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HomeMy WebLinkAbout0007 FERNWOOD AVENUE - Health 7 FERNWOOD AVENUE Hyannis A = 288 - 079 - 004 6 J i Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 7 Fernwood Avenue Property Address Thomas F. Lawlor Owner Owner's Name information is required for every Hyannis MA 02601 October 30, 2012 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. Important:When filling out forms A. General Information on the computer, use only the tab 1. Inspector: key to move your cursor-do not D wF h avid D. Coughanowr, R.S use the return . " a key. Name of Inspector Y _ Eco-Tech Environmental ICE Company Name t 43 Triangle Circle A"•,' '3 Company Address Sandwich MA `02563 `? City/Town State Zip Code •• 508 364-0894 1328 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 16.340 of Title 5(310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority t \ October 30, 2012 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•11/10 Title 5 Official Inspe io rm:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 7 Fernwood Avenue Property Address Thomas F. Lawlor Owner Owner's Name information is required for every Hyannis MA 02601 October 30, 2012 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: Inspector's Note==> The septic system described herein is deemed to pass this Real Estate Transfer Inspection if it does not meet any of the failure criteria enumerated in Section D on pages 4-5. The scope of this inspection is limited to health and environmental compliance and the septic system has been evaluated according to the conditions observed on the day it was inspected. No estimate or guarantee of system longevity is made or implied by a passing determination. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•11/10 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 a' 7 Fernwood Avenue Property Address Thomas F. Lawlor I Owner Owner's Name information is required for every Hyannis MA 02601 October 30, 2012 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh l5ins'•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 9 1 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 7 Fernwood Avenue Property Address Thomas F. Lawlor Owner Owner's Name information is required for every Hyannis MA 02601 October 30, 2012 _ page. Cityrrown 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: Youl must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/z day flow t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 7 Fernwood Avenue Property Address Thomas F. Lawlor Owner Owner's Name information is required for every Hyannis MA 02601 October 30, 2012 page. Cityrrown 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•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °^M 7 Fernwood Avenue Property Address Thomas F. Lawlor Owner Owner's Name information is required for every Hyannis MA 02601 October 30, 2012 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 gpd t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 I - . Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 7 Fernwood Avenue Property Address Thomas F. Lawlor Owner Owner's Name information is required for every Hyannis MA 02601 October 30, 2012 page. Cityrrown 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? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ® Yes ❑ No Water meter readings, if available (last 2 years usage (gpd)): 28 gpd Detail: 2010, 2011 Sump pump? ❑ Yes ® No Last date of occupancy: 2 weeks agoDate 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-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 7 Fernwood Avenue Property Address Thomas F. Lawlor Owner Owner's Name information is required for every Hyannis MA 02601 October 30, 2012 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: owner's agent 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-1 Ill 0 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts M W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 4M , 7 Fernwood Avenue Property Address Thomas F. Lawlor Owner Owner's Name information is required for every Hyannis MA 02601 October 30, 2012 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: Age: 28 years (As built card on file at Health Department indicates system was installed in 1984). Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2 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.): Sewer line appears structurally sound with no evidence of leakage or backup into dwelling. Septic Tank(locate on site plan): Depth below grade: 1 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: 8.5 x 5 x 6- 1000 gallon tank Sludge depth: 6 in t5ins•11110: Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 7 Fernwood Avenue Property Address Thomas F. Lawlor Owner Owner's Name information is required for every Hyannis MA 02601 October 30, 2012 _ page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 28 in Scum thickness none Distance from top of scum to top of outlet tee or baffle 10 in Distance from bottom of scum to bottom of outlet tee or baffle 14 in How were dimensions determined? Previous inspection report Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pumping is not required at this time. Maintenance pumping is recommended within 2 years and every 2-4 years thereafter. Tank and tees appear structurally sound and functioning as intended. 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-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 7 Fernwood Avenue Property Address Thomas F. Lawlor Owner Owner's Name information is Hyannis MA 02601 October 30, 2012 required for every page. Cityrrown 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-11/10 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 7 Fernwood Avenue Property Address Thomas F. Lawlor Owner Owner's Name information is required for every Hyannis MA 02601 October 30, 2012 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert at 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.): D-box appears structurally sound with no evidence of leakage in or out. Some solids in sump. 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.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 7 Fernwood Avenue Property Address Thomas F. Lawlor Owner Owner's Name information is required for every Hyannis MA 02601 October 30, 2012 page. City/Town 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.): Soils above leaching pit appear unsaturated. No evidence of surface ponding, breakout, lush vegetation, or other evidence of hydraulic failure was observed. A bucket of water was poured into the distribution box and was observed to pass through in a rapid and unobstructed manner, and could be heard splashing down loudly into the leach pit. 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 7 Fernwood Avenue Property Address Thomas F. Lawlor Owner Owner's Name information is required for every Hyannis MA 02601 October 30, 2012 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 > Commonwealth of,Massa�.chus.etts x u, Title 5 Official Inspectii ®rm'- Susurfa:ce Sewage Disposaf:System'Form- Not forVoluntary..Assess�ments _ I 7 Fernwood,AVe' nue, Property Addre"s's; I: Thomas F:.Lawlor Owner Owner's Name_ Information-is - H arinis w ._ _ MA% 02601_ October`30; 2012�egwred:for every - - page: C.Ity/Town. r. State�F Zip Cotl.e: Date of inspection, D Syste:m Informat>ton (cont.) Sketch Of Sewage Disposal System: Provide a:�iew of,ttie sewage disposal system, including ties fog at least.two permanent referenceaandmarks or benchmarks Locate:all wells within 1+00 fe't;'Locate where p4. c�water supply enters the building Check one of7the boxes,below: hand sketch in the jar-pa'.below drawing attached separately„^ ., y` `FZC W D o l5ins 11110.' Title 50fficial Inspection Form:Su6surfaee,Sewage Disposal System•'Pago 15 of 1.T Commonwealth of Massachusetts W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 7 Fernwood Avenue Property Address Thomas F. Lawlor Owner Owner's Name information is required for every Hyannis MA 02601 October 30, 2012 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: Previous inspection report of 10/12/95 ❑ Checked with local excavators, installers-(attach documentation) ® Accessed USGS database -explain: Barnstable GIS Department records You must describe how you established the high ground water elevation: Previous inspection report indicates high groundwater is more than 14 feet below the surface. Town of Barnstable GIS Department records indicate that the property is over 20 feet above groundwater table. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 7 Fernwood Avenue Property Address Thomas F. Lawlor Owner Owner's Name information is Hyannis MA 02601 October 30, 2012 required for every page. Cityrrown 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 TROY WILLIAMS SEPTIC INSPECTIONS Certified by MA Department of Environmental Protection (508) 760-1819 40 Old Bass River Road South Dennis,MA 02660 Con nnomeatth Of Massachusetts LOU JAL Executive Office of Envton mental Affaks Department of • Environmental Protection RCf� %'Aa W*W Oor 1 o Ow ffWMWStuhW a a� SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A e /^� CERTIFICATION s' Pr FP�✓✓1 (,Jnc /7'!ti �—��wr... SP s/ C d( W � �Y Address: Address of Owner. u-✓ Date of Inspection; /O 1a2 �j$ Of different) S Name of Inspector. r0 y w Company Name,Address anA Telephone Number: CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of inspection.-The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: asses _ Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signature: Date:' The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,'the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority. INSPECTION SUMMARY: Check A, B, C,or D: Al SYSTEM PASSES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. 81 SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system, upon'completion of the replacement or repair, passes inspection. Indicate yes, no, or not determined (Y, N,or ND). Describe basis of determination in all Instances. If'not determined', explain why not) The septic tank is metal,cracked, structurally unsound, shows substantial infiltration or exfihration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised I/iS/11S) 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 2 ('L✓rnwpo� Owner: job.rw C4 Date of Inspection: B) SYSTEM CONDITIONALLY PASSES (continued) Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are re i s laced P p obstruction is removed C) FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The cvstem nas a septic tank ano soil absorption system and is within 100 feet to a surface water supply or tributary, to a surface water supply. The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 PPm. D) SYSTEM FAILS: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. revised 8/15/95) 2 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 7 Fe h,o o Owner: p o ✓ A Date of Inspection: /o D] SYSTEM FAILS (continued): Static liquid level in the distribution box above outlet invert due to an overloaded or dogged SAS or cesspool. Liquid depth in cesspool is less than 6' below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to dogged or obstructed pipe(s). Number of times pumped Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of.a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E] LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria above: The design flow of system is 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area (IWPA) or a mapped Zone 11 of a public water supply well) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program ,equirements of 314 CMR 5.00 and 1.00. Please consult the local regional office of the Department for further information. (revised 8/15/95) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 7 Fe✓h &J a J Owner: �0.✓K CA y Date of Inspection: Check if the following have been done: Pumping information was requested of the owner, occupant, and Board of Health. None of the system components have been pumped for 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. ZAs built plans have been obtained and examined. Note if they are not available with N/A. The facility or dwelling was inspected for signs of sewage back-up. V The system does not receive non-sanitary or industrial waste flow ✓The site was inspected for signs of breakout. — g ✓AII system components, excluding the Soil Absorption System, have been located on the site. ZThe 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. I/The size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. , The facility ownp• land occupants. if different from owner) were provided with information on the proper maintenance of Sub- Surface Disposal System. (revised 8/15/95) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 7 Fe,K w oo e) Owner: r a CA Date of Inspection: /9 f FLOW CONDITIONS RESIDENTIAL: Design flow:33 6 gallons Number of bedrooms: 3 O Number of current residents: Garbage grinder (yes or no):IV6 Laundry connected to system (yes or no): YF S Seasonal use (yes or no):%/E 5 Water meter readings, if available: 4 y (7Si0oG c A f . Last date of occupancy: COMMERCIAUINDUSTRIAL: /Jli9 Type of establishment: Design flow: aallons/day Grease trap present: (yes or no)_ industrial Waste.Holding Tank present: (yes or no)_ Non-sanitary waste discharged to the Title S system: (yes or no)_ Water meter readings, if available: _ast date of occupancy: OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: Is/v ,OJ ham, p,�s i.1 1`� "a,1G I -,-L�/< cx4 13a.it.ssou ��� l✓e a fr.t t /�%�..r 7` System pumped gas pan of inspection: (yes or no),�V* If yes, volume pumped. fallons Reason for pumping: TYPE O 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) Other (explain) APPROXIMATE AGE of all components, date installed (if known) and source of information: 12d.- - 6 ., 1+ C..+ 13c�✓K5 4.2"b 1< 9.0-l1' Sewage odors detected when arriving at the site: (yes or no) � (revised 8/15/95) S SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 7 /"errn Wv o -A Owner: Date of Inspection: SEPTIC TANK:, (locate on site plan) Depth below grade: / Material of construction: ✓concrete _metal _FRP —other(explain) — /oo o Dimensions:_ Sludge depth: S " Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: ly „ Distance from top of scum to top of outlet tee or baffle: G " Distance from bottom of scum to bottom of outlet tee or baffle: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, de th of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) e 1 r �-,� fi« s ✓ha be %�. ..i o r!�; K o L✓. /y ca S .� O ����y��S 1, O Yam' 6—NLl 4 S t GREASE TRAP:I-1,1fI (locate on site plan) Depth below grade: Material of construction: _concrete _metal _FRP —other(explain) Dimensions: "cum thickness: Distance from top of scum to top of outlet tee or baffle: ni<_tance from bottom r�i .,rfim f- honor++ of ou!tp! tee or banie 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, et(-) ,revised 6/15/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Pr -Property Address: 7 F<.-h .� o cJl Owner: Py ra C Date of Inspection: y TIGHT OR HOLDING TANK:_N/, (locate on site plan) Depth below grade: material of construction: _concrete _metal_FRP other(explain) Dimensions: Capacity: gallons Design flow: Qallons/day Alarm level: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX: locate on site plan) Depth of liquid level above outlet invert: Comments: ,note if level and distribution is equal evidence of solids car ,over, evidence of leakage into or out of box, etc.) Z/— J Wu tvG hc� 1 6 h �' h o C✓ S i ✓ 1_41-u c, is PUMP CHAMBER:- /� (locate on site plan) Pumps in working order.(yes or no) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) irevised 8/15/95) 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 7 «n tj o o ut Owner: Date of Inspection: SOIL ABSORPTION SYSTEM(SAS):_Z (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: leaching pits, number:vti G �JC6 LGc.. 1, .�- w .2 leaching chambers, number:_ leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,etc.) S o: -'4v /VO K//�o 6 f L✓ti C �n � G.-.c �. 1 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, 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.) ,revised 8/15/95) 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 7 Fr,*-h Owner. Date of Inspection: �°''� "� �- /d/ram/�S SKETCH OF SEWAGE DISPOSAL SYSTEM: indude ties to at least two permanent references landmarks or benchmarks locate all wells within 100' i a� 3� 106 • 3b , 000, 3 4� y°� W oZ'S �►,� DEPTH TO GROUNDWATER Depth to groundwater: r feet adjusted high groundwater level method of determination or approximation: 1 X✓ g--` — (revised 8/15/95) 9 I ` TOWN OF BARNSTABLE L--OCATION SEWAGE# 05Y c/ �'II:LAGE k k �. s ✓Ja��' ASSESSOR'S MAP&LOTOY-07?" INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 6 y I- LEACHING FACILITY: (type) (size) k6 NO.OF BEDROOMS BUILDER OR OWNER PERMIT DATE: COMPLIANCE DATE: Y 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) Feet Furnished by r �` > r Rt E • s W.0 P F r a� (10-ra � L 0 C AT ION S E W A G E PERMIT NO. VILLAGE INSTA LLER'S NAME A ADDRESS R U I L D E R OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED r �'� � .:r. �� a � , v � ��. `� �. 0 1 /<46 Finc 54r............... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEZALT ............. ........OF.................t,0.000 ........ ............ .............. Ippli-r- a t-i ou for Disposal Work Tonstrurtion Vrrmit Application is hereby made for a Permit to Construct or Repair an Indi i Sewage Disposal Indi7 System at* ......... .... ... ......... ............... ............................... Location-AddressY o,' t NP. "loor— '_00e . .... ...... .. ..................... • .......... .............. ... ... ..;�V ....... 2=er Addr 0 ess '00 ........... ier ...........----------------- Install er Address Type of Building Size Lot.........174. U .Z' .............. 7------ -,-..Sq. feet Dwelling—No. of Bedrooms................... Expansion Attic Garbage Grinder Other—Type of Building -----....................... No. of persons--...................--..... Showers Cafeteria Otherfixtures ..................................................................................................................................................... Design Flow............................................gallons per person per day. Total daily flow......... 7,74................gallons. 1:4 Septic Tank—Liquid capacity/000.gallons Length................ Width------.--------- Diameter................ Depth................ Disposal Trench—No. .................... Width.................... Total Length..............._.... Total leaching area.. Z20-01,1--sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet........_......._... Total leaching area..................sq. f t. Z Other Distribution box ( ) Dosing tank ( ) 'A _7 I Percolation Test Res is r fPerformed by..............CjC-.r..C......................................... Date...... ...4r.ej.. 1-4 Test Pit No. U�&_4/_.Jfnioes per inch Depth of Test Pit.................... Depth to groundter........................ 1:14 Test Pit No.e�. ....... .6 Kin"t s per inch Depth of Test Pit.................... Depth to ground water........................ .. 0 . .. .... ....I............................................. ............................................................ 0 -Description of Soil 6--- -----_--- ..... ---------------------------------------------------------- \FJ W -----X;.....................------------------------------------------------ ---------------*------------ --------------4., ....................................................... ---------------------------------------.......................................................................................... 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 TlTlZj 5 of the State Sanitary Code—The.YD-Noersigned-further agree, to place the syste in 70 h�#h. /n operation uRti�a Certifi e of s been issu 5R17e bo�*pliance 1�a ..... ... ......... --- --------- --------- ........ .. ............. ..... .... ate ,e Appi cation Approved y-------------­----- --- ---- ---- ------ /.......... ............... ----- --- /V%/ Application Disapproved for the following reasons:................................................................................................ .............. ..................................................................................................................... ............................................................................. Date PermitNo................................................... Issued....................................................... Date ----—------------------------------------------------ .-,t,�V y F��.......54................. ...�.. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALT ^-........:.. ...OF.................... ..-- ., Applirtation for R-4pos al Wor ,i Tnni .union Trait Application is hereby made for a Permit to Construct ( ) or Repair (` ) an In idual a Disposal System a • / Location.Adddr ss.01J No. •--•-- -.. r._-may..............G.- !--C- 4 ...._�/�'' .Ll. _....r.� .................rwl�� ..... - -- --- .................. / Owner Address Installer Address Type of Building Size feet U Dwelling—No. of Bedrooms------------------ - -__--Expansion Attic ( ) Gartage Grinder ( ) Other—Type of Building No. of persons............................ Showers — Cafeteria Q' Other fixtures ____... ---- -- •---------•--•--------------- W Design Flow.............................:.....//_ .__ allons per person per day. Total daily flow____-__---7.;?.: ..............gallons. WSeptic Tank—Liquid capacitJeoCly allons Length................ Width_..._.._._...___ Diameter_______..___.... De tl ---------------- Disposal x Trench—No. .................... Width.................... Total Length.................... Total leaching area---Z7.4.-_____sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) ~ -----••----•--... Date.... ........... a Percolation Test Re lts Performed by________________________________•.__......._...._.._..___ ld �y a Test Pit No. ..minutes per inch Depth of Test Pit.................... Depth to ground water.__. (i Test Pit No. 2__ _. ._ ._minutes per inch Depth of Test Pit.................... Depth to ground water........................ ----------------- ... ••---•--•-•-------. ................................................................................................... Description of Soil .- U -•--------------------------•-•-•--•----------•---- --.---•-- •-----•----•-------------------•-••----------------...-•------------------- UW -------------------------------------•------------------------•--------••-•------------•-•----•----------------------------------------•------•--------•--••----------•-•-•---------------------------- 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 TITIE .5 of the State Sanitary Code—The un ersigned fu agrees to place the system in operationuntil a Certi. to of Go"mpliance 4as been issu oard ea s ned. .......... ? l. :: Ap licati`on p eed 13 y L ...... Cte to Application Disapproved for the following reasons:.............................................................................................................. ...................•---•-•--.........----••-----••-•-------------•------•--••--•--------•..........---- Date PermitNo......................................................... Issued--•----------------------•--------------•-------- ---------•--•----•......---•--•-_....Date THE°:COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF......................... ........ ................... Trtifiratr of TompliFanrr THIS IS TO C��Y Th the Indi ' al Sew�e Disposal System constructed ( ) or Repaired ( ) by-------------------- .-�......... ---------- rf• 1 f..C4t�.CE.:' ---...............------------------------.......--------....------------. ^' staller -- .'�� '?.,?tom. ..._. -. has been installed in accordance with the provisions of TITLE 5 of a State Sanitary Code as described in the application for Disposal Works Construction.Permit No y/._--,.!,a!/. ............. dated................................................ THE ISSUANCE.OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY.. DATE... .L,/----.-�� - ..... Inspector --------•---------------------------•-----•-•-----•-•-•--------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF............_..................._.........._..._..................................... No------------------- ---- FEE---•.S:Q-............. manrran�i '6 Permission is hereby ranted/ ...... .....SH.. .. to Construct ( rr Repair ( ) any"•I-ndividual Sewage Disposal stem • `�y� Street as shown on the application for Disposal Works Construction Permit Noii``f`hLy------- Dated...1 4................. Board of Health DATE................................................................................ FORM 1255 A. M. SULKIN, INC., BOSTON - , Y" v VIE Q'18 01 n3 T ,GZnj N Rl !L \ lol.�} /UDO GAL. \ SEP�!S M + 0 o!T y'uo ll r\ i o `� . . _ /. %✓ 7(? 8 Sri !�� '. .' ,boo•' Va � �0f f1�O F MA p � � naORSE vi Y ae 9 No.10951�0 LEGEND �. . EX19TIN.0 SPOT ELEVATION ORO T EXISTING CONTOUR --- ® =-_ �9` ;•: CERTIFIED PLO PLAN , . " .FINISHED SPOT ELEVATION t. ., � F, F1NO;SHED COhI'TOU.R 0 _. . °'��.. U r-°z� 1 " NOTE; `The location 'of any'- existing. undetgi-ound. sewerage, -- .wells, or other utilities shown on this plan is apyrox- IN ' mate."-only as determined from records and/or verbal A \, •�' � � a nformation.. The contractor is •responsible for the verification of the existing locations in. the field. SCALES ��- 4o ` DATE 1 ��% 4D-REDGE ENGINEERING Ca 861� �rc_i<vc<t s CLIENT.:.,____...__,_ I CERTIFY THAT THE PROPOSED EGISTERE RE41ST@RED JOB NO. 8,—,,,,�Z_�__. BUILDING SHOWN ON THIS PLAN ' �. CIVIL LAND CONFORMS TO THE ZONING. LAWS k DR BY ENO EER RV j O,f+ BARNSTABLE , MAS . 712 MAIN STREET CH. BY le � - HYANNIS : MASS. •1 2 !l � 8 �. - ' SHEET. OF ATE REG. LAND SURVEYOR /Y07E' /i &/7-HER THE.SFP77C TANK OR : aD F?. Ir IM. LgACN1/VG: P/T AN4F /►LORE TNA/V /2NBELoJ*v MAN GRA®F�A E4'O/AME7E-e CoNCR�FT� COPIER j /A fT SNAI.L BF <BRO&ON7' T® JTAAID.�AI✓ASr7AA t COKCRETE . 4 oYC PIPS ?1.E.4Yy CA ST /RON CO P/E:R S/s/�4 L L BE US�� k P/7GN /,=-/N DR/VE,kVa4 Y Y MIN. o .wE Co lYE/r CLEAN SAND BACk'F/L L. p 1/�tllD LEYFL •' � �. 4. wt$ - a LAYER , f . -. Pi=p ©a . a o ate' ' tl1l.P/TCf! GAL. ' . • • • e • •e • is ewe WASHED 5MVe IsrPT/C TANK. • a t t � • . +! BOX o • •. $ e r_ e •� � ,.•� • (. e e• • • .EFFECT/✓� • : i �i 314•- f2� • • • •• DEPTH • •• ' e .. WASNEO STONC l . s e o • e • e e•t1 lo •s r r p � • O t.t • e • • �• • . ;.. 7 0 i d� • •t • • e • •• • o •a r PREC/1.S T SE 4G ' G/Ty _ �¢B 6e�L/1J.4� • s �L: 3/• t n /NYERT AT ".1 DIN6 ' ? •BF7` /�.ATloiv� I.YG�r 007'4�&7 SEPTIC 'TA p N I� GROu/VD WATEIf T SEC?y'/® 0 A+.E T;. II LEA':t�rOCfTIA r .:®!7 oj-7 7 F� SAW : Ql.� s�;.��.� 'E/e'd. ?` '101VollgAWL . x NG i DESf6X CRpTFR/ NL1A�►e�dEe� ®Ir�,�®�9.5 3 C►o/yENS/O E3 4 `T. :��''J �; i_ TOrAk ESTY/ 'E® PLOdtI 3 3 o GAL O `ir SO l L.TEST A/ SO/L 7ZS / 2 ; X l��EeP QF '1ACHdAl P/? �F[E8/ 9 9 � .�1�Y, :OATS Off' SQIL TBS?` ��3 C � f'1LcNiviEw�cZ �' S/Di.t.EAGHIOJG PER fs/T, l8'� ®T s. R�SCi�.TS N!T/VG�S�'E® BY o =z g AWMCOd/lTIONbTw 0 LDS. >yi �d,rCx 60TTO/yt�.CNIAMG PER PIT -7s " Sq. ACT. cb �© Z(o h _> 3 c_ PEICCOdAT/O/V RA7,F ,°>s1 M1N.' INCff 4 . TO7A, I CH/NG.AR1=A .SQ vo S, y,p ! t: R, aEe�b�Ed sCl�dllvc�,l4i$ZA zbfi Sq FT. Z 4 At- r ORSE _ . Noz.10951 'O s b• =---/ NA I�f�vE�y� S s , '�r`�•� � v /1/lCKU4�4-S -t...: , $ .y ,. �:.a.. {, 4u!.L 1 ; ,:) •:..Si 7a .. I:I. l Yf ;.},.y .....,l s k-1 �"L Y- i - hh;..,A -_, -. .. w. _ f -...,_ :;" £ 5 4 e •y..t 'S-b .4:�...�,,.-,yr ., zMr ;l�Y� t ...-...�....,3x...:.-,_ T � ....., .r w. �-` _... d : ..•c. � , . s -�...,... .._..}.r,_,,,.,.. u,,.. _ ;�:A'!�a '�.-g: __st` r ..•+'.5 .:s,:f__3v ..,eta-t...v.' w.lt'.�'3z,.�.��`.,x,. �es��»'.z..o.x,.