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HomeMy WebLinkAbout0059 LEWIS POND ROAD - Health 59 LEWIS POND ROAD, COTUIT _ A= 020 022 Commonwealth of Massachusetts Oo2b Oa , Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;:''���� y< ,0 59 Lewis Pond Road Property Address Philip & Bethany Odence Owner �-+ Owner's Name information is required for every Cotuit ✓ Ma. 02635 02/02/ 16 page. City/Town State Zip Code Date of M&ection 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 11,V0- on the computer, use only the tab 1. Inspector: key to move your cursor-do not Michael T Bisienere use the return Name of Inspector key. Cape Septic Inspections �y Company Name 624 Old Barnstable Road Company Address r� Mashpee Ma. 02649 Cityrrown State Zip Code 508-280-3356 S13938 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal.systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 C M R 15.000). The system: ® Passes., ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 02/02/2016 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report'only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments I ,•�' 59 Lewis Pond Road Property Address Philip & Bethany Odence Owner Owners Name information is required for every Cotuit Ma. 02635 02/02/2016 page. Cityrrown State Zip Code Date of'tnspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 C_ MR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: This home has a H-10 1500 gallon septic tank a H-10 D-Box and two 500 gallon leaching chambers 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): 15ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments •''( 59 Lewis Pond Road Property Address Philip & Bethany Odence Owner Owners Name information is required for every COtUIt Ma. 02635 02/02/2016 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or breakout 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): El 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 El 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 a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 59 Lewis.Pond Road Property Address Philip & Bethany Odence Owner Owner's Name information is required for every COtUIt Ma: 02635 02/02/2016 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 ❑ ® 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 '/2 day flow t5ins•3113 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 °� ,•'' 59 Lewis Pond Road Property Address Philip & Bethany Odence Owner Owners Name information is required for every COtUIt Ma. 02635 02/02/2016 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. E ® 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 ❑ 0 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 s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 59 Lewis Pond Road Property Address Philip & Bethany Odence Owner Owners Name information is required for every Cotuit Ma. 02635 02/02/2016 page. Cityfrown 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-3113 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 59 Lewis Pond Road Property Address Philip & Bethany Odence Owner Owners Name information is COtUIt required for every Ma. 02635 02/02/2016 page. City/Town State Zip Code Date of Inspection D. System Information Description: f Number of current residents: 0 Does residence have a garbage grinder? . El Yes ® No Is laundry on,a separate sewage system? (Include laundry system inspection El Yes No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonaluse? ® Yes ❑ No Water meter readings, if available(last 2 years usage(gpd)): Detail: In 2015 17,000 gallons were used and in 2014 16,000 gallons were used I Sump pump?p ❑ Yes ® No Last date of occupancy: Fall 2015 Date' Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ ,Yes ❑ No Water meter`readings, if available: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,.•'` 59 Lewis Pond Road Property Address Philip & Bethany Odence Owner Owner's Name information is Cotuit Ma. 02635` 02/02/2016 required for every ' page. Cityfrown 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: 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 ❑ s 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 r ❑ :Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts. Title 5 Official Inspection Form Subsurface Sewage Disposal System.Form - Not for Voluntary Assessments ,•'' 59 Lewis Pond Road Property Address Philip & Bethany Odence Owner Owner's Name information is required for every Cotuit Ma. 02635 02/02/2016 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: 2001 plans from Barnstable Health Dept. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): `Depth below grade: 2811feet 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.): Septic Tank(locate on site plan): Depth below grade: 19"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: standard 1500 gallon 3„ Sludge depth: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 59 Lewis Pond Road Property Address r Philip & Bethany. Odence Owner Owner's Name information is required for every Cotuit Ma. 02635 02/02,12016 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 apx. 35" Scum thickness 1" Distance from top of scum to top of outlet tee or baffle apx. 5" Distance from bottom of scum to bottom of outlet tee or baffle _ap . 12" How were dimensions determined? sludge Judge Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): This home has an H-10 septic tank and should not be driven over. I would recommend the new owner put the tank on a maint. plan with a local septic pumping co. based on the future use of the home.The Barnstable Health Dept. has a list of local pumping Co 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 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments °�w ,•�'< 59 Lewis Pond Road Property Address Philip & Bethany Odence Owner Owner's Name information is required for every Cotuit Ma. 02635 02/02/2016 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 II t5ins•3/13 Title 5 Official Inspection Forth: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 •' 59 Lewis Pond Road Property Address Philip & Bethany Odence Owner Owner's Name information is required for every Cotuit Ma. 02635 02/02/2016 page. Cityrrown State Zip Code Date of Inspection D. System Information(cont.) Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert oil 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.): This home has a H-10 D-Box and it should=not be driven over.At the time of the inspection there no signs of solids carryover or evidence of hydraulic failure. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in.working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): *If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 59 Lewis Pond Road Property Address Philip & Bethany Odence Owner Owner's Name information is required for every COtUit Ma. 02635 02/0212016 page. Cityrrown State Zip Code Date of Inspection D. System information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: Two 500 gallon ❑ 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.): There are two 500 gallon leaching chamber in the driveway and they a labled H-20 . H-20 leaching chamber are designed to be driven on. Cesspools ;cesspool must be pumped as part of inspection) (locate on site plan): Number andr configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No . t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form.- Subsurface Sewage Disposal System Form- Not for Voluntary Assessments •'f 59 Lewis Pond Road Property Address Philip & Bethany Odence Owner Owner's Name information is required for every Cotuit Ma. 02635 02/02/2016 page. citylrown 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 ofsoili signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,.•'' 59 Lewis Pond Road Property Address Philip & Bethany Odence Owner Owner's Name information is required for every COtUIt Ma. 02635 02/02/2016 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 4 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 TOWN OF BARNSTABLtE LOCATION 4 i W i 5 J6 A SEWAGE# VII-LADE e Pi. 7 ASSESSOR'S MAP 8t LO .�0•?2 INSTALLER'S NAME A PHONE NO. /C �.r•t t �► �7,�� 7 7l SEPTIC TANK CAPACITY��of 4 LEACHING FACuff:(type L G (size) NO.OF BEDROOMS 3 BUILDER OR OWNER %is Cop vA PERMTTDATE: a 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 facili ) pp Feet Furnished by t! /)9 �IDlgLt—yJrAt � r _ i f- r� Lew r s .. .I ,� ►� Commonwealth of Massachusetts Title 5 Official inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments s•�' 59 Lewis Pond Road Property Address Philip & Bethany. Odence Owner Owner's Name information is required for every COtult Ma. 02635 02/02/2016 page. Cityrrown State Zip Code Date of Inspection D. System Information (Cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 10 plus feet 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: I augered a hole to ten feet to show five plus feet of seperation. Before filing this Inspection Report, pie ase see Report Completeness Checklist on next page. s' t5ins•3/13 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 59 Lewis Pond Road Property Address Philip & Bethany Odence Owner Owner's Name information is required for every Cotuit Ma. 02635 02/02/2016 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 t�17e 13y�—) Jri vF t5ins•3/13 Title 5 Official Inspection Pone:Subsurface Sewage Disposal System-Page 17 of 17 07/27/2004 08'.41 FAX 17817210293 HALL AND SULLIVAN 02/002 JUL-27-2004 09 :57 AM P. 03 REGISTRY: S L TITLE REFERENCE: +/Q/�O 83 31 PLAN REFERENCE:P/ d, &'Z/-_ L&-Tr IAr j 1�y s�L Lt�oh pE��C N l -4 /4�4,Z EL L�E W IS PC:>N t�) o . Ills plan was not prepared ftM an instrument survey. MORTGAGE INSPECT-1 PLAN Offsets and distances shown should not be used to establish property Mom LOCATION This phm is Intended for mortgage purposes only. h �b��� I ccrtify that the swic nre-__ shown on this Plan SCALE:G = Dom: r 6 4n conformance with zoning setbacks ifi eftt at the time or construction. CERTIFIED TO- f CAMERON BRQTMRS INC. Job No. 11 Towo Ave.Medford,MA (781)324-9566 - TOWN OF BARIISTASLE L CA 1iON SEWAGE''# ®� U VILLAGE 7'el ASSESSORS MAP &.LOTO'� A� �- INSTALLER'S NAME&-PHONE NO. SEPTIC TANK CAPACITY'1 s e-d t , i LEACHING FACILITY: (type),X 4 C, (size) /3:d�O'�`- NO. OF BEDROOMS 3 BLUDER OR OWNER ,-/ A G0 VA . PERMITDATE: 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 facili ) _ Feet Furnished by -I'Mw ^�. �� /�� � �` ,,: •�1:i .. �`' f • !+ d' w � .. � I ---�.. ' �� � ��u. � s �. TO N OF BARJNSTABLE LOCATION ,(�u�, s ��d /cr SEWAGE # O oZ O VILLAGE. 7 ASSESSOR'S MAP & LOT a Z z INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) V JVO�F-0`, (size) NO. OF BEDROOMS 3 OR PUBLIC WATER BUILDER OR OWNER - [IT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No ', `� J I �� - �, t , /f fiw � - No. to/� "! . Fee$5 n / THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: +/ Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01pprication for Miooe;ar *pgtem Cougtructiou Permit Application for a Permit to Construct( )Repair(X)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. 59 Lewis Pond Rd. , Cotuit Joan Lacava Assessor'sMap/Parcel 0 C/�/_, _® a 7- 215 Driftwood Rd. ,Canonsburg, PA Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Wm. E. Robinson Septic Service P 0 Box 1089, Centerville P � Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil sand Nature of Repairs or Alterations(Answer when applicable) Title-5 septic consisting of a 1 , 500 tank, D-box ( heavy duty) and 2 precast- 1Pa;;�hrhambprc (heavy duty) with stone all around. 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 Certifi- cate of Compliance has been issued by this B ardA HAalth. Signed Date 6 / Application Approved by Date Application Disapproved for the following reason Permit No. Date Issued z � � " ♦ �No. � Fee It S n THE COMMONWEALTH OF MASSACHUSETTS Entered in:.compaler: JPUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS Y&jV/ ZIpprication for Mfi5paal *potem Construction Permit Application for a Permit to Construct( )Repair(X)Upgrade( )Abandon( ) ❑Complete System 11 Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. 59 Lewis Pond Rd. , Cotuit Joan Lacava Assessor'sMap/Parcel VZU _0Z Z 215 Driftwood Rd. ,Canonsburg, PA Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Wm. E. Robinson Septic Servi°ce P O Box 1089, Centerville Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title t Size of Septic Tank �Type of S.A.S. Description of Soil sand Nature of Repairs or Alterations(Answer when applicable) Title-5-septic consisting of a 1 ,500 tank, D-box ( heavy dutv) and 2 precast leahhchamhers (heavy duty) with stone all around. �II 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 Certifi- " cate of Compliance has been issued by this Band Health. Signed C r� Date Application Approved by i ` Date i Application Disapproved for the following reasons/ l / i Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS Lacava BARNSTAtf, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( ) Repaired ( X )Upgraded( ) Abandoned( )b Wm. E. Robinson Septic Service at59t4tLewis Edon Rd , Cotuit has been constructed in accordance with�the provisions of Title 5 and the for Disposal System Construction Pe;?I t 1' ,10 f ;VegF�_dated Installer Wttl. E. Robinson �SA_fibtie SeryieEDesigner ai 3i The issuance of this permit shall not b construed as a guarantee that the system Will function as designed.,. Date �.J 6^'��` Inspector --�j---------Yja�--i,---.---.-.--.--.----. .--------.-.- _ No. s,'�!'�t'" ' Fee $5 0 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS .S Sk Lacava xiooal *pgtem Construction Permit Permission is hereby granted to Construct( )Repair(X )Upgrade( )Abandon( ) System located at 59 Lewis Ponca Rd. , rr t,t; t and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Constructio must a c(f /om 1 ted within three years of the date of tf7. Date: �� �v Approved by v try 1!(il94 rNOTWE:This Form U To Be Used For the Repair Of Failed Septic Systems Only- CERTMCAMM OF SMOMM AND AP�AIMOH� FOR A D� WORKS CONsr UMON 14ff_ DEMNED PLANS) L William E. Robinson,S Y certify thm the appticltion fir disposai works 4ropmY located at 59 Lewis Pond Rd. , Cotuit mems A of the following criteria: • The failod sysm®is om uccad to a rcideadd otdy. T13cmamnocommemialorbusimm uses assocaamd with the dwellinW,. soil is daasa6ed as CLAM l and the perm taw is I=tictu or cgmal to 5 aunuues per inch c are no wedam&within 100 feet of me proposed sapuc a3'acm — art no priivatc WdJS within l jO fact of*c pmpomed 9*dc sysm1 There 'so inata5e in 800v affi!o[cbmw in tic ptnpOSW • There an vari==mep esmd or nmde& • The of the 11 femmbimg fad VAIL amt ba k,,ftd less than five fia abam the maadjusmd Sgammawm akk ekvation:fAdpa at der cable using the Frimptor when appk*kl 1f S. -S.wi11 be locand wkh 250 ft=of MW veaptamd wedands.Um Oottm of the proposed faality WiV M be lac= d kss than fourteen 1141 feel above the ma'Cu mm adjusted tabk dmavafmo cc=pkze&ehHmkt6, A) Top of Gmtmd Ekvmjm fImemg GIS kkamminul e, G.w , , x MO G.w_ t LdU =AO DIFFERENCE BETWEEN A aM 8 SIGNED: t 7 -�-�--4 /1/ DATE:. [Swch mposed pba of Sysall on baal- lF beaftfolacr.-mi 14, 6Id 1 I u K r c R` > ,� .,�� :.is•�'.,y.�3- ���t�:,� 'fir -�''�� �,n � �` � � `�t',=rrr� °�.' ��"�- r. �•` s-i9'>'3. , 4 t:t 't, " rXM:- k--1'.?r �. wv t -1 ' % • F TOWN OF BARNSTAF3LE ��L ' LOCATION: yC! <F: p.r, VILLAGE „ C �!J"`� ) AS9:ESSOR`S MAP''& LOT�� o� 2. ' ' sy�y _ ' INSTALLER'S NAME&PHONE NO /L o 6 e" r s: «- `� 74� SEPTIC`TANK CAPACITY / �-6 LEACHIN 'FACIIITX.• `:G size : NO .OF BEDROOMS 3 f BUILD OR OWNER 1 �► .''C,� ✓. .. PERMTTDATE �� COMPLIANCE DATE i , , ,.... 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 f on site or;within 200 feet of leaching facility) Feet r " Edge of Wetland and Leaching,Facility(If any-wetlands.'exist .within 300 feet o'f leaching facili ) _ Fee74 . t Furnished by i - 74+.. .... w' Commcnwectm of Massachusetts Executive Office of Environmental Affairs 966 I Department of ®Jn� Lbw Environmental Protectionr� V- wlplam F.wow - t Titidt/cotes Arpeo Paull CNluod ` � David B.Si:ufts u.oor.eo. Conu,+rnonw pub Ua7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 59 Lewis Pond Rd. Cotuit MA. Address of Owner. Date of Inspection: 03/26/96 (If different) Name of Inspector. Frederick Kiel V Company Name, Address and Telephone umber. Environmental Reclamation Inc. 446 Waquoit Hwy. Waquoit Ma. 02536 CERTIFICATION STATEMENT (508) 457-5020 1 certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of 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: Passes _ Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority ¢ _ Fails i, Inspectors Signature: > ) Date: 03/26/96 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 tfte 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 0: SYSTEM PASSES: See attached note 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. B] 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 NO). 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 exfiltration, 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. (ruvised 11/03/95) 1 One Wlrtter Street a Boston, Massachusetts 02108 a FAX(617)5S80049 • TMephone(617)292-SW A Pnntee on Recycled Paw 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION,FORM PART A CERTIFICATION (continued) ! property Address: Owner: Date of Inspection: Bj 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 pipets) are replaced obstruction is removed C1 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 i Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. Z) 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 system has a septic tank and 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 pnvate 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 conform 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• 3) OTHER (revised 11/03/95) 2 ENVIRONMENTAL RECLAMATION, INC. 446 Waquoit Highway P.O. Box 3596 Waquoit,Massachusetts 02536 Tel# 508-457-5020 Assessment / Remediation Fax#508-457-502? LSP Services / Real Estate Consulting March 26,1996 The system passes the inspection at this time. However, this is after a period of inactivity. Continuous use in the future may cause the cesspool to meet one or more of the failure criteria. I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Owner: Date of Inspection: 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. 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 1/2 day Flow. 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 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 suppiyweil. 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. El LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 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 II 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 requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 11103/95) 3 i j SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ' i PART B ' CHECKLIST Property Address: Owner. Date of.hnpectiwe 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. 1. As 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. The system does not receive non-sanitary or industrial waste flow SL..The site was inspected for signs of breakout.. All system components, excluding the Soil Absorption System, have been located on the site. JThe septic tank manhoies were uncovered, opened, and the interior of the septic tank was inspected for condition of baffleso tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. 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. V/The facility owner(and occupants, if different from owner► were provided with information on the proper maintenance of Sub- Surface Disposal System. (revised 11/03/95) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C - SYSTEM INFORMATION (continued) I Property Address: Owner: Date of Inspection: I SEPTIC TANK:_ (locate on site plan) Depth below grade: Material of construction: concrete _metal _FRP —other(explain) Dimensions: Sludge depth:_ 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 battle: 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, etc) GREASE TRAP:_ (tome on site Tian) Depth below grade: Matenai of construction: _concrete _metal _FRP _other(expiain) Dimensions: Sam thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc) I (revised 11/03/95) 63 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C ( SYSTEM INFORMATION Property Address: 5,9 �� ,. Pc:u a `��. �•,; , , Owner- Date of Inspection: FLOW CONDITIONS RESIDENTIAL - Design flow:_pailons Number of bedrooms: Number of current residents:_ Garbage grinder(yes or no): n_ Laundry connected to system (yes or no): i A_ Seasonal use(yes or no): ij Water meter readings, if available: Last date of occupancy: COMMERCIAUI N DUSTRIAU 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 5 system: (yes or no)_ Water meter readings, if available: I.=date of occupancy: OTHER (Describe) Last date of occupancy. GENERAL INFORMATION PUMPING RECORDS and source of information: System pumped as part of inspection: (yes or no)A If yes, volume pumped: sraallons Reason for pumping: TYPE OF SYSTEM Septic tankidistribution boxisoil 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: '{� Sewage odors detected when arriving at the site: (yes or no) (revised 11/03/9S) i i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Owner. Date of Inspection: SOIL ABSORPTION SYSTEM (SAS):_ (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._ 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.) CESSPOOLS: _ (locate on site plan) Number and configuration: Depttmop of liquid to inlet invert: ' fZ'J Depth of solids layer. — Depth of scum layer. — Dimensions of cesspool: Materials of construction: M(,-,4 2 c�— T�i?i c K Indication of groundwater. I, ,v 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 11/03/95) 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Owner. Date of Irapection: TIGHT OR HOLDING TANK:_ (locate on site plan) Depth below grade•. Material of construction: _concrete _metal _FRP—other(explain) Dimensions: CapacW. gallons Design flow: 0Ions/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 carryover, evidence of leakage into or out of box, etc) PUMP CHAMBER_, (lode on site plan) Pumps in working ordec(yes or not Carnments: (note condition of pump chamber, condition of pumps and appurtenances, etc) (revised 11/03/95) 7 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART C SYSTEM INFORMATION (continued) Property Address: Owner. Date of Inspectiom SKETCH OF SEWAGE DISPOSAL SYSTEM: indude ties to at least two permanent rnferel ces landmarks or benchmarks loose all wells within t 00' 4. DEPTH TO GROUNDWATER Depth to groundwaoer:2_feet method of deb mination or approximation: Tres S i c= I S ' o c AmE-l` J+Q 2v ',(. �►�Fc;12cnJ C.%) 'r-��. � •2 FCC ' �v �;.-/? 1J 3i_` c� (revised 11/03/9S) 9 J TO OF BARNSTABLE ' LOCATION �n� c��� SEWAGE # n Dip VILLAGE C .i � ASSESSOR'S MAP & LOT O Z 't INSTALLER'S NAME PHONE NO. SEPTIC TANK CAPACITY / ��s LEACHING FACILITYAML-) (siu) 3is OR PUBLIC WATER . NO. OF BEDROOMS BUILDER OR OWNER p* t1T ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No i d _ �.e ic I +Li�.l�lsksc :l�5. u IF IItElM I� ._... I RID e1c - • : i I II I O, I 0E.) '7.S:1.50M'LJ !I7 SCtiI iSG:C1t.�!7. \� 1 : LmV I ' I � iJ�t'slx,u< cu,�.,.1 •_Y--- cnr• — \• a�.uec.tutltrut�S+sut:�E1:. ___ .__. .. 8 -qu ruR Ri:Llftu_ - tF:e16'• i `.0 y� , �: l7 © k£YlSOLM 21 Q i , I •� Q ID O .-Y•c.c�nP, t wTa Cl-r� 54Ce,iG.i_E.3:isy '44.`'•(Cl .a _ IW- 'F' m-IT tla�Tia(ON2-NF\ ....- 'suww�._rLTausrt_,na.��w .... nOI.eJ qur� w nc.:�_.3c>•IE:u�t.5 2: �Q_ FI-7FLcl�lz-,,,tr= N S.ruc,- Devlin Design® CGTu T. 77.8-2.3"773 � I M t I � I i I g 2mi2h+'.awac+`s•- �' .-:- --_ ,_�,ICER.a __ _ _ � i+ 9 m _ U Q I' — 1 I 2,400 w-ITS iT .:. �©,a..'YZ Eon-' �. _,,- ,:, � �� .�� J_•-.�� _ 4 I hi;hT— 2 . ` a Ae4 AU vy I! , I :" a. � •� �' � 4 `F C. � :I;Y� ° �'",. � .�k�t'Z�`�' i � '- . 1-- -- '� - ti Z6. I � 'UT �\vJev -IS.,E/_ � 1' I� •� L:p�ir�✓ t, -��'-.. •�' � I .,.m � ' _��z r ( 11 � ���'! ,� �I� '4 � . • 11 e, ;a ,✓b,!�Z..�LC�S�B...plJl ta- : I i r Km X p�dlorc� ST}uYA5 1 6d�� WlbPf R�S.I.IQ_tJS_c /SS�1R/1Un:$ p` iJi�ACnr Co�NctR�sln I <C CIV -•''>` - � � .. � 5 J C£5��._(�C2��_�'J^:?J.. N\�a 774238X1773 -