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0042 NELSON LANE - Health
W 42 Nelson Lane ;" ' Marstons _ A = 126-095 Mills I i COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION r TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION i -"3 Property Address: 42 NELSON LN MARSTONS MILLS ` CSL�2 ° Owners Name: DAVID NNEN in y. Owner's Address: o - '' �-� Date of Inspection: 11/14/05 ca can r— rn Name of Inspector: (please print) Douglas A.Brown Company Name: Douglas A.Brown Septic Inspections Mailing Address:P.O Box 145 Centerville,MA 02632 Telephone Number. 508-420-4534 j 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: X Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature:A�2�4e�_ Date: 11/14/05 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 LEACHING CHAMBERS ARE DRY AT THIS TIME STAIN LINE ONE INCH FROM BOTTOM. ****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. Title 5 Inspection Form 6/15/2000 page 1 Revised on 10/31/2000 Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 42 NELSON LN MARSTONS MILLS Owner's Name: DAVID NIVEN Owner's Address: Date of Inspection: 11/14/05 inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: X I have not found any information winch indicates that any of the failure criteria described in 3 10 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: one or more system components as described in the"Conditional Pase'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. Answer yes,no or not determined(Y,N,ND)in 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. ND explain: 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 obstruction is removed distribution box is leveled or replaced 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 obstruction is removed Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 42NELSON LN MARSTONS MILLS Owner's Name: DAVID NIVEN Owner's Address: Date of Inspection: 11/14/05 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 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 I of a public water supply. I _ 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 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. 3. Other: Page 4 of 11 OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 42NELSON LN MARSTONS MILLS Owner's Name: DAVID NIVEN Owner's Address: Date of Inspection: 11/14/05 D. System Failure Criteria applicable to all systems: You must indicate"yes or no to each of the following for all inspections: Yes No X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool X Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped X Any portion of the SAS,cesspool or privy is below high ground water elevation. X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone 1 of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well. X 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.] NO (Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 3 10 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 with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or no to each of the following: (The following criteria apply to large systems in addition to the criteria above) 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-I"A)or a mapped Zone 11 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 yeg'm 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 Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 42 NELSON IN MARSTONS MILLS Owner: DAVID NIVEN Date of Inspection: 11/14/05 Check if the following have been done. You must indicate"yes"or"no" as to each of the following: Yes No X Pumping information was provided by the owner,occupant, or Board of Health X Were any of the system components pumped out in the previous two weeks ? X _ Has the system received normal flows in the previous two week period? X Have large volumes of water been introduced to the system recently or as part of this inspection? X _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) X _ Was the facility or dwelling inspected for signs of sewage back up? X _ Was the site inspected for signs of break out? Were all system components,excluding,the SAS,located on site? X _ 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? X 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: Yes no X _ Existing information. For example, a plan at the Board of Health. X _ 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(3 ))(b)] S 5 Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address:42 NELSON LN MARSTONS MILLS Owner's Name: DAVID NIVEN Owner's Address: Date of Inspection. 11/14/05 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN How based on 3 10 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents: I Does residence have a garbage grinder(yes or no): NO Is laundry on a separate sewage system(yes or no): NO [if yes separate inspection required] Laundry system inspected(yes or no): Seasonal use: (yes or no): NO 03 - Cos,Qp© C-SC,-1 Water meter readings,if available(last 2 years usage(gpd)): O 4 - 5a,©CX.*) Cc 1 Sump pump (yes or no):_ 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 no):_ Non-sanitary waste discharged to the Title 5 system(yes or no): _ Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Was system pumped as part of the inspection(yes or no): If yes,volume pumped: gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM X Septic tank,distribution box, soil absorption system _Single cesspool _Overflow cesspool _Privy s _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)? 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: 42 NELSON LN MARSTONS MILLS Owner's Name: DAVID NIVEN Owner's Address: Date of Inspection: 11/14/05 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: cast iron _40 PVC_other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK:_ (locate on site plan) Depth below grade: 12" Material of construction: _concrete_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: 1000 gal Sludge depth: TRACE Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: TRACE 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 LOOKS STRUCTUALLY SOUND AT THIS TIME GREASE TRAP:_(locate on site plan) Depth below grade:_ Material of construction:_concrete metal_fiberglass_polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or bailie: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition, structural integrity,liquid levels as related to outlet invert,evidence of leakage,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: 42 NELSON LN MARSTONS MILLS Owner's Name: DAVID NIVEN Owner's Address: Date of Inspection: 11/14/05 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches, etc.): DISTRIBUTION BOX: X (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: 0 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.): PUMP CHAMBER: (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Page 9 of 11 OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 42 NELSON LN MARSTONS MILLS Owner's Name: DAVID NIVEN Owner's Address: Date of Inspection: 11/14/05 SOIL ABSORPTION SYSTEM(SAS): _(locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number: X leaching chambers,number: 2 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.): CHAMBERS DRY AT THIS TIME STAIN LINE ABOUT 1 INCH FROM BOTTOM 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 or no): Comments(note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation,etc.): PRIVY: (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation,etc.): Page 10 of 11 OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 42 NELSON LN MARSTONS MILLS Owner's Name: DAVID NIVEN Owner's Address: Date of Inspection: 11/14/05 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. �- 2G G t x- 33 -I a, r s Y Page 11 of 11 OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM ] INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 42 NELSON LN MARSTONS MILLS Owner's Name: DAVID NIVEN Owner's Address: Date of Inspection: 11/14/05 SITE EXAM Slope: Surface water: Check cellar: Shallow wells Estimated depth to ground water 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: 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: :T TOWN OF BARNSTABLE LG6ATI0N yam? .dZif1101/ L AAA e SEWAGE # 7 7 VTLLAGE_ A4,4,& 51,111.5 1241 ZZS ASSESSOR'S MAP & LOTZ2,6 J INSTALLER'S NAME&PHONE NO. J' /YIod C 6 Ald ex f 15,0A, SEPTIC TANK CAPACITY l<0 6 *' f 71L FACILITY:FACTTY: (type) ,'C �LOu/ C fVA MBiPS(size) 015 NO.OF BEDROOMS BUILDER OR OWNER 1 � PERMTTDATE: —Q COMPLIANCE DATE: -.31 Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by lip°- 't Vti� �q r�� l z 50 3a V 0 No. 9 7- i' Fee $ 50.00 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS Z(ppfication for Migogaf 6potem Construction Permit Application for a Permit to Construct( )Repair MUpgrade( )Abandon( ) El Complete System ❑Individual Components Location Address or Lot No. 42 Nelson Lane Owner's Name,Address and Tel.No. — rstons Mills,Mass. 02648 Robert H. Eckhoff Assessor'sMap/Parcel 42 Nelson Lane,Marstons Mills,Mass.02648 Installer's Name,Address,and Tel.No. 775-3338 Designer's Name,Address and Tel.No. 775-3338 J.P.Macomber & Son Inc. J.P.Macomber & Son Inc. Box 66 Centerville,Mass. 02632 Box 66 Centerville,Mass. 02632 Type of Building: DwellingXXX No.of Bedrooms 3 Lot Size sq.ft. Garbage GrinderWO ) Other Type of Building RES No. of Persons 2 Showers( ) Cafeteria( ) Other Fixtures Design Flow 330 gallons per day. Calculated daily flow 3x110=330 gallons. Plan Date 7/24/97 Number of sheets Revision Date Title Size of Septic Tank 1 Q00 Pxi ati ng box Type of S.A.S. exi sting 1000 leach 12it Description of Soil Medium to fine sand Nature of Repairs or Alterations(Answer when applicable) Adding two 500 gallon chambers to the exstittg g,,Djlc e�rGt.Pm T,Pa chi ng area'_ 20 t x9 t x21 Date last inspected: 7/23/97 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 issu d by this Do o lth. Signed f a Date 7/24/97 Application Approved by Date 7-3 Gig —9 7 Application Disapproved for the f owing reasons Permit No. 2,Z— 25 L 7 Date Issued $ 50.00 # yNo. �' c�_ Fee : THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS f.J Z[pp[ication for ]Digpogar *p!tem' Construction permit Application for a,Petmit to Construct( )Repair(:Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 42 NelsonlAne Owner's Name,Address and Tel.No. 428--1056 Marstons Mills,Mass. 02648 Robert H. Eekhoff Assessor'sMap/Parcel 42 Nelson Lane,MarstonsMMills,Mass.02648 Installer's Name,Address,and Tel.No.. 775-3338 Designer's Name,Address and Tel.No. 775-3338 J.P.Macomber & Son Inc. J.P.Macomber & Son Inc. Box 66 Centerville,Ma,ss. 02632 Box 66 Centerville,Mass. 02632 Type of Building: DwellingM No.of Bedrooms 3 Lot Size sq. ft. Garbage Grinder NO ) Other Type of Building RES No. of Persons 2 Showers( ) Cafeteria( ) Other Fixtures Design Flow 330 gallons per day. Calculated daily flow 3XI 10=330 gallons. Plan Date 7 24 97 Number of sheets Revision Date Title Size of Septic Tank 1000 existing box Type of S.A.S. existins l000 leach pit Description of Soil Medium to fine sand } 1 Nature of Repairs or Alterations(Answer when applicable) Adding two 500 9all.on cHambers to the 4xis+�,.. ingseutic system.Leaching area. 20lx9lx2t o Date last inspected: 7/23/97 Agreement: .,X 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 nd'not to place the system in operation until a Certifi- cate of Compliance has been d by this o� alth. Signed Date 7/24/97 issu Application Approved by Date 7 Application Disapproved for the fo lowing reasons 7 Permit No. / ' 7 Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired�Pa)Upgraded( ) Abandoned( )by J.P.Naeomber & Son INC. at 42 Nelson Lane Marstons Mi.11S Mass. has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 7 3 ?7 dated Installer J.B.Ma.eomber & SON Inc. Designer J.P.Macomber & Son Inc. The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date ✓� Inspector ----- c2----------------------------------- No. '3 7 - 33 ^l Fee $ 50-C0 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Xigpogar *pztem Con5truction Permit Permission is hereby granted to Construct( )Repair Upgrade( )Abandon( ) System located at 42 Nelson T.tane Marstons Mills,Mass. 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 must be completed within three years of the date of this permit. Date: 7 U 7 Approved by t ._. CERTIFICATION OF SKETCH AND APPLICATION FOR A D1SP(,.. WORKS CONSTRUCTION Pl lt�,II'I' (W1'1'IIOU'1' DESIGNED PLANS) I Joseph P.Macomber Jr. _ :,„;,; certily that the application for disposal works construction permit signed by me sated _ 7/24/97_ concertung the priperty located at42 Nelson Lane Marstons.-Mills,Mass meets all of the following criteria: _ • There are no wetlands within 300 fcct of the proposed septic system • There are no private Nvells within 150 tvct of the proposed septic system, • The observed groundwater table .s 4 feet or greater below the bottom of the Ieaching-facility • There is no increase in flow and/or chanbe in use proposed • There are no variances requested or needed. SIGNED : f DATE: 7/24/97 LICEN D SEPTIC SYS'fE,'vl IivS'I'ALLEIt IN'1'IiE T0%YN OF BARNSTABLE NUMBER ° [Attach a sketch plan of the proposed Also if the licensed installer posesses a certified plot plan, this plan should be submitted]. 7 1 1t � 111V 10 COMMONWEALTH OF MASSAC. ETTS F �4 8 9 Y J EXECUTIVE 0 I F�'EN01@I ENTAL AIvF4A ' 3 e DEPARTMENNt ENVIRIONMEi`1TAL PROTECT ] ONE WINTER STREET. BOSTON. MA 02108 617-291-5500 ✓ Cf��e� VA •` �j 'O�voF 8 19gT WILLIAM F.WELD a y�(TH FPTjAB(E � DY CORE Governor Secretary ARGEO PAUL CELLUCCI ID B.STRUHS Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM E ti Commissioner PART A G��f CERTIFICATION Property Address: 42 Nelson 4. Marstons Mills Address of Owner: same Date of Inspection:J u 1 y 15,,19 9 7 (If different) Name of Inspector: F r pc1 ta r i r•k K i e 1 y I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000) Company Name: Environmental Reclamation, Inc Mailing Address: _446 Waguoi t Hwy Waquni t- MA 02536 Telephone Number: (S 0 R) 4 r,7_r,11 q n CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true. accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: _ Passes Conditionally Passes Needs Further Evaluation By the Local Approving Authority x ,X Fails Inspector's Signature: Date: July 18, 1997 The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (30) days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the System owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. INSPECTION SUMMARY: Check A, B, C, or D: A] SYSTEM PASSES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: 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:Iealth, will pass. Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If"not determined", explain why not. The septic tank is metal, t.r,Eess the owner or operator has provided the system inspector -.with a copy of a Certificate of Compliance (attached) indicating !hat the tank was installed within twenty (20) years prior to the date of the inspection; or the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass iit.spenon if the existing siutic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 04/25/97) Page 1 of 10 DEP on the World Wide Web: http:uwww.magnet.state.ma.uwdep CJ Printed on Recycled Paper i C • �.. � SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART A CERTIFICATION (continued) l` Property Address: 42 Nelson Rd. Marstons Mills Owner: Mr. & Mrs. ECkhof f Date of Inspection: July 15.,1997 81 SYSTEM CONDITIONALLY PASSES (continued) Sewage,tfackup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s)'or due to a ;roken, settled or uneven distribution box. The system will pass inspection if(with approval of the -Board of Heai `'` )escribe observations: _ )roken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced The system re;uiren Pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if (with :.--Droval of the Board of Health): oken pipe(s) are replaced ';struction is removed Cl FURTHER EVALUATION 15 REQUIRED BY THE BOARD OF HEALTH: Conditions exist which re further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety anc -nvironment. 1) SYSTEM WILL PASS UP:_:.3 30ARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT" 'r PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ Cesspool or privy 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 UN 5_, THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCT JNiNG IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet-to a surface water supply or tributary to a surface water supply. _ The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. _ The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation not valid). 3) OTHER (revised 04/25/97) Page 2 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 42 Nelson Rd. Marstons Mills Owner: Mr. & Mrs. Eckhof f` Date of Inspection July 15,.1997 D] SYSTEM FAILS: You must indicate ea!,er "Yes" or "No" as to each of the following: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No _ Backup of sewage into f.XAijyXpXsystem component due to an overloaded or clogged SAS or cesspool. X 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. X Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped _. d X Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone I of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well. X Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E] LARGE SYSTEM FAILS: You must indicate either "Yes" or "No" as to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area- IWPA) or a mapped Zone II of a public water supply well) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 04/25/97) Page 3 of 10 f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 42 Nelson Rd. Maritons Mills Owner: Mr. & Mrs. ECkhof f Date of Inspection:Ju1y 151.1997 Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Yes No X _ Pumping information was provided by the owner, occupant, or Board of Health. X _ None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. X _ As built plans have been obtained and examined. Note if they are not available with N/A. The facility or dwelling was inspected for signs of sewage back-up. X _ The system does not receive non-sanitary or industrial waste flow. g _ The site was inspected for signs of breakout. X _ All system components, excluding the Soil Absorption System, have been located on the site. YP X _ The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. The size and location of the Soil Absorption System on the site has been determined based on: X _ The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of Sub-Surface Disposal System. X _ Existing information. Ex. Plan at B.O.H. X _ Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) [15.302(3)(b)] (revised 04/25/97) Page 4 of 10 L w SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 42 Nelson Rd. Marstons Mills Owner: Mr. & Mrs. Eckhof f Date of Inspection. uly 15,,1997 FLOW CONDITIONS RESIDENTIAL: Design flow: 330 g.p.d./bedroom for S.A.S. Number of bedrooms:'_ Number of current residents: 2 Garbage grinder (yes or no):np_ Laundry connected to system (yes or no):yes Seasonal use (yes or no):njo_ Water meter readings, if available (last two (2) year usage (gpd): Sump Pump (yes or no): no Last date of occupancy: current COMMERCIAUI N DUSTRIAL: Type of establishment: Design flow: gallons/day Grease trap present: (yes or no)_ Industrial Waste Holding Tank present: (yes or no)_ Non-sanitary waste discharged to the Title 5 system: (yes or no)_ Water meter readings, if available: Last date of occupancy: OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: System pumped as part of inspection: (yes or no)= If yes, volume pumped: gallons Reason for pumping: maintai nance TYPE OF SYSTEM xxx Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) I/A Technology etc. Copy of up to date contract? Other APPROXIMATE AGE of all components, date installed (if known) and source of information: The system was built in Si.pt 1 ca80 Sewage odors detected when arriving at the site: (yes or no)j= (revised 04/25/97) page 5 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 42 Nelson Rd. Mar-stons Mills Owner: Mr. & Mrs. Eckhof f Date of Inspection: July 15,.19 9 7 BUILDING SEWER: (Locate on site plan) Depth below grade: Material of construction: _cast iron _40 PVC_other (explain) Distance from private water supply well or suction line Diameter Comments: (condition of joints, venting, evidence of leakage, etc.) SEPTIC TANK:_ (locate on site plan) Depth below grader" Material of construction:X concrete _metal _Fiberglass _Polyethylene _other(explain) If tank is metal, list age _ Is age confirmed by Certificate of Compliance _(Yes/No) Dimensions: i non ra 1 _ Sludge depth: 2' Distance from top of sludge to bottom of outlet tee or baffle: " Scum thickness:—N/A Distance from top of scum to top of outlet tee or baffle: N/A Distance from bottom of scum to bottom of outlet tee or baffle: How dimensions were determined: measured Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) S,a i-;�t,3nk is ; n gnnri r-nnai t-; nn GREASE TRAP:N/A (locate on site plan) Depth below grade: Material of construction: _concrete _metal _Fiberglass _Polyethylene —other(explain) Dimensions:' Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) (revised 04/25/97) page 6 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address:42 Nelson Rd. Marstons Mills Owner: Mr. & Mrs. Eckhof ,f- . Date of InspectionJuly 15 r,1997 TIGHT OR HOLDING TANK:N/A (Tank must be pumped prior to, or at time, of inspection) (locate on site plan) Depth below grade: Material of construction: _concrete _metal _Fiberglass _Polyethylene _other(explain) Dimensions: Capacity: gallons Design flow: gallons/day Alarm level: Alarm in working order _ Yes; _ No Date of previous pumping: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX:_ (locate on site plan) Depth of liquid level above outlet invert: 3" Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) There is no evidence of solids in the D-Box, however the high iqui I -awal ai- (-ha out-1 A+- i n vrzrt i nr3i at•arj a hydr-A i c failure in the SAS PUMP CHAMBER: N/A (locate on site plan) Pumps in working order: (Yes or No) Alarms in working order (Yes or No) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) (revised 04/25/97) Page 7 of 10 f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address:42 Nelson Rd. Marstons Mills Owner: Mr. & Mrs. ECkhof f- Date of Inspectionj U 1 y 15,,1997 SOIL ABSORPTION SYSTEM (SAS):_ (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: leaching pits, number: 1 leaching chambers, numoer:_ leaching galleries, number: leaching trenches, number,length: leaching fields, number. dimensions: overflow cesspool, number: Alternative system: Name of Technology: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) t)iiri nq the 1 nnat i on phase of the inspection the orohe rnd shnwpa wat-npAs n ramai > test 04 t_ahnup the SAS fi 1 1 Pd wi th 1 i giji d to a 1 t-viz 1 appr'oxi matel 20 inches below the grade of the lawn, i nai nAttj nQ A hjzd3 a j1 i 3i 1 jr . CESSPOOLS: _ N/A (locate on site plan) Number and configuration: Depth-top of liquid to inlet. invert: Depth of solids laver: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater: inflow (cesspool must be pumped as part of inspection) Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY---A�/A (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) (revised 04/25/97) Page B of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM • PART C SYSTEM INFORMATION (continued) Property Address: 42 Nelson Rd. Marstons Mills Owner: Mr- & Mrs . Eckhof f Date or Inspection:July 15,.1997 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) s• � i 34 '� • �/sue L� �w� ���, (TOV%zed 04/23/97) Page 9 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 42 Nelson Rd. Marstons Mills Owner: Mr. & Mrs. Eckhof f- Date of Inspection:July 15,.1997 Depth to Groundwater 20 Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record _X Observation of Site (Abutting property, observation hole, basement sump etc.) x Determine it from lorr31 conditions x Check with local Board of health =MA Maps Check pumping records -.iecx local excavators, installers x Use USGS Data Describe in your own words how you established the High Groundwater Elevation. (Must be completed) Met with the installer ; groundwater was not encountered during excavation. Spoke to Mr. Jerry Dunning,, (Barnstable Health Inspector) ,. he indicated that there were no common problems in the .area. Reference the USGS Map Sandwich Quad. The property elevation and the surface water elevation of nearby Shubael Pond indicates the depth to the water table is approximately 20 feet. (revised 04/25/97) Pags 10 of 10 40 LO-CATION SEWAGE PERMIT NO. VILLAGGE INST-A LE 'S DAME i ADDRESS ` S U I L D E R OR ,DOWNER DATE PERMIT ' ISSUED DAT E COMPLIANCE ISSUED -,�-� _ . �' 1 _... / i �� a.-� . 3� �� �� N ........ THE COMMONWEALTH OF MASSACHUSETTS BOARD 0 HEALTH OF........ ....................................................... Appliration for Disposal Works Tonotrurtion Vernfit Application is hereby made for a Permit to Construct (v)-or Repair an Individual Sewage Disposal Systxat: 14,4 ............. .. t...A......................................................... 0/......... or Lot No. .... ........ .......... V ........................................ Address ....... .................................................................................................. Address Type of Building Size feet Dwelling—No. of Bedrooms--- ........3...........................Expansion Attic Garbage Grinder �o 04 Other—Type of Building ............................ No. of persons.-2...................... Showers Cafeteria (f 04 Other fixtures .......................................................................... - --- ---- ----- -------------- ----------- ------------Design Flow.......!�_S�.........................gallons per person per day. Total Septic Tank—Liquid capacity/00.4allons Length................ Width..._.__.___._... Diameter..._.._......... Depth_._..__......... Disposal Trench—No. .................... Width.................... Total Length.....................Total leaching area........__...._ sq. f t P t ... Seepage Pit No ....I----_-------- Diameter.....1.0i..... Depth below inle�J�........... Total leaching area. ..sq. ft. Z Other Distribution box (I ) Dosing to Cy Percolation Test Results Performed by...: � ---- --V. . .............. Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit................... Depth to ground water.___...........__:_..__. (14 Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water___......_........_.___. 94 .............X---- ....... ..................... 1....... - ..../4'.- -------------------- .. . -- - 0 Description of Soil.............. U ............. ......... . --------- ....... ----------------------------------------------------------- ....................................................................................................................................................................................................... U Nature of Repairs or Alterations—Answer when applicable................................................................................................ ............................................................................................................................ .......................................................................... Agreement: ' The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TI I TI IS 5 of the State Sanitary Code undersigne4 further agrees not to place the system in operation until a Certificate of Compliance has bee is edbyt oard health. Sign 7-7Ad Sign' .. ..... . ......... .............................. ............D.................. :S Application Approved By._......._ ....................... .... ... ....................... Date Application Disapproved for the following reasons:....................7.................................................................................. ...............................................................................................................................................:------------------------------------------------------ Date ........................................................ Issued.........Permit No. M -------------------e ------ ay N .............. THE COMMONWEALTH OF MASSACHUSETTS BOARD C)f HEALTH ......... ....---.....OF......... ...................................................... Appliratiou for Disposal Works Tonstrurtion thrutit Application is hereby made for a Permit to Construct (C#,)r-or Repair an Individual Sewage Disposal /�yste /oca -------------------------------------------o •Addre ji>,I t No.ww_ .. ........ft.. .......................................................... r �ow Address Install Address Type of Building i Size Lot-ke U Dwelling—No. of Bedroo, S ....Sq. feet m ..................Exip' an's�*on Attic Garbage Grinder -7— --- Other :T Showers (:Z,6-- Cafeteria ype of Building .... ................ No. of persons.________________-------------------- .Other efiure's,':.............................................................................................. -------------------------------------- 6 W. -ga �Totd'�IaiVA .................gallons. Flow ..... Design F ...... .............................. lions per person per day. P4 Septic Tank—Liquid capacity/4)(44allons Length................. Width_. ..______... Diameter________________ Depth____________.__. Disposaf" rench—No. .................... Width___._..._.__._:_._._ Total Length___._.__ Total leaching area ...sq. ft. Seepage Pit No....I-------------- Diameter..... Depth belo./w.,inle 4-1---------- Total leaching area;."Zsq,. ft. Other Distribution box (I Dosing to Percolation Test Results Performed,b- ...... ._.i........ Date------------- 1.4 t Pit Test Pif-No. I----- ____minutes per inch Depth of Test Pit..................... Depth tp.grqund water________________________ r-14 Test Pit No. 2...................minutes per inch Depth of Test Pit__.___..___ .... Depth to ground water._._____..______.______. ......... ....... -- ------ ------......... x Description of Soil.............. .......-.,- j! ----------S--.-:��42... .......... .C----I... .. ...... ..................... .... .... ........................... .............. ..... .... U Nature of Repairs ...................................................... .................................................... ............................................ -----------------------------or Alterations—Answer when applicable. ---------------.................................................................................. ...........................................................................................................:...............................I.............1-1............................................ Agreement The undersigned agrees to install the aforedescribed Individual Sewage Disposill System in accordance with the provisions of T I T 1Z- 5 of the State Sanitary C de— undersignecl further agrees not to'place the system in operation until a Certificate of Compliance has bee i e "oard 1.i&alth.-,.-, y -7 Sign . .................... S' . .......................k............................. ................................ Cp D Application Approved By........ A-41_-------------------- ........................................ Date Application Disapproved for the following reasons:...................... ................................................... --------------------- ----------- .................................................................................................I ................................................................................................... _W;' Date PermitNo......................................................... Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF EALTH ............ 0 F............... .......... . ....*..................................... Trrfifiratr of Toutplialarr THl TO CERtl' hat the iy ividu . Se Ispo I System constructed or Repaired --------------- ........ -- ----- - ------ .......... ..............Z9 ------ ....... I taller at.. W. ....... ..... ..... ----44_.�t 11 A. .... -------------------------- -------- --------------------- .... ..... ....... has been installed in accordance with the provisions of T of The State Sanitary Code a dx�* Fd in the application for Disposal Works Construction �_,/ Ji Permit N� ........... dated... .... .. ............................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CON RUE® A A GUARANTEE THAT THE SYSTEM WILL FUNCTION SAT�7TORY* DATE.............le-1 s, Inspector.. .......................................... ....... ............................... In s1ty ividu g is 0_-P---p� THE COMMONWEALTH OF MASSACHUSETTS BOARD O)IF HEALTH OF.................... .............................................. N CO......... FEE...... ............. Disposal orks n n ;V i �ereby granted.............Permission ...... ... ......... ................... t'� . ........ .. to Construck( or,Aepair�' 4in ' ndivi, al Se e Di s System at A....... .. . ........ ................ .......... a-d �_ Street as shown on the application fo rl'. - Dated___...f., r Disposal Works Construction Pg No. , D ------------------------- ...... 0 .......... .... ... .... I....................... Board of Health `% DATE........ ...f..-.d24 ..................................................... FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS JY l ,tea .� �sT�i Cry c s� Al o2R_) C)w „� ZO/ IJ TCSa2J L� . 0 (,C-s S ) rd n!J S p1 A.l i7 PA LA�jiTRy gt1rv6� . CD Ll S ut� t:�' C - C&x C'Av 1)?L>,,— S. lo. P`S\A OF At, F//J. I�=L�i/ g° H RY w' L � L_ Gov O �Ja gS A Ro.26575 p \,... _ e F G/STEM �a J/ANAL j� `X et'i°Vc M !t/V. cOJ`f.$a r/7i/d.9y.oD INV. 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