Loading...
HomeMy WebLinkAbout0511 SEA VIEW AVENUE - Health r 511 SEAVIEW AVE.-; '-' OSTERVILLE A = 138 029 001 I_ MAR-18-2014 0:28 FROM: TO:1508790SM4 P.2 t Massachusetts Department of Environmental Protection 1100194773 Ll Bureau of Waste Prevention--Air Quality Decal Number Project Revision Notification For Asbestos Notification ANF-001 and AQ 06 h en�"t filling cut W A. Facility Location When forms on the Rp8EgT Karr-AsON cgmpUtotAr,tt&Q only the tab key 1.Namo of Facility to move your gy1 SEAVIEW AVE cursor-do not 2_Street Address use the return --- key. BARN$TA9 m- 3.City 4.Stale S.zip Cttr]e rb 9-Telephone Number INSTRUCTIONS B- Project Cancelled 1. This form is ' only available for Check here it this project isANas cancelled, online filing of Protect date revisions. 2. Enter project decal number. C. Project Dates 3.d Valldet that projsd O=1/2014 03/21/2014 the Icc ation is correct 1.Original start Date mm_ lddhi �fjgjn4l.-�rid.G�3tQ.(tfl¢tCd4 YKYY� _ _...- r.�� for the entered I dam' 3.Latest Revised Start Date(mm/ddlyyyy) 4.Latest Revi 4. Enter your new Revised End Date(mmlddlyyyy) project dates, 5. Certify your notification. D. Revised Project Dates Submit date changes. 03/18/2014 03/1012014 1.Revised Stem Date(mrryddlyyyy) 2.Revised End pate Date(mmlddfyyyy) E. Other Project Revisions •� e F. Revision Histo I �s ' �.. O I �J lit ant060m.doc-rev.215104 MAR-18-2014 13:28 FROM: TO:15087906304 P.3 e �- Commonwealth of Massachusetts . �oo19a773 Asbestos Notification Form ANF-001 Decal Number Invont Whenrta filling out A. Asbestos Abatement Description forms on the computer,use 1. a. Is this facility fee exempt-city, district, municipal housing authority,owner-occupied tab only the key residence of four units or less? ✓ Yes ❑No to move your cursor-do not t�. provide blanket aecal number if applicable:use the return Blanket Decal Number key. 2. Facility Location: ROSERT KETTEFISON 511 5EAVIEW AVE � r Aqa BARNSTSABLE IMA J 102655 c.City/Yown d.State a.Zip Code f.Telephone Number INSTRUCTIONS 3, Wor'ksite Location: 1.All saclions of this SAME form must be a.Building Name/Building Location b,Building# c.Wing d.Floor e.Room aompletod In ordor to comply with 4. Is the facility occupied? Yes ❑No k DEP notification requirements of 310 OMR 7.15 S. Asbestos Contractor: and the Dlvlslon of Occupational AIR SAFE INC 61 ENDICOTT STREET safety(DO$) a.Name b.Address notifiwtion NORWQOD 020�2 7$17623390 �— requirements of 453 CMR 6.12 c.City/Town d.Zi Cade e-'1 Telephone Number AC000464 f.DOSLicense umber g. Contract Type: [✓]Written [j Verbal h, aCl ntapt person i.Contact Person's Title 6 JAIME E AMAYA ASOSO847 a.Name of On-Site SuPervi5odForem. an b.SupefuisodForemen DOS Certification Number a.Noma of Pro' ct Monitor b.Pro ct Monitor DOS CertMeatlon Numbe'r $' a Name of Asbestos Analldical Lab =a Anfilytinal Lab IJOS CaCdcpflaa Number o a 03/21/201 a 03/21/2014 a-Project Start Date mmlddl h.t=nd Date(mm/dd/yyyy �0 7AM -GPM N e, Wrle hours WnXii 1.1 1An hni irs atX in 10. a. What type of project is this? Demolition Renovation ®�. Repair ( Other, please specify: e. Describe 11. a. Check abatement procedures: ✓❑Glove bag Encapsulation �o j]Enclosure Disposal only ` ❑Cleanup ❑Other, specify: _:., _....�... . �z C]Full containment b.Qescdbe a 12. Is the job being conducted: JZ1 Indoors? ❑Outdoors? anf001ap.doo•10102 Mbestoo Not'rficalion Form•Page 1 of 3 MAR-18-2014 13:29 FROM: T0:15007906304 PA Uhl Commonwealth of Massachusettts ■ 100194773 Decal Number l i Asbestos Notification Form ANF-001 A. Asbestos Abatement ,cent Description p (cont.) 13. Total amount of each type of Asbestos Containing Materials(ACM)to be removed,enclosed, or encaDsulateda 16 0 a.Total pipes or ducts Vinear otal olmer surfaces square c.Boiler,breaching,dud,tank surface coatings Lin.ft. ft d.Insulating cement Lin.ft. a.Corrugated or layered paper 8 f.TroweMprayer coatings pipe insulation Lin.it. .ft. Lin.ft. Sq.k. g.Spray-on fireproofing Lin h.Transite board,well board n i.Cloths,woven fabrics Lin --ie j.Other,please spec4 k.'rhermal,solid core pipe insulation Lin. Sq.ft. I•specify 14 Describe the decontamination system(s)to be used, 2 CHAMBER DECON 15. Describe the containerizationldisposal methods to comply with 310 CMR 7.15 and 453 CMR 6.14(2) (9)' 8 MIL POLY BAGS 16. For Emergency Asbestos Operations, titre DEP and DOS officials who evaluated the emergency, a.Name efDEPM Gal b.Us, c.Date mmift )of Authorization d.OFP Waiver# a.Name of DOS Meal - f DOS Oftal Title N g gate(mm/dd/yyyy)of Autho aGon h.DOS Waiver# �a 17, Do prevailing wage rates as per M.G.L. c. 149,§26,27 or 27A—p apply to this project? El Yes R)No B. Facility Description CAN i iesioENTIA4 ®� 1. Current or prior use of facility: 0 2. Is the facility owner-occupied residential with 4 units or less? ,/1 Yes ❑No 3. SAME a.Fadl!nf Owner Name � b.Atldress G 0 c,Cityfrown d,Zip Code e.Telephone Number area code and extension u. 4 a.Name of Facili Owner's - ite Manager b.On-Site manager Address ®z I S a City/Town dd.ZipO 9.Telephone Number(area code and extension) ■ anf001ap.doc■10102 Asbestos Notification Form•Page 2 of 3 MRR-18-2014 13:29 FROM: TO:15oe7906304 P.5 e Commonwealth of Massachusetts ?� 100194773 1 Asbestos Notification Form ANF-001 Decal Number B. Facility Description (cant.) 5' a.Name of General Contractor b.Address c.CilviTown d.Zip Code e.Telephone Number area rode and extension f.Contractor's Workers Comp.Insurer o.Policy Number. h.Exp.Date mm/dd 6. What IS the SIZe Of thlS facility? a.Square Fait b.Number of floors C. Asbestos Transportation and Disposal 1. Transporter of asbestos-containing material from site to temporary storage site(if necessary): AIRSAFE Note:Transfer a.Name of b,Address Stations must comply with the C.City/Town d.Zip Code e.Telephone Number Solid Waste Division 2. Transporter of asbestos-obnt$ining waste material from remaval/temporary site to final disposal site: Regulations 310 CMR 19.000 .Name of Trans orter b,Address c.C /Town d,Zip Code 6.Telephone Number 3. a.Refuse Transfer Station and Owner b.Address c.C& Frown d._Zip Code e.Telephone Number 4. MINERVA ENTERPRISES INC a. Final Di osal ae L tion Name b Final 01 sal Slte Location Ownees Name 9000 MINERVA ROAD IWAYNESBURG c.Final i_ nr,Al SM Addr a d.Cityrrown OH ,.� 44688 ®� e.state f.Zip Coda g.Telephone Number 4 D. Certification N The undersiytad hereby states,under the IDF WALSM ® penalties of perjury,that he/she has reed the a.Nam b.Authorizednature o Commonwealth wealth of Massachusetts regulations Vp for the Removal,Containment or mmIdol PositionlTitle ate r Encapsulation of Asbestos.453 CMR 8.00 and C.31 76/Title AS 310 CMR 7.15, and that the information contained in this notification is true and correct a.Tale hone Number f.Representing ° to the best of his/her knowledge and belief. 61 ENDICOTT © Address u. [NORWOOD [0062 h.Cityfl'own I.Zip Code enf001 ap.doo•10/02 Asbesto9 Notification Form+Page 3 of 3 �. I r COMMOti�EALTH OF ir'ic�.$J�11,ni.SETTJ i EXECUTIVE OFFICE OF ENVIRONMENTAL AF,FAIRSSt'r DEPARTMENT OF ENVIRONMENTAL PROTECTION t gOF 8 boo ONE WINTER STREET, BOSTON MA 02108 (617) 292-5500 % i " - Q + S H r b U4DY CORE V, Secretary ARGEO PAUL CELLUCCI Governor DAVID B. STRUHS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Commissioner ! PART A CERTIFICATION Property Address:511 SR V IGU J AVE, Name"of`Owner G (oAC,j 6A p,l Ur Address of Owner:- RDCFWC;/ F NELq Date of Inspection:�-19-aow Name of Inspector.(Please Print) QW69 D C,&0SFtaC) !am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.OU0) Company Name: �QW,42Q �_ 3c?��SFIELD Marling Address: sra�(.tld'�_�AVE. SR/LO,;;KN/3lA,oas�� Telephone Number: - SbS 4t53s3 relAUZ11I 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 maintenance of on-site sewage disposal systems. The system: and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and Passes Conditionally Passes Needs Further Evaluation By the Local Approving.Authority Fails/ - Inspector's Signature "Date: Q'l�'� The System Inspector shall submit`a copy of this inspection report to the Approving Authority(Board of Health or DEP)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. NOTES AND COMMENTS I 3t_�CK/ i ( gZLO/U b f)RimRRY' CEss poo 3-7SS G A•uav (3 L&-K OVER Row Coss QoC..(_ O-6atc • /UCU) 3000 GA(-LCW` P.REc [4s CEACH P/F revised 9/2/98 Page 1 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: Owner: AC�EN H�T Date of Ins on: _ -koo INSPECTION SUMMARY: Check B, C, o/ D: A. SYSTEM PASSES: I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist. Any failure criteria not evaluated are indicated below. COMMENTS: B. SYSTEM CONDITIONALLY PASSES: One or more system components as described in the "Conditional Pass" section need to be replaced.or iepaired. The system, upon completion of the replacement or repair,as approved by the Board of Health, will pass. Indicate yes, no, or not determined(Y, N, or NO). Describe basis of determination in all instances. If "not determined", explain why not. The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance (attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection; or the septic tank, whether or not metal, is cracked,structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health). broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s)• The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced r. obstruction is removed s 7 revised 9/2/98 Page 2of11 I� r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM' PART A n CERTIFICATION(continued) perty Pro Address:S� 504 VIE ,d L)C Owner: W k V-61uko T Date of Inspection: �-fl-jxo C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 15.303(1)(b)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 surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF ANY)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE 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 soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS 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. Method used to determine distance (approximation not valid). 3) OTHER revised 9/2/98 Page 3of11 r r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:J se4ulcuj rTUC r Owner: U,11V.KCN kUT Date of Inspection: D. SYSTEM FAILS: You must indicate either"Yes" or"No" to each of the following: I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped_. Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less-than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria,volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E. LARGE SYSTEM FAILS: You must indicate either "Yes" or "No" to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System) and the system is a significant threat to public health and safety and the environment because one or more of the,following conditions exist: 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) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional office of the Department for further information. revised 9/2/98 Page 4or11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 5 5C-/4U1ELk) Aug -owner: �L'/ KEtL'HUT Date of Inspection: Check if the following have been done:You must indicate either "Yes" or"No" as to each of the following: Yes NO Pumping information was provided by the owner,occupant, or Board of Health. - X None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. 066E H45 Ej(f E/l7�OT}� X As built plans have been obtained and examined. Note if they are not available with N/A. The facility or dwelling was inspected for signs of sewage back-up. — The system does not receive non-sanitary or industrial waste flow. X — The site was inspected for signs of breakout. n I — All system components,a have been located on the site. The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions,depth of liquid, depth of sludge, depth of scum. The size and location of the Soil Absorption System on the site has been determined based on: Existing information. For example, Plan at B.O.H. - �X — Determined in the field (if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable) 115.302(3)(b)1 — The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of Subsurface Disposal Systems. revised 9/2/98 Page 5of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address_: �I I SFRUtEUj PAVE, Owner: L '4KEIL'HVr Date of Inspection: 2, ,.;tCco FLOW CONDITIONS RESIDENTIAL: Design flow: /1 0 g.p.d./bedroom. Number of bedrooms(design): Number of bedrooms(actual): Total DESIGN flow Number of current residents:_ Garbage grinder(yes or to:-&r) I1y� Laundry(separate system) (yes or 0g:t: If yes,separate inspection required Laundry system inspected (yes or no) Seasonal use t$!�e5-)or no)--i=5 Water meter readings,if available(last two year's usage(gpd): Sump Pump(yes orop: /11a Last date of occupancy: COMMERCIAL/INDUSTRIAL: Type of establishment: Design flow: qpd ( Based on 15.203) Basis of design flow Grease trap present: (yes or no)_ Industrial Waste Holding Tank present: (yes or no)_ Non-sanitary waste discharged to the Title 5 system: (yes or no)_ Water meter readings, if available: Last date of occupancy: OTHER:(Describe) Last date of occupancy: GENERAL INFORMATION _ PUMPING RECORDS and source of information: System pumped as part of inspection: (yes or no)AoO If yes, volume pumped: gallons Reason for pumping: TYPE OF SYSTEM Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records,if any) I/A Technology etc.Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other IVEW APPROXIMATE AGE of all components, date installed(if known)and source of information: CpX 1?9 7 CFss�c S !-�p9PDX 34-YD wS Sewage odors detected when arriving at the site:(yes oro revised 9/2/98 Page 6of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Icorrtinued) Property Add-'ress: 51I SEAtC--W AUc owner: t0kKGL 07" Date of Inspection: 12 BUILDING SEWER: (Locate on site plan) Depth below grade:_ Material of construction:_cast iron_40 PVC_other(explain) Distance from private water supply well or suction line Diameter Comments: (condition of joints,venting, evidence of leakage,etc.) SEPTIC TANK:_ (locate on site plan) Depth below grade:_ Material of construction:_concrete_metal_Fiberglass Polyethylene_other(explain) If tank is metal,list age_ Is age confirmed by Certificate of Compliance (Yes/No) Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: How dimensions were determined: Comments: — (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage,etc.) GREASE TRAP: (locate on site plan) Depth below grade:_ 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: 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.) revised 9/2/98 Page 7of11 • SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C / SYSTEM INFORMATION(contmed) Property Address: AUF Owner: Lt,�gC K�NNt1i Date of Inspection: _jp_U cc TIGHT OR HOLDING TANK: (Tank must be pumped prior to, or 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/day Alarm present Alarm level: Alarm in working order:Yes_ No_ Date of previous pumping: Comments: (condition of inlet tee, condition of alarm and float switches,etc.) DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above outlet invert: r'rT8077441 OF OVT-05 Comments: (note if level and distributior%is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) D)S%RI&-7100 /S 6690P--/UO S;00DS PUMP CHAMBER:_ (locate on site plan) Pumps in working order:(Yes or No) Alarms in working order(Yes or No) Comments: (note condition of pump chamber,condition of pumps and appurtenances,etc.) revised 9/2/98 Page 8orn r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM , PART C SYSTEM INFORMATION(continued) Property Address: S 1156'9Vt 4) fgvc Owner: • Date of Inspection: -�y_�oc� SOIL ABSORPTION SYSTEM(SAS) (locate on site plan,if possible:excavation not required,location may be approximated by non-intrusive methods) If not located, explain: Type C.YI�C gk g+ leaching pits, number:_ leaching chambers,number:_ leaching galleries,number:_ leaching trenches,number,length: leaching fields, number, dimensions: overflow cesspool,number:_ Alternative system: Name of Technology: Comments- (note condition of soil, signs of Hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.) svEu, �EACN Pir c 5 OR y ,/NO (.ra0+o CESSPOOLS: (locate on site plan) Number and configuration: f N segi FS Depth-top of liquid to inlet invert: Claim Aoee DQ'>'� NO c-1,00,0 Depth of solids layer: NONE Depth of scum layer: /VOW& — Dimensions of cesspool: CA;EZ 6 X'= I did 16a15,Iwo)$X to=3-7SSL-4Ls Materials of construction: RILOCIC Indication of groundwater: /VONG inflow (cesspool must be pumped as part of inspection) CESS t i-S ARE QRV, Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY:_ (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments: (note condition of soil,signs of hydraulic failure, level of ponding, condition of vegetation, etc.) revised 9/2/98 Page 9of11 ' SUI3SURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 511 SEAU(EW AVM= Owner: (,4'40,GAA.I NV(' Date of Inspection: „N-1000 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100' (Locate where public we er supply comes into house) 19' 6� `b sfoc- ciq 10' rvtw ati _ LCACO GESSfcou- PiT revised 9/2/98 Page 10of11 ► SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner: W RCKE►UH U^1 Date of Inspection: _I�_�eOo NRCS Report name Soil Type_ Typical depth to groundwater USGS Date website visited Observation Wells checked Groundwater depth: Shallow Moderate Deep SITE EXAM Slope Surface water Check Cellar Shallow wells Estimated Depth to Groundwater 2 Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observed Site(Abutting property, observation hole, basement sump etc.) Determined from local conditions Checked with local Board of health Checked FEMA Maps Checked pumping records Checked local excavators, installers Used USGS Data Describe how you established the High Groundwater Elevation. (Must be completed) y�mR GROUn)C)c:,at62 rhAP 7veo ^qp revised 9/2/98 Page iiorii w �t No.------- � Fee---- - 6-~-�------ BOARD OF HEALTH TOWN OF BARNSTABLE Application-for VrIt Con�trurtionpermit Application is hereby made for a permit to Construct Alter ( ), or Re air ( )an individual Well at: — Location — Address _ Assessors Map and Parcel Owner v Address le�J 4414 v ----- _—A—;--------------------— Installer — Driller Address Type of Building Dwelling--_—--- -- ----------- Other - Type of Building-- -------- No. of Persons-------_—_____--__—___ T e of Well r � ------- Ca acit YP P Y---— — — --——---_ -- Purpose of Well---- ----- Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation until a Certificate of Compliance has been issued by the Board of Health. Signed — —_— -- �A�Z/ r /d e Application Approved By ---- ` 6 o date Application Disapproved for the following reasons: ---------------- ____—_ ___ _____---------_--__---date ---- Permit No. -- -- Issued--------------- -- --------- date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate Of Compliance THIS IS TO CERTIFY, That the Individual Well Constructed 1"I, Altered ( ), or Repaired ( ) y .,Installer �---------- _--- at "/1has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Prot tion Regulation as described in the application for Well Construction Permit No.�®� ---Dated '7,119 o-1- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE Inspector-------------_ —_—_--____ BOARD OF HEALTH `'`TOWN OF BARNSTABLE Certificate ®f (Compliance THIS IS TO CERTIFY, That the Individual Well Constructed Altered ( ), or Repaired ( ) by--_ — ----- — ---- ---------------------------____-- ._. Installer _—� -- at has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Prote tion Regulation as described in the application for Well Construction Permit No. `---Dated—� ,1�' ol THE ISSUANCE OF THIS CERTIFICATE•SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE - - -- Inspector---------------------__��_____—�______ BOARD OF'HE LTH TOWN OF BARNSTABLE ..deli Con5tructionPermit bj V' No. ---- ---- Fee- Permission is.herebYg ranted' . . to Construct (i ), Alter.( ) or epair ( ' ) an I dividual ell�t: F No: (. Street _ as shown on'{the application,for a Well Construction Permit 7 6 �/ r '; No._ iqZ� Dated- - - —_—_ --- DATE - Board of He th --.-- Fee-----�-�-,��- a No.--- _--------- ----- BOARD OF HEALTH a a :. .TOWN OF BARNST'ABLt 4. ,1 - Applicat ion AflftC* Con5truction ermit S 6 Application is hereby made for a permit to Construct Alter ( ), or Re a' ( , )an individual Well at: Location — Address , w `' Y` '�"'+.---Assessors Map and Parcel r2z/ Owner Address Installer Driller Address x- Type of Building Dwelling .w. :.: . .. _ .. Other - Type of Building--- --------- No. of Persons--------______—__—_—______ Type of Well— , � W . -- Yp -- Capacity-----------——--- Purpose of Well--- -- — y Agreement: The-undersigned"agrees to install the aforedescribed individual well in accordance with the provisions of The r; .Town of Barnstable Board:of Health Private Well Protection Regulation The undersigned..further..agrees not to , , . place,the well,in.operation-until.a;Certificate .oftompli:ance;has.been.issued by the Board of Health, Signed _� _�_ � �— Application Approved By — date Application Disapproved for the following reasons: ----------- ----- date Permit No. -- Issued--- -- ---_--— -- -- _--------- date i pS�,�,E'/�i//G -�' ��l �d�� 9 �o�� ,;. ., ,, �,, ,, . �. ,�,�,� , F 1 .` j � r TOWN OF BARNSTABLE LOCATION S// Sc,90c''too /t v,e SEWAGE # 7`- y VILLAGE �c r- i �.' ASSESSOR'S MAP & LOT 1 �J � . INSTALLER'S NAME & PHONE NO. lL�/ 'V '-uo2}—: c cci k=oG/y SEPTIC TANK CAPACITY ;Z Q0 Q_ c yew ' LEACHING FACILITY:(type) 8 �� /S^�O (size) g-xr NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER A< BUILDER OR OWNER / t . DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: ^7 VARIANCE GRANTED: Yes No 0� 1 i < Dj� Cn 10 cc) I 1' e1 e t�1 `i�t'AG`trY� (nlP 1 f h c w Ad Wi'il c f rJ %rPi THE COMMONWEALTH OF MASSACHUSETTS BOAR® HEALTH ra � ._..6.' N...................OF.......:................... ......5 C' ._................ Appliration for Bispootal Works Tonstrnrtion 11amit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ,�/ ................// SV v. ..�?.......L.e.-------------------------------- --- -1 '. .vl _...................................................... Location-Address or Lot No. IfV Llq.�.E9. .u.:#' - ..... - �� Owner /" Address / ,Wa ---- l2 ............I�:1/MC ..........--•-•---------------------- /' Q a a� I----------�' / .!_..................... Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms................. ___........._...___.___Expansion Attic (• ) Garbage Grinder Other—Type T e of Building No. of persons............................ Showers tz, YP g -•--•---•-•----------•-•---- P ( ) — Cafeteria ( ) Q' Other fixtures --------•--••-•-••-••-••---•••-• . ------------------------------------------------- •------------------------- W Design Flow............................................gallons per person per day. Total daily flow........................._..................gallons. 1:4 Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter___---__--____ Depth................ Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area--______-_-------sq. ft. Seepage Pit No--_---------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water......................... �T, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ O Description of Soil............................-----------------------------------------•..._.•--- x W --------------------------------------------------------------------------------------------------------------- ---------------------------------------p - --------------------------------- U Nature of Repairs or Alterations- nswer when applicable...._..t�C __�-1_t_.__: �... -d _______�'1_____________ _e1'_ ._°. Agreement: -1- 1 +e W q '/ .S4 c q(O Pip t• L.4 S Oro y C,®�a r*5 The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'TTLi� p 5 of the State Sanitary Code— The undersigned further agrees not to puce the yste in operation until a Certificate of Compliance has beetLi s by the boa lth. . -- h Application Approved BY-••--... --• �� -- ......._ /- � r • .------ - ---- Date Application Disapproved for the following reasons:---•--•••••---.....•-•••••-•--•••••••--•••--•••-••-•-•••••----••------•--•-••--------•-••--••--•---------------- --------------------------------------------•--------------------•--••-------------------------•-- ----------------------- -----------------------------------------------------*-------- Lj Date PermitNo..---�..`.......................��-----... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOAR® E HEALTH ....--- -•-----..-..OF.............. AVp iration for Di-qVusa1 Works Tnnitrurtiun Frrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: /f .........................S�%,...�.w..... TU.� G`.�.�?'K�1� �........................................................... _ Locatio -Address .•---•-_•---•-----------------------------or Lot No. C...... .........� C �_� ......_..._........................... ---------.-------------------------.-----•-•------- Owrer Address :...__.Y2 Lf+t1.f�I� ........................................ ..-.. ..!-•--------�..........-...--.......--.......----- Installer Address Q Type of Building Size Lot-------------------.........Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type T e of Building ______________ No. of ersons.............._.._......_... Showers — Cafeteria a 11� yP g P ( ) ( ) P4Other fixtures ----------------------------------------------------------------------•-------------•---•--•----------------------------•--••-•---------------------- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 0� Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ a Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.................__-____ a ------... r Description of Soil-------'sf//I7Gp.:....................... x ----------------------------•-------------------------------------.....---•----- U --•--•--•--------•---------------•-------•----------------••-•---•------------------------•---•------........---•--------------......-•---- W ----------------------------------------------------------------------------------------------------------------------------------------------------- ..__. U Nature of Repairs or Alterations,—Answer when applicable_.._._( tx A. .... i�_c ct-A_fja----•---•-ni t---------l'u.t.t`► ............. = Agreement: �- N P w 1-i " Sy c G l o p;n c G l4 S (Y o y u v c r S The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions-of i?'HE ; of the State Sanitary Code—The undersigned further agrees not to place the yst in operation until a Certificate of Compliance has be 's by the bo ealth. s . ----- •--------•------ ---------------- > r Application Approved B -• �� ' PP PP y --•----•............. ..........................................•-- -••----------•-- . ....-•-- Date I Application Disapproved for the following reasons:------•--------------•-----...-•----•-------•-•-------•-------•------------------------------------------••-.. ------------•---------•----•----------------•----------......------------------••---••-------............._..........---•-----•• ----•--------------------•-•----------•------•-••--••------•----------- Date PermitNo......................................................... Issued....................................................... Date TH COMMONWEALTH OF MASS CHUSBTTS BOARD OF HEALTH ..........................OF....... . ............. .... ........ ................................................ ........... Tntifiratr of Tompliaurr THIS IS TO CERTI �That the Individual.Sewage Disposal System constructed or Repaired ... by........... .127-v.............. ................InstaL.......er......j......................................................................................... at...... /............ . .....j��.c........................�2­5.r:.r...-•v r G ----------------------------------....................... has been installed in accordance with the provisions of of 57he State Sanitary Code as described in the application for Disposal Works Construction Permit No._...5�....... .....9--- ...... dated-.---------------------------------------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT HE SYSTEM WILL FUNCTION SATISFACTORY. DATE................. .................................. Inspector..... ...................................................................... THE COMMONWEALTH OF MASSACHUSETTS —BOARD OF HEALTH 0�tlP ri 5.-7 _,OF........ ................................ ..................................................................... F ................ No.................!-5�!.. EE. Disposal Works Tonstrurtion "Prrutit Permissionis 1W nted........................................................................................................................................... to Construct 0( )(or e RL an h3oividual Sewage DispQsal System ............................... at No.........................................� ......... .......... 0 ............. Street j .).......... as shorn on the application for Disposal Works Construction Per — ........ Dated...... ,0 j Board o f H ealth DATE. 2 ......... /4-7- .................. FORM 1255 HOBBS & WARREN. INC.. PUBLI ERS I O-CAT ION SEWAGE PERMIT NO. 9ILLAGE INSTA LLER'S NAME i ADDRESS / �.1�s4y v 0 U I L D E R 0R OWNER OA T E P ERMIT ISSN_ E D DAT E C 0 M P L I A N C E ISSUED -�� F' } .-� i I J ` ,�\ eo� a / � � 3� � ,�K `� �. 4 4 O Q cG V �� ��/����� �dvX 6 No. Fms.... 3................. THE COMMONWEALTH OF MASSACHUSE-1 BOARD OF HEALTH ..........................................0 F......................................................................................... Appliration for Bispaaal Works Towitrurtion ramit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at .....................................4/.c.....................Aation-A o.r?r.0 ........................ Ow r .. ... .... ---------------- A ss, ler ............ Ass Instal ------------­-- ------ . .. ........------ ..... W PQ ss U 1� Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms----- .................................Expansion Attic Garbage Grinder per,, Other—Type of Building ............................ No. of persons........_............__.____ Showers Cafeteria P-4 Other res ........................... W ........................................................................................................................... < a Design Flow............3T..............................gallons per person per day. Total daily flow............................................gallons. ... ...... P4 Septic Tank—Liquid capacity.Z gallons Length................ Width....._.____._._. Diameter__-_-__---_____- Depth.......-_...._.. Disposal Trench—No..................... Width.................... Total Length.................... Total,leaching area....................sq. ft. Seepage Pit No.___-_-->—------- Diameter........k.U_. Depth below inlet.................... Total leaching area..................sq. f t. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by......................................................................... Date........................................ Test Pit No. I----------------minutesperinch Depth of Test Pit._______............ Depth to ground water--_-_--______-__-...___. 0-4 rXf Test Pit No. 2.:..............minutes per inch Depth of Test Pit.._...........__.... Depth to ground water........__...._......._. 9 ............................................................................................................................................................ 0 Description of Soil..................... I/.... ------------ -------------------*----------------*----------------------------------------- ----------------------------------------------------------........................................................................................................................................... ...................................................................................................................................................................T.................................... U Nature of Repairs or Alterations—Answer when applicable............................................................. ................................. ..............................................................................................................I.....................................................................0............. Agreement: The undersigned agrees to install the afored c ib d Individual Sewage Disposal System in accordance with morede rlDe" -,n"'V" the provisions of TLITU 5 of the State Sanitary C de—The undersigned further agrees not to place the system in t operation until a Certificate of Compliance h be A-ue by Atoard jp9heal 1� Z Signeed. ... . . ....... . . . . .. .. d. ..--.. . .......... . ............. ............................. . ....... Date ApplicationApproved By............ . ... ......................................................... ............. ............./k) r Date Application Disapproved for the ollowing reasons:.............................................................................................................. ........................................................................................................................................................................................................ Date PermitNo------- 0................................. Issued....................................................... .Date ------------------------------------------- —--—-------------------------- - -------- ......................... ' THE COMMONWEALTH OF MASSACHUSE%TS f' BOARD OF HEALTH r OF....................................... Appliration for Disposal Works Tnnstrurtiun Frrutif Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at , ... ocat' ASldr s --------..e......................... .. j t r ° - ...... - -... ....------- .......• ..................•.... -- -= ` � `�� ; ress..... lC_f_.f;._�.. Installer 'Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms..... ..................................Expansion Attic ( ) Garbage Grinder (>e ) aOther—Type of Building ............................ No. of persons..........--.........--..... Showers ( ) — Cafeteria ( ) Otherfixtures -•--••-•---•-••-•----••-•.............................................................. W Design Flow...........�..............................gallons per person per day. Total daily flow..........................._____._....____..gallons. WSeptic Tank—Liquid capacity.f`�,O gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No... �%^._.---- Diameter..._...f.:"_.F__ Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) a Percolation Test Results Performed by.......................................................................... Date..................... ------------------ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2...............:minutes per inch Depth of Test Pit.................... Depth to ground water........................ D9 .---•-•-------------------------------•----------....---------------•--..........-----....................................................................... Description of Soil----•--------•-------�.....e-...................................................... x -----------------------------------•-----------------------..................... � 1 V ...................................................... ............................................................................................................................................... 0 Nature of Repairs or Alterations—Answer when applicable........................................................._...._...._.___-...._._____s._:.••_._. . -••-----•-•-••••---•-....-•----------------•------•••-••--•----•-•--•---•-----•--•••-•••-•---••--•--•------••••••......•-----..........-----• Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of T I T 11 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 t e board of heal, Si ned +='r )! / Date d Application Approved B �. `r --.. ...-_ PP PP Y---••-------- - f Date Application Disapproved for the following reasons-------------•--•----•----------•--------------------•--------------------------•----------------------..------- ----------------••--•-....---•-----------.....-•-----•-••----...--•-•-------•-----••----.....-----....._...------•...._...---------•----------•-•...--•-•-•----•---•-•--•-••------••----•••-•------...--- Date PermitNo......�!.`I. ......-------------------------------- Issued-..................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ................... u v 69lt .1 C9rrtifiratr of Toutpliattrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) Y ..------•----------------------------•-----••--- ----------------------•-----.......-•--•---------------------•---..........._-----------........ /C' Installer -..--------- has been installed in accordance with the provisions of TITLE 5 of The{State Sanitary Cosa escribed in the application for Disposal Works Construction Permit No. ..`..31 ................ dated_7,.__ .ed....s' --------------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE tFa SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH i ..........................................OF..................................................................;.................. No......................... FEE.............:.......... 'Disposal Works Thangtrnrtuan Virrutit Permission is hereby granted................. ----- 1----. ------------ ------------------------•••---•-•-•-••---....---•...---........................ to Construct (X ) or Repair ( ) an Individual Sewage Disposal System at No........_.---------••--• ZZ roc.,- / ,,'« 1'> .., s, rz 7 11 -. -••-•-•------------- •=•.-•--•-. -•-• -- ---•• .. . . Street as shown on the application for Disposal Works Construction Permit Wo Z......__ Dated.......... / _____________ -// _ -- ------------- ' Board of Health DATE..= 1:: = .................................................... FORM 1255 A. M. SULKIN, INC., BOSTON " r aT vc, do v"'I GAlp., � y i �• � Z4 WOT V.,tTUFS.S® v �.,Nr� 10 T:= L Tv 6 E 4 eQ) w/ DS FbSA L. c�SE 1 G7v Ght 5 TA,N PIS wiz ":7TZ.JuE cE�Ti,�lEo or�T ��A,v i / C,6-e7 TN,47 T.4/� ,t DD1 TZU,U S,vo�✓�u t .eEcu/c'o�1O,G ys W/r!V SCA Z.E-; / - 40 TE. G" Z 7 T^�S•��?E.CI.CI� .fi.+/J.SETBA C� �,L A.t1 .2E�"�.2E�C�� Ag � �ir�.Gc/ TyE FLoaD,�G4/�i! G C, / 7 //✓ � .$1��?�� Tf�� aSTE,e✓/,C.C�a MASS TOWN OF BARNSTABLE = UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION OWNER AND INSTALLER INFORMATION ., ADDRESS: 1 fi la.ar / ( '` MAP NO. PARCEL NO '00 OWNER NAME: l (� - a �;' ,' VILLAGE: - � INSTALLATION DATE: BY: ADDRESS: ,, CERT. NO. ans Air- 11 TANK INFORMATION LOCATION OF TANK: �. et l 09 CAPACITY x ' TYPE �A AGE ? UEL/CHEMICAL 4 a TESTING CERTIFICATION E ] PASS E ] FAIL DATE +.-•LEAK DETECTION E�7 CHECK IF N/A TYPE/BRAND \ ZONE OF CONTRIBUTION E I YES ] NO DATE TO BE REMOVED FIRE DEPT. 'PERMIT ISSUED E. YES E ] NO DATE l C.'( CONSERVATION E ] CHECK IF N/A DATE BOARD OF. HEALTH TAG NO.6)q ]E ]E ]C ] DATE; PLEASE PROVIDE A, SKETCH -SHOWING THE TANK..LOCATION ,ON THE BACK -OF THIS .CARD. ? . a + l _.�: .a..x'tlR.r n.. .:�.8 ... ,......,,.. ..1na.,., f� .......u -. .. -. t �35 . .S'. ,.. ]....a. .• s.... ., .. ., ..._ .L . c. V '.f..... -... .�. _ .... -. .. . .. „h ” id-.f".'w,')s S4''`"'rs'F`1'+'^^..-�iYk'ti1..fi�7�}pt*'!s«r},..rh*fit'Acy'naAw"A'Y�7°.t^f7+�.1+-s:..+w.s.:++Yv^,,t•'�..'':��yw.F"'i:,.. .r�}x�,#` s'"'�,.'�"'�`+F•.Cei.;� ; 'iy�c._�7 �"'3;:'*;ii.!„�i ,. - ' .TOWN OF BARNSTABLE — UNDERGROUND FUEL AND ,CHEMICALISTORAGE REGISTRATION OWNER AND INSTALLER INFORMATION'A ADDRESS: _�7 �,a �!(��l 1�' [ /2�' /��+ttF / MAP NO. �! i PARCEL NO. �1 ! F V &5_5 yJ OWNER NAME: M_ folii�t.� � iC L VILLAGffE: ste. Vt INSTALLATION DATE: : BY: •' Y Olt ADDRESS: "CERT. NO. y ,. " STANK u INFORMATION {LOCATION OF TANK: t xlm# ftowce d LL CAPACITY .5U I TYPE '�t AGE ". ; FUEL/CHEM I CAL i TESTING CERTIFICATION C J PASS C J FAIL,)DATE LEAK DETECTION C CHECK IF, N/A TYPE/BRANDS e ZONE OF CONTRIBUTION Ap C 1-J YES C J NO DATE J OI BE REMOVED x r ,r FIRE DEPT. PERMIT ISSUED C J YES C J NO DATE *n_ CUNSERVAIION C ](CHECK IF N/A DATE " r j BOARD OF HEALTH TAG NO: :C J C J C J C J DATE A 7'1 PLEASE PROVIDE A SKETCH SHOWIING �THpE TANK LOCATION ON' THE BACK OF THIS CARD Y i eT 1 'f�Y`� ""�i�, i � i, �=1 d � � t � e � � d s _ \\ M M i _T - .�'�-�� � II xisri rv2z/ L iz?l -- d �