HomeMy WebLinkAbout0064 MELBOURNE ROAD - Health 64 Melbourne Road, Hyannis
A=
r
i
r
Commonwealth of Massachusetts
Executive Office of Environmental Affairs
Department of 2 ��'
Environmental Protection
WHYam F.Weld / Trudy Coma
Gamw
ArW Paul Celluccl Struha
u Governor �m Coe sttirlonei
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A -
CERTIFICATION
Property Address. Dana Heilman
64 Melbo�ne Rd. , Hyannis (���fntowner.
Date of Inspection 9—2 5—9 6
Name of Inspector. W.E. Robinson SR
Company Name,Address and Telephone Number. ( 5 0 8) 7 7 5—8 7 7 6
W.E. Robinson Septic Service
P.O. Box 1089 Centerville MA
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate
and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and
maintenance of on-site s/Passes
wage disposal systems. The system:
_ Conditionally Passes
_ Needs Further Evaluation By the Local Approving Authority
_ Fails
Inspector's Signature: '&LA , �......�� � Date: 9
The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this
inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the
report to the appropriate regional office of the Department of Environmental Protection.
The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority.
INSPECTION SUMMARY:
C •A,B,C,or D:
A) TEM PASSES:
I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303.
Any failure criteria not evaluated are indicated below.
SYSTEM CONDITIONALLY PASSES:
One or more system components need to be replaced or repaired, The system,upon completion of the rep100e131ent or repair,passes
Uffection-
Indira yes,no,or not determined(Y,N,or ND). Describe basis of determination in all instances. If"not determined",explain why not)
The septic tank is metal,cracked, structurally unsound,shows substantial infiltration or exfltration,.or tank failure is
imminent. The system will pass inspection if the existing septic tank is replaced with a ponforming septic tank as approved
by the Board of Health.
(r 'sed 11/03/95) I
One Winter Strsat • Boston,Massachusetts 02108 • FAX(617)556-1049 isTN•phan(617)292-NO
Printed on Recycled Paper
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(oontinued)
propetyAddeess: 64 Melborne Rd. , Hyannis, MA
owner. Dana Heilman
Date of Inspection: 9—2 5—9 6
Bl SYSTEM CONDITIONALLY PASSES(continued)
Sewage backup or breakout or high static water level observed in the distribution boa is due to broken or obstructed pipes)
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 boa is levelled or replaced
_ The system required pumping more than four times a yeas due to broken or obstructed pipe(.). The system will pass
inspection if(with approval of the Board of Health):
broken pipe(.)are replaced
obstruction is removed
FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH:
Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to Protect the
public health,safety and the environment.
1 SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A
MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT:
_ Cesspool or privy is within 50 feet of a surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh.
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 private water supply well.
The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water
supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free
from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm.
3) ER
(revised 11/03/95) 2
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
PropertyAddre.a: 64 Melborne Rd. , Hyannis
Owner. Dana Heilman
Date of Inspection: 9—2 5—9 6
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 corroct the
Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool.
Discharge or pouding 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 leas 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 supply well.
Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no
acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for
ooliform bacteria,volatile organic compounds, ammonia nitrogen and nitrate nitrogen.
E)LARG SYSTEM FAILS:
following criteria apply to large systems in addition to the criteria above:
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
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 U of a public
water supply well)
The owner o operator of any ouch system shall bring the system and facility into Hill compliance with the groundwater treatment
program
requiremen of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information..
(revised 11/03/95) 3
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
PrProp rtyAddrew 64 Melborne Rd. , Hyannis, MA
Dana Heilman
Date of Iaspeot M 9—2 5—9 6
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
during that period. Large volumes of water have not been introduced into the system recently
has been a receivingro normal flow rates
system recently or a part of this inspection.
As built plans have been obtained and examined. Note if they are not available with N/A.
_jd0i``'he facility or dwelling was inspected for signs of sewage back-up.
—Y-fle system does not receive non-sanitary or industrial waste flow
the site was inspected for signs of breakout.
system components,excluding the Soil Absorption System, have been.located on the site.
The septic tank manholes were uncovered,opened,and the interior of the septic tank was ins
pected tees,material of construction, dimensions, depth of liquid,depth of sludge, depth of scum. for condition of baffles or
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.
TThe 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
PropertyAddresm 64 Melborne Rd. , Hyannis
0wn0r Dana Heilman
Date of Inspection: 9-2 5-9 6
FLOW CONDITIONS
RESIDENTIAL
Deep
Number of bedrooms: S
Number of comsat residents:,
Garbage grinder(pea or no):-&-
Laundry connected to system(yes or no):�
Seasonal use(tires or no): -0
Water meter readings,if available: 9 4-9 5 6900 cubic f t.
95 96 8700 cubic ft
Last date of occupancy: 9-z 4-1 �a
COMMERCIAL/INDUSTRIAL:
Type of establishment:
Design flow: gallonsiday
Greece 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 motor readings,if available:
Last date of occupancy:
OTHER:(Describe)
Last date of oocupancy:
GENERAL INFORMATION
PUMPING RECORDS and of information:
System pumpo&as part of inspection: (yes or no)Lt O
If yes,volume pumped: s:allons
Reason for pumping:
TYPE g SYSTEM
Septic tank/distribution box/soil absorption system
Single cesspool
Overflow oesspool
Privy
Shared system(yes or no) (if yes,attach previous inspection records,if any)
Other(explain)
APPROXIMATE AGE of all components,date insWled(if known)and source of information: O
Sewage odors detected when arriving at the site: (yes or no) U
(revised 11/03/95) 6
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
PropertyAddrem 64 Melborne Rd. , Hyannis, MA
Owner. Dana Heilman
Date of Inspection: 9-2 5-9 6
SEPTIC TANK_4
(locate on site plan)
Depth below grade:, I
Material at construction:_,l,4w ete_metal_FRP_other(ezplm) f
t I ` d To wC/
Dimensions: '}
Sludge depth: -7
Distance from top of sludge to bottom of outlet tee or baffle:-1-;f
Scum thiclmess: '(•I
Distance from top of scum to top of outlet tee or battle:
Distance fbom 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 /C A., S
G
G E TRAP:_
(k�ca on site plan)
j
ade:
struction:_concrete_metal_FRP_other(e:plain)
op of scum to top of outlet tee or battle:
ottom of scum to bottom of outlet tee or baBle:
n for pumping,condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert,structural integrity,
age,etc.)
1
(revised 11/03/95) 6
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
P,opertyAddre.s: 64 Melborne Rd. , Hyannis, MA
Owner. Dana Heilman
Date Of I=Pwtk m 9-2 5-9 6 '
1(condition
HOLDING TANK:_
( te plan)
vide: _,metal_FRP _other(e:plaia)
Materialoonstr+ictioa _concrete
no
aallozWday
f islet tee,condition of alarm and!lost 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 leafage into or out of boa,etc.) /05
LLpllan)
1
r:(yes or no)p chamber,condition of pumps and appurtenances,etc.
(revised 11/03/95)
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 64 Melborne Rd. , Hyannis, MA
Owner, Dana Heilman
De"OfI=P 9-25-96
SOIL ABSORPTION SYSTEM(SASk_
(locate an sits plea,if possible;excavation not required,but may be a ro;umated
PP by non-intrusive methods)
If not determined to be preeent,sxplaia:
TyPe leachmB Pits,number:
leeching chambers,number:_
leaching galleries,number:
leaching trenches,number,length:
leaching fields,number,dimensions:
overflow cesspool,number:
Comments note oonditioa of soil,Si of hydraulic failure, level of ponding,condition of vegetation,etc.) /[7 0 cd r,w Sicar
r '
POOLS:_
( on tits plan)
N and configuration:
Depth p of liquid to inlet invert:
Dew of solids layer.
De of scum layer:
of cesspool:
of construction:
of groundwater:
inflow(cesspool must be pumped as part of inspection)
Co nts:(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.)
P
on site plan)
o!construaion Dimensions:
Depth solids:
:(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.)
(revised 11/03/95) g
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
property Address: 64 Melborne Rd. , Hyannis, MA
Owner. Dana Heilman
Date of Inspection: 9—2 5—9 6
SIMMU OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent references landmarks or benchmarks
locate all wells within 100'
�40
f
DEPTH TO GROUNDWATER
Depth to gcwndwater: !L'_ feet n
method of determination or approximation:
(revised 11/03/95) 9
LOCATION SEWAGE PERMIT NO.
VILLAGE
INSTALLER'S /fNAME & ADDRESS
BUILDER OR OWNER
oDATE PERMIT ISSUED ZZ
oDATE COMPLIANCE ISSUED
F
Q
11 � �� v
�.
�: �' Cv
o�
- �-----\
r°a
� -
J
No. .Y.. ...................
THE COMMONWEALTH OF MASSACHUSETTS
r-- BOARD.-OF HEALTH
01LU 0................OF.......)Jt ..�..._......��. ���.A ---------------
------
Appliratiou for Disposal Works Toustrurtinn Frrmit
Application is hereby made for a Permit to Construct (X or Repair ( ) an Individual Sewage Disposal
sy -
-eta , .�Z.. �— � :_ ���.� rt............
_-- L on:A ess Lot No.
----------------------------•----..... ..............................................
C Owner ................................Address
� Installer Address
d Type of Building, Size Lot..__.` QaQ.....Sq. feet
Dwelling—No, of Bedrooms.............3........................Expansion Attic ( ) Garbage Grinder
Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
Other fixtures ...........................
W Design Flow................................S >..gallons per person per day. Total daylypw............... _-c3----0...........pa ons.1,
WSeptic Tank—Liquid capacity..•-.._._._.gallons Length f_=G..... Width--- Diameter--------------- Depth .....
x Disposal Trench—N ........ Width.................... Total Length........... ....... Total leaching area....................sq. ft.
Seepage Pit No.------- Diameter..........F..... Depth below inlet........ Total leaching area..;;�GO.sq. ft.
Z Other Distribution box (�— Dosing nk ( ) p Q
aPercolation Test Resul Performed by___.. .�5 _l _ .. __ .�..a.............. Date.... _ ..K.q•__...
,a Test Pit No. I...�....`-minutes per inch Depth of Test Pit___ �__._..... Depth to ground water.___O�Y__PU
rX4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
'� - --------��� ........................."'rtf t
Description of Soil..............•••-•.7A............. ..� S Q L;---.. {� � .
x
W
V Nature of Repairs or Alterations—Answer when applicable...............................................................................................
.......................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TIT E 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of health.
Signed......................................................................................
Date
ApplicationApproved By-- ••• ••=-•-•--•-•----------------•---•-••-•-••••••-----•-•--•-•-----------•---•--•------
Application Disapprov f the following reasons-------------•----------------------------------•---= •----.....------.....--•---. Dare..............
---------•----------••-•---------------------------------------------•-----------•--.....---•--------•----•....._...--•••-••----••--------------------•-•---------•-•--••-----•-----------•••-•--•-•---
Date
PermitNo...:..................................................... Issued_-----------•------------•-- ^
'--...-•------•--------- -
Date
N /— _ Fss 5 ....._............
THE COMMONWEALTH OF MASSACHUSETTS ~'
--- BOARD, OF HEALTH
--- .o F......1. i. r .i �t,t.............................
App iraation for Di,ipufiFaf Works Tonuiruriion ramit
Application is hereby made for a Permit to Construct Q<) or Repair ( ) an Individual Sewage Disposal
System at:
...
j - L c ion•Add'ess ( qr Lot No. `
• n:r ----.1..: %.�.
.... -----•-•--•---------------...-•--••-• v--.......---......_...--••---------------•------•---.....
Owner Address
................ --------...... -
Installer Address
U }.(.Type of Building �� Size Lot....... ......Sq. feet
Dwelling 1—No. of Bedrooms___........_t;--).........................Expansion Attic ( ) Garbage Grinder ( �
`-4 Other—T e of Building .. No. of persons____________________________ Showers — Cafeteria
QI Other fixtures ....................................---•--
Design Flow.....-.z-:........... per person per day. Total daily flow............... ...........gallons,.
Ix Septic Tank—/ Liquid capaeityC_tr_C...gallons Length('=l_...... Width.q__�6!�.I. Diameter................ DepthCi
W x Disposal Trench—No. ................... Width..._............... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No-___--__/---------- Diameter.......... Depth below inlet.......(,=....... Total leaching area.. ft.
Z Other Distribution box Dosing tank ( ) -f,_ , 1
a Percolation Test Results Performed by__..�<_...._......._�_r _fi_. __.__..._,�I. ................. _ L! .
r , M r e 1� -1 Date
Test Pit No. 1---?�___ Lminutes per inch Depth of Test Pit._l N ._.____ Depth to ground water.._ v
(z, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
D Description of Soil------ j �..� r'3.17L >L�1'_ /,�t t�- —1l) lj` I t'� -j _� •(
......:_---••.
U ••••-•--•••••--•--•-----•_....---•--•-•--•---•-•-•....••-•••--•••--•••••-•----•--•••._,.._------••--•••--•••-•----•-••••---••••---•-...__.-•---••-•••••-•-•-.___.._.•-••------•..._......--••-------•-
W _
U Nature of Repairs or Alterations—Answer when applicable...............................................................................................
--- -•- ---•-•----•--••-••---._...•---••••---------------••-•-------.....--••
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of health.
I'the-
Signed-------•-•--••-----•----•-•..................•--•--•-----------....•--•--•---••......• -••••-••-••••--•.._.......Application Approved B •---------•-----••--•---•--------------•--•--......-----........._._......- Date
•-•--••-•----...---•-•....................................•----••--DateApplieation Disapprov ing reasons__________________________ ._..._..__...
---------------------------------------•-•------------•-•--...----•---•---•-----....-------•--••-•-•--._..__..•......._........•-••••-------•----------•----------------------•-•-•••...----------------
1 Date
PermitNo......................................................... Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..........................................O F.....................................................................................
//lI �rrtifirFa#r of TompliFaurr
THI/ IS 7ERThFY, That the Individual Sewage Disposal System constructed ( or Repaired ( )
by........ Er ........% __- --- _ ................••-•---------•-•-._._._...__........---------•------•-------•--...._....._
Installer
---------------------------------------------------•--------•--------------------•----------
has been installe i accordance with the provisions of TI 5 of The State Sanitary Code as described in the
application for D sposal Works Construction Permit No... ___y__-fv. __1_____.___. dated................................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE........................................... -•64 Inspector.......................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
` ...........................................OF...................------.......-----------..........._...._.........................
Nor... r/.- FEEL.....--...............
Dili usal 10u u n ion �ernii#
Permission is hereby ranted.. l.. L.:....
to Constru raj' ' 0 pair' ' an An idual rage Disposal System
atN ............................................................... .......................
,. Street
as shown on the a'plicati for Disposal Works Construction Permit. ...................... Dated..........................................
............... ... -•-•----•-------------•-------------•----...-------•------.:..---..........._..._
(/ Board of Health
DATE....? 2 --......................•---•----••--••--•-••••--...... /
FORM 1255 A. M. SULKIN, INC., BOSTON - / '
��1►.IG�.[-. FAMILY _ ;3 g�pRooM -� ,� � � �� / - �iF ir"'.}
1.JUr;,tGARBAGE (�WNDE2 ��( •�; � � �``G l }�lY
fc:..
33oG.Pq
SEPTIC TP►JK = 330x15U% - '497G.Ro I Z '
USA- %000 GAV. __ -- $Z•Z ; 'I..K ,'
V SPc r .. RT loci �,a� 3'S c�• �� P .j '
SI DI�ALA.. _ 13?. Sf ->_ low u a�.
I
r1phk .I
Tot—�c. 17BS 16j ° LdA 3 Gm. ,htr>' L6 6
F
' pEq,co�.ATioN RATES ('SIN ZMIN o�t_�55 9
1
go
13
SJ . DAVIRC.
> 1 +
o OILLIAM �G 4 o TNULIN
C. ^� Na 2� 6 Cat Gr �TE ;�-, /
N,Y E a� 1
F
,p No. 19334 O Is
$ C_JI.F �.11
�s10 AlE1►�'
� Q r•
To NU -lZ•'CS: .
P F ;
3 4 S-4 ��Z � :INV.
G
G3�, _
65rctC, A15T. INV.
BMX SEPT �y ..
. 000G1 INV TANK ,
PIT INV. IN. -7.4 �(15 I...
m 1;
WIT"
r
v (`�.l� i
AS"r.D
1 ,1 7`i 5T0l1E 8 �U/7 iLU'. ►-'l►IJ B� -- ` V 1 j <ya
I s F
s .„{ . C� RTIFIGC� PLoT ' PI—AN _
N
PRUPIL
,D t_o C 4't I o N ,� o
NO SCALE G I VATS
is .2 4 5 A�� 1 =3v
p L P.I.I REF 62EN G
r
1 C E R'T I F Y -t N AT T H E P�P. 1u5� 5No�rYN
NERIcoN GOMPL`{5 WITH -THE 'S I o6LIN'�
I A►.!D 5 6T�. K 6 Q v►2 M E N'f� o f I 1 I E-
'T c>W1,4 or- 1,1 A.VWSI-A6LE Af o -A P�i.A�
LOCp.T'ED WI NI TN
BAxTEcz.e P.I`{E INC•
O y ��'/ REG I SZ E.ZEr-D'►AN D 5 u FLY E�(olzS
"Tt115 Pl-QN 1 � NorT C3n5t=o oa ,a
N I2U ME NT' S U ZV E E n. 1=FSETS Suou�, I 5T Y � -T N
NoT D� 'v5E D TO OETE.R/^ItiIE APPLICP.►—IT J A NAtfS I F
<al►JG�G Fp.M►.t_`(
► 0 '6AR.BAGE (�wt.►DE2 �� .� f I:.� 3'7+ .
�a►l:"If
-� _ow :. Iivx 3 - 33oG•Pt? Tl� _ ) lq
p I ,1•
.,SEPT►G TA►JK = 33ox15o% - /19%6.PD
u51` 1000
�K 2
'p15►x.�6A!_ SIT- 1.4�
SID3-vALL.. 13 . Sf u �. :.
— � .5` 1� �•
132 x 2-5 = IV
paM.y.o N& Aa4&AIISFcr
1
� T41"A�• l�Sl6r1.1 ° Q.d.3 G1�D �� 1'i�uSE, ..� .r�. ` ,y it fl ;
PEq,co�.ATioN FZATEi (''IN 2MIN 0r--L1✓5S
go
• ! r r
OF
DAVIQ
WILLIAM C. G� GO• ly 1 I G �rk
THULIN
N Y E 0 �Na 2
, ^,� 1
p No. 19334 O 'o pprF 1$ ,J�G /`�` Q—[5 Cl) ' � l.. .
STEFp� t/0 AL E� 1
7
- �- .
,4. __ . �_ �'S�� Y Top
r �( i�r/`
•t'� — �d-SQ �z Cj-S�i7.Y�yiv✓`T� '��^ INV. •(• �* � r 't ri;. �
1000
r✓6$caC_ D 1 ST. I N�. cpr
•rra0.:. I$�.,4 ' TAN (�� t -,i Al.. ,
LEa u r a
D PIT INV. INY
61A14ir `_
D PR LoC4.71oNPNNlS fG?1 :.:ePit :.s l
NO SCALE 5CALE�� =3U SATE 71.
NU pLp.N REFE2ENG I
CEP-T►FY TVA AT 'TNT ��P. 1400C 5NoWN
i A►.I D 5 6T K se-E. 0►Q R.E M I=NTH o
'jo W N o r- � AR•.P5`(A 6LE A N-0 ►S WO T L-At>�1 t✓�-U 1� Z 5 U �� 14-� i
DOD PI..AI
I.00P.TED •Wl HI TN�
DATE
BAxTE2e
. �z.E6 I S'T f�Q6U'I-AND 5 u R.v EYoiZ�S
-TIlI5 Pt. N ►5 Non 4n5ET� o►a A 0:57E2v1LLE
INSTRUMENT 5�2v>=Y -rNE n►=F51:_r5 6WOULD
I `
No-T C3E uSEOTc� DETERI^ItiIE �.oT ►NE�j APPLICA►-IT