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HomeMy WebLinkAbout0282 LONG POND ROAD - Health 282 Long Pond Road Marstons Mills F A = 029 005003 1t 1� <� TOWN OF.B/iRNSTABLE 'LOCATION PER Long PonO/ Rd• SEWAGE # Q®oS -3yj7 qVILLLAGE nrs-Jfln.S Mi l J S ASSESSOR'S MAP& LOT a 9 - .S INSTALLER'S NAME&PHONE NO. JRc6,-H G;Kor . SoR• y7'7 • 0G S3 SEPTIC TANK CAPACITY /000 qci J I on LEACHING FACILITY: (type) .Sbo 4a I e h a rnS (size) x 3 a x Z NO.OF BEDROOMS Y BUILDER OR OWNER nlorfr)otn .Sm,-fc- PERMFFDATE: 0009 - 3N'7 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the 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 Az 30 " BZ = zz A3 J63 23 U AEI -39 ' Ry a9 ' O ''As AG = Ss B6 ' 30 t 4 OD 3 • Commonwealth of Massachusetts w Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ' t'a M 282 Long Pond Road „9 Property Address h, John MacLean Owner Owner's Name ` information is arsonsMills 4-10-18 a required for every N M t Mill M 02644 page. City/Town State Zip Code Date of Inspection P t'1 Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information on the computer, use only the tab 1. Inspector: key to move your cursor-do not Brett Hickey use the return Name of Inspector key. B&B Excavation _ rab Company Name 374 Route 130 Company Address Sandwich Ma 02563 City/Town State Zip Code (508)477-0653 SI 13747 Telephone Number License Number B. Certification 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 the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340.of Title 5(310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 4-10-18 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 is a shared system or has a design-flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes 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. l5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage DisZo l System-Page 1 of 17 a�-� V S • Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 282 Long Pond Road Property Address John MacLean Owner Owner's Name information is required for every Marstons Mills Ma 02644 4-10-18 page. City[Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I 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: The system was in working order at time of inspection. B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or.repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5:ns•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form m' Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 282 Long Pond Road Property Address John MacLean Owner Owner's Name information is required for every Marstons Mills Ma 02644 4-10-18 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed 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 F1 Y El N El 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): 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 public health, safety or 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 public health, 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 t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 282 Long Pond Road Property Address John MacLean Owner Owner's Name information is required for every Marstons Mills Ma 02644 4-10-18 page. Cityrrown State . Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ 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. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup 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 ❑ ® 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 Y2 day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 282 Long Pond Road _ Property Address John MacLean Owner Owner's Name information is required for every Marstons Mills Ma 02644 4-10-18 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet 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 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CM 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the questions in Section D. 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 If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 f Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 282 Long Pond Road Property Address John MacLean Owner Owner's Name information is required for every Marstons Mills Ma 02644 4-10-18 page. CitylTown State Zip Code Date of Inspection C. Checklist Che--k if the following have been done. You must indicate"yes" or"no" as to each of the following: 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)] i D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (Actual) _3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330/GPD t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 r Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 282 Long Pond Road Property Address John MacLean Owner Owner's Name information is required for every Marstons Mills Ma 02644 4-10-18 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? El Yes Z No Water meter readings, if available last 2 ears usage d See below 9 ( Y 9 (gp ))� Detail: "WELL WATER" Sump pump? ❑ Yes ® No Last date of occupancy: Current Date Commercial/Industrial Flow Conditions: Type of Establishment: NA 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 Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 282 Long Pond Road Property Address John MacLean Owner Owner's Name information is required for every Marstons Mills Ma 02644 4-10-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Owner-last pumped 2016 Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? 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) ❑ 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): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 282 Long Pond Road Property Address John MacLean Owner Owner's Name information is required for every Marstons Mills Ma 02644 4-10-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: A new SAS was added to the existing septic tank in 2005 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2'feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: Town feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): 1 Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000gallons Sludge depth: 2 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts tt W Title 5 Official Inspection Form l Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 282 Long Pond Road Property Address John MacLean Owner Owner's Name information is required for every Marstons Mills Ma 02644 4-10-18 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 34" Scum thickness 0 11 Distance from top of scum to top of outlet tee or baffle NS Distance from NS sta ce o bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank was in working order at time of inspection with liquid level equal to outlet invert. Tank is not in need of pumping at this time but should be pumped every two years for maintenance. Grease Trap (locate on site plan): Depth below grade: NA 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 t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 282 Long Pond Road Property Address John MacLean Owner Owner's Name information is required for every Marstons Mills Ma 02644 4-10-18 page. City/Town State Zip Code Date of Inspection . D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: NA Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day 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 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ° 282 Long Pond Road M Property Aldress John MacLean Owner Owner's Name information is required for every Marstons Mills Ma 02644 4-10-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): 011 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.): D-bcx is in working order at time of inspection with liquid level equal to outlet invert. D-box did not show signs of back up. 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.): NA I * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 282 Long Pond Road Property Address John MacLean Owner Owner's Name information is Marstons Mills Ma 02644 4-10-18 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: (3) 500 gallon ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: — ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching was in working order at time of inspection with no sign of hydraulic failure. Leaching was dry when viewed. I Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration NA 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 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 282 Long Pond Road Property Address John MacLean Owner Owner's Name information is required for every Marstons Mills Ma 02644 4-10-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: NA Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form.- Not for Voluntary Assessments °M 282 Long Pond Road Property Address John MacLean Owner Owner's Name information is required for every Marstons Mills Ma 02644 4-10-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent 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 REAR B Al- 26' B9- 17" f AZ- 22' B2- 22' A3-42' B3-23' A4- 39' (� B4=29' . A5-45' B5.28' A& 53' 3 B6- 30' t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts v Title 5 Official Inspection Form m� Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ° H 282 Long Pond Road Property Address John MacLean Owner Owner's Name information is required for every Marstons Mills Ma 02644 4-10-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: No GW @ 12' feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record 6-9-05 If checked, date of design plan reviewed: Date 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: Plan on file with BOH. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 282 Long Pond Road Property Address John MacLean Owner Owner's Name information is required for eve Marstons Mills Ma 02644 4-10-18 a every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist E Inspection Summary: A, B, C, D, or E checked E Inspection Summary D (System Failure Criteria Applicable to All Systems) completed E System Information— Estimated depth to high groundwater E Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file I I t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 r TOWN OF BARNSTABLE L-0-C CS'1ION iQ 11'� Lnne,. _;?C�A6Q SEWAGE # `VILLAGE CX\cafs�ws ASSESSOR'S MAP & Li,TO t INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) L%z, ` (size) k<ZKQ10 NO.OF BEDROOMS —S BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: z'7\e':T2 �'�L y/y� r,eofw ':w yy Maximum Adjusted Groundwater Table to the BBttom 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 o � o � 51 , TOWN OF BARNSTABLE LOCATION o25:1 �o>1Q �o n 9 0a d SEWAGE # VILLAGE `1/1L LlA(07t-v / ASSESSOR'S MAP & LOTga900S'� psi/C/;�' SEPTIC TANK CAPACITY ` LEACHING FACILITY: (type) (size) NO.OF BEDROOMS -3 BUILDER OR OWNER �d PERMTTDATE: X�OMPLIANCE DATE: Separation Distance Between the: 4+ Maximum Adjusted Groundwater Table to the 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 ��� -1 1� .C��'�7'""� j P � f sl. ��,� �,� . ��- �02���93 eve' W3•. No. 6l^�3 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01ppYication for Migonl *pgtem (Conotruction Permit Application for a Permit to Construct( )Repair( )Upgrade( ✓Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. ASe` Lo n ci tpo n0 98- Owner's Name,Address and Tel.No. Mgrs+-ons Mttls-Lot5 Norman Sei fel 509 -`i28-3647 Assessor's Map/ParcelM P 2.9 'P4 P'L r-1 5_3 42. 'Pt n lc ha m D 25 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. l� g68-Lt�7-Rpbef- Ctk ofn I { Tlry �ore gl - W . Cro5SftceoRcl 531j7 mores+cQle Type of Building: C-e-Q. .5Vg= Dwelling No.of Bedrooms � Lot Size -[ z sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 44 6 gallons per day. Calculated daily flow 33 gallons. Plan Date to 1`1 1 D 5 Number of sheets Revision Date Title ?r'O +1 L Onnrcjda 252 LDnn Pono R O p CI Size of Septic Tank I O Type of S.A.S. 3? pj1?r Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been is Wed by this Board of Health. Signed Date ((5 19 Application Approved by Date a r d 3 Application Disapproved for he following reasons Permit No. v2rjyS 3 y7 Date Issued '•-• r�-.�v�n`..,a..•..i�..(• -`. s�. •� ti .. `r +--mot ..l• �:ti f`".•.ls.r ,. 4r� ...ii. ,a...--*.d ...... .... ,r, �... ,• .� o f ,.... "— <; Fee . 100 No. - ` THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: W., PUBLIC HEALTH"DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes Z(Pplication for IDiopol *#!stem Con.5tructior permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) O Complete System 'O Individual Components Location Address or Lot No. O n c7 1 JU n0 Kc - O er's Name,Addre s and el. o. - Mcirsi�ns /t'1+ 11S- Lots Irrt-le,� ei e: 509 `129- 3447 Assessor's Map/Parcel H 2 -P+`}it 1 t , e D AgP29 ( rirtel .5-3 56n d(-L,.)+cr+ kA taavv,er s Name, ddres .and Tel No. Designer's Name,Address and Tel.No. I�et' t 2—t�i 'uy t (3�Xtr,Vci ,Un �inr�+ r�PPr� ri vjc)45 5vs-917- 5313 19 -11,eCi.bf(r� Lrv� _ra(P51dni( 'I17-�i~53 W . t (a5sjtr_1Z RC1) _�oresioc,ie Type of Building: Dwelling No.of Bedrooms Lot Size / sq.ft: Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 440 gallons per day. Calculated daily flow 3 gallons. Plan Date (° t, Number of sheets Revision Date Title JrU�05e6 l(- U C�C'CICIL' 82 D n 1,U f1 f� C)C.+ .I Size of Septic Tank U U Type of S.A.S l 3 ,f lM C 3 X /.s';�?, Description of Soil Nature of Repairs or Alterations(Answer when applicable) �t K Date last:inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been ' stye by thi B d 1,Hea l I Signed Date 7 1 1 5 D Application Approved by`, el-j VL Date 0 '2 r d S 0 Application Disapproved for the following reasons e Permit No. G� _ Date Issued a( o•3 THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE;MASSACHUSETTS Certificate of Compliance THIS IS TO C��RT FY, that the,On-s'te Sewag�Dipsal�System Constructed ( )Repaired( )Upgraded( ) Aband e. ( , by K U ��r i -�I ` U - I�t 1� t ><C C1 V CI t I U(1 at (J r�01 U r�Q ^(� C 1(5 v on S M ► 5 has been constructed in accordance ru r .,, f r` oa S -�W dated 71 aV ' with the provi ions of Title( an for Disposal System Construction Perrlut No:C' Installer I�v��r `1 1 1 U�� Designer (- k n 9 The issuance of this e s 1 of e�°nstrued as a guarantee that the s ste n do as desi md. Date p ✓ g Inspector y g � A tJfJ/ No. o .UG S 3 y / �Fee�/�� THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS ?Digpogat *pgtem C0115 r ctton permit Permission is hereby.,g an�t`ed;o Construct_ U)+J_) p r-( �Cpgrade(�Ab n�,do�t0 n)S i 5 System located at cc L 1 _ T J and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction Pst be completed within three years of the date of this,p' et�tlhit.n _ Date: �_ / �/ 3 Approved by r - Town of]Barnstable Department or.Regulatory Services • `���'(O Public Health Division Date 9•659. 200 Main Street,Hyannis MA 02601 Fee Pil 1' ®� Date ScheduledXen� Time_ i ,foil Suitability Assessment fog ewage . i sal � ,,q �s , Performed By: �2'rer _, C-EA�� Witnessed By: a LOCATION & GENERAL INFORMATION ",�n� Owner's Name �t�C,to 0.� e Location Address .z8 2 ��b P-4 SzrA Address �•2 ��n V��� �� {"pro.-(j vt5 Gl.%05, �� SA.to�w.'t� +"�►� GZSfo Assessor's Map/Parcel: O 2 I)l00 S dp?j Engineer's Name NEW CONSTRU(`TION REPAIR _ Telephone# �S'�S� �-i''S 3 t'3 • 5 �,�►- Slopes(%') L Q Surface Stones • Land Use �0 ft Possible Wet.Area l�� ft Drinking Water Well 7!�0 ft Distances from: taper.Water Body 2 — o � or ft prainage Way r ft Property Line Z ft Other SKETCH $tree:name,dimensions of lot,exact locations of test holes&pert tests,locate wetlands in proximity to holes) PUN i g,,� C•' � k5 ti (�(rot•1 �- q J fi�wg Depth to Bedrock Parent material(geologic) J /V f � Depth to Groundwaer. Standing Water in Hole: Weeping from Pit Face . 1 Estimated Seasonal;High Groundwater DtTMAINATTO•N FOR SEASONAL HIGH WATER TABL,E Method Used: in, Depth td sell mottles: Depth dbser+ed standing in obs.hole: fr in. Groundwater Adjustment Depth to weeping from side of obs.hot : _ A factor.,,®� Adj.Groundwater Level Index Well# Reading Date: Index Well level PERCOLATION TEST Date � � - Observation , Time at 9" -— Hole# b Time at 6" __-- I'( De th of Perc ti, - r, P , � t�'Z i Time(9"•6") ...^,---- ------^�-�—p^" Start Pre-soak Time.@ ZjC� 5 A Ori s «a End Pre-soak � a � t•� CQ ��'h�. 1 Rate Min./Inch Site Failed: Additional Testing Needed(Y/N) Site Suitability Assessment: Site Passed =x i i Original: Public Hedlth Division .1 Observation Hole Data To Be Completed on Back-------- t7 u must first notify the f ***If percolation test is to be conducted within 100 of wetland,yo Barnstable C4riservation Division at least one(I)wei6k prior to beginning. i n•rcarrfnPRRCr6RM_D0C r DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture .Soil Color Soil i Other Surface(in.) (USDA) (Munsell) Mottling (Struc�ure,Stones,Boulders. Consistent 4b ravel �b oa-e DEEP OBSERVATION HOLE LOG. Hole# - Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistent %Gravel it 11-3Zr► 5(- to Y(Z-51b ;DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) {USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistent Grave 'DEEP OBSERVATION HOLE LOG Hole Depth from Soil Horizon Soil Texture 'Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consisten ra el Flood Insurake Rate Man: Above 500 year flood boundary No— Yes Within 500 year boundary No Yes, Within 100 year flood boundary No--4( Yes. Depth of NatutallyOccurrin Pervious Material Does at least foor feet of naturally occurring pervious material exist in all areas observed throughout the area proposed fbr the soil absorption system? Y E S---- If not,what is the depth of naturally occurring pervious material? Certification r a I certify that on. (date)I have passed the soil evaluator examination apprpved by the Department of environmental Protection and that the above analysis was performed by tree consistent with the required training,expertise and experience described in 310 CMR 15.017. Signature �.�—. �1 W"l L Date �f 5 �r 1 Q:SEPTICIPERCI ORM.DOC ' r r Town of Barnstable ` Regulatory Services � ; l Thomas F o Geiier,Director �.. Public Health nivimion te'* Thomas McKean,Director ---- 200?Baia Street,Hyannis,MA 02601 Office: 308-8624644 Fax: 508-790-6304 tnau ftr& Designer Certiticati4,P F Date: -a4 -OS Sewage Permit# 2oo-9' 3y1 Assessor's Map\Parcei j_ 5-- 3 Designer: Installer: oS- H Address: 12 ` C Z S S '-(Ao( ddress: On �7-��0 S' - n«v4-+i``--was issued a permit to install a (date) (installer)I� septic system at Z U n V� s 9 A °"�' M M based on a desip drawn by (address) FC�C/"`Tt �/VC Evk+eR (T—dated 8' �-o (designer) I certify that the septic system referenced above was installed*substantially according to the design, which may include minor approved changes such ai-lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State dt Local-Re ulations. Plan revision or certified as-built by designer to follow. N of M,ts'c s ' PETER T. tiT i o MCENTEE 2� CIVIL y (Installer's Srgnat ri) M 9 No.35109 F Q �.c Q/STEP�O '(Designer's Signature) (Affix [designer's Stamp Mere) ELEASE R IU1LN 10 A&USIABL ' is 'ALIC UFALTH D1VaSION, CE211EIC'ATE Of EL= &NsTABLE PUBLIC HEALIj Q:HealMepticDesiper Certification Form 3-26-04.doc r ,. y 1-3 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENT LY'VPA $A LE DEPARTMENT OF ENVIRONMENIA,. . OTECTION 4�uJ 44 r 1M V� s ON TITLE 5 FAIED 1NSPECjj()jV OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 282 Long Pond Road A Marstons Mills 1 r, Owner's Name: Norman Seifel O Owner's Address: Date of Inspection: 4/4/2005 ® I Name of Inspector: (please print) Patrick T. Sullivan Company Name: Ready Rooter Mailing Address: P.O. Box 371 Sandwich,MA 02563 Telephone Number: (508)888-6055 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 the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The System: Passes Conditionally Passes Needs Further Evaluation by the Local Authority Fails 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 is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Notes and Comments y ****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. Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 282 Long Pond Road Marstons Mills Owner: Norman Seifel Date of Inspection: 4/4/2005 Inspection Summary: Check A,B,C,D or E/ALWAYS complet all of Section D C. System Passes: 7 I 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 criteri ot evaluated are indicated below. Comments: B. System Conditionally Passes: f One or more system components as described in the"Conditional Pass"sectionfieed to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by/t�e Board of Health,will pass. r Y Answer yes,no or not determined (Y,N,ND) in the for the following statements. If"not determined"please explain. The septic tank is metal and over 20 years old*or the septic tan l*whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure.' 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 /ot leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. f 1 ND explain: Observation of sewage backup or break out or hiwstatic 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 pkp/e(s)are replaced obstru ion is removed distrib6tion box is leveled or replaced f ND explain: The system required pumping mop 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): i broken pipe(s)are replaced obstruction is removed ,j 1 f ND explain: ` / f i ' r Page 3 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 282 Long Pond Road Marstons Mills Owner: Norman Seifel Date of Inspection: 4/4/2005 C. Further Evaluation is Required by the Boa/harcdu Conditions exist which require further evalard of Health in order to determine if the system is failing to protect public health,safety or the env 1. System will pass unless Board of Healthaccordance with 310 CMR 15.303(l)(b)that the system is not functioning in a mannerrwct public health,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 Wate/the ny)determines that the system is functioning in a manner that protects the public health,saonment: _The system has a septic tank and soil absorption system(SAS) s within 100 feet of a surface water supply or tributary to a surface water supply. /r The system has a septic tank and SAS and the SAS is witW a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS i�,,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 deterrytine distance f "This system passes if the well water analysis �erformed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicate hat the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate n'• ogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: i i Page 4 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 282 Long Pond Road Marstons Mills Owner: Norman Seifel Date of Inspection: 4/4/2005 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No _ Backup of sewage into facility or systecn 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 Static liquid level in the distribution box above outlet invert due to and overloaded or clogged SAS or cesspool Liquid depth in cesspool is less than 6"below invert or available volume is less than '/2 day flow ' Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped Any portion of the SAS,cesspool or privy is below high ground water elevation. Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone 1 of a public well. Any portion of a cesspool or privy is 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 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,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] S(Yes/No)The system fails. 1 have determined that one or more of the above 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. E. Large Systems: To be considered a large system the system must serve a facility ith a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the followin (The following criteria apply to large systems in addition to a criteria above) yes no the system is within 400 feet of a surface dri ing water supply the system is within 200 feet of a tribut to a surface drinking water supply. _the system is located in a nitrogen s nsitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply ell If you have answered"yes"to any que ion in Section E the system is considered a significant threat,or answered "yes"in Section D above the large s stem has failed.The owner or operator of any large system considered a significant threat under Section E r failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner shou contact the appropriate regional office of the Department. i Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARVASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 282 Long Pond Road Marstons Mills Owner: Norman Seifel Date of Inspection: 4/4/2005 Check if the following have been done. You must indicate"yes"or"no"as to each of the following: 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? _10L 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? -Z _ 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? _jZ_ Was the facility owner(and occupants if different than 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: Yes No 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 15302(3)(b)] Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 282 Long Pond Road Marstons Mills Owner: Norman Seifel Date of Inspection: 4/4/2005 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): Number of current residents: Does residence have a garbage grinder(yes or no):, � Is laundry on a separate sewage system(yes or no): if yes separate inspection required] Laundry system inspected(yes or no):— Seasonal use:(yes or no): Water meter readings, if available(last 2 years usage Sump Pump(yes or no):�0 Last date of occupancy: COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no):_ Industrial waste holding tank present(yes or _ Non-sanitary waste discharged to the Title system(yes or no): Water meter readings, if available: Last date of occupancy/use: OTHER(describe): / GENERAL INFORMATION Pumping Records Source of information: c)(„Q�,,.�,J— Was system pumped as part of the inspection(yes or no): If yes,volume pumped: ZX(TJgallons--How was quantity pumped determined? Reason for pumping: !SA j TYPE OF SYSTEM Septic tank,disc 4ior x,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) _Tight tank _Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: (� Were sewage odors detected when arriving at the site(yes or no):.&� Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 282 Long Pond Road Marstons Mills Owner: Norman Seifel Date of Inspection: 4/4/2005 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction:_cast iron�0 PVC_other(explain): Distance from private water supply well or suction line: I r Comments(on condition of joints,venting, evidence of leakage,etc.): SEPTIC TANK:-�ocate on site plan) Depth below grade: Material of construction:_zconcrete_metal_fiberglass_polyethylene —other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):—(attach a copy of certificate) Dimensions: '?, y �L S Sludge depth: 'Z +1 Distance from the top of sludge to bottom of outlet tee or baffle: T i Scum thickness: `' --c' c3 Distance from top of scum to top of outlet tee or baffle: 3 '� Distance from bottom of scum to bottom of outlet tee or baffle: How were dimensions determined:��v y�c3��c�.�-c- Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc): GREASE TRAP:_(locate on site plan) Depth below grade:— Material of construction:_concrete_metal_fiber ass_polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or affle: Distance from bottom of scum to bottom of out t tee or baffle: Date of last pumping: Comments(on pumping recommendations, ' let and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of lea ge,etc.): Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 282 Long Pond Road Marstons Mills Owner: Norman Seifel Date of Inspection: 4/4/2005 TIGHT or HOLDING TANK: (tank must be pumped time of inspection)(locate on site plan) Depth below grade: / Material of construction:_concrete_metal_fjberglass_polyethylene_other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: f' Comments(condition of alarm4md float switches,etc.): DISTRIBUTION BOX: (if present must be opeA (locate on site plan) Depth of liquid level above outlet invert: Comments(not if box is level and distribution to outlets equal, any evidence of solids carryover,any evidence of leakage into or out of box,etc.): f 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,..eondition of pumps and appurtenances,etc.): i Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 282 Long Pond Road Marstons Mills Owner: Norman Seifel Date of Inspection: 4/4/2005 SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: Type �eaching pits,number: leaching chambers,number: leaching galleries,number: leaching trenches,number, length: leaching fields,number,dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure,level of ponding, damp soil,condition of vegetation, etc.): 'i y��zS !",� SL�.�-' �"'C'' Y";',w� ^-�JG•.ti �`-y a�+l � �-��l-�+c' L,..9•,� v.� CESSPOOLS: (cesspool must be pumped as part of inspection) cate on site plan) Number and configuration: Depth—top of liquid to inlet invert: j Depth of solids layer: / Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil, signs of by raulic 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 lure, level of ponding,condition of vegetation,etc.): f Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 282 Long Road Marstons Mills Owner: Norman Seifel Date of Inspection: 4/4/2005 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch 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. 3= LA < � c — LAC � O r V r � ' /1 Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 282 Long Pond Road Marstons Mills Owner: Norman'Seifel Date of Inspection: 4/4/2005 SITE EXAM Slope t/_ Surface water Check cellarv/ Shallow wells Estimated depth to ground water>t S- feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record—If checked,date of design plan reviewed: JZObserved site(abutting property/observation hole within 150 feet of SAS) Checked with the 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: (� ` _ �, �- S � S ���.`� c7� �.,r r7w L YLI.rcJC, � �-7�J ���•�-� i No...O. Fps..........` ....... s THE COMIMONWE�ALTH OF MASSACHUSETTS BOARS r OF HEALTH .00 ....... Appliration for Uiipoottl Workii Tonidrnrtion runfit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal .. . -- t............................... ...........•--..• ---------------------------------------- Location-Address No. _^ --------------------'.......•--------- ..-:---------------- • ........................................ Owner — Address• - a - - .-.----•---- ----------------- '*r <4 ............................................. Installer Address Type of Building Size Lot..--. . . _'...__..Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( *I-- Garbage Grinder (44 aOther—Type of Building ...........:................ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures ........................................................------------------•-------------------------------------------.----.---------.---.--•-•--•---- Design Flow...........-•�`��+.. ................gallons per person per day. Total daily flow.........--. .............gallons. WSeptic Tank—Liquid capacity. gallons Length................ Width................ Diameter..._. ...... Depth................ x Disposal Trench—No. ......... .. .... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.......0.._ iameter...........4: Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ aTest 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 ------------------------------------------------------------------------• •----•-------------•---------•-•------............_.......... ............ 0 Description of Soil........................................................................................................................................................................ x x ------------------------------•---•---•----••----•--•.....••--•----------------•--•--•--•--•----•-------•------•----------•--•--------•-.......................................................... U Nature of Repairs or Alterations—Answer when applicable............................................................................................... Agreement: he undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with t e ovi us of TITLE 5 of the State Sanitary Code— The undersignj1ith her agrees not to place the system in Op ti erti• to of Compliance has been iss d by the boar o . Signed...... ...................••-----•-----...... -•-•--•---------•......... Date �.._............... G[d, p ication Approved By----------- 4.�t-'......` ...... Date pplieation Disapproved for the following reasons--------------------------------------------••----------'------•------------•-•-•----------...--••-•---•'-.....- --------------------------------------------'-------�1�.........--••---••------••-•••-•••-••.............................-••••--••-••--•.....-••-••••--•---•-------...-----...Date••---........_ Permit No. .... -----`.... ........... .. Issued._......_..._..._.... .............. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD-OF HEALTH, GC ... .OF...... ..... ' .l.t"....._ .............. ' S. Aji;ifiration for Dhipooaf Workii Tonotrur#ion nutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at 121 ?' ?, < ,e , ....... :... .... ....: ------••--••-•---•--•---......--••-- Location-Address f or-Lot No., ..... _ c e........ ........................................ .........................�:-.--... ..r:.rY.-t. F........_........_...._.......... Owner Address of A ..�_...r. # ! Installer Address d Type of Building Size Lot..._ - .:L.......Sq. feet 0-4 Dwelling—No. of Bedrooms.............. ...........................Expansion Attic ( r)- Garbage Grinder (A4 pa., Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures ...........•••• ......••------• - Desi Design � ............•- W g gallons per person per day. Total daily flow------- . .....................gallons. WSeptic Tank—Liquid capacity.'a`_::gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. ................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.- ...... Diameter...........`.:..... Depth below inlet.................... Total leaching area..................sq. t. Z Other Distribution box ( ) Dosing tank ( ) 0-.4 Percolation Test Results Performed by.......................................................................... Date........................................ 1.4 Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water..................... fi, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ------------------------------------------•-------...............---................_........_-•--•-.....................I......................... .--------- ODescription of Soil.....................................................................................................................................--••••......•••-•-................ x w x --••----------------------------------••••-•--•••••------•--------------•-•-•----------•--•-••••-••----•••••-•-•-----•------••-•----•-••••••--•-•-••---•••••..._..••••••••••••......••••._.............. U Nature of Repairs or Alterations—Answer when applicable............................................................................................... ----------------------------•••.._...-----.••-•••-••••••••-••••••••••••••••••••••..........--.-•••••-•••••••--•-•-•----------•--•-•-•-•-------•-•••••-•--•••••---••••-•••••••••••••-••••-•••-•••-•-••--- Agreement: he undersigned agrees to install the aforedescribed Individual Sewage',Disposal System in accordance with t e ov .ns of TIT1Z 15 of the State Sanitary Code—The undersigned further agrees not to place the system in op do��iil'a+C�erti- to of Compliance has been issued by the board of Health. r. Signed............. ...` t.../...............-- /1.,;( rj d..._.... . •...•. Date ication Approved B �... r ,P PP Y = f :: .:_rf..l... .. /.. ............. Date PPlication Disapproved for the following reasons-----------------------•--------•----------------------••----•-----------------.........--.. ..._...... --------...-•--------•--------------------•--•----------•-•••••-•.•••••••-•-••-••-----......_................................•--...•--•-•-•-•-••••--••••--••...._...•-••--•••••-•••--•----•-••--•--•-•-•- y it Date Permit No.------ 1 G Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... Trrtif iratr of Tontplianrr THIS IS TO,,CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by... -''=..•�-•••-•-•-•--------------------•............--••••-••-••----•-----••----•-••-•------•...-•••••••-•---•-•-•-••-...............-•--•••.............--•-••-•-....-- I staller at. 1- ... a-•----------.—------------------ ---- ---------•--•--...--------------------•-•--------•--- has been installed in accordance with the provisions of TIZT�_F�� 5-o Th State Sanitary Code as described in the =zd application for Disposal Works Construction Permit No.......................................... dated_-....�.L. _.1.._�_!.......................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUAiANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. � GJ DATE......................................... ..�'•`-----..:----�------•---- Inspector..........)C.....---••-•--------------•----•-•--------........---............ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........................................OF..................................................................................... No......................... FEE........................ Diopoottf Workii Tonotrnrtion "permit Permission is hereby granted.------ 11 r -•-........••-••••....._....-•--------•••••-•••••••-••-•••...-••••••••••••••••••.....•-•••.......................•-_.. to Construct_( or Repair (� t,)yap individual Sewage Disposal System at No......`;...... �': " C --n--•-•- n ..........--------------------------------------------------------------------------------------------------- as-shown on the application for Disposal Works Construction—Per St7t tNo.t_..•......,................ Dated.......................................... ................................... ................................................ Board of Health DATE - s-------------------- -- ..FORM 1255 A, M. SULKIN, INC., BOSTON ti 'L Oqq&'TION SEWAGE PERMIT NO. 5 �• /vS"6 '(VI I LACE INS A LLER'S NA E i ADD ESS 1- &A t ' eA . a d DER OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED f � �w s f T Ste. — - -- i � 94� �` �, � G (� �I ., .. _g.. East. -s �''` �A s Rd/•p< r Srofe D� River Rood t ell LEGEND ,.�,. �' f1 6 v 99 PROPOSED CONTOUR \\\� a 545'tTO FRONT " PROPERTY CORNER• 3 1A93S 99 PROPOSED SPOT GRADE L,�,�c . v \ / EXISTING CONTOUR \py Lot 5, \ `^ , 'g' 1'u EXISTING SPOT GRADE �° \� 1 TEST PIT Wakeby Rd LOCUS Map 29RVI E Parcel S- �, � y W EXISTING WATER SE C si' Asti . r , AA at^ LOCUS MAP N.T.S. it ✓ .v' v yy .. 3 IPA P1. h," L{L 5-4 •...2 i Q' � � ';fiJ '�� GENERAL NOTES: o e ~ A s I/RpUt� 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED .BY THE LOCAL N �Eti�-�g BOARD OF HEALTH AND THE DESIGN ENGINEER. �� t 5o pRG� 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS x��)��' R OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE LOCAL RULES AND REGULATIONS. A. 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR s2 ,� TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE , : DESIGN ENGINEER, 80 _. :l S3 y EXISTING S.A.S TD BE PUMPED & 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING h FILLED V1 SAND FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN f f (See also, Note 11� ENGINEER BEFORE CONSTRUCTION CONTINUES. t 0 c9 .- 5. ALL ELEVATIONS BASED ON ASSUMED DATUM (NGVD±). W 100' .b�IFfER'. ' �� � 7P-2"AQ qVE."TP=1� - - EXISTING SEPTIC TANK 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF �- 9y `V w W ' ---=-- M- THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF D `. ; "— TDP EL 75.62 •• '� , ; � INV(DUT) ELF 74.25t HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. r _ 7, WATER SUPPLY PROVIDED BY PRIVATE WELL. " ', w�~ #`�p•� fr `s � f J.4000 Benchrlark set 8. THERE ARE NO PRIVATE WELLS LOCATED WITHIN 150' OF THE S.A.S. Left cor. brick entry f�`_y ._ i �-•• EL=77.30 (Assurled) 9. ALL AREAS CLEARED FOR CONSTRUCTION ARE TO BE RESTOREO TO r SILF f`ENCE tTr'P.) A CONDITION AGREED UPON BY THE OWNER AND CONTRACTOR. ,• £, 2EXfST.TNr, ;. f 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE �DM Xe`'" - THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING ftz.) { +r: f - CONSTRUCTION. R 71 w REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS RE E r .. .. 11. WHERE Q a .r` ' IN THE AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF THE S.A.S. S 255(3). I AS SPECIFIED IN 310 CMR r N FILL':,✓ C WITH CLEAN A REPLACE F AND 12. EXISTING S.A.S. SHALL BE PUMPED DOWN PRIOR TO INSTALLATION OF THE PROPOSED S.A.S. AND UNSUITABLE MATERIALS WITHIN 5 FEET OF r � G PETER T, McENTEE THE PROPOSED S.A.S. REMOVED AS DESCRIBED IN NOTE 11. -' CIVIL ti No, 35109 ' mac___-y...^�,a�� - .., _���'. _-• __ .... _fig• ' + rr` •� RfGIS�E�\� �Q Yam. - ssI PROPOSED SEPTIC SYSTEM UPGRADE _ __......__ fated_ ` a o �,____. - Y_-� - - ve9e = �'� �a `0. 282 LONG POND ROAD, MARSTONS MILLS, MA Prepared for: Norman Seifel, 42 Pinkhom Road, Sandwich, MA 02563 `4 Engineering by: Surveying by: SCALE DRAWN JOB. NO. 4 water g g , P.T.M. 130-05 f Engineering Wow Te»y A. Warner P.L.,R 1 =30 POND 12 W. Crossfield Road 22 Long Road DATE CHECKED SHEET N0. LONG Edge Forestdate, MA 02644 Harwich, MA 02645 POND ELEVATION = 51.0 (508) 477-5313 (508) 432-8309 6/9/05 P.T.M. 1 of 2 L 4 ,x NOTE: TO FIINISHEVZNT GRADE SHALLUT, THE NOT BE PROPOSED< E82 0 .) TOP OF FOUNDATION F.G. EL: 77.6(MAX) FOR A DISTANCE OF 15' AROUND THE • EL: 76.7t F.G."EL: 77.Ot(EXISTING) PERIMETER OF THE S.A.S. F.G. EL: 76.5t(EXISTING) F.G. EL: 76.8t(EXISTING) .r� MAINTAIN 2% MIN SLOPE OVER S.A.S. MAX. COVER = 36" INSTALL RISERS OVER INLET & OUTLET INSTALL RISER OVER D-BOX TO 3-500 GALLON LEACHING CHAMBERS IN_ E131ES INSTALL RISER OVER CHAMBER/S WITHIN 6" OF FINISH GRADE SH❑WN ❑N PLAN AND SET C❑VER/S TO WITHIN 6" OF 'FINISH GRADE WITH 4' STONE ALL SIDES WITHIN 6' ❑F FINISH GRADE L =16' L =13'(MAX) 9. 4" SCH 40 PVC It 4" SCH 40 PVC EXISTING lo• • 14• @ S= 17 (MIN.) 6" @ S= 1% (MIN.) (EXISTING) a: EXISTING Q; EXISTING) 1000 GALLON INV. ELEV.=74.09 INV. ELEV.=73.92 2' EFF, DEPTH ' " ( SEPTIC TANK 4' S,2' 4' INV.EL: 74.25t FFECTIVE WIDTH = 13,2' 1� GAS BAFFLE TO 8E INSTALLED ON (EXISTING) OUTLET TEE AS MANUFACTURED BY INV. ELEV.=73.80 TUF-TITE, ZABEL, OR EQUAL TOP CONC, ELEV.=74.6 --BREAKOUT ELEV.=74.3 madomm INV, ELEV.=73.80 "EFFECTIVE ®23® ®®� D-BOX SHALL BE SET LEVEL AND TRUE TO GRADE 0 EM !Tam ON A MECHANICALLY COMPACTED SIX INCH CRUSHED BOTTOM ELEV.=71.80 3 x 8.5' = 25.5' 3' STONE BASE, AS SPECIFIED IN 310 CMR 15.221(2). 5' MIN. ABOVE B❑TT❑M ❑F LENGTH = 31.5' SEPTIC SYSTEM PROFILE T,P, EXCAVATION OR G.W. LEACHING SYSTEM .SECTION NO G,W, ENCOUNTERED �� 11F M4Jf9r N.T,S, BOTTOM OF TP EL1 66.80 s� (3) 5" DIA.OUTLETS p PETER E 16' ��2• T. Mc IV L DESIGN CRITERIA CIVIL N No. 35109 RfGIS1E��� ��Q NUMBER OF BEDROOMS: 3 BEDROOMS 1ss• ' 6" `, SOIL' TYPE: CLASS I L- - J -L TH-10 LOADING 2" SOIL LOG DESIGN PERCOLATION RATE: 2 MIN./IN. 0-BOX DAILY FLOW: 330 G.P.D. w*� DESIGN FLOW: 440 G.P.D. (FUTURE EXPANSION) DATE: MAY 26, 2005 (REF#P10,983) SOIL EVALUATOR: PETER T. McENTEE PE, CSE GARBAGE GRINDER: NO INSPECTOR: DONALD DESMARAIS, BARNSTABLE B.O.H. LEACHING AREA REQUIRED: (440) = 594.6 S.F. .74 JE ®®6�® 0 Ea ma®® Elev. TP-1 Depth EIeV. TP-2 Depth SEPTIC TANK (EXISTING): 1.000 GALLONERE300®®®®®® 33" 76.8 0" 79.t 0„®E3 E3 EM M®®®®®� E A SANDY LOAM Eafir®®®®®®®®® FILL 10YR 2/2 USE 3-500 GALLON LEACHING CHAMBERS IN SERIES 76.0 A SANDY LOAM 10" 78 6 6 6' SANDY LOAM SIDEWALL AREA: 2(13.2' + 31.5') X 2 = 178.8 S.F. 102" 10YR 2/2 I 10YR 5/6 FRONT 75.6 14' BOTTOM AREA: 13.2' x 31.5' = 415.8 S.F. -17 B SANDY LOAM 76.4 C 32° 4" KNOCKOUT d tOYR 5/6 TOTAL AREA: 594.6 S.F. 20" OIA. COVER "?JS S8 p" Zb c99 72.8 C �„ DESIGN FLOW PROVIDED: 0.74(594.6) = 440.0 G.P.D. KNOCKOUT O�4" KNOCKOUT 62„ PERC ------------ 60„ M—C SAND 4" KNOCKOUT e0.4 10YR 6/6 PROPOSED S,A.Si � M-C SAND PROPOSED SEPTIC SYSTEM UPGRADE I =31.5 .ice ,oYR6/6 282 LONG POND ROAD, MARSTONS MILLS, MA 500 GALLON CAPACITY, H-10 LOADING ss.s t2o" s9.t 120" Prepared for: Norman Seifel, 42 Pinkham Road, Sandwich, MA 02563 CHAMBERS Engineering by: Surveying by: SCALE DRAWN JOB. NO. n.rs NO G.W. ENCOUNTERED Engi nearing Works Terry A. WarnerP.L..S. N.T.S. P.T.M. 130-OS PERC RATE: <2 MIN/IN. "C" HORIZON 23 Deer Hollow Road 22 Long Road DATE CHECKED SHEET NO. Forestdole, MA 02644 Harwich, MA 02645 (508) 477-5313 1 (508) 432-8309 1 6/9/05 P.T.M. 2 Of 2 r r- 5 , r - MyA Iwo All • F 1Qv D - : i NV , , 4 - i > , f - g t _ Ja ' , All1 v. ,_ � U ��..a��f'✓ - '.mid�/�' `' , r 56'C.�, d y"rY- CJ GAL _ f W/3"_5171E .— _ 1 / //,-3 x I is :r , / ..�.4' it�., fir/'" y,."',.- .�� ./\, ��, /©� +� �'-oF�'f%u''.'� �� •� ^ •_., � .. � T.A�/'k' • , . lid. , +c.vt ► z�€ Z> 1 / C7 } f - ' Of'1 „{ � 4 AIAN .. (( �y�• ec c _ �i���' '' :4 ter:'�''�- • _ ' q 7v, 7 r , r r , I