Loading...
HomeMy WebLinkAbout0294 SANTUIT ROAD - Health i 294 Santuit Road Cotuit �� A= 020-058-001 , \ a Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 294 Santuit Rd Property Address Cullen Owner's Name /, EamSta�_ '}"' MA 02635 5/15/12 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. A. General Information 1. Inspector: �Z P � Frank Nunes III Name of Inspector saa Company Name Box 841 Company Address East Falmouth MA 02536 Cityrrown State Zip Code 508.272.6433 Telephone Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and thalthe information reported below is true, accurate and complete as of the time of the i�pection. Vib ins) ction was performed based on my training and experience in the proper function andrmaintenance of on=site sewage disposal systems. I am a DEP approved system inspector pursuantfto'FSection:15.340 sf Title 5(310 CMR 15.000).The system: _ ® Passes ❑ Conditionally Passes :❑ Fails p ❑ Needs Further Evaluation by the Local Approving Authority ' 5/15/12 inspecto s Signat 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 'I.v.A the same or different conditions of use. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �M 294 Santuit Rd Property Address Cullen Owner's Name Barnstable MA 02635 5115/12 Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: . ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: Pumping suggested every 3 yrs to prolong the life of the system 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. Answer yes, no or not determined (Y, N, ND) in the ❑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. ND Explain: n/a ❑ 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 ❑ obstruction is removed Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 294 Santuit Rd Property Address Cullen Owner's Name Barnstable MA 02635 5/15/12 Cityrrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced ND Explain: n/a ❑ 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 ❑ obstruction is removed ND Explain: n/a 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 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 1100 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. f - Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments G M , 294 Santuit Rd Property Address Cullen Owner's Name Barnstable MA 02635 5/15/12 Cityrrown State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ 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 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: n/a 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 town overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/day flow ❑ ® 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. I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 294 Santuit Rd Property Address Cullen Owner's Name Barnstable MA 02635 5/15/12 City/Town State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cunt.): Yes No ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. El ® 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. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �M 294 Santuit Rd Property Address Cullen Owner's Name Barnstable MA 02635 5/15/12 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 S on the site has � System(SAS)1 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)] r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments G'M , 294 Santuit Rd ' Property Address Cullen Owner's Name Barnstable MA 02635 5/15/12 City/Town State Zip Code Date of Inspection 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 Number of current residents: 1 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)): Sump pump? ❑ Yes ® No Last date of occupancy: Occupied Date Commerciallindustrial Flow Conditions: Type of Establishment: n/a Design flow(based on 310 CMR 15.203)- Gallons per Y(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: Last date of occupancy/use: Date Other(describe): n/a r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 294 Santuit Rd Property Address Cullen Owners Name Barnstable MA 02635 5/15/12 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) General information Pumping Records: Source of information: Pumped 3 yrs ago per owner 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): Approximate age of all components, date installed (if known)and source of information: 11/4/96 per as built Were sewage odors detected when arriving at the site? ❑ Yes ® No Commonwealth of Massachusetts uTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 294 Santuit Rd Property Address Cullen Owner's Name Barnstable MA 02635 5/15/12 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: 24"feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: >10' feet Comments(on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: 18"feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) Risers at inlet and outlet covers f If tank is metal, list age: t Years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No -------------------------------------------------------------------------------------------------------------------------- Dimensions: 1500g Sludge depth: 311 Distance from top of sludge to bottom of outlet tee or baffle >12 1,. . Scum thickness Distance from top of scum to top of outlet tee or baffle >211 Distance from bottom of scum to bottom of outlet tee or baffle ,211 How were dimensions determined? Measured Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 294 Santuit Rd Property Address Cullen Owner's Name Barnstable MA 02635 5/15/12 CityrFown 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.): Pumping suggested every 3 yrs to prolong the life of the system Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): n/a 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 Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): n/a 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): n/a r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �M 294 Santuit Rd Property Address Cullen Owner's Name Barnstable MA 02635 5/15/12 City/Town State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank(cont.) 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.): n/a ' Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No .Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Level w/the bottom of the pipe 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 2'6' below grade and in average condition for its age Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �M 294 Santuit Rd Property Address Cullen Owner's Name Barnstable MA 02635 5/15/12 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): n/a Soil Absorption System (SAS)(locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: 0' perx4' ® leaching fields number, dimensions: 12 12x4 asbuilt ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leach field was probed and soils are dry and compact. Top of SAS approximately 3' below grade Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M Svey'et 294 Santuit Rd Property Address Cullen Owner's Name Barnstable MA 02635 5/15/12 City/Town State Zip Code Date of Inspection D. System Information (cont.) 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 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.): n/a Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments wM 294 Santuit Rd Property Address Cullen Owner's Name Barnstable - MA 02635 5/15/12 CityrFown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a sketch 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. L3 ar\� L� .� s l Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M °'r 294 Santuit Rd Property Address Cullen Owner's Name Barnstable MA 02635 5/15/12 Cityrrown State Zip Code Date of Inspection i D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: >12 feet Please indicate all methods used to determine the high ground water elevation: i ❑ 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: per eleavation of home to nearby surface water 0 OF BARNSTABLE � LOCATION �l SEWAGE - a-0 VILLAGE -3,a y'� ASSESSOR'S MAP LO _ INSTALLER'S NAME&PHONE NO.�� _ � ��Clr' C~ *tI'l SEPTIC TANK CAPACITY �r LEAC4-UNG FACILITY: (type) IlCer(( (size) 12 >Q�r,, NO. F BEDROOMS ER OR OWNER 1]0 C PERMTTDATE: 7— `�� �s/COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet off l f11aci � hty) Feet Furnished by f � 1 \ a — ..s 0 �,o No. Fee g THE COMMONWEALTH OF MASSACHUSETTS P BLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 01ppYication for Migpogal tem Cow5truction Perron �'rr( <o".Application is hgeb?m ermi to� r Xr( )an On-site Sewage Disposal System at: Location Address or Lot N . Owner's Name,Address and Tel.No. �_o-F-• I - 5 i qu <Z-4 L-\.s 1 55ei,450-S Wd 10Lor 578-I Installer's Name,Address,and Tel.No. signer's Name,Address and Tel.No. U CG Type of Building: Dwelling A---Na.of Bedrooms _ Garbage Grinder Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow -v U gallons per day. Calculated daily flow gallons. Plan Date _ Nu er of sheets C;?— evwon Date Title Cg i Description of Soil _ q� 'rS�� fL 0'— Nature of Repairs or Alterations(Answer when applicable) '. R 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/oe Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued b of H Signed Date Application Approved by Application Disapproved for the llowing reasons Permit No. �4�0 a 13 Date Issued o No. �, Fee rp MON THE COMMONWEALTH OF MASSACHUSETTS '71� 9 ;r, k PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 2pplication for Migpozal 46PACM Con!5truction Permit Application is herebyr an On-site Sewage Disposal System at: Location Address or Lot No. Owner's Name,Address and Tel.No. 7 I L ,-I P-5 N1 Z.(.,) toT- Installer'91Narne,Address,and Tel.No. Designer',Name,Address and Tel.No. kj c- �e ))_ M &lo L)i RD 14 Type of Building: N Dwelling t,-­No.of Bedrooms Garbage Grinder Other Type of Building No. of Persons Showers O Cafeteria Other Fixtures Design Flow 7:? C gallons per day. Calculated daily flow -Irallons. Plan Date u ber of sheets C:;71 Revision Date Title k A- VLO r A-0 t ',AAA ;2 q' t26501L /,Q C65� �-_50 514-,W Description of Soil r-) ku)c Nature of Repairs or Alterations(Answer when applicable) 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 TitleV/e Environmental Code and not to place the system in operation until a Certifi- cate is is of Ti of of Compliance has been issued bid oard of He Signed Date Application Approved by Application Disapproved for the ilowing reasons Permit No. el, 30 Date Issued THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY that the On-site Sewage Disposal System installed 54 or repaired/replaced on by jo 4 v4- —for SXA22 5; as has been constructed in accordance wit h the provisions of Title 5 and the for Disposal System Construction Permit No._9? - -'?D dated7 Use of this system is conditioned on compliance with the provisions et forth below: Ile' No. Fee THECOMMONW MASSACHUSETTS. 0". PUBLIC HEALTH DIVISI RNSTABLL MASSACHUSETTS ligpoMl *p!ftem Construction Permit Permission is hereby,granted to to construct('>e repair an On-site Sewqg&ystem located at and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her dut to comply with Title 5 and the following local provisions or special conditions. All construction must be completed within two years of the date below. Date: Approved by _ - tdlsarT I of 2 -�te.+4 PAXA F,4A► W Z ram r PLA 14 OW BAGK. u f' VAIL-y PWVJ * 3 he ll =.33D6M _ swnc txgr• 33v,C?oo%W GG46X vq. 15�co • stet ATrucA►m#4 A A fib• -� ipp LeAvo 4 A¢s4 T AN ' A. P�¢..�, c a►Pe sc 6d6 " K Aj 7T6 -i E 2" 5ILIM � cu LT�'C 3�4" ry ����N� wnkg tt� l`A b . lJ Q► � tit 3►� -�va=�v► "''v im' �• 31 c� d � g TA,Y YY I �. OF T/WC PETER L SULLIVAN �• NO.29733 91 CIVIL y No. 19)84 •40 Wes• ROT 4�o�r12 LCY.�T![�1 F. en A;' U13*4 ,� u Q�r tU 15 c 4 -2-0 06walL l� 'SC.ALEz 1 S Nr.1 1 • '7"2 �l�o t ,icy• Tom►• ;Vie•. ______.= -�-- • ' Ctwlp�= r I W ITK.'CS s dMbM W6; AUO 9 ...OR TWC ovum W ,�• "Z U Pam— 5'�',-1 t3a2�Jbt�136�J�►ib ; ts.Iw LoeATvo w!TuIN 0 t d�CT� NYE 1►•tG �a4LHATAFtswv � � �t.� L�u1v St�avrtYt>� •a1�i•.tca3�f �� C,�. OSTII�/tut MAsf. aroatrs WILL i 4ir i iw Uor •v I W 1 A I S iW A I �� ~ SEP hG - T)t y CAW Of wicu yes � p AN LYE " CN►L V1 N PALissue y� A� � C c COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL.AFFAIRS i DEPARTMENT OF ENVIRONMENTAL PROTECTION MAP F PARCEL LOT TITLE 5;. OFFICIAL INSPECTION.FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART'A CERTIFICATION Property Address:., of Owner's Name: > �E:(►��VE Owner's Address: ` C �'7 � . Date of Inspection: JAN 3 0 2002 Name of.Inspect r: leas print) �/! TOWN OF BARNSTABLE Company Name: 'i �, .: HEALTH DEPT. Mailing Address AVIX Telephone Numbers -� CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information rt..ported below is true, accurate and complete as of the time of the inspection.Tile 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 ection 15.340 of Title 5(310 CMR 15.000). The system: Passes Conditionally Passes Nee s.FurtI Evaluation by the Local Approving Authority ai Inspector's Signature: Dater 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..; Notes and Comments ****This repo t 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: Title 5 Inspection Form 6/15/2000 page 1 Page 2'of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE'SEWAGE DISPOSAL SYSTEM INSPECTION Ir'ORM 9AM PART A y6+w�5ggg3E� CERTIFICATION continued ( ) 'Property Addre Owner, Date of-Inspection:' p Inspection Summary: Check A,B,C,D'or E 1 ALWAYS complete all of Section D A., S stem Passes: 1:I have not found an information which indicates s that any of the failure criteria described in ]0 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section nee d_to'beyeplaced or repaired. The system,upon completion o0the,replacement or repair, as,approved.bythe hoard of Health,will pass., Answer yes,no or not determined(Y,N,ND)in the 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. ND explain: Observation of sewage backup or break out or high static wa ter level,in th.e distribution box due to broken or obstructed pipes)or due to.a broken;settled or uneven distribution boz:System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or-replaced ND explain: 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 obstruction is removed ND explain: 2 Page 3 of 1'1 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY'ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION.FORM PART A CERTIFICA'TION.(continued) Property Address: _/� 1' y . "4 Owner: . Date of Inspection: o — 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 no.t functioning in a manner:which.will protect public health,safety acid 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 any)determines that the system is functioning in a uran,ner that protects the public health',safety and environment: _ The system has a septic tank and,soil absorption system(SAS).and the SAS is within 1.00 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 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 iitrogen 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*: 3 s,. Page 4 of I I R OFFICIAL.INSPECTIONFORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE`DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) t Property Address: 4 Date of Inspection: QIP D. System Failure Criteria a licable:tosystems:all Y PP You must indicate"yes"or"no"to each of the following for all inspections: Yes N 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 _ j Liquid depth in cesspool is less than 6"below invert or available volume is less than %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 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. Anyportion 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 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, provided that no other failure criteria are triggered.A copy of theanalysis must be attached to this for (Yes/No)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 he system must"serve a facility with a'design flow of 103000 gpd to 15,000 gpd• You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no _ the system is within 400 feerof`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 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.. 4 Page 5 of 1.1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSE$SMEN:I'S SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM. PART B . CHECKLIST Property Address: q y �► Owner: Date of Inspection: Check if the following have been done You must indicate ye of"Ito" as to each of the following: Yes j o —� Pumping.infornration.was provided by the owner,occupant,gr:.Baard,of"I-Iealtti 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? I�Have large.volunies of water been introduced to the system rpcently or as part of this inspection? Were as built plans of the system obtained and examined?(If they were not available note as NIA) Was the facility.or dwelling inspected for.signs of sewage flack 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 scull,? Was,the facility owner(and occupanls,ifdifferent from owner),pro.vided 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: Yes no — Existing information.For example,a plan.at the.Board of Health. fs 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(3)(b)] 14 r, 5 'k• Page 6 of 11 OFFICIAL•INSI I+CTION FORM NOT FOR VOLUNTARY ASSESSIVMLNTS SbRSURFAC:E SEWAGE DISPOSAL SYSTEM INSPrC7 iON.TORN PART C SYSTIJM INFOi RATION Property Address: � � Owner -Pa Date of Inspection. 00 FL' OW OW CONDITIONS RESIDENTIAL. ✓ Number of bedrooms(design): Number of Bedrooms(actual): DESIGN flow based on 310 CMR 15.263 f for example: 110 gpd x#of bedrooms;:� 30 Number of current residents:Q Does residenceliave.a garbage grinder(yes or notl�- — " Is laundry on a separate sewage`system (yes or n0)/j&[if yes separate inspection'required] Laundry system inspected(yes or not Seasonal use: (yes or no)` ,Q- Water meter readings, if available(last 2 years usage(gpd)); Sump Pump(yes or no — Last date of occupancy: COMA1ERCIA`L/INDUSTRIAL4t&- Type of establishment: Design flow(based on 310 CM11.15.203): glitl Basis of design.flow(seats/persons/sgft;etc,): : :.. Grease trap present(yes or no):_ Lidtistrial waste holding tank present(yes or no):_ Non-sanitary waste discharged to the Title 5 system (yes or no):_ Water meter readings, if available: Last date of occupancy/use: OTHER(describe); GENERAL INFORMATION Primping Records Sourc,e,of information:, Was system.ptimped as part of the nspection_(yes or no If yes, volume pumped: . gallons Ilow was quantity pumped determined? Reason Tor pumping: . TYPE Or SYSTEM ptic 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) , —Tight tank +Attach a copy'of the DEP.approval Other'(describe): Approximate age of all components,date installed(if known)and source of information: Were sewage odorsAetected when arriving at the site(yes or no):­,ZX,0— 6 f Page 7 of I 1 OFFICIAL IN'SPECTION FORM—NOT:FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: - Owner: Date of Inspection: ' _o )o1 BUILDING SEWER'(locate on site plan)�� j Depth below grade: Materials of construction: _cast iron _40 PVC.: other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of 1'eakage;.etc.): SEPTIC TANK: - (locate on site plan) Depth below grade: Material of construction: ,/concrete_metal' fiberglass_Polyethylene —other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance (yes or no):.-(attach a copy of certificate) Dimensions: /b�I i y(P°X s Sludge depth Distance from top of sludge to bottom of outlet tee,or baffle: Scuni thickness:. Distance from top of scum to top of outlet tee or baffle: Distance from,bottom of scum to bottom of outlet tee or;baf e'. /I How were dimensions determined:'4�C 6""1 <2Fig�f 71- Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural.integrity, liquid levels related to outlet invert, ev•dence of leakage, etc. ryl GREASE TR (locate otiate plan)= Depth below grade:_ Material of construction: concrete metal fiberglass_polyethylene_other (explain): — — — " Dimensions: Scum thickness: Distance from top of scum to top of out or baffle: Distance from.bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations, uilet and outlet.tee or baffle condition,structural integrity, liquid levels as related to.outlet invert,evidence of leakage,etc.): C, r. i ,r i ', 7 Page 8 of I l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARYASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner: Date of Inspection. ,,?' TIGHT or HOLDING TANK:'a&ank must be pumped at time of inspection)(]ocate on site plan) Depth below grade: Material of construction: - concrete metal fiberglass_polyethylene- . other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): 'Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches, etc.): DISTRIBUTION BOXf'' (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: � �toeX Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of akage iA�®rof box, etc.): �"V PUMP CHAMBER: (locate on site plan) Pumps in working o✓✓rde""r(yes or no): Alarms in,workin order,(y s.qr no)..,- Comments (note condition of pump chamber,condition of pumps and appurtenances,etc.): 8 Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION'.FORM PART C SYSTEM INFORIVIATION.("continued) Property Address: Lgv. Owner:_ Date of Inspection. OQd SOIL ABSORPTION SYSTEM (SAS): locate on site plan, excavation not required) If SA$not located explain why: Type leaching pits, number:_ -leaching chambers;number: �eaching 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.): + y 4_0'� CESSPOO� (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 or no): Comments(note condition of soil,signs of hydraulic failure, level of ponding;�condi[ien cf vegetation;etc.):. PRIVI./U—(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.): F . qI, - 9 II . Page 10 of 11 OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSME,NTS SUBSURFACE SE VVAGI DISPOSAL SYSTEM INSPECTION FORM PART C ' SYSTEM INFORMATION(continued) J Property Address:17NV zz Owner_/' �f?/Y� Date of Inspection f C� 'Do 00 SICETCI-I OF SEWAGE DISPOSAL.SYSTEA4 Provide a sketch of the sewage disposal'system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells Nvithin 100 feet. Locate where public water supply enters the building. 4409?L-f, t a 1 10 Page 11 of 11 OFFICIAL INSPECTION FORM,—NOT;FORNMUNTARY ASS!JSSMENTS -SUBSURFACE.SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART'C SYSTEM INFORMATION(continued) Property Address: pl ..Owner. o Date of.Inspectioni SITE EXAM'. Slope Surface water Check cellar. Shallow wells j Estimated depth to ground water. Z 1 feet Please indicate(check).all methods used to determine the high ground water elevation: Obtained from.system design plans on record-If checked, date of design plan reviewed 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: , 1 ; 11. Permit Number: Date: ar— Completed by: HIGH GROUND-WATER-LEVEL COMPUTATION yr Site.Location: � SG�d� t/�` Ol, �( j,'�/� Lot No. N; Owner:—__ e/iri�a�t Pi � �G�/� Address: ' ,for/�P&A 0/1 �:r... Contractor:_ =S Address: L✓5y ✓�°�ltf,SJ"Os� %%� Notes STEP 1 Measure depth to water table to nearest 1/10 ft. Date f month/day/year STEP 2 Using Water-Level Range Zone { and Index Well Map locate .site and determine: I , AO Appropriate index well....................................................: > �Q © Water-level range zone ..................................................... STEP 3 Using monthly report"Current Water Resources Conditions" determine current depth to 12 water level for index"well .:................::...... L k/ month/year STEP 4 Using Table of Water-level Adjustments for index well (STEP 2A), current depth to water level for index well (STEP 3), and water-Level zone (STEP 213) determine waterdevel adjustment.................... . � STEP 5 Estimate depth to high water by subtracting the water level adjustment (STEP 4) from measured depth to water level at site (STEP 1) ................ ......................:.............:.........:....:..................:............:....... �-' Z Figure 13:-Reproducible computation form. 15 i G'd LF;j�'���� ��. '��p �. �—ems.. . r i? FORM 11 - SOIL EVALUATO RgeFOR M _ a Dater , /2/mac. No. Commonwealth of Massachusetts Massachusetts goal c uitabili A essment or -Site ewa a Dis osal Date: Performed B mac. r +a o ,+ �,a ..C3.`.�c ....... ..Y1� Witnessed By: .....: .:. F ...('� .. .... P' �� 't t__vl F1 5i uu IG / ' Address.Ard Lo T _ a r 1-e- i Tekp m. �o MKT 4 iV �T- New Construction Repair ❑ Office Review • . Published Soil Survey Available: No F1 Yes • ' ":= � • �q93... - Publication Scale .!.::1�-� Soil Map Unit Year Published..:.,,;: .............. o::...::Soil Limitations ..p�a�o...P�-,O;tv,!�n:f3��,�r.(..,.�`''a..f�+�Te-R��,�.cnoK�,-1 w� Drainage Class ❑ Yes Surficial Geologic Report Available: No ' U.0,30 Year Published i.�.,7.r5::::. Publication Scale ' a ....�•r•':'•.p......................................................................................................................................................... Geologic Material (Map Unit) .................................................................... Landform Flood Insurance Rate Map: Above 500 year flood boundajjlNo ❑Yes Within 500 year flood'boundary N,o [ Yes ❑ Within 100'year flood No. Yes boundary . Wetland Area: unittiro��..................................................................................... National"Wetland Inventory Map (map ) n a AT..M,ta o ................................................ ' 'Ma ma unit) .......................... . Wetlands Conservancy Program p(map Current Water Resource.Con 'tions(USGS): Month slq Range :Above Normal Normal ❑Belc.w Normal ❑ Other References Reviewed: DEP APPROVED FORM-12/07199 I i FORM 11 - SOIL EVALUATOR FORA, Page 2 of 3 Location Address or Lot iJo. Lo•r I - Sfl�T�'T Qo� e�'"'T On-site Review o 1 0 f4M GI�-Q..:T:;= Deep Hole Number' ::)...� ti. Date:.:.--1:... :: : .:. We er q.�- SITE oF.,AR-aDos�O.:.PR-,':!�'!:'•.`•�-0--t.::.`:..:E�Pv�,st oN:.::xQrC,:: '`�..,..... Location(identify on site plan) «' Land Use Slope (%) -3 . Surface Stones ::t.Qr.. Vegetation Landform ::..:..:. :....,.n..... :. ..:..:..... ... :.. .. Position on landscape (sketch on the back Distances from: Open Water Body 51Po. feet 4- Drainage way .,77c�7 feet 2'so . feet Property Line .::. ..<... 'feet Possible Wet Area .:.:. J Drinking Water Well °-' ° feet Other DEEP OBSERVATION HOLE LOGS Other Depth from Soil Horizon Soil Texture Soil Color Soil Gravel) (Structure,Stones,Boulders, Consistency, Surface(inches). (USDA) (Munsell) Mottling 96 Fn w,e- QocT� �agp,g@,�<t�0 LOyR5�3 f-.c,..a6 SI'-•Gt.E �Q*-1�-'1 3 S E SIHvt� � '•,LocsE, l070�2.++sc '_ 'Lfi•' ('S A.1�U 5rt-I.tD Ic`!Q- �/re 4-.+cr.+� TV- 71NbL� 6Q-Ih 1•� , Lo01� Q' fe/LL• Lip yy'r'Q... a rtoP c 42" t t c Ti.IL Px:w c o„ # 2 C ��G l GI-I►�iAt— oar-�o-r�srl DepthtoBedrock:• Parent Material(geologic) Weeping from Pit Face: Depth to Groundwater: Standing Water in the Hole: o>v E Estimated Seasonal'High`Ground Water: { >' DEF APPROVED FORM-12/07/9S FORM 11 - SOIL EVALUATOR FORM r Page 3 of 3 Location Address or Lot No. Le r r - Sri-3 r411T a...A . 4�7v "r i • Determination for Seasonal High Water Table Method Used: ❑ Depth observed standing in observation hole inches ❑ Depth weeping from side of observation hole................. inches ❑. Depth to soil mottles 'D""Ground water adjustment ......!.-..I...... feet Index Well Number .M!.w.t-�- A Reading Date ......5/9� Index well level ............ Adjustment factor ......!.:..1.':. Adjusted ground water level ............. 1................................ Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? -t E s If not, what is the depth of naturally occurring pervious material? Certification I certify that. on /11 S (date) I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training, expertise and experience described.in 310 CMR 15.017. Signature. Date i • I r' DEP APPROVED FORM-12/0719S t t i J FORM 12 - PERCOLATION TEST Location Address or Lot No. lro r �+�►-n"r COMMONWEALTH OF MASSACHUSETTS Massachusetts i . Percolation Test* ' Time:....Date: a Observation Hole # Depth of Perc a- Start Pre-soak ,o ; o C. End Pre-soak Time at 12" Time at 9" i Time at 6" Time (9"-6") ZS e-AL M 15 5 Rate Min./Inch LeSS -r"AI.4 2AA ,/,*4 " Minimurin of 1 percolation test must be in both the primary area AND reserve'area. (� Site Failed ❑ Site Passed - - ............................................................................ Performed,By: Witnessed By: F ' Comments: � _ ..,�:....�,..n.�.... ....,�,..�,�..�sw:..�...�Mw._���.�•. ...-..�w............. DFp AMOVW FORM-12W/9S i ap 4 !S AC-S AO PA- k.01 vp N %.00 Ab Cps` „ •/� ASV 7734 *.Sit to �-1 113 d, -OP,4c ,