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Home My WebLink About0158 SWIFT AVENUE - Health 158 SWIFT AVENUE OSTERVILLE A= 165 -083 Massachusetts Department of Environmental Protection Bureau of Resource Protection Well Completion Reports Well Driller Please specify work performed: Address at well location: New Well Street Number: Street Name: 158 SWIFTAVE Please specify well type: Building Lot#: Assessor's Map#: Irrigation -� 165 Assessor's Lot#: ZIP Code: Number Of Wells: 83 02655 City/Town: Well Location BARNSTABLE In public right-of-way: GPS 0Yes r-tb North: West: 41.63707 70.36605 Subdivision/Property/Description: Mailing Address: 'click here if same as well location addres Property Owner: Street Number: Street Name: CO EJ JAXTIMER 48 ROSARY LANE City/Town: State: Engineering Firm: /q Vk -RNSTAE LE MASSACHUSETTS V `'U�IP Code: 02601 Board of health permit obtained: (-Yes 0 Not Required Permit Number: Date Issued: W2021058 10/08/2021 Massachusetts Department of Environmental Protection Bureau of Resource Protection—Well Driller Program Well Completion Reports(General) Well Driller - General Well Form DRILLING METHOD Overburden Bedrock uger Choose Bedrock— WELL LOG OVERBURDEN LITHOLOGY From(ft) TOM Code Color Comment Drop in drill Extra fast or slow Loss or addition stem drill rate of fluid II, 0 20 Fine To Coarse S ii• Brown + t Slow Fast( YES NO �W4__� Loss Addition 20 40 To Coarse S;�• Brown '" =SN 'Fast{ Slow [LossFine7iton-- � WELL LOG BEDROCK LITHOLOGY Drop In Extra fast or Loss or Visible Rust Extra From(ft) TOM Code Comment addition of Large drill stem slow drill rate fluid Staining Chips �J- �..� Choose Code =(7�. .YesFast Slow -17Yes ADDITIONAL WELL INFORMATION Developed Fr. es f";No Disinfected Taxes f"No� Total Well Depth 40 Depth to Bedrock 1 Surface Seal Type None � �racture Enhancement f"'Yes 1:No CASING Is Casing above ground? From To Type Thickness Diameter Driveshoe 0 33 Polyvinyl Chloride Schedule 40 + 4 IL_Yes' SCREEN r No Screen From To Type Slot Size Diameter} 33 40 Stainless Steel Well Point 0.012 =. _I WATER43EARING ZONES 1`"'DRY WELL From To Yield(gpm) 18 40 12 PERMANENT PUMP(IF AVAILABLE) Choose Pump Choose Pump Description Horsepower Description— Horsepower--- Pump Intake Depth(ft) Nominal Pump Capacity(gpm) ANNULAR SEAL/FILTER PACK Water Batches Method Of From To Material Weight Material Weight (gal) 1(count) Placement Massachusetts Department of Environmental Protection Bureau of Resource Protection—Well Driller Program Well Completion Reports(General) Choose Material1 Choose Material f _� �_� —Choose One WELL TEST DATA Date Method Yield(9P m) Time Pumped Pumping Level(ft Time To Recover Recovery(ft (HH:MM) BGS) (HH:MM) BGS) 10/29/2021 Constant Rate Pump 12 01:30 20 00:01 18 WATER LEVEL Date Measured Static Depth BGS(ft) Flowing Rate(gpm) COMMENTS WELL DRILLERS STATEMENT This well was drilled or altered under my direct supervision,according to the applicable rules and regulations,and this report is complete and accurate to the best of my knowledge. WILLIAM Monitoring[M] Supervising Driller DESMOND, DrillerURQUHART Registration# 877 Signature PATRICK, DESMOND WELL Date Job Complete Firm DRILLING INC. Rig Permit# 0551 to/2s/2o21 NOTE:Well Completion Reports must be filed by the registered well driller within 30 days of well completion. ' r ENVIROTECH LABORATORIES, INC. MA CERT. NO.:M-MA 063 8 Jan Sebastian Drive Unit•11 Sandwich,MA 02563 (508)888-6460 1-800-339-6460 FAX(508)888-6446 Client Name: Desmond HIM Drilling Location Address : PO Box 2783 158 Swift Avenue Orleans, MA Osterville 02653 Lab Nunfber: DW-215215 Collected By: DWD Date Received: 10/29/21 Sample Type: well Well Specs: 40/18 I.oCa#�e$`Suttre _ DIIfE `OAECt�tf 'aGT A- ',,e U� T RG a �io mouse w• . 3,a Analysis Requested Units Recommended Limits Analysis Result; Metliod DateAraalyzed Analyzed By Total Coliform CFU/100mL 0 0,bg 0 SM9222B 10/29/2021 CF @�1400 -- __._...._-_ -_ __._. pH pH units 6.5-8.5 6.16 SM 4500-H B 10/29/2021 SD - - ----- —_ _ _� --- -- - w ------- -Specific ConductanceII umhoslcm 500` 259_ EPA 120 1 10/29/2021 SD ._.. _. ._..._..__..__...__..._..__....____._. _. _.._..__ - - Nitrite-N mg/L 1.00 <0.006 EPA 300.0 10/29/2021 SD Nitrate-N mg/L 10.0 1.00 EPA 300.0 10/29/2021 SD Sodium mg/L 20.0 42 EPA 200 7 10/30/2021 KB Total Iron mg/L 0.3 <0 01 EPA 200.7 10/30/2021 KB Manganese mg/L 0.05 0,093 —EPA 200.7 —10/30/2021 _ KB _ - -_— ---------------- Comments: pH is below recommended limit and may have cor rosive characteristics. Sodium level is not a health hazard. Drinking water may naturally have manganese and,when concentrations are greater than 0.050 mg/L,the;water may be discolored and taste bad.Manganese is not a health hazard at levels 0.05-0.300 mg/L. All samples were analyzed within the established guidelines of US EPA approved methods with all requirements met, unless otherwise noted at the end of a given sample's analytical results. We certify that the following results are true and accurate to the best of our knowledge. Water meets EPA-standards and is suitable for drinking for parameters tested. Date 11/8/2021 fr Ronald J.Saari hs Laboratory Director BRL=Below Reportable limits 'See Attached Page 1 of 1 ❑Certification is not available for this analyte,for potable water samples.. 40 No. �d � f Fee BOARD OF HEALTH TOWN OF BARNSTABLE ZippYication _for lVell Construction Permit Application is hereby made for a permit to Construct�, Alter( ), or Repair( ) an individual well at: \500 Swi Pie-. uAk-t- , WY31 Location-Address Assessors Map and Parcel 0rnC.S C ON 0-\V\o \lc�i�►c�.�olo '�J� ��1�1c�,—T'� ,�1� 33�13 607,er Address Installer-Driller d Address Type of Building Dwelling Other-Type of Building No. of Persons Type of Well y s C� P - Capacity ` y-Y, Purpose of Well Agreement: The undersigned agrees to install the afore described 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 Certi cate of Compliance has been issued by the Board of Health. Signed /c'l 1 wzZ Date Application Approved By + ate Application Disapproved for the following reasons: Date f Permit No. Issued J�O lob- Date -------------------------------------------------------------------------------------------------------- BOARD OF HEALTH TOWN OF BARNSTABLE Certificate of Compliance THIS IS TO CERTIFY,that the individual well Constructed Q0, Altered( ), or Repaired( ) by Q-Q S NY\tSrc& \NO,\\ c;V r 3)(\c /n� Installer at \ �W I - C�i de , oa�C has been installed in.accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. Dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORILY. Date Inspector No. � f -�' Fee BOARD OF HEALTH TOWN OF BARNSTABLE C5 ZIPPYication _for Yell Con5tructiou Permit Application is hereby made for a permit to Construct�, Alter( ), or Repair( ) an individual well at: , xs �S�� e., cf��1� ��1�3 aL Location-Address Assessors Map and Parcel �h oYraS C oSVoAV\d \\ol Aoe yo,10 Q2 Owner Address n�_sm V� 1� ►CJ�11� ? u. y R3 , � ,�,s, a�6fi 3 Installer-Driller ) Address I•, v Type of Building Dwelling Other-Type of Building No. of Persons 4'�S W40 PVC., Type of Well 1 apacty Purpose of Well Agreement: f The undersigned agrees to install the afore�d`escr-ib�e�ind'vi�dual well in`accorda cce with the provisions of the Town of Barnstable Board of Health Privafe�Well Profectio`Regulati iik'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 U �1 Date Application Approved By _ t + Date 'J Application Disapproved for the following reasons: :.. Date ram Permit No. 11� �a — o S_p Issued V r Date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate of (Compliance THIS IS TO CERTIFY,that the individual well Constructed(K), Altered( ), or Repaired( ) by Q-kSMw4 \NLA —� Installer at has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. Dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORILY. Date Inspector 14 rrr, r -w�?�.e-•,.ter. .fir r.r;:e. .�e.c r�j_s r.. rr� _s_r_ r_ - -�'a..�. ,r1 �. fir. _�►r r_ ��. :i:r�'r.w. .®r.�� ,e. _ +. - r��r o,s 'r ...r rr.a_ BOARD OF HEALTH TOWN OF BARNSTABLE Yell Construction Permit No. �a) 0)� oy0 r Fee L� , Permission is hereby granted to ` �)C Ainc, Installer to Construct*),y� Alter( ), or Repair( an individual well at: No. �5� vJ� �r'�C' ke- Street G J as shown on the application for a Well Construction Permit No. Dated Date �� '/� Approved By \ a LOCATION MAP: ASSESSORS REF.: Al,les,vp.cu ru DIRECTIONS: _ \•'". 1R hrn Nymnk- to ftllpv 1A sleet Ine teat / // i /� / ,ii�//// � �\\ \ i`\'\\\•`'\``\ � AMI A- A.rel 1. 4.1. .u,ln s lw n pr®�o) : / '/ i/ , , / %/, .." .. BENbf uArB` \� \ r•. '' G;p�n up ..1�pnfh 1•�'.>T J / // �/ .'r Lots 2&3 / \ ,.lsmancpEamm lof area-rd7;a5001 - i ! e OVERLAY DISTRICT: .A0G11iDYAl PD10 1ES!-.. 28f Acres \� / f Al-Aaulre.Profectbn—.1 TAKIA-1 REFERENCES: \ —1 e..2Jm52 PB 1 FLOOD ZONE: J92 Pv m l.pt J zp^e,AE n.p. \ •, - - 1 f � t � ) at 2 DanmunllY Pm,tl Ns \ ' O , , , y000120 58J J d:, M ZONE: I Yiree I H Zmh RI-1 R RL, 9 ', j I- -i , •:., I r - fmlvge(mN)10' O ..."....... , Mdfn(mh)125' \ I xfeper,: ao t Jo o \ Rc ,l,SEO SF : rB'.mlvge(mM)20' xtbacev 9 I 1 � I I.. �• - front 20' - a 9 . ♦ Tlwdt / / \ � x , r D / CD °i IBita,c i i a j I y\ IJ I r LEGEND: o W 77, I I � W. iX, ARE: PREPARED Br PREPARED I.. Nol- Site Plan Proposed Improvements ' �.l EnglQeering& Thomas Ca—fho 1)me p.pprty lh.hfom plm ,no. .p,c^pp.a nr _ P AP 1101 Arevolo De Avila a ai evae —d Mr-1.. y ^. d a ep k Mb elb.pe.pleM e v r Ulllv � UQQawWQgfiQ('i Tampa FL 33613 W�/23/2 nir„^ oiom,e nn annw DE^vn..nnvw 158 Swig Avenue =onANOY:mA;°<om'.uwM sm'ry o.Mmnxo'mMM" nat m°epfvm b N010'es o n,ee meo ,.v let v Barnstable losrervrlrel Mass. Drv,C LDi/Aa fltld ,cm/" DAT. SCAIE: Reeser CRi/JDO Lamp.y#eNer: A--- September 27,2021 1'=20• A pepcl:Jarl4nr_ISe s m ve aF lgse1 PROPOSE \ \ \ IRRIGATION; \\ \\ \\ , WELL \ \\ \ BE616 MARK` Ea . �+ 2 &# PIKE IN GROUNtl\ �' � \ EL.22°3� � it h 5'JSTRIPQUT-IF REQUIRED L o f Are-0 -1`�7, 45Os f+ % �� ( ,1ADDITI+ONAL PERC TEST OF-- , 3.28± Acres 1 i I B LAYER MAY BE PfFRFORMED \ !I 1 I f B1Y ENGINEER AT TIME OF \ " INST CLLATION i ! �fl..... .. `::: :1'2: 10T• -10 I E ( ( ( ( ` t I =� \ , PROPO :r::: O I I ! I l ....................:........ II i I E I s II i i F S PROPOSED E 1 ! ! I ( r TIC TANKS OWDE CLE NOUTS TYPICAL- .., / 7r j ) Existing Barn r / i r r c N Commonwealth of Massachusetts -; Title 5 Official Inspection Form 1. Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 9 p Y rY 158 Swift Ave ` Property Address01 ANTKOWIAK, THOMAS L & IRENE A TRS Owner Owner's Name information is 73' required for every Osterville Ma 02655 8/30/18 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 A. Inspector Information filling out forms on the computer, use only the tab Michael DiBuono key to move your Name of Inspector cursor-do not DiBuono Sewer And Drain use the return key. Company Name 35 Content Lane Company Address Cotuit Ma 02635 City/Town State Zip Code 508-364-9587 SI 13522 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 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 9/3/18 -,'Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system 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 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 Commonwealth of Massachusetts ,F Title 5 Official Inspection Form F Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 158 Swift Ave Property Address ANTKOWIAK, THOMAS L & IRENE A TRS Owner Owner's Name required for is every Osteryille required for eve Ma 02655 8/30/18 page. Cityrrown 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: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: System contains a 1500 Gallon septic tank as well as a concrete distribution box and 5 leaching galleries in 3' of stone. 2) System Conditionally Passes: ❑ One or more system componerits 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): l5insp.doc•rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form (/ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 158 Swift Ave Property Address ANTKOWIAK, THOMAS L & IRENE A TRS Owner Owner's Name information is required for every Osterville Ma 02655 8/30/18 page. CityrT'own 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 ❑ 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 OWN p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4' 158 Swift Ave Property Address ANTKOWIAK, THOMAS L & IRENE A TRS Owner Owner's Name information is required for every Osterville Ma 02655 8/30/18 page. Cityrrown 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 rSoil absorption system p SAS and the Y (SAS) 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 158 Swift Ave Property Address ANTKOWIAK, THOMAS L & IRENE A TRS Owner Owner's Name information is required for every Osterville Ma 02655 8/30/18 page. CitylTown 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 ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than %day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public 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 fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 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 Commonwealth of Massachusetts p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments •V, 158 Swift Ave Property Address ANTKOWIAK, THOMAS L & IRENE A TRS Owner Owner's Name information is OSterville required for every Ma 02655 8/30/18 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 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 158 Swift Ave Property Address ANTKOWIAK, THOMAS L & IRENE A TRS Owner Owner's Name information is required for every Osterville Ma 02655 8/30/18 page. Cityrrown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms(design): 5 Number of bedrooms(actual): 5 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 550 Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No 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 ears usage d 182 9 ( Y 9 (gp ))� Detail: Sump pump? ❑ Yes ❑ No Last date of occupancy: Date t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 158 Swift Ave Property Address ANTKOWIAK, THOMAS L & IRENE A TRS Owner Owner's Name information is Osterville required for every Ma 02655 8/30/18 page. Cltyrrown State Zip Code Date of Inspection D. System Information (cont.) 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: h d 2015 pumped per home owner Source of information: III, Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 1500 gallons How was quantity pumped determined? Site glass on truck Reason for pumping: Maintenance ;i t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 f c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 158 Swift Ave Property Address ANTKOWIAK, THOMAS L & IRENE A TRS Owner Owner's Name information is required for every Osterville Ma 02655 8/30/18 page. City(rown 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: installed 1991 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 2.5 feet Material of construction: ® 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.): System is vented at the roof line 6insp.doc•rev.7/26/2018 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 158 Swift Ave Property Address ANTKOWIAK, THOMAS L & IRENE A TRS Owner Owner's Name information is Osterville required for every Ma 02655 8/30/18 page. Cltyrrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 2 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene El other(explain) 1500 If tank is metal, list age: • years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: Sludge depth: 3" Distance from top of sludge to bottom of outlet tee or baffle 24" Scum thickness 3" Distance from top of scum to top of outlet tee or baffle 40" Distance from bottom of scum to bottom of outlet tee or baffle 30" How were dimensions determined? Tape Measure Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pumped 8/30/18 t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 158 Swift Ave Property Address ANTKOWIAK, THOMAS L & IRENE A TRS Owner Owner's Name information is Osterville Ma 02655 8/30/18 required for every page. CitylTown 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.): r 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 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 158 Swift Ave Property Address ANTKOWIAK, THOMAS L & IRENE A TRS Owner Owner's Name information is OSterville required for every Ma 02655 8/30/18 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 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.): 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 158 Swift Ave Property Address ANTKOWIAK, THOMAS L & IRENE A TRS Owner Owner's Name information is required for every Osterville Ma 02655 8/30/18 page. Cityrrown 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.): Sewage ejection pump in basemant operational * If pumps or alarms are not in working order, system is a conditional pass. I 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type. ❑ leaching pits number: ❑ leaching chambers number: ® leaching galleries number: 5 ❑ leaching trenches number, length: ❑ leaching 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 lg Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 158 Swift Ave V Property Address ANTKOWIAK, THOMAS L & IRENE A TRS Owner Owner's Name information is ill terve M required for every Os a 02655 8/30/18 page. City/Town 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.): 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 layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 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 InspectionForm �' la Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u 158 Swift Ave Property Address ANTKOWIAK, THOMAS L & IRENE A TRS Owner Owner's Name information is required for every Osterville Ma 02655 8/30/18 page. Cityrrown 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 � . Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments u 158 Swift Ave Property Address ANTKOWIAK, THOMAS L & IRENE A TRS Owner Owner's Name information is required for every Osterville Ma 02655 8/30/18 page. City/Town 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 9/3/2018 Assessing As-Built Cards -----.. TOWN OF BARNSTABLE �+ LOCATION /J�8 ✓G�/i ��' Al-, SEWAGE# VILLAGE Qa'N�l.� ASSESSOR'S MAP& LOT �✓�� all INSTALLER'S NAME& PHONE NO. , MQ SEPTIC TANK CAPACITY �.3'QZ+ �c,P IV LEACWNG FACILITY:(type) 6,#,c (sue) ,�"' NO.OF BEDROOMS c,,57 POOR PUBLIC WATER BU1LMR OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No 1 Q 4 , d ly J 1 http://www.townofbamstable-us/Assessing/HMdisplay.asp?mappar=165083&seq=1 1/9 i c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u 158 Swift Ave Property Address ANTKOWIAK, THOMAS L & IRENE A TRS Owner Owner's Name information is required for every Osterville Ma 02655 8/30/18 page. Cityrrown 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: 10 + 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: 2/11/91 Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Test hole data on plan 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 c , Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments u 158 Swift Ave Property Address ANTKOWIAK, THOMAS L & IRENE A TRS Owner Owner's Name information is required for every Osterville Ma 02655 8/30/18 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 TOWN OF BARNSTABLE LOCATION �� ✓ G(/� �� //,C SEWAGE # VILLAGE ]�?'W�' �/`i�� ASSESSOR'S MAP & LOT �- �e INSTALLER'S NAME & PHONE NO. yr, a �� IV SEPTIC TANK CAPACITY LEACHING FACILITY:(tVpe) 6,04 C (size) /�/�744_ NO. OF BEDROOMS P OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: i5�'' /v e` VARIANCE GRANTED: Yes No J LOT NO. : ADDRESS: 614NERS NAME: %gym n f ug..;�. k SEWAGE PERMIT NO. : %/, ( a NEW: REPAIR DATE ISSUED: 311 S / DATE INSTALLED: - t INSTALLERS NAME: INSTALLATION OF: i S-b C,, A/ u y C- WATER TABLE: FINAL INSPECTION BY: DRAWING OF INSTALLATION ON REVERSE SIDE : 1Z '1 ll��-=aS3 Fss.....�1 ...._ THE.COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE Appliration for Uiiposal Works Tonstrnrtion Permit Application is hereby made for a Permit to Construct (;�-j or Repair ( ) an Individual Sewage Disposal System at: .1.5-e _5L,°- .. { C s -......... ---------------------•-••---------. ....................•.................... .. Locatio.�n.,Address or Lot No. .. \- ill. !lcS.d[L s .i� .�,?�^ �.- ..' ................................................. —� Owner dyes -- .. G.!^.................. a Installer Address Type of Building Size Lot............................Sq. feet UDwelling—No. of Bedrooms..........`J...............................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures ---------------------------- W Design Flow..... .................gallons per person per day. Total daily flow........... ........................gallons. WSeptic Tank—Liquid capacityl&?'U.gallons Length__ ......... Width... .......... Diameter................ Depth.-`/........... x Disposal Trench—No...--................ Width._10- .-.--__-__-_ Total Length__.. •..._....... Total leaching area___t.1'2 .___---sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( �• DosiM tank ( I `'' Percolation Test Results Performed by__.{�k -!�....CL-+ s..: :......................... Date........................................ Test Pit No. I.......Z------minutes per inch Depth of Test Pit-----t_____.____.. Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water_--___-____-----__--_--. a ..............................................l.1................................................--- .................................................... Description of Soil vk..: ✓!.r `'`�------••----------•--•---•---- x 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 TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance ha been issued by the board o health. Si ned -- ------ .% . ------. . 3 c'�---------- g � to c Application Approved By .. J Dw� -1.-� Application Disapproved for the following reasons- ....................................................---------------------------------------------- -------- ------------------- -------------------------------------------- ------------------------------------------- -------- --------...--------------------- 7- Permit No. - Issued -------------- ------------ D. ................--- ----'-'----'--`e Date FEB.....1-12- 2...... THE COMMONWEALTH OF MASSACHUSETTS _ 4 ` BOARD • OF HEALTH TOWN OF BARNSTABLE Allp iratinn for Disposal Works Tnnstrnr#inn Permit Application is hereby made for a Permit to Construct (k or Repair ( ) an Individual Sewage Disposal System at: :5 L, �V � ds c v .--------- ------------------------------------------- ...--•--.............................---- -•-. .. ..... Location•Address /for Lot No. i! .....-------•......................... ....... �.S c. � � = ---....... ............................. •— Owner / /' ( CA�ddress W l V_•(l�hC 1� 9 ti. .L�. ��1 --•.-V l _ �.�.w.K.._._�t.�:............�............ J Installer Address � Type of Building k--- Size Lot............................S q. feet � Dwelling—No. of Bedrooms...........5...............................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons.......1................... Showers — Cafeteria Q' Other fixtures --------------- --------------------------•-----' . W Design Flow..... -----------------gallons per person per day. Total daily flow____-__--.5 ........................gallons. WSeptic Tank—Liquid capacity-L., gallons U Length__j6_......... Width_.�.......... Diameter________________ Depth..`✓.......... x Disposal Trench—No..................... Width._A?.......... Total Length....d............ Total leaching area___/-9.-7 ...sq. ft. Seepage Pit No--------------------- Diameter-------------------- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box Dosing tank ( _ ,a Percolation Test Results Performed by.. r ?...ZC.......................... Date........................................ Test Pit No. 1.....1.......minutes peOnch Depth of:Test Pit-----a,........ Depth to ground water_______________________ „ G=, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ w .................................................'6----------------------------------------•-----------------------------------_--------------------------_. O Description of Soil........ �V 1.�a�y ��, -------�'.................................. '` ; �G.y_ ................................................... x V W ----•--'------------•--------------'-------------•-----------------•---------------•-------------------------------..............-----•----•---------------------•-......_•----•------------------------ UNature of Repairs or Alterations—Answer when applicable............................................................................................... l Agreement: _ The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has,been issued by the board o health. Signed .- 3 /S/ ---------------------------- Dare Application Approved By ------------ 2nra.....R).-.r -----..--'-----------------.....-------.......------------------------------ Dare Application Disapproved for the following reasons: ...............................:. ..................................................I.......................... ------------------ ----------------------------------------------------------------------- --------------------------------------------------------------------------------------------------- . ------------- -------------- . .f Permit No. ----------C� �-------------------- Issued ..................... -...-----'------'----------te----- are i THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Tertifira e of Graptittnee THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired ( ) �y� .� ...........................................?.e_nJ--- ------------------------------------------------------------------------------------------------------- by ....................... '1 °!1!1. iP. .....---- --'-- Installer at ..................l all ----- e+ ��-o..... /�3 -:..---.... L� _��.Q -... has been installed in accordanckith the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. .............�-..�..�,........ dated ...................--..............------....... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. 00 DATE ... Inspector ............................. .... ... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH / TOWN OF BARNSTABLE 1 No.-.��=--`p.r�: FEE..%n..c2....... Disposal Morks Tnnstrnrtinn "permit Permission is hereby granted ....- � --••----•--•................................•-•--•------..---.----------------.-•--- to Construct or Repair ( ) an Individual Sewaje Disposal System atNo..........................4.1_8- --------:"5,: .....C62--f.............. ,� q � Q�i.-..-.--.----------------•-----•--••---•---..-.----. Street > as shown on the application for Disposal Works Construction Permit No .. Dated Dated.......................................... ....................................... " 4)..•-----.........._-----------.......__..... oard of Health DATE....................... ......./...... ............ FORM 36508 HOBBS&WARREN.INC..PUBLISHERS AsBuilt Page 1 of 1 TOWNN OF BAARNSTABLE LOCATION ✓�i T /7!/.0 SEWAGE # VILLAGE �J'l�' ¢��,� ASSESSOR'S MAP & LOT d f"- G• .3 INSTALLtR'S NAME & PHONE NO. 00, Mot SEPTIC TANK CAPACITY Zt// JPV c.P LEACHING FACILITY:(type) Vq e.L (size) NO. OF BEDROOMS P . OR PUBLIC WATER BUILMR OR O WNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No t --tom Lo -- *14 . i i http://issgl2/intranet/propdata/prebuilt.aspx?mappar=165083&seq=1 8/28/2018 ..� ��E�f�� Ml� I G�� r�f:L�L �3 �+ � ,''sue•- i JAMze ry 65 p s � I-L4-40 { =- y i Sc A C-- i f , 11` MEN dJrL �J-," ;.:-T'iovj M44"vi.,A- 'f�a >r t't' i �. 73 � I I,d�lC�1t.6 AV, eCe, AA 'r tTS _ "� ►err G L'*l"d IJ _ ,,' -, r ,- 'r� h''i t�.S'b. ice.,-�y-Y�1.1►�t�ice) ,�.:� �'?r: v� "� Ida I(.AI.S rcns PC��i>-y+c�% t�C� dt✓V" ; 1 i I � � ----- J��. �tr�• 4o?Z f t ley 15 } `� ,' /l /// Ey�►�l� —' ;: I 1 S• (rt�-- 3�'is 3v ' •- Ok GeW+,�� I Llr1',G� V'�•Gt t�l f� ' ( t �,�� , ,� � /, �,�� __"' •-� � , �! t�'�Tw�C"��Ic• ?L�� ;' „�p'� i�^' lbw�� /-'/ /�! �, �-J i 110 �i`�� !f-'�a►.!E /_`1 2Qa / ,, r .. ✓ ;�i; x y I.H `r3 c.�J ,,'��..ice, 'r. ., p ��+f� �TQ � �, � i � �` +/' ��t✓ Isom C-tAt, u Eh�r1Cr Lv�1rr0JE�� i-JaJ low { ►,� lF (�-� ��t,IdM �. �-�ia�E ,t- �=, 1 ! 44: 4 4- I fj 3 �'�` �l✓►1� �.tr�. �.f;Ge.,l►.i 4,`• r IG �{�',Ci C,,;; L:. t".�'�,,,, \2� 4' 1 G111xti� ,� it s 5,3�J1y! x 7d4)Y G"Qta�° <:r,,� i3+ t''> `jar• `.ii*, r^. ..G t ' C:�t F% 'e'''k- +�.C`'( C. � ,l,. rc.sa Cq 104 )it 'S L �!'e.. 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