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0043 DESIRE'S LANE - Health
43 DESIRES LANE WEST BARNSTABLE A = 088 008 003 I� 4 �I �!!lnie+a� aECYccFo� UPC 12034 ;o �o- No.2-1�53LBE *Posr•toNs�`� NAVINRS,MN 1eoZ�7VS:f 4 � r" 4 , n.- f OF BARNSTABLE LOCATION ( eC44-t f—EWAGE # g VILLAGE (C� MAP&c LOT �'� INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY ITOd LEACHING FACILITY: (type) y1J (size) /o X 7 t7 NO. OF BEDROOMS BUILDER OR OWNER � fl� PERMTTDATE: l ) / O / 9' 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 Ato on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of 114ac f Feet � Furnished by ,� �1 en %PO-a ' G b . to Q� � t TOWN OF BARNSTABLE LOCATION 73 Lpt//�``S �A/ SEWAGE# oZOaO —q0'-1 VILLAGE ASSESSOR'S MAP&PARCELD INSTALLER'S NAME&PHONE NO. l�.•Qr ��,L ICJ SEPTIC TANK CAPACITY LEACHING FACILITY:(type) '10( Urykl (size) /n�X yo, NO.OF BEDROOMS 3 OWNER PERMIT DATE: J J 9 COMPLIANCE DATE: / oZ 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) r - Feet FURNISHED BY 3 co �2 y A Il9���,►-- 2� �.G r z,� f 0 '5 Gv� Fee No. THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Rppfitation for 7Upgraade slbpstem Construction Permit Application for a Permit to Construct( ) Repair( ( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. yI ?H ire i� Llv O-7/v Owner's Name,Address,and Tel.No. Assessor's Map/Parcel ORB jony1ca-3 Installer's Name,Address,and tel.No. Designer's Name,Address,and Tel.No. i Type of Building: Dwelling No.of Bedrooms Lot Size4, 1,40 sq.ft. Garbage Grinder( ) Other Type of Building ' No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. ;SCO Cl2)6j Le4h c- 4 kys��4 t, Description of Soil Nature of Repairs or Alterations(Answer when applicable) �ry� C, : eid 4. S , /y iZ~,ry& Cr rat Qs S ow a ©% COPY)Ou& C05inj S A S AAO 14SiG 11 t.1. SQMf- ,fie j ' l' b I dasa a4f_11_ �rt� 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 Certificate of Compliance has been issued by this Boar Health. Signed f �- Date IR_ Application Approved by Date Application Disapproved by Date for the following reasons Permit No. Date Issued 3 No. C Fee ._ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 2ppYitation for ;Disposal *pstem Construction Permit Application for a Permit to Construct( ) Repair(XPgrade( )'':Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 3 L7P5 °�S LN G(�-�J 'N Owner's Name,Address,and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and I el.No. Designer's Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size U1 ___sq.ft. Garbage Grinder( ) Other Type of Building ( /51�t J ��; No.of Persons Showers( Cafeteria( ) T T- Other Fixtures Design Flow(min.required) �j gpd Design flow provided gpd Plan Date >64umber of sheets Revision Date Title Size of Septic Tank Type of S.A.S. (,,a,rh r ,, 6= Sit Description of Soil Nature of Repairs or Alterations(Answer when applicable) '�_,, � A j&A) < < 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 Certificate of Compliance has been issued by this Board of Health. Signed l�`�_ Date Application Approved by Date Application Disapproved by Date for the following reasons ?f Permit No. �^} Date Issued --------------------------------------------------------------------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( ) Abandoned( )by 1. M at ) ' fv f has been constructed in accordance— J with the provisions of Title 5 and the for Disposal System Construction Permit Z-/ dated �_�Aw/-4— Installer-D:A t1(, we, S„t r Design #bedrooms Approved desig flow gpd s The issuance of this permit shall not be construed as a guarantee that the system will function as designed. �} Dates — `} 1 Inspector �� ----------- ---------------- --- -----------------' -----------------"--- '---------------------------------------- No.Ayy' Fee THE COMMONWEALTH OF MASSACHUSETTS y PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal *pstem Construction Permit Permission is hereby granted to Construct( ) Repair Upgrade( ) Abandon( ) System located at ' and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this pe it. Date / / Approved byy, r Town of Barnstable 'THE F, Regulatory Services Thomas F.Geiler, Director B`E ' Public Health Division ArF163 Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Date:471� Sewage Permit# ,9000 '' Assessor's Map/Parcel �- Q*4V3 Installer&Designer Certification Form Designer: Dik),r,70, 4"4,/ Installer: �� (pwk) ` —,,) Address: itS,lr � 1/��it�G "/ Address: , 0, (�)( /y On A/ W V �(���� was issued a permit to install a (da e) (installer) septic system at e ES/rc_is L nI based on a design drawn by yk, ks6c /,0�A���,.,.f (address) �sP� LJMQ'1>I�c/- 1"'I60 ' dated (designer) / I certify that the septic system referenced above was installed substantially according to .the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Stripout (if required) was inspected and the soils were-ound.satisfactory. 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 & Local u "tions. Plan revision or certified as-built by.designer to follow. Stripout (if r?- .Cted and the soils were found satisfactory. SH OF Mks DAVID �y (Installer's Signature) - M `r 003 Commonwealth of Massachusetts Ogg, o08— Title 5 Official Inspection -Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 43 Desire's Lane Property Address david &Susan Derosier Owner Owner's Name inormation is every West Barnstable required for eve Ma 02668 11/28/2020 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, 1 use only the tab Sean M. Jones key to move your Name of Inspector cursor-do not S.M.Jones Title_V Septic Inspection use the return Company Name key. 74 Company A Lane Co Company Address Centerville Ma 02632 Cityrrown State Zip Code 774-248-4850 smjonestitle5@gmail.com, S14522 sean@smjonestRie5.com 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 11/28/2020 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.7126/2018 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 1 of 18 y _ i Commonwealth of Massachusetts � Title 5 Official, Inspection on Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 43 Desire's Lane Property Address david &Susan Derosier Owner Owner's Name information is required for every West Barnstable Ma 02668 11/28/2020 page. CitylTown state Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ❑ I have not found 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: 2) 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): l5insp.doc•rev.7126/2018 Title 6 Official inspection Fond:Subsurfaoe Sewage Disposal System•Page 2 of 18 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 43 Desire's Lane Property Address david&Susan Derosier Owner owner's Name information is required for every West Barnstable Ma 02668 11/28/2020 page. Cityrrown 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.7/2612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts ' lP Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 43 Desire's Lane Property Address david &Susan Derosier Owner Owner's Name information is required for every West Barnstable Ma 02668 11/28/2020 page. City/rown state Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system Is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ® ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc-rev.7/26/2018 Title 5 Official inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts j Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 43 Desire's Lane lv� Property Address david &Susan Deresier Owner Owner's Name information is required for every West Barnstable Ma 02668 11/28/2020 page. Citylrown 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. 0 ® 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 16,000 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 11 of a public water supply well t5insp.doc•rev.7l26=8 Title 6 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 43 Desire's Lane Property Address david &Susan Derosier Owner Owner's Name information is required for every West Barnstable Ma 02668 11/28/2020 page. Cityrrown 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)] 15insp.doc•rev.7/2612018 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 rr 43 Desire's Lane Property Address david &Susan Derosier Owner Owner's Name information is required for every West Barnstable Ma 02668 11/28/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information 1. 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 _ Description: Number of current residents: 3 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 years usage(gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: current Date t5insp.doc•rev.7/26r2018 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 43 Desire's Lane Property Address david & Susan Derosier Owner Owner's Name information is required for every West Barnstable Ma 02668 11/28/2020 page. Citylrown 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: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? -- Reason for pumping: t5insp.doc•rev.7126=18 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18 f Commonwealth of Massachusetts ilp Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 'r 43 Desire's Lane Property Address david &Susan Derosier Owner Owner's Name information is required for every West Barnstable Ma 02668 11/28/2020 page. Cityfrown 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) ,l ❑ 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: pp g { } original system installed 1999 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 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.): Joints in good condition, no leakage,vented through roof. t5insp.dac•rev.7/26=18 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 43 Desire's Lane Property Address david &Susan Derosier Owner Owner's Name information is required for every West Barnstable Ma 02668 11/28/2020 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 1 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 Q No Dimensions: 1500 gallons Sludge depth: w Distance from top of sludge to bottom of outlet tee or baffle .� w Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? 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 pumped 2 weeks before inspection per owner. Water level was at outlet invert. Outlet tee had heavy scum buildup on top indicating the tank has been overfull in the past. t5insp.doc-rev.7l26018 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 43 Desire's Lane Property Address david &Susan Derosier Owner Owner's Name information is every West Barnstable required for eve Ma 02668 11/28/2020 page. Citylrown State Zip Code Date of Inspection D. System Information (coat.) 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 Full 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.): Outlet pipe from tamk to d-box was video inspected and was found with heavy scum. Camera went underwater approx T from d-box and was submerged into box indicating the d-box and leaching facility is hydraulically overloaded. d-box was not excavated and opened because of water level, box is 4' below grade. I t5insp.doc-rev.7262g1 S Title 5 Official Insp ection Form:SubsuAace Sewage Disposal System•Pape 12 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 43 Desire's Lane Property Address david&Susan Derosier Crooner Owner's Name information is required for every West Barnstable Ma 02668 11/28/2020 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ® leaching pits number: 4 500 gal chambers ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/altemative system Type/name of technology: t5insp.doc-rev.7/26/2018 Title 6 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 18 f Commonwealth of Massachusetts Title 5 official inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 43 Desire's Lane Property Address david &Susan Derosier Owner owner's Name information is every West Barnstable required for eve Ma 02668 11/28/2020 page. Cityrrown 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.): water level in d-box indicates that the leaching facility is full and failed. 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.): I t5insp.doc•rev.7/28/2t118 Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ' 43 Desire's Lane Property Address david&Susan Derosier Owner Owner's Name information is required for every west Barnstable Ma 02668 11/28/2020 page. City/Town 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.7r2612016 Tft 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 16 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 43 Desire's Lane Property Address david&Susan Derosier Owner Owner's Name information is West Barnstable required for every Ma pa CitylTown 0266$, 11/2$/2020 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 CIO SOLD 6 A Q k O to t5insp doc•rev.72612016 Title 6 Official Inspection Fwm:Subwface Sewage Disposal system.page 16 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 43 Desire's Lane Property Address david &Susan Derosier Owner owner's Name information is required for every west Barnstable Ma 02668 11/28/2020 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar I ❑ Shallow wells Estimated depth to high ground water: feet -— Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-I explain: You must describe how you established the high ground water elevation: Groundwater elevation was not established. Before filing this Inspection Report,please see Report Completeness Checklist on next page. t5insp.doc-rev-7/2612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 18 f ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 43 Desire's Lane Property Address david &Susan Derosier Owner Owner's Name information is every West Barnstable required for eve Ma 02668 11/28/2020 page. City/Town 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 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4(Failure Criteria)and 6(Checklist)completed ® D. System Information: I 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.7/2612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 r, 12/11/2020 ShowAsbuilt(1700X2800) ')'c'1-e I-TQ"OF BARNSTABLE LOCATION 4a Q ^S(;2C.0 1"A1tt. SEWAGE# VILLAGE_ ty 1-?O,A ASSESSOR'S MAP&LOT INSTALLER'S NAME$PHONE NO.._ _1/A 1. of SEPTIC TANK CAPACITY /Sbd- LEACHING FACIUN;(type) _y1S� (size) /0 K 7 IP NO.OF BEDROOMS--," s BUILbER OR OWNER �f0-L/- Kft���+ PERMITDAT'E:� �I0��9I COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Tableto the Bottom ofLeacbing Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feu of leaching facility) Feet Edge of Wedand and Leaching Facility(If any wetlands exist within 300 feet of Feet Furnished by 'S''�A•EJ ZI:n /yam 0 k De d � o https://itsq Id b.town.barnstable.ma.us:8431/Home/ShowAsbuilt?mp=088008003&sq=1 1/1 � doh z b� No. �L� FEE THE COMMONWEA .TH OF MASSACHUSETTS 7MASSACHUSETTS l� f �kyyfirativn for Visposal *Votem (gonstrurtion Fierntit Application is hereby made for a Permit to Construct ( ) or Repair( )an On-site Sewage Disposal System at: Location Address or Lot No. >e A �//j�� wner'�ame,Ad ress apd Te o. / / lG 7�z�t�fY t-/2 r�rat C 1'.,i Ai� Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. T f =x 0A).sl s-t�, 1J P ppr'{c rf°�- @ '� STS Type of Building: Dwelling No. of Bedrooms Garbage Grinder( ) Other Type of Building No. per Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow lid gallons per day. Calculated daily flow �3 gallons. Plan Date �/ I 's Number of sheet Revision Date Title 2 Ar-i, Vul > �v . Cec,r., Description of Soil =-3 f��cn�,� /Irt otic�' �^ �" S✓Qr/�Y �OCn1t -- l%���� �g '' 6° ' �c,� — Ica` /30?'` n�a�✓oY eels� Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the aforedescribed on-site sewage disposal system in accordance with the provisions of Title 5 of the Environment Code and not to place the system in operation until a Certificate of Compliance has been* u hi oard of Health. Signed Date 0 J Application Approved by Date Application Disapproved for the following reasons Permit No. / 7" y t Date Issued 00 DO No. :. FEE THE COMMONWEA ®,-MASSACHUSETTS MASSACHUSETTS wool �pyt rattan for Visposal Sgote (gunstrurtturc 1hrinit Application is hereby made for a�Permit to Cons�tructj ) or Repair( )an On-site Sewage Disposal System at: Location Address or Lot No. c t A A`0vvner'j Name,Ad N Address a�d Te o. �C.-r I,G r`^ - ,b 1, Atl r-a / La';�'7 j`/ �i. �6v Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. J, Ie( /'/)GA l s'I 3 r�r' ''J< fl, :Zr-. 0oylr I^q rtejl. ('s 0uk SS S L L i'Type of Building: ,,,,+ Dwelling No. of Bedrooms Garbage Grinder( ) Other Type of Building No. per Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow ��U gallons per day. Calculated daily flow �3 gallons. , Plan - Date ����,�� Number of sheet Revision Date Title S t d �,�/ -1r Ci 1,,trr� wL+_par �1� Description/of Soil 6 � ���r�• f r^cir�c P -3 — d=' �dn y 60(.'`I Zi 5 CJ a t/GA YY1 ��/ 3L�� r✓4 i✓� U!�.,-t ,."*'^.�. Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: \ The undersigned agrees to ensure the construction and maintenance of the aforedescribed 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 Certificate of Compliance has been i suled .1tthi oard of Health. Signed ' Date Application Approved by _ Date Application Disapproved for the following reasons / Permit No. ' I ('7 i Date Issued THE COMMONWEALTH OF MASSACHUSETTS &��a— ���°� MASSACKUSETTS Qxrtttitrate >s# 010mVIiunre THIS IS TO.CERTIFY, that.the On-site Sewage Disposal System mstalted'( );or repaired/replaced( ) on by for` ' at T g,— :J�, f has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 9 Ff y%t' dated Use of this system is conditioned on compliance with the provisions set forth below: The issuance of this certificate shall not be construed as a guarantee that the system will function as designed. This Certificate expires on DATE Inspector l ` THE COMMONWEALTH OF MASSACHUSETTS 6(/ No. e , MASSACHUSETTS FEE f /; is nsttl gs#Pm (fnnstrnrtion Permito �, c Permission is hereby granted to r J Y f �� J. <y :'y to construct( ) or repair( )an On-site Sewage System located at �.•? - r _ 7. , 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. All construction must bee co pleteld within three years of the date below. DATE > ��/2 Approved by ' 1 FORM 1255 Rev.3/95 A.M.SULKIN CO:-BOSTON,MA l/ 1 �pe,a CERTIFICATE OF ANALYSIS Page. 1 Barnstable County Health Laboratory Report Prepared For: Report Dated: 02/25/1999 Fitzpatrick,Mike Order Number: G9901475 Mike Fitzpatrick Lot 2,Desire's Lane West Barnstable MA 02668 Laboratory ID#: 9901475-01 Description: Water-Drinking Water Sample fi#: 01475 Sampling Location: Lot 2,Desire's Lane,W.Bstable Collected: 02/23/1999 ollected by: Customer Received: 02/23/1999 Test Parameters ITEM RESULT UNITS MDL MCL Method# Tested LAB:Microbiology Total Coliform Absent CFU/100rnL 0 0 MF 02/23/1999 Note: Water sample meets the recommended limits for drinking water of all above tested parameters. Approved (Lab Director) Z-As/4� i Superior Court House, PO.Bog 427, Barnstable, MA 02630 'Ph: 508-375-6605 l _ InvoiCe #s G9901272 :k Project#; 132rnstable County He.41th Laboratory Fitzpatrick,Mike t=onments t condition: Mike Fitzpatrick Loft 2,Desire's Lane West Barnstable LNIA 02668 Date!`lily ie V to!TJ me Lab ID#° Sample#® _a mRb� :-5 TY earl Collected v � c lre ; ti r� ele ted: �c�i��cte� �.o. .�.e B, ��:�.: 99i)1272-01 Water•Lh•n n �T�.t r �t,'(,i 9 ;L; ill^r,c� k; Lce i,];esifc's Lane 1:iMo PivS 1:�3:00 PM Lab Tesgf1g. Tem -ua � flnAy � rt Rautizie 7TV 12 Jf2-V2 Water-; .nk�11`i Water V.' ;ii>EV._3 : 0_11 _Jt3 Lem 2, Lane 1.33:00 P.NV 1.510:40 py, Lab TeBferi.�: Texxtlr;afa f'. Sate; 01114,'94A aF Full EPA 524.2 Ltattery x� Superior Court House, F0.Box 427, Barnstable, 02630 Ph. 53ilit-6-.2511 Page � ;+ � �s �'Jr.r `' i +li t, r S I. .f «l�.r� a�, s i` I M• Ram 41 V02 2-mla,141 For: Pit`zpatriOC,Mike Order N atv�lb�r; 4 st �xi >rk i T esf Bd7llstabt MA 0'668 �. +wry �} ltib6.1 lU r 10 0i ;n 9 12'l f."��1 &3Irri gffwl I i , IEt1 �,�+Yt�RIV no Water Sample#: 5� � !i F ti nt 1.8 ?,1J Ir�'s l an: Cottoned 4�/01�1�95 Cgll�,r W-by! Cusiomor ! Reccly@rI 0",%Oi 198A y s� r ITEM R%l5t1LT !4+I�R �1 "�eelrad r; Tea 'r� TA _•L.97� I it!wa A T'I'SIL 0.1 10 VTA 300,0 LA 02/01,"109 L a�MOW$ ; V et,_ 0.1 0.t 1.3 sm AIIIB LAP 02i02/1999 . 0.2 sn�1f, t..1 00.3 M 311 to LAP 02/02/1999 " l�f it�111. mail. 1.0 20 R-131 i 1 E IIIAP n 0-1949 Total Coliform Y/A AS 02/01/00 ,G�1B:.X'�t,�alcnl�C`leetni�atry .w� ■hl1nduO y{�a 84 utrc�hr✓crr�_ 1 tPA.120.1 MHS -152/01/1999 5.7 pH-Unks 0 BPA 150.1 1ti1m 02/01/1'mIA i :?f p a o 't ( j iy �r° "+ i i,;, x®caurr�ri�■an:+�fi®sxeeuxe�—��u�aaa _ ma�raaAama.,-r-_cu„aeaRsrraar;eai;m�i.o }s � y� -a IZStUiPZ�C: � w t` � 1I� 'OR € �° - 1;I�o6H�1!° :3ti•i9S1 t u4'P��+edlre's�T:a��i` ,;:� ;sample Number° arn,jiIt Do oription; Water.DrinUing Water u K p "�f dJl4da ! ti L U.:i %aG 1"?A S�tY he arch:d a., ,� "I 17 �#a.t�X111ii , , , = etracfil+�r + tlb�rae 1DR 7 1,�,2-Tr cbloroethane ti�, :�. r. A sc�_.z r�V..t�H .. >; }n -1 iclzloroetlxaoe Tttta 0.3 FFA 012 Kucn x VU99 l .t-Dichloroethrne B �^� 0.5 7.0 $PA R112 Kim x 2rtm9 .�; 3�. r�!l77����yy �r ,bTA�nJ.r u:..L ..3 {f' 1.,1 Dlchlorop.r.openo VIA,a �. Kann r� �li�� ,E. e ' ug/L 0.5 EPA 5012 Kam H 2/ll99 �., �, -Tricrllorobenzene .. �1,2 a-�"nioblor opropano [/ 1. 2�4.Triclblorobeuzcue ' - 1/99 "h l,k, �' ` s ethylbe�iixex�e B.RI s2 ��'A�Wl Xwion x 211/09 ( , ugtL EFA 502.3 K if VIA),) 1,2-01b�r®mo-3-�,'l�loropro 1,2-Dibaro mloethane(EDB) BRA u�L o.s UA 3cz.2 Kiow x �ri�9 i27Dichloraethaue RRL UEA, i1.n 5.0 ,A 502._2 Sri �t 211199 ey '�'�T ��p{ , � ➢ � ItDi'0] � 1 d1 BRL .Y'ii 5t}�. 1�.$fC1iH jzy -5-".l'rhuethylbenz+rRa�.e li t� f. t�. ��sua.�J ;�::re� i IF t ,.: n�c =1; �°c�ben t�rie 13 % ��, o. Ica. �txn r /1i ; r 1,5v- 9G 1 (1)rQpC0�Je1.1t4r .�+tiL ug/L, 0.5- E. y�"i,2 Karen14 2t319K � 0.5 5,() ERA 502.2 amn i'i 111/99 � .{7,IT, q- , - 0.5 EPA dVefi.r L LrM s L 2!1/99 al 1ar ot uez3 PIT. - , �e Pit N , i on;re�x'e LL BRL EPA 502,2 Yketa If ?11lt a` S 1 mllobellzer•c te, u L BRL :1', fl i, Karen H 2/."i/94 E $x-t�ILI�Fcl1:l�a ry.�rietl�at�e I ,y .Uromodichlorometl ane � 4 Er ,de�.w :�.t�ixi VIM n rgIbT4AfUI"Ci7, B u�C , 013 EPA�2.2 Karen H 211J99 � `. _ F; ���.o�x1l1lx��tl��ne B���•r � �'�� U,5 )EPA 402:2 1%;rsn b 2!1!99 +:� �r�l, ►o tetrachloride d" lo1r-obe"PIP-e ` n L ©5 1W1 ETA 302.2` Kw-4,r,F M;90 x r ' >� C'111kFA-oerhane 3 VOL 0.5 E:2A 502.2 Karen N 211r99 ti i 4 11{/'� ]�(T�/'� 'i ,1 5 - - 4 'H ( Fyn t. Chloroform V•'.I Y �4 5012 Si IA..,Cl 411177 _BRL tt 11, - 3.:: E-PA.u.,,2 Kgrrx,El -7,'IM is.M ,�� xc1lar4el�e�c B � 1r, .s ?r, FYt; �1�,7. 1' ;r ,t 4n,,9 CIS-1,3-Dichloropropene BRL u s.s sKxai H 211/99 I wl j?,ib�o� ,ochlo�romelthan:e o W ,�L.2 1;� x z!1f 9 I R ff, Vol y EPA 02 H M 41-h p F B , ptL 5 EPA 02'.2 1- 211�199 �O ' Oi;rblorodifluoromethase 13'l�3 iz�'>cte B UpL 115 i is ''EPA 502 Karen�$ 21i194 t � e ac oroliz�,�r dielae u r;. 9BRL !s f' t22. Ken 1I 2!1J4 fi y 1sop.1"o ; 1benzene B L: 0.5 FP,.MSri2 csi1i � 1 �"' $- It t}' ether BRL �aa, C Mt'A 5.0,2 �;�f r 1i 211,99 �y .,, rPA Sol — el ene ;$B t�gJ3. U.S EPA:C2.2 T"arm H 2i1/59 4 1II aCOJ�l� 1:Aiv 11 191) L11 pw BRL ca4i" 1 .5 r':4.•i3 •' 'K.is sa I1 2117QR 1 �#a111 k!kk .r,�1G PQ.Irq' 1r��aUX11,l1JIe r �r ?Pt,.§Qi.2 h wa !�'9 a.1. °4 k} k � k' r b4 31�i�aa¢a a•� r , Bill- ILT U�"L'Ibor. Fitz dL R ti .a 5 ell. s`r � P! r * & 'NK - Y'der 4 Lit�Jil)4 f� "�dl�Of'� ,A�t�'ii.- �y:�r d_.�'.t nr�99 1,. ec-Butylbemene �t � ttgri.� J.5 EPA 402.E Kajaa H 2j16?9 UVi_ 1':OO EPA,502 2 Bann H 211AP9 . tert-Butyllacnzene , Te-h-ach..loroethene Ti rol. ug/L t EPA502.2 4wzn H 24/99 g T#Yl1.teue F �_, ��;L 0.5 �v�' VEPA".+ii."- Keen en F 11/94 x 'l���I�X ��T2k'9 F'PA 162 2 Korea F' 11199 kL y(. BJJR L U-IL, ��1:� Y;`A 55U2 Karcri 1-1 [./A11f}4 .� , ��s^aa�-x,a-i�Ycbla�r�,ethcne _ guns-1,3-Tfichir roprope BR1. qVL 0.1 �P.A O::>2 Kwen�, a �y p°rc lor�►e#ht",RCr 8,�.X A p,� {� ly g 7 y,�T r:F.rIi�'Ylltl' oRI Z'� �4"t:RX"��.� :1' ISJI.r 'J��I- f..ti ,P.-Ai.SiJ,.> �`i:iil't;tl� «:��1��' �s... Vinyl chloride RRL uG L o.. n ETA Karr.N 3,,p 4t' r. ' J 3or41G 'F 1.fV LJ.r li u A e , F^; No.---------- --------- Fee- -3------------- BOARD OF HEALTH TOWN OF BARNSTABLE Zipplicat ion,forWell Construct ion Permit Application is hereby made for a permit to Construct ("), Alter ( ), or Repair ( )an individual Well at: Location — Address ssessors Map and Parcel (,Y y Owner Q Address CA tom► �-- Type of Building Installer — Driller Address Dwelling-----140 — - - —---------------- Other - Type of Building----------------------- No. of Persons-------------------------__ —_____ �l r Type of Well—---------� - ----— -- - Capacity------------------- — ---- - —--— Purpose of Well ------ Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation until ertificate. Co pliance has been issued by the Board of Health. C r � rqg Signed _ 7 .., .- - ------------- _-�-__-------1----- ----------- -------- date Application Approved By — — -- - ------ — Zn Application Disapproved for the following reasons: --------------------______—__— --_ --- ----- -- --- ---------------------------------- ------------- --- date Permit No. --- Issued--- -- - - - -- ---— - -------- — date BOARD OF HEALTH TOWN OF BARNSTABLE (Certificate Of Compliance THIS IS TO CERTIFY, That the Individual Well Constructed ( ul, Altered ( ), or Repaired ( ) byoL caw c�o2e --------- ..�.., -- nstaller 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 SATISFACTORY. DATE-----— — - -- Inspector----- —-- -------------- t • Y .. r- ,.G S`S "� .. r _.-4'�.i'r's.,..y. ^fY.-t'. .. ._.. -. _.r .., ... _.-1 No.------------------- Fee- ------------- BOARD,dJ,F,HEAWTH TOWN OF BARNSTABLE Applitatton-ArVell Cott9tructioni3ermit. Application is hereby made for a permit to Construct (,- Alter ( ), or Repair ( )an individual Well at: Location.,'=;Address ssessors Map`and Parcel c►K - c .2 b�- �c� , _ ®.—�- - -i��L PoCe s-tcc�21- ;- _na(.vY i Owner t Address Installer — Driller Address, Type of Building ' �( Dwelling ------------------------- Other - Type of Building----------------------------- No. of Persons------------------------------------ Type of Well------- ---- - ----- __— Capacity---— - --—-- —- -—— Purpose of Well------3 Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation = The undersigned further agrees not to place the well in operation until a ertificate .of Compliance has been issued by the Board of Health. Signed( -_= — ---- --- - —1—� date Application Approved By� — - ------— — --- date x Application Disapproved for the following reasons:--------------------------------------------- --- date Permit No. -— — Issued----- --- --- -- ---- - date i46TifitiliRiTaiaTi•_�i76!e�i'li!►Ti'S34i41Yti4iTiTGK4s!i!84iTBsiRis6TtlnTGli�Gl3PiTeDi4i�i'TA3'G'e6ViBeTe'laQiKli�RaYilSTIiT34G Wl"i!i06i$Qi.fGC4AiQ.5tili!iRiSi!iTi4.?�lii$!i!.i!t-�''rT-S?• BOARD OF HEALTH TOWN OF BARNSTABLE Certificate (Of Compliance THIS IS TO CERTIFY, That the Individual Well Constructed ( ►� tered ( ), or Repaired ( ) by �"v _—f f' -- ,� -------' -a ----- nstaller/ at__L -f-` 1�P r f'�, I- —_�`='-_ ✓� S"fC��2t�- -- �'S'----— 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 SATISFACTORY. DATE--------- -- --- Inspector-- - ---- - ----------—-__ mva++rfu4eia5eVaeil'.ihwatiiiTiliTafasiRi4aTi9asaea4iTi'nisi9asal3liia�asiK.Ti94eiei.TieaoatGSL48lG4asaNaygihseiiTa4i4a!aTM�i!Nei@i!i4cTGTa%4a?fs�i�STiT:.TiTa>aT.i° BOARD OF HEALTH TOWN OF BARNSTABLE Well Congtructionpermit <L) No. ---- //'3 Fee Permission is hereby granted 12 A,0. -, C-c 0 ( r ; C,___ to Construct (Alter or Repair ( ) an Individual Well at: No. - Street as shown on the application for a Well Construction Permit No. - (.y — Dated-�--------___------------------------- 47 ,_ ' � DATE �/Z G� L -- Board of Health 02-26-•1999 10:22AM CAPE COD TOBACCO CONTROL 15093622603 P.0.1. CERTIFICATE OF ANALYSIS I Page: 1' R. I Barnstable County Health Laboratory. rt e For. Report Dated: 02/25/1999 Fitzpatrick, ke Order Number; , G9901 75 Mf w Fitzpatrilk Lot 2„Desire's e West Bamstabl MA 02668 I I Laboratory M#: 9901475-01 DeseriDtivn: Water-Drinking Water $ample#: 01475 Samyline Location: i.at 2,Doire's Lane,Wlimable I _a) ; 02123/1"9 alleged by: Customer teC"ved: 02*31109 Test Parameters ITEM — RESULT $ _ MDL Mc 4 LAB:11fier061010gy Total Coliform Absent M/10offiL 0 0 MF � 02 311999 Note; Water v,Unple nxdets the recommended limits for drinking water of aII'abovle tested pmmetffm � l 4proved { (Lab �r) I s j : Superior Court Houle, PO.Box 427, Barnstable, MA 02630 Ph: 508-375*05 � I 02-26-1999 10:22AM CAPE COD TOBACCO CONTROL 15083622603 P.02 i CERTIFICATE OF A,NA►LYS18- Page: 2 i� Barnstable County Health Laboratory Re ort Pr are For' ]Report Dated; }02123/19" j t Fitzpatrie ,Mike to rder N•umbei: G9 466 Mke Fit atrick j Lot 2,Des'Vs Lane. I West Bator ble MA 02668 Laboratory m 9901466-02 Description: `Pater-Drinldng Rater Sampl #: 0991 982 Sampling Location: Lot 1,Desire's Lane,W.Barns. '� C Collected: O Z2t1S ollected y: A.Sylvia private well ( Received; 02V22115 i EPA 502.2 odatile Organics by PrbIECL.D ITEM RESULT LWXTS 14IIJL MCL Method# � Tested 1111112 Tetra chloroethane ND ug/L 0.5 EPA.$02.2 02/22/1990 1,1,1-Trichl oethane ND ug/L 015 200 'EPA 502.2 02/2211999 1,1,2,2�Tetr hlaroetlxane ND ugrt o.s 'EPA 502.2 02/22/1999 1,1,2-Trichlo roethane ND uj!L 0.5 s.o EPA 502.2 ! 02122/1 9 9 9 1,1-Dichloro thane . ND VS/L 0.5 EPA 502-2 I 02122l1999 1,1-Dichloro ene ND ug/L 0.5 7.0 EPA 502.2 : j; 02/22/1999 i 1,1-bichloro opene I lib . 4L 0.5, EI?A 9022 + i 42122/1999 . 1,2,3-Trichk idbenzene ND Epic .2 ; I 02/22/1999 1,2,3-Trichlt repropa�ne ND iurx o EPr k 1902Z i 02n2/1999 1,2,4-Trichl >robenzene ND Iug/L 0.5 7.0 Uk 502.2 j 02/22/19W 1,24-Trimet ylbenzene ND ug/L 0.5 EPA 502.2 • 02/22/1999 1,2-Dibromo-3-chloropropan ND ug/L 0,5 0 F.FA IO2.2 ( 02/22/1999 i 1,2-Dibromo ane(EDB) ND vsVL 05 EPA�02.2 02/22/1999 1,2-Diehloropenzene ND ug/L 0.5 j 600 %�r-A oz.z OV22/1999 1,2-Dichloro hane ND ug/L 0.5 5.0 EPA 502.2 02/22/1999 1,2-Dich1oro ropane ND ug/t 0.5 EPA J02.2 02/22/1999 1,3,5-Trimet ylbelnzene ND uWL 0.5 EPA 502.2 I� 02/22/1999 1,3-Dialoro .enzene ND ug/L 0.5 EPA S02 2 `. i 02/22/1999 1,3-Dichloro 3ropane ND :ug/L 0.5 FrA sae z 02/2V1999 1,4-1)ikhloro6enzene ND uf/L 0.5 5.0 EPA 502.2 0=211999 2,2-Aichlor4ropane ND ug/L 0.5 EPA 5022 I OMV1999 � 2-616roto ene ND ug/L 0.5 EPA sot Z I 02/22/1999 4-Chforotoft ene ND ugrt o.s EPA s02.2 : i f) 02/22/1999 I 1 � Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph: 508-375-"45 i j 02-26-1999 10:23AM CAPE COD TOBACCO CONTROL 15083622603 P.03 F CERTI � i �, CERTIFICATE A �{t 1��/7+��y Page: 3 .4 av � �� ��L' ANALYSIS' IJ��. I Barnstable County Health Laboratory II Report Prengred For: 'Repon Dated: 02/23/1999 Fitzpatrick,tv like Utde3r Number:! G990 466 Mike Fitzpatz ick Lot 2,Desire's Lane West Bhrnstab Le CIA 02668 Laboratory m#: 9901466-02 Deserintlon: 'Water-DriaJdag Watery Sample#: 0981 902. Samnl4ne Location: ILot] DeOre's Lane WA, erns P � � Coltceted: 42l22/ 999 ollected b 'private well Y� A.5 YlviS i Received: 02/22/;999 Benzene ND ug/L 0.5 5.0 EPA 50rt.3 ) 02/22/1999 Bromobenzene ND ug/L 0.5 EPA 50'2.2 p02l22J1999 Bromochlorom thane ND ugl ; 0.5 EPA50Z.2 i DPr2zit999 I � t Bromodichloro ethane ND ug/L 0.5 EPA5&-i 4f2ri2Jt999 Bromofonn ND ug/L 0.5 EPA 502.2 02/22/1999 Bromomethane ND ug!t, 0.5 EPA 502.Z 0�2/22t1999 Carbon tetrach ride ND ug/L. 0.5 .o EPA 502.E 0zrz2/1999 Chloroberaene ND eg/L. 0.5 100 EPA 502.21 02/22/1990 Chloroethane ND uPJI 0.5 EPA 502.21 0�'122/1999 Chloroform 4.0 ug/L. 0.5 I EPA 502.2 0�2/1999 Ch103 Omethane &D ug/L. 0.5 EPA 502.2j 02/22/1999 cis-42-Dichloro thene ND gfL 0.5 !70 SPA sozzl 122/19s9 cis-1,3-Diehloro ropene ND ug/L 0.5 j APA 502.2 122/1999 Dibromoc'hlora ethane 0.5 ug/L 015 EPA$02.2; Dibromamethaz a ND U91L 03 EPA 50i.2 o /zv1999 Dicblorodifluor inethafe ND ug/L: 0.5 EPA 502.2 4 02/22/1999 . Ethylbenzene ND ug/L, 0.5 700 4PA 502.21 ` OV2211999 l i � �exachlot�obn iene ND ug/L1 0.5 ; EPA 502,2! r p /271t 999 tsopropylbenze i ND ug/L+ 0.5 I I3PA sqi o ria/tssg Methyl-tert•bu I ether: ND uglLI 2.0 EPA 50ii 02122/1999 Methylene chloT We ND us/. 0.5 5.0 EPA so2.2: 03/22/1999 n-Butylbe=ene ND ugjV 0.5 EPA 502.2 0/22/1999 n-Propylb�,elnaeu ND uoi i'i o.s EPA 502.2. O?12/1999 Naphthalene ND ug/Ll 03 EPA 502. o2l2vtY p-1sopropyltolu ne ND USI-L: 0.5 EPA 302.2� 0 la211999 sec-Butyltlenze ND u9/1.: 0.5 EPA 502.2! OZ/22/1999 Styrene ND wa1Li 0-5 100 EPA 502.2 iU22/1999 1 Superior Court House, PO.Box 427, Barnstable, MA 02630 Pat:508-315.4645 t 02-26-1999 10:23AM CAPE COD TOBACCO CONTROL 15083622603 P.04 s Pa I T, j I Page: 4 CERTIFICATE OF ANN ALYSIS Barnstable County Health Laboratory Re-DO" Pre eed For, Rtport Daud: 02n3/1999 Fitzpatrick,IN fike 0i der Number:I G990 A746 Mike Fitzpab ick i Lot 2,Desires Lane West$amsta le MA 02668 � I Laboratory M#: 9901466-02 oesg ption. 'Water-Drinldng waber j Sample#• Q981 982 Sampling Locatiojt Lot 1,Desire's Laws,*,Bator. CI llected= 07422/1999 ollected by: • Ax.Sylvia private well Reeived: p2/22f1999 tent-Butylbenz a ND ug/L 0.5 EPA$02.2 02/22/1999 T'etrachloroeth ne ND ug/t 0.5 510 SPA 5Q2.2 j 02/2211999 Toluene ND ug2' 0.5 200 EPA 5023 02/22/1999 i Total xylenes ND *11 0.s i,0000 SPA 502.i j i '02/22/1999 trans-1.,2-0iehl i•oethene ND ug/i. 0.s lop SPA 502.2 �4 1 W2211999 trans-1P-'Diehl ropro¢ene ND ug/e 015 FA502.2 622/1999 Trichloroethen ND u > p.5 :5.0 -tPA 50,. •0I2J22/1999 Trichlorofluor methane ND ug/c 0.5 ;$11A 502.2 @v2z/1999 Vinyl chloride ND 119/L 0.5 12.0' -F,PA X2.-� 12/22/190 i Note: Approved BYE r 1 (3'..ab hector) � 1 Z/,2 . IJ l i I II i 'I I I Superior Court House, PO.Bog 427, Barnstable, MA 02630 Ph;$08-3754605 t I I 02-26-1999 10:24AM CAPE COD TOBACCO CONTROL 15083622603 P.05 ' I 8 CERTIFICATE OF ANALYSIS, i Page: 9 Barnstable County Health Laboratory i e ; pre red Report Dated: 02/23l1999 l j Fitzpatrick,TV like Order Namberr:j G990 `6 Milne F3tzpat ick I Lot 2,I}esi re`s Lane West)3=wtab e MA 02668 baboratga mg: 9 90 1 4 66-0 11 Description: Water-Drininng Water f i Sample it: 01466-01 Sampling Location.. Lot 1,Desire's L.ane,W.Darris, Callected• 02/22l "9 oilected by: A.Sylvis, jtrivate well `Received: OZ/22l1999 ( i .Routine ' I TRM RESULT NJTl DL i .1tICL hoai i I +1I'ested LAB:IC Lab Nitrate: <0.1 mWLj 0.1 io EPA 306.0! i oi/2211999 }. LAB: Metals Copper <0.1 mg7L� 0.1 1.3 SM 31118! 0 23/1994 YTt1II 0.1 mg71,! 0.I 0.3 SM 3111 B I o2/23/1999 Sodium 37 mZ/L, 1,0 20 SM 3111131 02/23/1999 4AN. Microbiotogy Total Colaorm N/A P& 0 Assent PIA i I LAB:Physical Chem"stry i Conductance 235 umahs/cm ; �A 120.l - JO /22/1999� pH 6.4 pH-nisi 0 EPA I50'.1 0/22/1999 i � � I Note: Based o the results of the parameters tested,the wu#er 1S suitable for-dri"Ing,but has high:levels of sodlof Du¢to residual chlorin in the sample,tbe total eoliform analysis could not be performed. I i i j i � � I Superior Court House, PO.Box 427, Uai astable, MA 02630 Ph:508_375.660S TOTAL P.05 0 r i Customer: Fitz ANALYTICAL- REPORT Order#c G9901272 Report Dated: 0210211999 Laboratory ID#: 9901272-02 Collected: 2/1/99 Sampling Location: Sample Number: Received: 2/1/99 Lot 2,Desire's Lane Sample Description: Water-Drinking Water EPA 524.2-Volatile Onganics by GUMS PARAMETER RESULT UNITS MDL MCL Method# Tech'n Tested Note 1,1,1,2-Tetrachloroethane BRL ug/L 0.5 EPA 502.2 Karen H 2/1/99 1,1,1-Trichloroethane BRL ug/L 0.5 200 EPA 502.2 Karen H 2/1/99 1,1,2,2-Tetrachloroethane BRL ugfL 0.5 EPA 502.2 Karen H 2/1/99 1,1,2-Trichloroethane BRL ug/L 0.5 5.0 EPA 502.2 Karen H 2/1/99 1,1-Dichloroethane BRL ug/L 0.5 EPA 502.2 Karen H 2/1/99 1,1-Dichloroethene BRL ug/L 0.5 -7.0 EPA 502.2 Karen H 2/l/99 1,1-Dichloropropene BRL ug/L 0.5 EPA 502.2 Karen H 2/l/99' 1,2,3-Trichlorobenzene BRL ug/L 0.5 EPA 502.2 Karen H 2/l/99 1,2,3-Trichloropropane BRL ug/L 0.5' EPA 5022' Karen H 2/1/99 1,2,4-Trichlorobenzene BRL ug/L 0.5 70 EPA'502:2 Karen H 2h149-, 1,2,4-Trimethylbenzene BRL ug/L 0.5 EPA 502.2 Karen H• 2/l/99 1,2-Dibromo-3-chloropro BRL ug/L 0.5 0 EPA 502.2 Karen H 2/l/99 1,2-Dibromoethane (EDB) BRL ug/L 0.5 EPA 502.2 Karen H 2/l/99 1,2-Dichlorobenzene BRL ug/L 0.5 600 EPA 502.2 Karen H 2/l/99 1,2-Dichloroethane BRL ug/L 0.5 5.0 EPA 502.2 Karen H 2/1/99 1,2-Dichloropropane BRL ug1l, 0.5 EPA 502.2 Karen H 2/l/99 1,3,5-Trimethylbenzene BRL ug/L 0.5 EPA 502.2 Karen H 2/l/99 1,3-Dichlorobenzene BRL ug1l, 0.5. EPA 502.2 Karen H Vl/99 1,3-Dichloropropane BRL ug/L 0.5 EPA 502.2 Karen H 2/l/99 j 1,4-Dichlorobenzene Q,( ug/L 0.5 5.0 EPA 502.2 Karen H 2/1/99 2,2-Dichloropropane BRL ug/L 0.5 EPA 502.2 Karen H VIM 2-Chlorotoluene BRL ug/L 0.5 EPA 502.2 Karen H 2/l/99 I t Customer: Fitz ANALYTICAL" REPORT Order#: G9901272 Report Dated: 0210211999 4-Chlorotoluene BRL ug/L 0.5 EPA 502.2 Karen H 2/1/99 Benzene BRL ug/L 0.5 5.0 EPA 502.2 Karen H.- 2/1/99 Bromobenzene BRL ug/L 045 EPA 502.2 Karen H 2/1/99 Bromochloromethane BRL ug/L 0.5 EPA 502.2 Karen H 2/1/99 Bromodichloromethane BRL ug/L 0.5 EPA 502.2 Karen H 2/1/99 Bromoform BRL_ ug/L 0.5 EPA 502.2 Karen H 2/1/99 Bromomethane BRL ug/L 0.5 EPA 502.2 Karen H 2/1/99 Carbon tetrachloride BRL ug/L 0.5 5.0 EPA 502.2 Karen H 2/1/99 Chlorobenzene BRL ug/L 0.5 100 EPA 502.2 Karen H 2/1/99 Chloroethane BRL ug/L 0.5 EPA 502.2 Karen H 2/1/99 Chloroform 2.7 ug/L 0.5 EPA 502.2 Karen H 2/1/99 Chloromethane BRL ug/L 0.5 EPA 502.2 Karen H 2/1/99 cis-1,2-Dichloroethene BRL ug/L 0.5 70 EPA 502.2 Karen H 2/1/99 cis-1,3-Dichloropropene BRL ug/L 0.5 EPA 502.2 Karen H 2/1/99 Dibromochloromethane BRL ug/L 0.5 EPA 502.2 Karen H 2/1/99 Dibromomethane BRL ug/L 0.5 EPA 502.2 Karen H 2/1/99 Dichlorodifluoromethane BRL ug/L 0.5 EPA 502.2 Karen H 2/1/99 Ethylbenzene BRL ug/L 0.5 700 EPA 502.2 Karen H 2/1/99 Hexachlorobutadiene BRL ug/L 0.5 EPA 502.2 Karen H 2/1/99 Isopropylbenzene BRL ug/L 0.5 EPA 502.2 Karen H 2/1/99 Methyl-tert-butyl ether BRL ug/L 2.0 EPA 502.2 Karen H 2/1/99 Methylene chloride BRL ug/L 0.5 5.0 EPA 502.2 Karen H 2/1/99 n-Butylbenzene BRL ug/L 0.5 EPA 502.2 Karen H 2/1/99 n-Propylbenzene BRL ug/L 0.5 EPA 502.2 Karen H 2/1/99 Naphthalene BRL ug/L 0.5 EPA 502.2 Karen H 2/1/99 p-Isopropy'ltoluene BRL ug/L 0.5 EPA 502.2 Karen H 2/1/99 Customer: Fitz ANALYTICAL' REPORT Order#: G9901272 Report Dated: 0210211999 sec-Butylbenzene BRL ug/L 0.5 EPA 502.2 Karen H 2/1/99 Styrene BRL ug/L 0.5 100 EPA 502.2 Karen H 2/1/99 tert-Butylbenzene BRL ug/L 0.5 EPA 502.2 Karen H 2/1/99 Tetrachloroethene BRL ug/L 0.5 5.0 EPA 502.2 Karen H 2/1/99 Toluene BRL ug/L 0.5 .200 EPA 502.2 Karen H 2/1/99 Total xylenes BRL. ug/L 0.5 10000 EPA 502.2 Karen H 2/1/99 trans-1,2-D chloroethene BRL ug/L 0.5 100 EPA 502.2 Karen H 2/1/99 trans-1,3-Dichloropropen BRL ug/L 0.5 EPA 502.2 Karen H 2/1/99 Trichloroethene BRL ug/L 0.5_ 5.0 EPA 502.2 Karen H 2/1/99 Trichlorofluoromethane BRL ug/L 0.5 EPA 502.2 Karen H 2/1/99 Vinyl chloride BRL ug/L 0.5 2.0 EPA 502.2 Karen H 2/1/99 Thomas F. Bourne, Ph.D. Laboratory .Director i 'A CERTIFICATE OF ANALYSIS page. 1 Barnstable County Health Laboratory Report Prepared For: Report Dated: 02/02/1999 Fitzpatrick,Mike Order Number: G9901272 Mike Fitzpatrick Lot 2,Desire's Lane West Barnstable MA 02668 Laboratory ID#: 9901272-01 Description: Water-Drinldng Water Sample#: Sampling Location: Lot 2,Desire's Lane Collected: 02/01/1999 Collected by: Customer Received: 02/01/1999 Routine ITEM RESULT UNITS MDL MCL Method# Tech'n Tested LAB:IC Lab Nitrate A mg/L 0.1 10 EPA 300.0 LAP 02/01/1999 LAB:Metals Copper <0.1 mg/L 0.1 1.3 SM 311113 LAP 02/02/1999 Iron 0.2 mg/L 0.1 0.3 SM 311113 LAP 02/02/1999 Sodium 11 mg/L 1.0 20 SM 3111B LAP " 02/02/1999 LAB:Microbiology Total Coliform A P/A 0 Absent P/A AS 02/01/1999 LAB:Physical Chemistry Conductance 84 umohs/cm 1 EPA 120.1 MHS 02/01/1999 pH 5.7 pH-units 0 EPA 150.1" MHS 02/01/1999 3 r � Superior Court House, PO.Bog 427, Barnstable, MA 02630 Ph: 508-362-2511 7rP f4�1NdAT/6W K. /ZZ.S SEII/�E 5'Y57'�/►!' f�J�O�/GG'� .SD/Gs 7�5�- ,QEsUL 7'S GRADE Mm/, SLR Di Z �/ �z,//78 T 2 �Z. ,D G"MAX• Co✓ER 9"M/�✓ ("Off /�IAX dr, d�o/yP• Q d D�caryP �/� 9"Mih/, 0054A C.S ', ¢„ o c"Allc-T �` scH•4D PvC sc PVC /sT BDrY LIl "rsrJNIP /iV!/,/��2° 3�"M/�X, 2„COVER %''-�''s?a /oYRf'kl3 3 Z-AM If /Da Lo M L�QrJ/b Al 40 PVC 191, ��1 /NV• //I!l/i 16" �� l/✓V i /NV N- / n L�My L�� LEv£� 14 //�.�z //S.6 //2 3 +' / 2" /6YR�7/8 sAn�O 8i✓ �sbvd //S,4s SroN� tom , co r--�, � l¢ - � 29 3G 500 C.LH4CW C'94 Ari9s Z' E-if DEP77/ C-L 1/'• r ' G7 Q C7 C7 CI 20 a ,� IoY�Y/7/2 L44M Cl LOAM 2'7" +16" 2'7" �o•, Ei. //2.8 �¢'t USE /$oa (544, CONC, SEPTIC MA/K STD NE WI-N INLFT16417L6r TE�.S C 10' IN /140,C6ANCE 07H 316 CHR /5. 227 8'Z BOTTOM OF ?�S T S YR B Z S/1�uDY Lo�M L DAM ,4,0 I [' WASHED 570/IE _ 2•7" '` oL. �G./DS.O I , /32 ./ /3z" It:70l/R S G. Z C-A N CRAM RS 3' 6eDvwD�JA7 NOT EJVCDUiVTL�.P�p 7/ 'N5'TJg061& 8.D,Al - G. PUjVN/NG 5d/LS Et/f1G UATt�,e = ✓.DoYG E /sT 'C, A 47,5- < S M/N1/i✓ChV P�•9/v VIEW of Sr9,S. [3°X ��p!'4'`� S�WAG� sysTEM DES1(5* CA/ c01-4 T/oNS h1� GPD PEt 13ED,pDoM 1b 3 B�,2oo.MCs x //o GPI 331) GPd IN \ 3, USE FOUR SDD G. LEAGy Cl"A'0 'Eie.S lit//77,1 2'7"61C Wi9S/ALrD /✓t- ON Z31D E ' O PAO z - \ _ SOTTvti /o x .¢,x� s f= Y. I I PPe 1//S/4 V= 40e a C \ ASSESSd�- MA•� �8 R►,er�►LS rS-2 �'. SrSTEM rlYDclT On/ S /3- 99. eK>X /Sf "A � \ E n .aKR ` //B -------- O JOHt3 �yG ' / ' 1 �� \ `+ �'9S`r� ` ray [fOYLE.I►Y C'' Q 'O / ' / ' ' 1 ' ' N \�nn v 4, ,I1�•-- - -` Eit/T <5' -� No.�!?►+tRc4 � [-OG�S 'pfGISTERE� C,4 ,yivY 14 'f ( r5� - /25 I ; V Locus M.IP Doti i D p q 5// Alvo SE AIV ',40 / + �O. yt/ I ------ `'O7. //A Ct` WILLIAM - '� \ ~' I` p LIfB£RMAN v, �P�SE� 3 BE�h'oQM L//VG O L D 7O. 2 DF 5'/14F5 ENE /SID �f�►oN�E'"� )14 SAWN-5 4,61-E MA, �64�E: /''= 30 iuol/�gE,e /73 /"R .s'�s-t/.AGE •sYS7�f5 lDCA7� �9 Cho Rl�//I/G 7Z) --5Ct125ti, -77C F1Z-EO h//Th/ SAOU) i114,4 Ss�"Ar�s sued/�/siav, � GR� rc sG9c� '^'/fT Pep°� 0 boYG E 4556c14 TLS s J'o, f3aX S9s 1✓. FAQ Mo 4/7T/'/ eZ Sr,