HomeMy WebLinkAbout0060 SUNSET LANE - Health 60 SUNSEYLANE-OSTERVILLE
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TROY WILLIAMS
SEPTIC INSPECTIONS
Certified by MA Department of Environmental Protection +(508) 760-1.819
40 Old Bass River Road 6�
South Dennis,MA 02660 'S;9
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Commormeatth of Massachusetts
Executive Office of Environmental Affairs
Department of
Environmental Protection
William F.Wald Trudy Coxe
Gammm .sea sUy
kpoo Paul Calluccl David B.Struhs
LL GoMmor Commiwloner
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A -
CERTIFICATION
Property Address: 66 Sv h S¢ >l L h Q s-> ci v, l l e Address of Owner. A31-i o.n
Date of Inspection: s/iy/96 (If different)
Name of Inspector�o yy �i-� S`
Company Name,Address and Telephone Number. CO"t,
C, 6"iC� 0o263a
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate
and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and
maintenance of on-site sewage disposal systems. The system:
Passes
Conditionally Passes
Needs Further Evaluation By the Local Approving Authority
Fails
Inspector's Signature �SKu,,e" Date: /mil 6
The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this
inspection. If the system is a shared system.or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the
report to the appropriate regional office of the Department of Environmental Protection.
The original should be sent to the system owner and copies sent to the buyer,if applicable and the approving authority.
INSPECTION SUMMARY:
Check A+, B, C,or D:
AJ SYSTEM PASSES:
_ZI have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303.
Any failure criteria not evaluated are indicated below.
B) SYSTEM CONDITIONALLY PASSES: N�/9
One or more system components need to be replaced or repaired. The system,upon completion of the replacement or repair, passes
inspection.
Indicate yes, no,or not determined(Y, N,or ND). Describe basis of determination in all instances. If"not determined",explain why not)
The septic tank is metal,cracked,structurally unsound, shows substantial infiltration or exAltration,.or tank failure is
imminent. The system will pass inspection if the existing septic tank is replaced with a Conforming septic tank as approved
by the Board of Health.
(revised 11/03/95) 1
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address; 6(5 S Jh S 2
Owner. OG
Date of Inspection:
B]SYSTEM CONDITIONALLY PASSES (continued)
Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s)
or due to a broken, settled or uneven distribution boa. 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
obstruction is removed
Cl FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH:
Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the
public health, safety and the environment.
1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A
MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT:
Cesspool or privy is within 50 feet of a surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh.
2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE)
DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND
SAFETY AND THE ENVIRONMENT:
The system has a septic tank and soil absorption system and is within 100 feet to a surface water supply or tributary to a
surface water supply.
The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well.
The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well.
The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water
supply well, unless a well water analysis for ooliform 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.
9) OTHER
(revised 11/03/95) 2
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
/ CERTIFICATION(continued)
Property Address: 6 d Sv+�s e.
Owner.
Date of Inspection:
s/iy /q
D] SYSTEM FAILS: N14
I have deternuned that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for
this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the
failure.
— Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool.
— Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or
cesspool
— Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool.
— Liquid depth in cesspool
P poo '�s leas 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.
El LARGE SYSTEM FAILS:
The following criteria apply to large systems in addition to the criteria above:
The system serves a facility with a design flow of 10,000 gpd or greater(Large System) and the system is a significant threat to public
health and safety and the environment because one or more of the following conditions exist:
— the system is within 400 feet of a surface drinking water supply
— the system is within 200 feet of a tributary to a surface drinking water supply
— the system is located in a nitrogen-sensitive area (Interim Wellhead Protection Area(IWPA)or a mapped Zone II of a public
water supply well)
The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment.progiam
requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information.
(revised 11/03/95) 3
r
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 6 U c5v
Owner. (�O.c.e-c'
Date of Inspeotioo:
7 9
Check if the following have been done:
Pumping information was requested of the owner,occupant, and Board of Health.
None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates
during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection.
_k/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. -
ZThe system does not receive non-sanitary or industrial waste flow
The site was inspected for signs of breakout.
All system components, excluding the Soil Absorption System, have been located on the site.
The septic tank manholes were uncovered, opened, and the interior of the septic tank was 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 or
/approximated by non-intrusive methods.
V The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance-of Sub-
Surface Disposal System. -
(revised 11/03/95) 4
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 66
Owner. cc-`c y
Date of Inspection:
RESIDENTIAL- FLOW CONDITIONS
Design Jjow: 332 gallons
Number of bedrooms:_
Number of current residents: a
Garbage grinder(yes or no):_Se,,:�7 S
laundry connected to system(yes or no):,�S
Seasonal use(yes or no):��
Water meter readings, if available: C Oo 6 0
Last date of oocupanry: J!��K41 07 o j,
COMMERCIAL/INDUSTRIAL•
Type of establishment:
Design flow:—�p1lons/day
Grease trap present: (yes or no)_
Industrial Waste Holding Tank present: (yes or no)
Non-sanitary waste discharged to the Title 5 system: (yes or no)
Water meter readings, if available:
Last date of occupancy:
OTHER(Describe)
Last date of occupancy:
GENERAL INFORMATION
PUMP17G RECORDS and source
of information:
/` �`'�K1.�. I'l d I K/ lJ L✓C�S ON 0C./ I L L .O.t✓ f/1 �-O /�J,� !_,G,
System pumped as part of inspection: (yes or no)LClO
If yes,volume pumped: gallon,
Reason for pumping:
TYPE
/�OF SYSTEM
Septic tank/distribution box/soil absorption system
Single cesspool
Overflow cesspool
Privy
Shared system(yea or no) (if yes, attach previous inspection records, if any)
Other(explain)
APPROXIMATE AGE of all components, date installed-(if!mown) and source of information: H 5 e
Sewage odors detected when arriving at the site: (yes or no) Ard
(revised 11/03/95) 6
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
// 1 SYSTEM INFORMATION(oontinued)
Property pertr Ada b y 31141 S G 7
Owner.
Date of Inspeotion:
'5
SEPTIC TANK
(locate on site plan)
Depth below grade:. r i-15e;✓-
Material of construction:✓ncrete_metal_FRP—other(explain) `
Dimensions: C1
Sludge depth:-_ y/
Distance from top of sludge to bottom of outlet tee or baffle: 07
Scum thickness: 6/( rz
Distance from top of scum to top of outlet tee or baffle:NO
Distance from bottom of scum to bottom of outlet tee or baffle: lO_
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.) (/L l
✓ 4 'I K u( hL.Jo✓ . o .5 i O
GREASE TRAP:_///g
(locate on site plan)
Depth below grade:
Material of construction:_concrete_metal_FRP_other(e:piain)
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:
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 11/03/95) 6
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: �-
Owner.
Date of Inspection: ,� y
TIGHT OR HOLDING TANK:- 14
(locate on site plan)
Depth below grade:
Material of construction:_concrete_metal_FRP—other(explain)
Dimensions:
Capacity_ gallons
Design flow: gallons/day
Alarm level:
Comments:
(condition of inlet tee, condition of alarm and float switches,etc.)
DISTRIBUTION BOX:
(locate on site plan)
Depth of liquid level above outlet invert: v
Comments:
(note if level and distribution is equal evidence of solids carryover, evidence of leakage into or out of box, etc.) X W co! S
PUMP CHAMBER:�/9
(locate on site plan)
Pumps in working order-(yes or no)
Comments:
(note condition of pump chamber, condition of pumps and appurtenances, etc.)
(revised 11/03/95) 7
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
/ SYSTEM INFORMATION(oontinued)
Property Address: 66
Owner. �Ac.Gb
Date of Inspection:
SOIL ABSORPTION SYSTEM(SAS)._
(locate an site plan,if Posable;excavation not required,but may be approximated by non-intrusive methods)
If not determined to be present,explain:
Type: keCling Pit',number:_at1-L
leaching chambers,number._
katlin8
galleries,number
leaching trenches,number,length:
leaching fields, number,dimensions:
overflow cesspool, number:
Comments: (note b condition of soil, signs of hydraulic failure, level of n ' �n�,) �; ; J, -A o _ po dutg, condition o ve
v Y—L v arc>(' e_�, s
CESSPOOLS: ,9
(locate on site plan)
Number and configuration:
Depth-top of liquid to inlet invert:
Depth of solids layer.
Depth of scum layer.
Dimensions of cesspool:
Materials of construction:
Indication of groundwater:
inflow(cesspool must be Pumped as Part of inspection) —`
Comments:(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
PRIVY:
(locate on site plan)
Materials of construction: Dimensions.
Depth of solids: _
Comments: (note condition of soil,signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
(revised 11/03/95) 8
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address:
Owner:
Date of Inspection:
SKETCH OF SEWAGE DISPOSAL SYSTEM:
indude ties to at least two pemtianent references landmarks or benchmarks
locate all wells within t M'
�31 ' 3�
3,5
LL '[J✓K
35 '
37
36
DEPTH TO GROUNDWATER
Depth to groundwater: feet adjusted high groundwater Ievc(
method of determination or roximation.*
aPP cam. ,._.c..� � t o -- -6-0. - v� �• �Lw
e
ti
No.. : . F�$.. ' ..............
THE COMMONWEALTH OF MASSACHU�_*ETTS
BOARD OF HEALTH
-------------------- --------- -------OF...-...........-....-.--... _...
Appliratiun for Disposal Works Tnnitrn.rtion Prratit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
........... _.....
��ve .. - i -
......... ..-.... ...••--•---.•-•-------•..............
cation-Add s ® or Lot No.
.......... ........................................ ------------..............................
a ..............� O,wner Address
d._. S& ---------•-----------------•-•---•-------- ..................................................................................................
Installer Address
Type of Building Size Lot...... -----Sq. feet
Dwelling—No. of Bedrooms........ .............................Expansion Attic ( ) Garbage Grinder (AA)
Other—Type of Building No. of persons............................ Showers
W� yP g ---------------------------• P ( ) — Cafeteria
dOther fixtures ...................................----------------......----------•---•----•-•----•--•----••---•------
W Design Flow....... dt ........................gallons per person per day. Total daily flow............F�� ._..................__gallons.
WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter________-__-_- Depth................
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
3 Seepage Pit No..................... Diameter...w".X8:....... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water----------..............
(X4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water......._................
- -------- --------- --------------
O ---------
........ 1 --------&.-----•----------=Z
x
U --•••---•-•---•---••-----------••---•----•-----.._..•---•-•-••-----------•-----•..................•--•----•---•...-••---------•--•------•-------•-----•-•-•---...........-----------•.........---•-----
W
UNature of Repairs or Alterations—Answer when applicable................................................................................................
-------•--•--•-----------------------------------------•--•----------------•----------•-----•----------------------------------------------------------------------------------•----•-.........-----•--
Agreement:
The undersigned agrees pq install the aforedescribed Individual Sewage Disposal System in accordance with
the provi ions of iITI4: he State Sanitary Code—The under4signedf agrees not to place the system in
operati I a Certifi Compliance has bee by t boigned •--.... --_------. .........•----•-_...._ ........ .� ..:a_
Application Approved y-- ------- -•------------ ---------------- ----.... �7
Date
Application Disapproved or t e following reasons-------------•-----.....----.....-----------------------•------------------------------..._...--------........--
......................................................------....--•-----------•-----•--...................
tA • - Date
PermitNo......................................................... Issued.......................................................
y 1
No.... :017 ................
.............. F�s!j..d
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.................. ........................OF........................................
.-... ...
Appliration for Disposal Works Tonstrurtion rnmit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
..... •-
N -
c.a.tion-Adf s. ` ...S or Lot o.
!I. .. Lam _..._. .. ._..._... ----...----•-•-•-----•-------•................
Owner . Address
a ------------------h1t r t/N ...._ .-......................._...-.
Installer :.,', Address
Type of Building Size Lot-----�_6__G�......Sq. feet
Dwelling—No. of Bedrooms....._-.< ..............................Expansion Attic ( ) Garbage Grinder �Cb)
Other—Type of Building No. of ersons--------------•_--_-______-. Showers
� YP g ---------------------------- P ( ) — Cafeteria ( )
d Other fixtures.
W Design Flow................qlS..................gallons per person per day. Total daily flow..............- 3o.................gallons.
WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter________________ Depth................
x Disposal Trench—No. .................... Width_-_ . -_-.-•.--.. Total Length-------------------- Total leaching area_ .__-_---_-__sq. ft.
3 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. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................
(s, Test Pit No. 2................
minutes per inch Depth of Test Pit.... Depth to ground water........................
1 ..
j �r �f -.
D Description of Soil +�"0r!11rn-----�-----�---- = -` �`�! '..7 ' --- !"<!` ,��t/ _
x
U ------------
W ---------------------
--------
.------------------------------------------------------------------------------------------------------------------_...................................................
..__
U Nature,of Repairs or Alterations—Answer when applicable....................................._..._,......................................................
-----------------------------------•------••------------•----------•-------------------•------......----•-----------------=--------------------•--------------------•--•---•._...•-•••--.._..-••--•-•-
Agreement:
The undersigned' agrees install the aforedescribed Individual Sewage Disposal System in accordance with
the pro i of TITL% f the State Sanitary Code— ndersigner agrees not to place the system in
been ' s �bo%oth.operati a Certifi of Compliance has
t
tgned ...� .®
Application Approved -------------------------------------- 17 /
Date
Application Disapproved or t e following reasons------------------•-----------------------------------------•----------------•---------------•--•-••---•••••-••--
..................................................-...........................................................................................................-----•-•-------••--------------••-...__....
Date
PermitNo..........................--...--------------------- Issued.......................................................
Date
fit,is THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF.....................................................................................
CInfifirtt#r of Tontpliatta
THI-S-'IS CERTIFY, That the Individual Sewage Disposal System constructed ( or Repaired ( )
by.. _ �� _ _ _:.5-•---.DJ?�SGOLC.�..........................................
Installer
(G,
at ------------
has been installed in accordance with the provisions of TI _5ef,Mile State Sanitary o �s abed in the
application for Disposal Works Construction Permit No......................................... dated----.-____-_----__--___________..•`__.____--_-.
v THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CO TRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE. I. - •-I
5 Inspector...... -
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
L _. ""
FEE.......................
p i o tt1 o ion irttr ionPermit
Permission is eby granted.................. - --• ------------
to Construct ( or R aGilt ( ) n Indivi �r a Disposal System
={ r� ;
atNo................................ -•...----•-- . .................... --------------------------•-•---------------------•--•--------•----------------......
Street
as shown on the application for Disposal Works Construction PerZ . o•----------------•-- Dated..........................................
------• -- •----•••--•--------•----------------•--•--••-••••--•-•--•-••----•---..._..---•--••---
6 DATE ... ......................•--•---• Board of Health
-•---....----••.-•-
FORM 1255 A. M. SULKIN, INC., BOSTON
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t:
S LD,V_v ALL A2E1b. = 150 6-F
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p 5 x t•o 5ca
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BAXTER & NYE, INC.
Registered Land Surveyors and Civil Engineers
7 Parker Road/Osterville,Massachusetts 02655/Tel. (617)428-9131
VIIII IAM C.NYE;R.L.S.-President
RICHARD A.BAXTER,R.L.S.-Vice President PETER SULLIVAN,P.E.-Vice President-Engineering
November 11 , 1985
Town of Barnstable
Board of Health
P .O. Box 534
Hyannis, .MA 02601
RE: Lot 111, Sunset Lane
Osterville
Applicant Bayside Builders
Gentlemen:
-Please . find attached an as built plan for
Lot 111 . At the request of 'the installer., Driscoll ,
the location of the system was modified to that shown .
on the plan. Also' due to the depth of the invert coming
out of house, the original test holes did not cover the
system. I dug by hand an additional test hole at the
bottom of the in.place system. The additional test hole -
verified that there is in fact 4 feet of clean dry
Ii . suitable material below the system.
I trust that this meets your .present needs .
Very truly yours,
Peter Sullivan, P . E.
Baxter & Nye, Inc.
PS/fmj
Ili
06
CC: Bayside Builders
KTER
SULLIVAN
No. 29733
S 6
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�onrA L
MEMBERS OF
CAPE COD SOCIETY OF PROFESSIONAL ENGINEERS AND LAND SURVEYORS i AMERICAN CONGRESS ON SURVEYING AND MAPPING
MASSACHUSETTS ASSOCIATION OF LAND SURVEYORS AND CIVIL ENGINEERS
TOWN OF BARNSTABLE U
LOCATION ��� 5 �— SEWAGE # P7 7
VILL.?.GE 6 S ASSESSOR'S MAP& LOT
` INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY l V
LEACHING FACILITY: (type) �. /' (size)
NO.OF BEDROOMS
BUILDER OR OWNER
PERMTTDATE: I7 I Y" COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) _ Feet
Furnished by �_� f • '"�5. /��SG
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LOCATION S E W A E PERMIT NO.
VILLiiAGE
� INSTA LLER'S NAME ADDRESS
ID
d 011 D E R 0 OWN ER
DATE PERMIT ISSUED
�D �-TE C 0 M P L I A N C E ISSUED
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