than 20'. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 39 Pond View Dr Property Address William Gurney Owner Owner's Name information is required for every Centerville MA 02632 4-24-13 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-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 ' i Y Fee No. �THE COMMONWEALTHEntered in computer: OF,MASSACHUSETTS p Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS applitation for )Disposal *pstem Construction Vermit Application for a Permit to Construct( ) Repair( ) Upgrade ) Abandon( ) 'Complete System ❑Individual Components Location Addr �ViE Owq�G'�N '� der 1.No. Assessor's or's Map/Parcel le&9,A 2 2 9 �i9�C• 2,0 GGff// h`�" Cs`!/ % \ Installer's Name,Address,and Tel.No. 'Z?Y­&1%SjX f Designer's Name,A dress,and Tel.No. � ��J( �� Z >G LoEE��/��.D Gt/As E- G/y!Q tJ Type of Building: Dwelling No.of Bedrooms „3 Lot Size A 7So sq.$. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures / Design Flow(min.required) 33 a gpd Design flow provided gpd Plan Date 5 2—Ar- Z3 Number of sheets Revision Date Title S EW4�Syf Size of Septic Tank /SQQ j5;,YL Ln/✓ Type of S.A.S. z �•e�i✓C�J4�S Q/' �,�C' ?� TS Description of Soil ®`l— " 5�3-r✓.O y G o rdI �=Z "GD/111 y.S yt/� 2?-'140 1 6g4, /✓d Nature of Repairs or Alterations(Answer when applicable) f 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 Bo of Healt Signed Date Application Approved by ��1'` 1����� 5 Date a Application Disapproved by Date for the following reasons Permit No. aO 13 Date Issued -6 - 1A i 4 No. I t -1 t , r Fee f :i � 'c THE'COMMONWEALa ,O aVIASSACHUSETTS Entered in computer: Y es PUBLIC.HEAL`IrN"D*ISIbN -TOWWOFIBARNSTABLE, MASSACHUSETTS Application for ]Dispos414pstrm Construction Permit Application for a Permit to Const�r•-uct Repair Upgrade /4andon VCom lete System Individual Components J Location Address or Lot No r O er's N e die s and Tel.No. 3 �`'.c�. 'ob"r�,�2N�-y Assessor's Map/Parcel ll)lq 2 Z 9 I-OAR '" 2 D i Installer's Name,Address,and Tel.Noti 7 Designer's Name,Address,and Tel.No. So J,,JjDyL E Associ, 7-e-5 l 'Pf 6)t /72 Z !45 L4oe,62&vola Cl-o c--,e 164,o M,41 z5. Z_1n6 v Type of Building: Dwelling No.of Bedrooms 3 Lot Size ��, 7 sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria•( ) Other Fixtures Design Flow(min.required) 330 gpd Design flow provided 3 gpd Plan Date 5 2-S- �3 Number of sheets �h. _ . ,�. •, Revision Date Title SL--�!/.� :,;5 1T 1��12i9,0 /�L.¢/✓ a/.? r Size of Septic Tank /_SQZ) �4L4=4 Al Type of S.A.S. Z Description of Soil `r- J i✓J/y G O i9 r�'I 7�=-Z P G a�ii ...52A-A/,r, 29=j 4o`4a. ,ex F SItND r t Nature of Repairs or Alterations(Answer when applicable) ( l I 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 Healt Signed Date Jr i Application Approved by 1�l Q/In_��,(_ 5 Date Application Disapproved by Date I for the following reasons Permit No. �D -J '�� 3 Date Issued �.. m THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance X THIS IS TO CE Y,that the On-site Sewage Disposal syst m Constructed( ) Repaired( ) Upgraded(Abandoned at N'j� ! n has been consttlicted in accordance I with the provisions of Title 5 and the for Disposal Stem Construction Permit No. dated Installer Designer #bedrooms Approved design flow h / gpd �t i The issuance this pe it shall not be construed as a guarantee that the system tiction as designbY Date Inspector ` -- - -- - --<--- ---- --------------------- -------------------------------------------------------- No. Fee r THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Disposal 6pstem Coustruction Permit Permission is hereby granted to Construct( ) Repair( t.�' Upgrade( )\ Abandon( ) System located at 31 PYl�l_!%!d�� j�/eUiC �P✓[�!_ /��- il 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. I Provided:Construction must be completed within three years of the date of this permit. Date M Approved by Town of Barnstable Regulatory Services . St, Thomas F. Geiler,Director BARMABL& Public Health Division MAM .`� Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Date: �U/✓� /� ZO/.3 Sewage Permit#2/3-/q3 Assessor's Map/Parcel Installer&Designer Certification Form Designer: Installer: Address: 17P GG®IIW14- D IZOY Address: _70 409A 9tl=-, tW449,, ^A- 0240M On -'"Z 9'�3 ������ ' Gad yT� was issued a permit to install a (date) (installer) septic system at 3 q /9DIV-0 111iW -OX IVX — reV7/ based on a design drawn by (address) .T.l oyG.,!!�- l p- acl f dated (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Stripout (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State& Local Regulations. Plan revision or certified as-built by designer to follow. Stripout(if required) was inspected and the soils were found satisfactory. _ , or fxI � q n ( staller's Signature) ra ME°.'Erb No. 1140 Jib. (Designer's Signature) (Affix, Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. gAoffice formsWesignercertification form.doc s oi�s T S T R.E 7- AIM FG DOR ,E•G ®8 /Ns7"AL G 5�"�1 Pt/c //ySi'EC7%ov p03e7- 72> MIMA/ 3' F/N- GYIU-0 E TP-/ 7f0 RISER 5�eAI,4a E SYSTEM f'�C'�3F/L.E O//E PER TRE.Vc171 If9 � ��.3 11.3° ©' �AM/ TO W/TN/N 6"fiN. G,p. 14 2...5Y"'�' �.� v 2,•y"'yR /3 . 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PRODUCT DETAIL MAY DIFFER SLIGHTLY FROM ACTUAL PRODUCT APPEARANCE. �I 4640 TRUEMAN BLVD LL4L� • HRLIARD, ONTO 43026 Are 36H C DETAIL a ADVMCM WMAGE SYSTEUS.mC. UNITS MUST BE STAMPED H-20 /. 00rt/7-.k'.9 CT©/F'' ZJ '*•30 32�•,,.7,S�T'D,'�Y9 S�/'�,,.�'��.k,/P�GLE?""d"C/sYO1y�/s'I�r9"T//o�rsc//i.�B�-�,L�.�'To-siy.i1'JEr'�©,-9s iBt/�ss,�/,�'i'�.•99i,�E U0AS b EG G C rlO,,, 1$l�71D-b--f AAZO /Y7 ,f/,9G S i //� Tfi1T/TL,E -' 7 N 4 -5, /iV4ET 2E,e 4T 1 - 4,' N72) TT /i4v .PT� �� A1- -1s72571 /y",2ri2 ,nT d 7/1l/G 7 7' \ o �. /,w ,g4c/�'F/•-G //1C -5 yY'4G Z- 59CCU,k' /l�4/, h 7D 11V,5;0EGT/©/I/ .-i/%/Z � c z:�X/,5 71/V 6 C 4 E✓1DlitT + ,r9/�/"/f'!31/i9L �y �/�� ,� Sr'G/11E ' /Q/✓Z� .B�f 1�%L'<S7/98G y��G Ts/ I.)�f T 3 //V 6 4; �•, ; ; e_ SE,Gt/AG E sysrEM IbOOiC40,5 0441t1 OKI 'Tf'2 �9� V Ds .�' Z2 9 f•9,PCEG 24 :OHN �y`� �'-. DA�iRE � 3 9 f' /'/.4 6/U4(/ Z)lel,4''16 3 ' 1H' __•' -- - 3' `/°1�r t '3 P.a DOYLE >tc;14 V7 � t o (�E R c� ,4h'/✓s/"�9BGE, /Nf,'. ►vo.33589 No. 1140 �S-e E: / ____ sd 5� 5`G'2p I'►/ Ise, oa' __ ER U 9 --------- l TAR` 00 4> 3 b G° v;.da�' ,yEsso T�s -5�8:5�'..3-/995'� /tea c�.o✓���i��� !�'A�'