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HomeMy WebLinkAbout0320 SEAPUIT RIVER ROAD - Health 320 Seapuit River Road I I A =;051 . `017 002'..ei lle (.(formerly 492 Grand aiid) j i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 320 Seapuit River Rd " Property Address Herbert Pheeney Owner Owner's Name information is Osterville Ma 02655 11/6/2020 it required for every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. Inspector Information '/4 16'0&T— -on the.computer, use only the tab Chad Hathaway key to move your Name of Inspector cursor-do not Hathaway Septic Inspections use the return Company Name key. P.O.Box 151 raa Company Address - Forestdale Ma 02644 Citylrown State Zip Code 774 274 2581 12866 Telephone Number License Number B. Certification I certify that: 1 am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); I have personally inspected the sewage disposal system at the-property address- listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 1-1/612020 Ins o—es Signature Date The system inspector shall submit a c y of this ' spection report to the Approving Authority (Board of Health or DEP)within 30 days of omple i his inspection. If the system has a design flow of 10,000 gpd or greater, the inspecto a system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: 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. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 18 i - I Commonwealth of Massachusetts ip Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary-Assessments 320 Seapuit River Rd Property Address Herbert Pheeney Owner Owner's Name information is required for every Osterville Ma 02655 t1/6/2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: I have not found an information which indicat es tes 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: This inspection is not a guaranteeand applies no warrantyof the described septic components in this report including but not limited to piping structual intergrity of components and life exspectancy of leaching and described components. This inspection is to describe conditions witnessed at time of inspection only. Regular tank maintenance and water conservation can prolong life of septic systems _Information on care and-do's and don'ts can be found at town health dept or mass ov 2 System Conditional) Passes: Y Y ❑ 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): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 I Commonwealth of Massachusetts r - ,ip Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 320 Seapuit River Rd Property Address Herbert Pheeney Owner Owner's Name information is required for every Osterville Ma 02655 11/6/2020 page. CityfTown State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes(cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced. ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced E 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): 3) 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. a. 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: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts ,lp Title 5 Official Inspection Form ' Subsurface Sewage Disposal System Form-Not for Voluntary-Assessments 320 Seapuit River Rd Property Address Herbert Pheeney Owner Owner's Name information is required for every Osterville Ma 02655 11/6/2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ 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 b. 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. c. Other: 4) 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 320 Seapuit River Rd Property Address Herbert Pheeney Owner Owner's Name information is required for every Ostervill.e. Ma; 02655 11/6/2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool El E 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 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.water supply 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 2000 gpd- 10,000 gpd. ❑ ® The system falls. I have determined that one or more of the above failure criteria exist as described in 310 CM 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. 5) 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 CA 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 L Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 320 Seapuit River Rd Property Address Herbert Pheeney Owner Owner's Name information is required for every Osterville Ma 02655, 11/6/2020 page. Citylrown State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes" to any question in Section C.5 the system is considered a significant threat, or answered"yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no"for each of the following for all inspections: 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)] t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 18 I Commonwealth of Massachusetts �- - p Title 5 Official Inspection Form Subsurface Sewage-Disposal System.Form-Not for Voluntary Assessments 320 Seapuit River Rd Property Address Herbert Pheeney Owner Owner's Name information is. required for every Osterville Ma 02655 11/6/2020 page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 6 Number of bedrooms (actual): 6 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 660 Description: 2- 1000 gal leach pits with 2-3 feet of stone Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No i Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage(gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: current Date t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal"System Form -Not for Voluntary Assessments 320 Seapuit River Rd Property Address Herbert Pheeney Owner Owner's Name information is required for every Osterville Ma 02655 11/6/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont j 2. 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 Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: 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 below): 3. Pumping Records: Source of information: unknown Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons Now was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 I Commonwealth of Massachusetts r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary-Assessments 320 Seapuit River Rd Property Address Herbert Pheeney Owner Owner's Name information is required for every Osterville Ma 02655 11/6/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. 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: 1985 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 1.75' feet Material of construction: ❑ cast iron ®_40 PVC ❑other(explain): Distance from private water supply well or suction line: 20+ feet Comments (on condition of joints, venting, evidence of leakage, etc.): . no signs of poor venting or restricted flow or leaks t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments b a 320 Seapuit River Rd Property Address Herbert Pheeney Owner Owner's Name information is required for every Osteryille Ma 02655 11/6/2020 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 1.25' feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) H10 1500 gal. precast tank If tank is metal, list age--- years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 10'6"x5'6"x4' Sludge depth: 6" Distance from top of sludge to bottom of outlet tee or baffle 2411 Scum thickness less then 1" Distance from top of scum to top of outlet tee or baffle 5" Distance from bottom of scum to bottom of outlet tee or baffle 48" How were dimensions determined? tape and 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.): PVC tee inlet baffle outlet. tank at working level no signs of heavy decay or leakage. l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments y 320 Sea uit River Rd Property Address Herbert Pheeney Owner Owner's Name information a Osterville Ma 02655 11/6/2020 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 7. 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 Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels-as related to outlet invert, evidence of leakage, etc.): - 8. 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18 cam`, Commonwealth of Massachusetts �n Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 320 Seapuit River Rd Property Address Herbert Pheeney Owner Owners Name information is required for every Osterville Ma 02655 11/6/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) . 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 9. Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 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.): Dbox appears to be newer then origanal. No decay or carry overs 1 inlet 2 outlets see asbuilt for piping diagram l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 320 Seapuit River Rd Property Address Herbert Pheeney Owner Owners Name information is required for every Osterville Ma 02655 11/6/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. 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. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ® leaching pits number: 2- 1000 gal leachpits ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ 1eaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts F Title 5 Official Inspection farm Subsurface Sewage Disposal System Form Not for Voluntary Assessments ,- 320 Seapuit River Rd Property Address Herbert Pheeney Owner Owner's Name information is required for every Osterville Ma 02655 11/6/2020 page. Citylrown State Zip Code Date of Inspection D. System. Information. (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): camera inspected pits due to depth in ground. Pit#1 2' of effective deptth below invert and pit#2 4 feet of effective depth below invert. Pit#1 is 10 feet from inground pool. Varience was granted by health de t from code of p o e 20 feet,to 1,0 feet-.. 12. 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 Payer 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.): I t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 320 Seapuit River Rd Property Address Herbert Pheeney Owner Owner's Name information required for every Osterville Ma 02655 11/6/2020 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 13. 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.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4 , 320 Seapuit River Rd Property Address Herbert Pheeney Owner Owner's Name information is required for every Osterville Ma 02655 11/6/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 14. 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 cok- tiz-30rb1' A3 - 01 lg3- ` � G R� r-33 61l IOV (9 9 o Ll 14.2 o �r� 1 � I P�L) 1 i t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 f Commonwealth of Massachusetts �9 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 320 Seapuit River Rd Property Address Herbert Pheeney Owner Owner's Name information is required for every Osterville Ma 02655 11/6/2020 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 18 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: town GIS mapping You must describe how you established the high ground water elevation: lot el. in area of leach pits el 20' bottom of SAS el. 10' low in area wetlands el .1.25' leaving greater then 4'of seperation from bottom of SAS to ground water. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for-Voluntary Assessments 320 Seapuit River Rd Property Address Herbert Pheeney Owner Owner's Name information.is required for every Osterville Ma 02655 11/6/2020 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria)and 6 (Checklist) completed ® D. System Information: For 8:Tight/Holding Tank Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 Commonwealth of Massachusetts r Title 5 OfficialInspection Form Subsurface Sewage Disposal System Form- of for Voluntary Assessments / wM 492 Grand Island Drive Property Address Joseph Russo Owner Owner's Name information is required for every Osterville MA 02655 1/15/2014 page. City/Town ! State Zip Code Date of Inspection F 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 A. General Information filling out forms on the computer, use only the tab 1. Inspector: (� key to move your. cursor-do not James Ford 'i e the return Name of Inspector key. Company Name P.O. Box 49 Company Address Osterville MA 02655 City/Town State Zip Code 508-862-9400 S12482 Telephone Number ' License Number B. Certification til s I certify that I have personally in 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 15.34C of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further valuation by the Local Approving Authority 1/22/14 Insp or's Signature Date Th stem 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,�onditions 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. /Z01 t5ins•3/13 Title 5 Official Inspe n F :Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of MaSSaChusettS Title 5 Of"ficia!' Inspection Form Subsurface Sewage Disposal'iSystem Form-Not for Voluntary Assessments 492 Grand Island Drive Property Address Joseph Russo Owner Owner's Name information is Osterville MA 02655 1/15/2014 required for every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 have not found any irifo�mation 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: } B) System Conditionally Passes: i. - h. ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.Tho system, upon completion of the replacement or repair, as approved by the Board of Health,will`pass. Check the box for"yes", ajo'l;or not determined" (Y, N, ND)for the following statements. If"not determined," please expla.n . . The septic tank is metal and',over.20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substan'tiai 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): .I t ➢ 1, i. 11 . I t5ins•3113 i Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Y , r: Commonwealth of Massachusetts Title 5 Oificiailrispection Form Subsurface Sewage Disposalli System Form-Not for Voluntary Assessments M 492 Grand Island Drive Property Address Joseph Russo Owner Owner's Name information is required for every Osterville MA 02655 1/15/2014 page. CitylTown State Zip Code Date of Inspection B. Certification (cont): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipes)or due to a broken, settled or uneven distribution box. System will pass inspection if(with;dbproval of Board of Health): ❑ broken pipe(s�,arereplaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution bok 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): I_ ❑ obstruction is,r,iemoved ❑ Y ❑ N ❑ ND(Explain below): i I i, i" •i� C i Further Evaluation n is* Required Y Re uired b 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 passunless 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 envirpnment: l ; ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 P ` Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 r Commonwealth of Massachusetts u Title 5 Official Inspection Form Subsurface Sewage DisposaU ystem Form -Not for Voluntary Assessments w 492 Grand Island Drive k `. Property Address Joseph Russo ` Owner Owner's Name .i . information is required for every Osterville s MA 02655 1/15/2014 page. CitylTown 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. El The system has a 60' tic 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. x, V ❑ The system has a septicAank 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: +i This system passes if the-yell 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: 9 4 11 �j ii .r. 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 df 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 duejo an overloaded or clogged SAS or cesspool El ® Sta,�c Liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liq .id-.depth in cesspool is less than 6" below invert or available volume is less than%4 day flow t5ins-3113 ! ! Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts u Title 5 Officia`!' Inspection Fora Subsurface Sewage Disposal.System Form-Not for Voluntary Assessments �M 492 Grand Island Drive Property Address Joseph Russo Owner Owner's Name 4! information is required for every Osterville :_;a MA 02655 1/15/2014 page. CitylTown State Zip Code Date of Inspection B. Certification (cont) Yes No Il El ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet frompa.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 icliain of custody must be attached to this form.] 1, ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 1 ubb.gpd. ❑ ® The systiern fails. I have determined that one or more of the above failure criteria':ekist 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 nec6ssary 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 musf1indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. 1; Yes No Pi ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the sytem is within 200 feet of a tributary to a surface drinking water supply ii ❑ ❑ 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 S10 CM 15.304.The system owner should contact the appropriate regional office of the Departine,nt. I , t5ins•3113 P Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 I' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposa4System Form-Not for Voluntary Assessments - i M 492 Grand Island Drive Property Address Joseph Russo Owner Owner's Name information is required for every Osterville MA 02655 1/15/2014 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following havei:been done. You must indicate"yes" or"no"as to each of the following: r - Yes No ® ❑ Pumpi'rtg information was provided by the owner, occupant, or Board of Health , ❑ ® Were af1y of the system components pumped out in the previous two weeks? ® ❑ Has the.$ystem received normal flows in the previous two week period? El ® Have Large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were asbuilt 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? L ; ® ❑ Was t�j e.'site inspected for signs of break out? ® ❑ Were all.system components, excluding the SAS, located on site? t ® ❑ 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? 6 ❑ ® Was the;.facility owner(and occupants if different from owner) provided with informa 'on on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been i lermined based on: ® ❑ Existirig`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 El approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information ' t Residential Flow Conditions: Number of bedrooms(design): 6 Number of bedrooms (actual): 6 DESIGN flow based on 31.0 CMR 15.203(for example: 110 gpd x#of bedrooms): - 660 t5ins-3/13 l Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 ii Commonwealth of Massachusetts Title 5 Officiafinspection Form n Subsurface Sewage Disposal±5jrstem Form-Not for Voluntary Assessments M 492 Grand Island Drive i. Property Address i Joseph Russo Owner Owner's Name information is Osterville MA 02655 1/15/2014 required for every , page. City/Town ri: ti State Zip Code Date of Inspection D. System Information Description: k� it , Number of current residents;?. Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes ® No information in this report.);] , Laundry system inspected? El Yes ® No Seasonal use? ?; ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Detail: unavailable :p a. ti a 't- i „ Sump pump? ❑ Yes ® No currently. Last date of occupancy. i Date Commercialllndustrial Flow Conditions: Type of Establishment: f Design flow(based on 310 �MR 15.203): Gallons per day(gpd) 1 ' Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? f: ❑ Yes. ❑ No Industrial waste holding tanh.,present? ❑ Yes ElNo Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3/13 0` Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 7 of 17 ti Commonwealth of Massachusetts.:. Title 5 Officia ` nspection Form Subsurface Sewage Disposal'System Form-Not for Voluntary Assessments M 492 Grand Island Drive Property Address Joseph Russo Owner Owner's Name information is required for every Osterville MA 02655 1/15/2014 page. City[rown State Zip Code Date of Inspection D. System Information. (cont.) Last date of occupancy/use:'I Date 31 Other(describe below): r� General Information Pumping Records: Source of information: 1500 Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: gallons s � How was quantity pumped:determined? u maintenance Reason for pumping: Type of System: i . ® Septic tan'.k,.distribution box, soil absorption.system r ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared %istem (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 tanle, Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3113 it Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 t . Commonwealth of Masshusetts _ . Title 5 Official` Inspection Form Subsurface Sewage Disposal S`y`stem Form-Not for Voluntary Assessments r ii•. i 492 Grand Island Drive Property Address + . Joseph Russo Owner Owner's Name ' 1 information is reequiredquired for every Osterville MA 02655 1/15/2014 page. City/Town State Zip Code Date of Inspection D. System Informati®In (cont.) Approximate age of all cornporients, date installed (if known)and source of information: installed - 1/14/1986 per info Were sewage odors detected when arriving at the site? r ❑ Yes ® No Building Sewer(locate on;site plan): Depth below grade: i ; `; feet Material of construction- t ❑ 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.): A. 't Septic Tank(locate on sit` Milan): 1211 P Depth below grade: ; feet Material of construction: l ® 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 E 1500 gals. Dimensions: I G 2° Sludge depth: is t5ins•3113 j Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 is 1 if Commonwealth.of Mass" chusetts fficial�=Inspection Form Title 5 O Subsurface Sewage Disposal:System Form-Not for Voluntary Assessments 492 Grand Island Drive Property Address Joseph Russo ;! x Owner Owner's Name information is required for every Osterville MA 02655 ; 1/15/2014 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) ' 29 Distance from top of sludg&to bottom of outlet tee or baffle Scum thickness 2 6 Distance from top of scum`Jtop of outlet tee or baffle Distance from bottom of s m ,t'u iio bottom of outlet tee or baffle 15 How were dimensions determined? measure Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to©utlet invert, evidence of leakage, etc.): The tees were present. There was no sign of leakage.The tank was pumped after the inspection. t a •> Grease Trap (locate on site plan): Depth below grade: r feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): N/a Dimensions: •i Scum thickness t Distance from top of scum;to top of outlet tee or baffle ` Distance from bottom of s"um to bottom of outlet tee or baffle :i Date of last pumping: Date a, pi t5ins•3/13 ; i Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Masspchusetts Title 5 Official Inspection Form Subsurface Sewage Disposaf stem Form -Not for Voluntary Assessments ,i Iy 492 Grand Island Drive A Property Address I Joseph Russo Owner Owner's Name .) information is MA 02655 1/15/2014 required for every Osterville ' ; 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 outl'ei'invert, evidence of leakage, etc.): F e y Tight or Holding Tank(tgnk'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 Dimensions: Capacity: gallons `j Design Flow: gallons per day Alarm present: ' ❑ Yes ❑ No Alarm level: " Alarm in working order: ❑ Yes ❑ No �l y Date of last pumping: ' Date Comments (condition of afar'm and float switches, etc.): F *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins-3113 ! I Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Officialinspection Forme Subsurface Sewage Disposa( ystem Form-Not for Voluntary Assessments 492 Grand Island Drive Property Address Joseph Russo {� Owner Owner's Name hi information is required for every Cisterville MA 02655 1/15/2014 page. City/Town State Zip Code Date of Inspection D. System Informati0o (cont.) ii' ; It R Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert even 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.): The D-box was broken down''structurally.A new D-Box was installed see permit#2014-13.The cover is 3" below grade. 1 y .. Pump Chamber(locate on site plan): Pumps in working order. El Yes El No" t Alarms in working order: i ❑ Yes El No* Comments (note condition:'of pump chamber, condition of pumps and appurtenances, etc.): N/a 1 •t " 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: ! A 1 : t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 r Commonwealth of Massachusetts Title 5 Official`` Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M ,•''y 492 Grand Island Drive Property Address Joseph Russo , Owner Owners Name F information is ;:( required for every Osterville MA 02655 1/15/2014 page. City/Town , State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pi4 number: 2- 1000 gal. ❑ leaching chambers number: a , ❑ leaching gall-e'eies number: , ❑ leaching trenches number, length: ❑ leaching fields; : number, dimensions: F ' a ❑ 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.): Both pits were clean.There-was no signs of failure.A camera was used for the inspection .a i. . I Cesspools (cesspool must,be pumped as part of inspection)(locate on site plan): Number and configuration ..;I N/a Depth—top of liquid to inlet invert 6'.t Depth of solids layer s; 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 i. Commonwealth of Massachusetts t N v Title 5 Official[_ Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments °M 492 Grand Island Drive Property Address Joseph Russo Owner Owner's Name information is required for every Osterville MA 02655 1/15/2014 page. City/Town r State Zip Code Date of Inspection D. System Informatiorh (cont.) l Comments(note conditionibf'soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): }i k t� it ••. - 1 hi +] Privy(locate on site plan): Materials of construction: 1 Dimensions Depth of solids if Comments(note condition�of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): N/a � w, t y� t f t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 ! i •'' Commonwealth of Massachusetts " Title 5 Official'; Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 492 Grand Island Drive Property Address Joseph Russo Owner Owner's Name information is required for every Osterville MA 02655 1/15/2014 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 refeF6ce 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 3 ! i A 4 o a a 3 30 yo 1 : f. kt i L ; A t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 117 ~' Commonwealth of Mas!;achusetts Title 5 Official[ Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments h 492 Grand Island Drive Property Address ! Joseph Russo ` Owner Owner's Name requinform r on is Osterville MA 02655 1/15/2014 requiredd for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: e s ❑ Check Slope {{ l ❑ Surface water r , ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 18 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 t , ❑ Observed sitel(abutting property/observation hole within 150 feet of SAS) ® Checked with;local Board of Health-explain: Using topo antl water contours maps ❑ Checked with diocal excavators, installers-(attach documentation) ❑ Accessed USES database-explain: You must describe how you'.established the high ground water elevation: see above. r, t 6 . Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 16 of 17 i is • Commonwealth of Massachusetts Title 5 Official; Inspection Fora Subsurface Sewage Disposal System Form-Not for Voluntary Assessments r 492 Grand Island Drive Property Address ' Joseph Russo o ' Owner Owner's Name (, information is required for every Ostervllle MA 02655 1/15/2014 page. City/Town > State Zip Code Date of Inspection E. Report Completeriess Checklist ® Inspection Summary: A, B, C, D, or E checked tr ® 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 Ri R 4 1 p. I a i s , 4 I 1 r' �I I rl l5ins•3/13 ;' Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 The Town of Barnstable Department of Public Works BARNSTABI,E MASS. ; 382 Falmouth Road'H annis MA 02601 MASS. Y � www tow n.bam#ablejTia.us 3� Daniel W.Santos,P.E. Office: -308.790.6400 Director ;_Fax: 508.790.6343, i Herbert&Pamela Pheeuey PO Box 1017 Osterville,MA;02655 Date:November 7,2014 Re Address re assignment for`Mob 051 Pc1.051=017.002,#492 Grand.Island.Drive,Ostgrvill.e Dear Mr.&Mrs.Pheeney; { Enclosed is a copy of your address change request for your property.: dentified above:.An inspection was conducted at the property site. According to,the Town.of Barnstable's Ordinance V for Numbering of Buildings(encl.),the removal of the driveway access on Grand Island Drive and-the new changes made to the access driveways on Seapuit River Road do qualify for an address change consideration. Viewing the site verifies the changes warrants a change of address for:your property from#492 Grand Island Drive to 320 SeapuitRiver Road.OsterAlle. 'This change will be forwarded to the Town,of { Barnstable's Building Department and all Town records will reflect this change m property location. Please contact me at(508)790-6400 x-4942 or at frank.schleeel@to-wn.barnstable:ma.us,during regular business hours when the new numbers.are.posted in accordance with the enclosed Building Number ' Regulations so that your E911 telephone accounts can be updated with the new address. Your attention to this matter is required:Please contact me or,Mr.Roger Parsons;PE:,Town Engineer at (50'8)790-6400 if you require further assistance with this notice: Y� :Sle rank . E911 Data Liaison Engineering Records Manager DPW/Technical Support 382 Falmouth Rd.%Rte.2g Hyannis;MA.02601 PH:(508.)790-6400 x4942 Email:frank.schleeel@-town barnstable.rna.us . t r t } Town of Barnstable Department of- Public Works 382 Falmouth Road,,Hyannis MA 02601. l ttp//www.town,.barnstablle.ma.ps Office; 508-790-64010 Daniel Santos,;Director Fax: 508-790-6406 Roger.Parsons,PE.Town Engineer SUBJECT: Numbering of Buildings Map No.051 Parcel No. 0 17 , 00a. Date' 06V. ?- 2.014 i Dear Property Owner, Notice is hereby given in accordance with the General'Or(,,ances of the Town of Barnstable, Chapter III,Article V,Numbering of Buildings, adopted March 3,1931,revised July 21,1994, public convenience and necessity requires the'assignment of number 3Z0 for your property located on ZONsWo i RtYGIL ('�4T�R��h 1LcF i STREET NAME VILLAGE This number should be affixed to your buildin so that:it is visible from the street as outlined in Exhibit"E"; Town of Barnstable Rules and Regulations for Numbering of Buildings. Please contact Mr.Prank Schlegel at ihe:Engii Bering Division at(508)790 6400 x 4942 and be prepared to provide all telephone numbers at this location so that your E 911 account records can be confirmed'when the correct.building.number is posted. Roger Parsons;P:E. Town Engineer end.''"'T.O.B.Rules&Regs.. Common Questions _✓Site Map Assessors Change"Form Town of Barnsle f Department of public Works Technical Support Division 382 Falmouth; Road Hyannis, MA 02601 . . 1 VIV f `Jib jfrCDv+ —e j4� •1 , a . - - f .. ERo i Cr C$ basemaps:dgn 11/6/20:14 3:07:09 PM; r r Pfopety,ii�es:sf�or�f:®n t�ite,plao _nre tor.as$essing Orposes,on6 and do•not represent ktuaE• E relatlonshipa..to pt�yslcal - ., r ... .«. ..,.:fir•. ., —' -. -_•—_.._..—...-r---rr'r��:. __. . _....-.-�- --...—___._—__. x x. - a l r' r x •' M1 .. Il t , k e 1 r • _ i,rDRIVEWAY - , SEAPUrr :RIVER ROAD TOWN,OF BARNSTABLE. DEPARTMENT OF PUBLIC WORKS I' ENGINEERING DIVISION 367 MAIN STREET 4T WANNIS,MA 02601 - M1 � :♦. `� � +- �n�e za�/' a .? t. � ..^� -� M".w'',,y�a i s ' ,.ti _..: ��� .x. �:. ,ram �^ — "♦a' - t�,. �� � - . f ,� .t„� g`""�, �, ♦ GG 1 is w.� '.f ssxs ;"'3. ,��.� •`� .�a .: 1 it .�,} � _ _` y I �riwi _ '� i CLOSE SEAPU17RIVER COMA GRAND ISLAM DRa GRAND ISLAND ROAD _ DRIVE = GRAND I[SLAND'DRIVE' k •_, -L o- li ParcelEdit Page 1 of 1 C. . r,7"IN+TA 1 L r" f a F' . grow W.W. TO t X t, Pl Sys a� _ ��.�e.�.. •" GT.* > � �L' y C{ +f (.i4r`6��. !i�si i w, J. 1 Logged In As: Thursday;November-6 201-4 I Frank Schlegel Parcel ! Application Center Road Svstein Reports Road_Svstem t Parcel Detail I . Parcel ID: 051017002_ Sewer Act: I T/R 07 fLj dat I i Devel Lot: LTOT 40 Owner: RUSSO, JOSEPH N III TR ET AL t� Co owner: %PHEENEY, HERBERT S&PAMELA`L` v J Street: IP O BOX 1017 f City: rOSTERVILLE -- State: A zip: 02555- -------------- Location: IGRAND ISLAND DRIVE'- �.-� village: Osterville ^ - J I _ I . I Road Index: 0646 Prl Frontage: To set road,you can also;enter road index and tali out of field. i Secondary Road: ISEAPUIT RIVER ROADY � f Sec Index: 11458 _ f Sec Frontage: - — i Visions Location: 492 GRAND ISLAND DRIVE ( Last Updated: - I ---------- -- _ i I No.Bldgsi 1 Account Nos 30326 1 Lot Slze'(acres) i State Class: 1010 I Year Added.: 1985: ' I Fire, _. I Deed Date: 1/7/2008 Deed Ref: C184986 I I Land Value: IL051500 Bldgs Value: 57 8200. �! Extra Features: 99500 Condo Complex: _ I Bullding:F 7 tJniti I Update ' { f http://issgl2/in4aneVpropdata/pledit aspx?ID=PL3450 11/6/2014 j . l y, ......... ... / o �G? r. ,• 4 ,as�, OA • y : basemaps.dgn 11/4/2014 4:00:31 PM Town of Barnstable c on ta,lo tam Department of Public Works are for Ir4pu *n'r, Technical Sup ort Division and,do not represent actuvJ - reIattoa�whi�sa#�o:phyais�i'� 362 Falmouth oadHyannis, MA 02601 . . . i � --�_..� :--_:. - •.-_. ..---.x .., _- _.'-- -o' e ;...;....:-s:�:__-.v__... ems_._.-+starar---..__..,.-,a:: e.«». .»._. ,-.—_. - ���tea_ .. __.-__._._ ., j • i , APPROX SCALE V'-2_4 d y . ' c _ 4.9 JoA- ze tq�3 IJ Ya • �i ids el 4 1 '�- ��" l.�� 'ar. �Tt 'tnn A�ussrrt- -II •} -S�S-t�� I/y � ..ys" -�tiS�mzL 95�3c' •� i�.i `I i.�•i �. 9CpLE r.lad - I•. ' To I I' { i OYWTEP,,_ ZEAL ESTATE April 28,2014 f i Mr.Roger Parsons - - DPW Technical Support 382 Falmouth.Road/Rt.28 i Hyannis,MA 02601 j RE 492 Grand Island Drive Oyster Harbors,-Osterville,MA 02655 Map#51 Lot#17-2 t 265'Frontage on Seapuit River Road, I 70'Frontage on Grand Island Drive l 4 75'Frontage orf curve Dear Mr.Parsons: ' The property currently has_3 curb-cut driveway entrances.We would like to eliminate the driveway entrance on Grand Island Drive and change the address from 492 Grand Island Drive to a new number on Seapuit River_Road; 1 Please contact: t ® Mr.Herbert S.Pheeney 508=776-8089 or,808-420-1000 o Mr.Craig Ashworth,E.B.Norris 508-243-5588 t Current owners: Herbert S. Pheeney Pamela R.Pheeney` Thank you for"your assistance; Sincerely, Herbert S.Pheeney `Pamela R. Pheeeney i 829 Main Street,Box 1017,Osterville,:Massachusetts 02655 (508)420-1000. FAX(508)428=1623 r Message Page 1 of 1 gWchlegel, Frank From: Parsons, Roger Sent: Tuesday, November 04,2014 710.AM ` To: Schlegel,Frank Subject:Address Frank-Greg Ashwood nailed again about a change'of address at.#492 Grand Island--,please call him at 508 243 5588-thanks- Roger V61j V, L r rL16- vM T �rcc: 1NsP� l f i ; .11%412014 ' OYIRTE_ s i i CAL EVTATE 4 t i i I Apri128,2014 i � i Mr. Roger Parsons DPW Technical-Support 382 Falmouth Road/Rt.28 Hyannis,MA 02601 j RE: 492 Grand Island Drive Oyster Harbors,Osterville,MA 02655: Map#51 1 Lot 417-2 265' Frontage on Seapuit River Road' 70' Frontage on Grand Island Drive 75' Frontage on curve Dear Mr. Parsons: I The property currently has 3 curb-'cut driveway entrances.We would like to eliminate the driveway F entrance on Grand Island Drive and change the address from 492.Grand island Drive to anew number on Seapuit River Road. F i Please contact: i ® Mr. Herbert S.Pheeney 508=7764088 or 508-42o-1000 ! i ® Mr.Craig.Ashworth,EA Norris 508-243-5588 - Current owners: Herbert S: Pheeney ' Pamela R, Pheeney Thank you for your assistance: Sincerely, Herbert S.Pheeney Pamela R.Pheeney. ' s i I 829 Main Street,Box 1017,Osterville,Massachusetts 02655 (508)420-1000 FAX(508)428-1623 i 1 Message Page.I of 1 Schlegel, Frank From: Parsons, Roger , Seat. Tuesday; November 04,2014 7:10-AM To: Schlegel, Frank Subject:Address Frank-Greg Ashwood called again about a change of address at 0492 Grand Island-please call him at 50&2,43 5588 thanks-_ Roger I i - YT iFsS4+6� U4a 7- is i i 11/4/2014 i Page 1 of 1 Wadlington, Ellen From: Schlegel, Frank Sent: Friday, November 07, 2014 10:08 AM To: Barrows, Debi Cc: Heath DeptMailbox Subject: Address Change for Map 051 Pcl.017.002, #492 Grand island Dr., Ost. Hi Debi, Enclosed is a copy of an address change for the property identified above. Because of the change of the access to the property, it was changed to#320 Seapuit River Rd. Please update any hard copy files you may have based on this request. Thanx, Frank Schlegel'E911 data Liaison Engineering Records Manager DPW/Technical Support 382 Falmouth Rd./Rte.28 Hyannis, MA. 02601 (508) 790-6400 x-4942 11/10/2014 Page 1 of 1 Wadlington, Ellen From: Schlegel, Frank Sent: Friday, November 07, 2014 10:08 AM To: Barrows, Debi Cc: Heath DeptMaiIbox Subject: Address Change for Map 051 Pcl.017.002, #492 Grand island Dr., Ost. Hi Debi, Enclosed is a copy of an address change for the property identified above. Because of the change of the access to the property, it was changed to#320 Seapuit River Rd. Please update any hard copy files you may have based on this request. Thanx, Frank Schlegel'E911 data Liaison Engineering Records Manager DPW/Technical Support 382 Falmouth Rd./Rte.28 Hyannis, MA. 02601 (508) 790-6400 x-4942 r 11/10/2014 • _DES/G/U, "�,d 7`,4 Wir�4 5 01r-le. 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U� �, �� l __ " ,� ............... t THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH .A1lV ..-........... ......................... Allp�irai>aoP)qviia!Agrks Tomitrurtion V amit Application is hereby made for a Permit to Construct (j(' ) or Repair ( ) an Individual Sewage Disposal Sy tern at: L ion SO Add ess _______________________________________•-•. Lot No. Owner Z�ress W ••••..........FY/AL7.-A••-._. ei Address _........•----......•..................•- •---•--•-••-••-•••••..__.......•-•.......-•- ........ _------------•------•----------- Install Size Lot...`: r ��*_____ U Type of Building `- •-- Dwelling Bedrooms ms � Expansion Attic Garbage Grinder r—Type of Building ................• No. of peons Showers Cafeteria ( ) Q' Other dW fixtures ................................. . - - -- •-• Design Flow............55-•_A P�� •--gosPP per day. gallons. WSeptic Tank—Liquid capa ity.1 . _ allos Len thi�� tidth $'� Diameter_.'�'.._ Depth. .-A... x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No 2-.----___-- Diameter-----tom....._. Depth below inlet..._?.r......... Total leaching area..( Z16..sq. ft. Z Other Distribution box ( } Doying�sX.�$,tank G (�l .. `-' Percolation Test Results Performed b !1l_ . �_ Date.... ...__.. W Test Pit No. 1,_.._:Z.___.minutes per inch Depth of Test Pit....A2»......... Depth to ground water. oa4 _ aiQu�c�1, f=, Test Pit No. 2_./. ____minutes per inch Depth of Test Pit....k�........ Depth to ground water_(_q .t.7eM0 M .................•--••••--•••••••-•-•••......_....._.•--•._:.._._.___..---------•---•--•-•-------------•--•-------------------------•------------------••---- xDescription of Soil...... 3= ........��v�.>�-15_Q.e�tf. ....._ .-.� ..... � � }LVD..........•-••-••-••••... v ............E� 0.... _Mkt".•••••-•-•••............••-•....-•-- •-••••....... W VNature 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 i'TiE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance hasAbDeens t rd of health. gned ............................................. Date I� Application Approved BY .:.. ---- . ------- �-/l- ' Date Application Disapproved for the following reasons:............................................................................................................... ......................................................................................................................................................................................................... Date PermitNo......................................................... Issued_.................. ................................ Date Jy No ..............- Fizz.............................. THE COMMONWEALTH OF MASSACHUSETTS B®AI ��OF HEALTH VIA..................O F.. ........................ Appliratiott for Disposal Works Tonstrurtion Permit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: 4 i _ 4 •_.�____ ......... ......... .......�._.....R. .............................................. ..... ................................. Lo0ion-Address or Lot No. ..,.�f7=---...-r?.`.. ...._....`.. ? ? ..................................... ............ ........................._..... Owner Address W Installer Address dType of Building Size Lot...%! d A,4c._.... Dwelling—No. of Bedrooms---A------------------------------------Expansion Attic 44(1, Garbage Grinder ( pa.I Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) . Q' Other fixtures ------------------------•---•-•. - W Design Flow_____ _ __: _} "�� gallons per person per day. Total daily flow....._ 4t�..........................gallons. 9 Septic Tank—Liquid*capacity_s.,`Kgallons Length_10_.tt'____ Width._'?.-..��_..._ Diameter--__--_--_-•--- Depth__...___... W Disposal Trench— Slo..................... Width............ Total Length.................... Total leaching area....................sq. ft. Seepage Pit No___________________ Diameter...._-1.Zr......._ Depth below inlet_._..__........ Total leaching area---`4�.___t.....sq. ft. Z Other Distribution box O Dosing tank aPercolation Test Results Performed bytSfx .W. .._.4�"`_.'� ¢¢,s ........... Date---- `- Test Pit No. L4....;____minutes per inch Depth of Test Pit _. .`_:-•-_____- Depth to ground ` (i Test Pit No. 2...4.. ._._minutes per inch Depth of Test Pit.... ---_T-------- Depth to ground water_ :_ x----- O Description of Soil ` tr L `? t'.< ��� '{k '-° <--- ...... - U ............ k? af. • -------------------•------•----------•-••-----...-•-•-•----------•----•---------•-•--------------•--•-------•----•--•-----•-- W ••-•-•-•--••------------•----•--•---•--••-----•-••--•-•--•--------------•-•-.......-------••-••--••--------••••--------....-------•--•-•----------•••••----•-•----•••---..........-•--•------•----..---- UNature 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 T I T TLE 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. S ..... - - ate ,� ned =i ------------------------------------- Application Approved BY Date Application Disapproved for the following reasons----------------•--.....--------------------------------•--------------------------------------•-••--•--------. ...........•--••------•-••-...-•-...---•------•-•---•-•-•--------••••---•-•-•---•--•...---•••••-••-----------•-••-----•--•----•-••-•--•---••---••-••--•••••••----•-•••••-•--•-••-----•-•-•-•-••---•---- Date PermitNo..................................--------------------. Issued--..-------------- ................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...............................I.,........OF..................................................................................... TUrrtif irttte of Tomplittttrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed O or Repaired ( ) , � bY--------------------------- - at . . �....� �, n ller -� � -�� has been :nstaiied in accordance with the provisions of TITS 5 of The State Sanitary Code as described in the application for Disposai Works Construction Permit No......................................... dated-............................................... K THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTIOtj DATE................ . . IM.....----......---.----------_.... Inspector:_.:._!. SATISFACTORY. -. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... No.....:M.—_.Iss'I FEE........................ Wi as ttl Morks To nstrt ion amit Permission is hereby granted............1,---w .....V.J......................................................................................... to Construct -an Gn e eiDisposal System - _ at No. \ ._.�.. Street as shown on the application for Disposal.Works Construction Permit No._:---�•- --_�---:' �bated�._ _}_�.G___ .�____........ .................................................. •-----------••--•------•----••-•,------.••... 2 � � Board of Health DATE........................ ...... .•'-=5---.............--•----••------- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS - No. y/ Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS Zlppfiratton for �Digoaf *p5tem CConotructton Verna Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. Assessor's Map/Parcel d smiCv,1(t, d r Russo Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Gordo^ BoMPLIs e'.d, 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 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 Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issue�t , of Health. Signe Date Application Approved by Date Application Disapproved for the following reasons Permit No. z4, —1zDDate Issued No. Doj q —o/~ e• GG0 ~ Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS application for M spool *P.5tem Con.5truction Permit x Application for a Permit to Construct( )Repair Q )Upgrade( )Abandon( ) ❑Complete System El Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. x W qa GOA, � rslgnc� ar Assessor's Map/Parcel { ` gl) SUSS® Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. t } " Govan alj/t'pu S /� FO(C Type of Building: Dwelling No.of Bedi oms 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 lRevision Date Title Size of Septic Tank Type of S.A.S. Description of Soil, 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 Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has�been issued by t`'s Board of Health. J Signet- I. f t?d Date I G ,,1•y Application Approved by \ \ Date IIIy Application Disapproved for the following reasons Permit No. (���14 — C Date Issued --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS iJ_ O c �P� BARNSTABLE, MASSACHUSETTS �✓ r Certificate of Compliance r� THIS IS TO CER^TIFY,that the On-site Sewage Disposal System Constructed( )Repaired. )Upgraded/ ( ) Abandoned( )by �Q(2on aomno S at G(Aac 'TS/en cl 'N (1 fFp/t,.16 has been construc71(olla. in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.-)L/�( `�/ dated / Installer G o(&n 904400,C Designer The issuance of this permit shal'1 not befcons�+trued as a guarantee that the system will function as designed. A Date f 1 1 4 Inspector , 11 A. _ --Q/ Z.-------------------i --- , No.,,-7 f Ll Fee /�v J THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS f�`(�OX xi.5poar *P!9tem C0n!5truction Permit C( Al Permission is hereby granted to Construct( )Repair 4,�4pgradg( )Abandon( ) System located at 9 C13- G_ /AA C T-s!A n [' rA f U� 14 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: Construct* n mu)�be completed within three years of the date of this permit. Date:_ �� �� `7 Approved b( M• Mar.Em 134TH _ I:I {1E--- '� i �I� - ). 1 � ' i it ic � sue-'. � '� li �'t 1 f '\,. {�11.)kU� iIJC� i_ a/_ ---�_ � I'..—.:�•__ .Q- • hr - 7=1 ir j CA NOT FOR U B•_� 1 ROYA ,s ------- 43 -- •----' I --- +' m ivs 711 a IF p ✓ .i I- --._. .P_.. i Rto. f IP ol 7.S .T _- I � _ -�'��,_ _ . ` t �/I� IL,3f.:•f I z f '.�L, �� r I tt/1 � ,, •ff , to If IV 4�1 GO tl�Tl�,� - t , r `.l