HomeMy WebLinkAbout0625 WILLOW STREET - Health r , v3o _o3a
r
Commonwealth of Massachusetts
Title 5 official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
�M 625 Willow Street
Property Address
MALOUF, LEROY G &ANTOINETTE A
Owner Owner's Name
information is required for every West Barnstable Ma 02668 7/16/2013
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to
at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate
where public water supply enters the building. Check one of the boxes below:
® hand-sketch in the area below
❑ drawing attached separately
118
C3
i
i
U
-y 9(�
t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17
i
y I y
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
625 Willow Street
Property Address
MALOUF, LEROY G &ANTOINETTE A
Owner Owner's Name
information is required for every West Barnstable Ma 02668 7/16/2013
page. Citylrown 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 filling out forms A. General Information
on the computer,
use only the tab 1. Inspector:
key to move your
cursor-do not Sean M. Jones
use the return Name of Inspector
key.
S.M.Jones Title V Septic Inspection
Company Name
74 Beldan Ln.
Centerville Ma 02632
Cltylrown State Zip Code
774-248-4850 smjonestitle5@gmail.com SI4522
Telephone Number License Number
B. Certification
I certify that I have personally inspected the sewage disposal system at this address and that the
information reported below is true, accurate and complete as of the time of the inspection. The inspection
was performed based on my training and experience in the proper function and maintenance of on site
sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of
Title 5(310 CMR 15.000).The system:
® Passes ❑ Conditionally Passes ❑ Fails
❑ Needs Further Evaluation by the Local Approving Authority
7/16/2013
Inspector's Signature Date
The system inspector shall submit a copy of this inspection report to the Approving Authority (Board
of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or
has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the
report to the appropriate regional office of the DEP. The original should be sent to the system owner
and copies sent to the buyer, if applicable, and the approving authority.
****This report only describes conditions at the time of inspection and under the conditions of use
at that time.This inspection does not address how the system will perform in the future under
the same or different conditions of use.
UjTd fi�113
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 17
' Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
M ' 625 Willow Street
Property Address
MALOUF, LEROY G &ANTOINETTE A
Owner Owner's Name
information is required for every West Barnstable Ma 02668 7/16/2013
page. Citylrown State Zip Code Date of Inspection
B. Certification (cont.)
Inspection Summary: Check A,B,C,D or E/always complete all of Section D
A) System Passes:
® 1 have not found any information which indicates that any of the failure criteria described
in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are
indicated below.
Comments:
The dwelling located at 625 Willow St West Barnstable is served by a Title V septic system consisting
of a 1000 gallon septic tank, distribution box and 2 1000 gallon precast leaching chambers. The
system was found to be in proper working condition at the time of inspection.
B) System Conditionally Passes:
❑ One or more system components as described in the"Conditional Pass"section need to be
replaced or repaired. The system, upon completion of the replacement or repair, as approved by
the Board of Health, will pass.
Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not
determined," please explain.
The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally
unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass
inspection if the existing tank is replaced with a complying septic tank as approved by the Board of
Health.
*A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of
Compliance indicating that the tank is less than 20 years old is available.
❑ Y ❑ N ❑ ND(Explain below):
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17
E
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
625 Willow Street
Property Address
MALOUF, LEROY G &ANTOINETTE A
Owner Owner's Name
information is West Barnstable Ma 02668 7/16/2013
required for every
page. Cityrrown State Zip Code Date of Inspection
B. Certification (cost.)
❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
B) System Conditionally Passes (cont.):
❑ Observation of sewage backup or break out or high static water level in the distribution box due
to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will
pass inspection if(with approval of Board of Health):
❑ broken pipe(s)are replaced ❑ 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):
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
P P Y 9 9
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17
I
Commonwealth of Massachusetts
AML Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
M 625 Willow Street
Property Address
MALOUF, LEROY G &ANTOINETTE A
Owner Owner's Name
information is required for every West Barnstable Ma 02668 7/16/2013
page. CityrFown State Zip Code Date of Inspection
B. Certification (cont.)
2. System will fail unless the Board of Health (and Public Water Supplier, if any)
determines that the system is functioning in a manner that protects the public health,
safety and environment:
❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within
100 feet of a surface water supply or tributary to a surface water supply.
❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water
supply.
❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.
❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or
more from a private water supply well".
Method used to determine distance:
**This system passes if the well water analysis; performed at a DEP certified laboratory, for fecal
coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal
to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must
be attached to this form.
3. Other:
D) System Failure Criteria Applicable to All Systems:
You must indicate"Yes" or"No"to each of the following for all inspections:
Yes No
❑ ® Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less
than Y2 day flow
t5ins•3!11 3 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17
f
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M , ' 625 Willow Street
Property Address
MALOUF, LEROY G &ANTOINETTE A
Owner Owner's Name
information is required for every West Barnstable Ma 02668 7/16/2013
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
Yes No
❑ ® Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped:
❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation.
❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supply.
❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well.
❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well.
❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. [This
system passes if the well water analysis, performed at a DEP certified
laboratory,for fecal coliform bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria are triggered.A copy of the analysis
and chain of custody must be attached to this form.] .
❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd-
10,000gpd.
❑ ® The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 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.
For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the
questions in Section D.
Yes No
❑ ❑ the system is within 400 feet of a surface drinking water supply
❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply
❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection
Area—IWPA)or a mapped Zone II of a public water supply well
If you have answered"yes"to any question in Section E the system is considered a significant threat,
or answered"yes" in Section D above the large system has failed. The owner or operator of any large
system considered a significant threat under Section E or failed under Section D shall upgrade the
system in accordance with 310 CMR 15.304. The system owner should contact the appropriate
regional office of the Department.
t5ins•3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 5 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
625 Willow Street
Property Address
MALOUF, LEROY G &ANTOINETTE A
Owner Owner's Name
information is required for every West Barnstable Ma 02668 7/16/2013
page. Cityfrown State Zip Code Date of Inspection
C. Checklist
Check if the following have been done. You must indicate"yes" or"no"as to each of the following:
Yes No
❑ ® Pumping information was provided by the owner, occupant, or Board of Health
❑ ® Were any of the system components pumped out in the previous two weeks?
® ❑ Has the system received normal flows in the previous two week period?
❑ ® Have large volumes of water been introduced to the system recently or as part of
this inspection?
® ❑ 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)]
D. System Information
Residential Flow Conditions:
Number cf bedrooms(design): 4 Number of bedrooms(actual): 4
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 gpd
t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
625 Willow Street
Property Address
MALOLIF, LEROY G &ANTOINETTE A
Owner Owner's Name
information is required for every West Barnstable Ma 02668 7/16/2013
page. Citylrown State Zip Code Date of Inspection
D. System Information
Description:
Number of current residents: 3
Does residence have a garbage grinder? ❑ Yes ® No
Is laundry on a separate sewage system?(include laundry system inspection ❑ Yes ® No
information in this report.)
Laundry system inspected? ❑ Yes ® No
Seasonal use? ❑ Yes ® No
Water meter readings, if available last 2 ears usage well
9 ( Y 9 (gpd)):
Detail:
Sump pump? ❑ Yes ® No
Last date of occupancy: current
Date
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
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available:
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17
f
Commonwealth of Massachusetts
o F Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
4 625 Willow Street
Property Address
MALOUF, LEROY G &ANTOINETTE A
Owner Owner's Name
information is required for every West Barnstable Ma 02668 7/16/2013
page. CityrFown State Zip Code Date of Inspection
D. System Information (cont.)
Last date of occupancy/use: Date
Other(describe below):
General Information
Pumping Records:
Source of information:
Was system pumped as part of the inspection? ❑ Yes ® No
If yes, volume pumped:
gallons
How was quantity pumped determined?
Reason for pumping:
Type of System:
® Septic tank, distribution box, soil absorption system
❑ Single cesspool
❑ Overflow cesspool
❑ Privy
❑ Shared system (yes or no) (if yes, attach previous inspection records, if any)
❑ Innovative/Alternative technology. Attach a copy of the current operation and
maintenance contract(to be obtained from system owner) and a copy of latest
inspection of the I/A system by system operator under contract
❑ Tight tank. Attach a copy of the DEP approval.
❑ Other(describe):
&ns•301 3 Title 6 Official Inspection form:Subsurface Sewage Disposal system-Page 8 of i 7
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
41M 625 Willow Street
Property Address
MALOUF, LEROY G &ANTOINETTE A
Owner Owner's Name
information is required for every West Barnstable Ma 02668 7/16/2013
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Approximate age of all components, date installed (if known) and source of information:
original system 1977
Were sewage odors detected when arriving at the site? ❑ Yes Z No
Building Sewer(locate on site plan):
Depth below grade: 1
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.):
Joint were ok, no leaks, vented through the roof
Septic Tank(locate on site plan):
Depth below grade: .5
feet
Material of construction:
® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain)
If tank is metal, list age:
years
Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No
Dimensions: 1000 gallons
Sludge depth:
6"
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17
i
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
625 Willow Street
Property Address
MALOUF, LEROY G &ANTOINETTE A
Owner Owner's Name
information is required for every West Barnstable Ma 02668 7/16/2013
page. CityrFown State Zip Code Date of Inspection
D. System Information (cont.)
Septic Tank(cont.)
Distance from top of sludge to bottom of outlet tee or baffle 3„
Scum thickness
3"
Distance from top of scum to top of outlet tee or baffle 611
Distance from bottom of scum to bottom of outlet tee or baffle
101,
How were dimensions determined? opened covers, took
measurements
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 does not need to be cleaned now but should be done soon and again every 2 years for proper
maintenance. water level was even with outlet, tank was not leaking and was structurally sound.
Grease Trap(locate on site plan):
Depth below grade: feet
Material of construction:
❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
Date of last pumping: Date
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
wM "r 625 Willow Street
Property Address
MALOUF, LEROY G &ANTOINETTE A
Owner Owner's Name
information is required for every West Barnstable Ma 02668 7/16/2013
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan):
Depth below grade:
Material of'construction:
❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Capacity: gallons
Design Flow: gallons per day
Alarm present: ❑ Yes ❑ No
Alarm level: Alarm in working order: ❑ Yes ❑ No
Date of last pumping: Date
Comments(condition of alarm and float switches, etc.):
Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No
t5ins•.3l13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
625 Willow Street
Property Address
MALOUF, LEROY G &ANTOINETTE A
Owner Owner's Name
information
required for every West Barnstable Ma 02668 7/16/2013
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Distribution Box(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.):
Distribution box was functioning as intended
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.
Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
t5ins•3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 12 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
�M 625 Willow Street
Property Address
MALOUF, LEROY G &ANTOINETTE A
Owner Owner's Name
information is required for every West Barnstable Ma 02668 7/16/2013
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Type:
® leaching pits number: 2x1000 gals
❑ leaching chambers number:
❑ leaching galleries number:
❑ leaching trenches number, length:
❑ leaching fields number, dimensions:
❑ overflow cesspool number:
❑ innovative/alternative system
Type/name of technology:
Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
leach pits were video inspected from the d-box with no sign of past hydraulic overloading
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
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
M 625 Willow Street
Property Address
MALOUF, LEROY G &ANTOINETTE A
Owner Owner's Name
information is required for every West Barnstable Ma 02668 7/16/2013
page. Citylrown State Zip Code Date of Inspection.
D. System Information (cont.)
Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
Privy(locate on site plan):
Materials of construction:
Dimensions
Depth of solids
Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
I
t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17
' Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
M 625 Willow Street
Property Address
MALOUF, LEROY G&ANTOINETTE A
Owner Owner's Name
information is required fcr every West Barnstable Ma 02668 7/16/2013
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to
at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate
where public water supply enters the building. Check one of the boxes below:
® hand-sketch in the area below
❑ drawing attached separately
�} ,+ `l
5D:b:,
l5ins-313 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17
' Commonwealth of Massachusetts
= u Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
625 Willow Street
Property Address
MALOUF, LEROY G &ANTOINETTE A
Owner Owner's Name
information is required for every West Barnstable Ma 02668 7/16/2013
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Site Exam:
❑ Check Slope
❑ Surface water
❑ Check cellar
❑ Shallow wells
Estimated depth to high ground water: 12'+
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-explain:
You must describe how you established the high ground water elevation:
Groundwater elevation was determined by accessing Town of Barnstable groundwater contour map.
I
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5ins•3/f3 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M 625 Willow Street
Property Address
MALOUF, LEROY G &ANTOINETTE A
Owner Owner's Name
information is required for every West Barnstable Ma 02668 7/16/2013
page. Citylrown State Zip Code Date of Inspection
E. Report Completeness Checklist
® Inspection Summary: A, B, C, D, or E checked
® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed
® System Information—Estimated depth to high groundwater
® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17
CERTIFICATE OF ANALYSIS Page: 1
Barnstable County Health Laboratory
'�sr�c itvcti�!
Report Dated: 6/5/2006
Report Prepared For:
Order No.: G0635618
LeRoy G. Malouf
625 Willow Street
W Barnstable, MA 02668
Laboratory ID#: 0635618-01 Description: Water-Drinking Water
Sample#: Sampling Location ":625 Willow St.West Barnstable,MA Collected: 5/31/2006
Collected by: LGM Map 130 Parcel32 Received: 5/31/2006
Test Parameters
ITEM RESULT UNITS RL MCL Method# Tested
LAB: Inorganics
Alkalinity 8.8 mg/L as CaCO 2.0 EPA 310.1 5/31/2006
LAB: Metals
Hardness 22 mg/L as CaCO 0.1 SM 2340B 6/2/2006
i
t r=a
LAB: Physical Chemistry
pH 6.2 pH-units 0 EPA 150.1 ;5%31/2066
Water sample meets the recommended limits for drinking water of all the above tested parameters., :-1 I
Approved By.
(Lab ire tc or)
RL = Reporting Limit
MCL=Maximum Contaminant Level
Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph: 508-375-6605
°j
y a CERTIFICATE OF ANALYSIS Page: 1
Barnstable County Health Laboratory
�ss�ritti;s�^/
Report Dated: 7/26/2004
Report Prepared For:
Order No.: G0426597
.LeRoy G.Malouf
625 Willow Street
West Barnstable, MA 02668
Laboratory ID#: 0426597-01 Description: Water-Drinking Water
Sample#: 2659701 Sampling Location[625 Willow St__ . West Barnstable MA.J Collected: 7/16/2004
I
Collected by: L Malouf neutralizer Received: 7/16/2004
i
(Routine
ITEM RESULT UNITS RL MCL Method# Tested
LAB: Inorganics
Nitrate as Nitrogen BRL mg/L 0.1 10 EPA 300.0 7/16/2004
LAB: Metals
i
Copper BRL mg/L 0.1 1.3 SM 3111 B 7/21/2004
Iron BRL mg/L 0.1 0.3 SM 3111B 7/21/2004
Sodium 1 _ 14 mg/L 1.0 20 SM 3111B 7/21/2004
LAB: Ph ysical'Chemistry
Conductance 190 umohs/cm 1 EPA 120.1 7/16/2004
pH 9.0 pH-units 0 J EPA 150.1*" 7/16/2004
Water sample meets the recommended limits for drinking water for all above tested parameters.
RL = Reporting Limit
MCL=Maximum Contaminant Level
Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph: 508-375-6605
Page: 2
CERTIFICATE OF ANALYSIS
y 7�
10 �
i
rrgrrus� Barnstable County Health Laboratory
Report Dated: 7/26/2004
Report: Prepared For:
Order No.: G0426597
LeRoy G.Malouf
625 Willow Street
West Barnstable, MA 02668
Laboratory ID#: 0426597-02 Description: Water-Drinking Water
Sample#: 2659702 Sampling Location 625 Willow St West Barnstable MA Collected: 7/16/2004 �
Collected by: L Malouf neutralizer water softener Received: 7/16/2004
'Routine
ITEM RESULT UNITS RL MCL Method# Tested
LAB: Inorganics
Nitrate as Nitrogen BRL mg/L 0.1 10 EPA 300.0 7/16/2004
LAB: Metals
I
I
Copper BRL mg/L 0.1 1.3 SM 3111B 7/21/2004
Iron BRL mg/L 0.1 0.3 SM 3111B 7/21/2004
Sodium 44 mg/L 1.0 20 SM 311113 7/21/2004
LAB: Physical Chemistry
i
Conductance 210 umohs/cm 1 EPA 120.1 7/16/2004
pH 9.1 pH-units 0 EPA 150.1 7/16/2004
Sodium level above the average.Those on a low sodium diet may wish to contact a physician.
Approved By:_
Director)
RL = Reporting Limit
MCL=Maximum Contaminant Level
Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph: 508-375-6605
Page: ,
CERTIFICATE OF ALYSIS
Barnstable County Health Laboratory
Repor* Prepared For: Report Dated: 07/13/2001
Order Number: GCRACEIVED
LeRoy G. Malouf
_625 Willow Street J U L 2 6 2001
West Barnstable, MA 02668
TOWN OF BARNSTABLE
HEALTH D
Laboratory ID#: 0110626-01 Description: Water-Drinldng Water
Sample#: 10626-01 Sainplina Location: 625 Willow St.,West Barnstable Collected: 07/10/2001
Collected by: LeRoy G.Mal "Barn Received: 07/10/2001
Routine
ITEM RESULT UNITS MC? Method# 'rested
LAB: IC Lab
Nitrates 4.5 mg/L 10 EPA 300.0 07/11/2001
LAB.Metals
Copper <0.1 mg/L 1.3 SM 3111B 07/12/2001
Iron <0.1 mg/L 0.3 SM 3111B 07/12/2001
Sodium 13 mg/L 20 SM 3111B 07/12/2001
LAB:Microbiology
Total Coliform Present P/A Absent P/A 07/10/2001
LAB. Physical Chemistry
Conductance 182 umohs/cm EPA 120.1 07/10/2001
pH 5.8 pH-units EPA 150.1 07/10/2001
Note: Recommended maximum contamination level exceeded due to presence of Coliform Bacteria. Nitrate level higher than
average. Monitoring is recommended two-three times per year to establish any upward trends.
Superior Court House, P®.Box 427, Barnstable, MA 02630 Ph: 508-375-6605
Page: 2
CIERTIFICAT E OF ANALYSIS
Barnstable County Health Laboratory
ry
Report Dated: 07/13/2001
Report Prepared For:
Order Number: G0110626
LeRoy G. Malouf
625 Willow Street
West Barnstable, MA 02668
Laboratory lm#: 011062&02 Description: Water-Drinlung Water
Sample#: 10626-02 Sampling Location: 625 Willow St,West Barnstable Collected: 07/10/2001
Collected by: LeRoy G.Mal House Received: 07/10/2001
Routine
ITEM RESULT UNITS MCL Method# Tested
LAB: IC Lab
Nitrates <0.1 -91L 10 EPA300.0 07/11/2001
LAB:Metals
Copper <0.1 mg/L 1.3 SM 3111B 07/12/2001
Iron <0.1 mg/L 0.3 SM 3111B 07/12/2001
Sodium 20 mg/L 20 SM 3111B 07/12/2001
LAB: Microbiology j
Total Coliform Absent P/A Absent P/A 07/10/2001
LAB: Physical Chemishy
Conductance 167 umobs/cm EPA 120.1 07/10/2001
pH 6,1 pH-units EPA 150.1 07/10/2001
Note: Water sample meets the recommended limits for drinking water of all above tested parameters.
Approved By: (Lab Director)
7113/2,00 1
Superior Court House PO.Box 427 Barnstable MA 02630 Ph: 508-375-6605
No........ ...... Fmic...�.`. �...........
THE COMMONWEALTH OF MASSACHUSETTS
L
BOARD OF HEALTH
/f 441........OF.......0".,V� 7",�gel zz.........................
Appliratioo -for Biipoottl Works Tomitrortioo Vrruift
Application is hereby'made for a Permit to Construct (' or Repair ( ) an Individual Sewage Disposal
System at:
' Ocation
t.Address
�tllr ..���9a
W f%� � 7✓.�fJ 4fl.za................•................... — -�--------S��II-�!\. ddre�....._.
Installer Address
d Type of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms.______l�`............................Expansion Attic ,(A/� Garbage Grinder W&V
Other—Type of Building�Ce_J/' .�. ! .o-- of pe-rsons....__.5_____________ Showers Cafeteria (V4�
Q' Other fixtures -•-•---------------------------- -
WDesign Flow............ ........................gallons per person per day. Total daily flow..........�,� __.____-__--_.-__...___-_.gallons.
WSeptic Tank—Liquid capacity/_V_gallons Length---------------- Width................ Diameter-----........... Depot...-______.__...
x Disposal Trench—,.No. ____?------------ Width-------------------- Total Length................. Total leaching area........_:_.-.......sq. ft.
Seepage Pit No.�-_`.21--_-_____ Diameter.... Depth below inlet----- Total leaching area.. .�v7---sc. ft
Z Other Distribution box (�) Dosing tank ( ) �ev/ 9
Percolation Test Results Performed by....e.-do.o-57....., ZMM6e............................ Date-_- c am~i� -----------
g
.4 'Test Pit No. 1._�___..__mrnutes per mch Depth of Test Pit....1�------- Depth toround water.Ao'0 L4"__.
a
rXq Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground
a
/ --fw`ate1r-_._-___.--__-______�__.�_.
----•-----•--•---------•--•----
!I 0 Descriptionof Soil_410a9_. �--
� � 9Z -----------------------------------•...............------ .
W ..................------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------
UNature of Repairs or Alterations—Answer when applicable______________ ______________________________________________________________________________
-•-•-------------------•-•------------------••------------------------------------••-•----.-.---•--•-•---•----------------•-----••-------------------•-------------- --------------------------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article NI of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by/1 e and of health.
/ /
Si e ---•-•-••...
ate
Application Approved B
` Date
Application Disapproved for the following reasons------------------------------------------------••------------------------------------------ --------------
-----•---------------- ----------•-----••-----------------------------------------------------------------------•-•-----------------...•---•----------------•-••--------•••--•._...------•-•---------.
Date
PermitNo......................................................... Issued........................................................
-,Date
71
No........ ....... ..........................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
0 F 0 ------------1111.............
Appliration -for Uigpviial Workii Tonstrurtion Vertu
Application is hereby`made for a Permit to Construct (M or Repair an Individual Sewage Disposal
System at:
6�...................................................................................................
A(Wres Location If or Lqllo-..d
;OL / le -
&e
Z, ------_---------
Owner Ad4ess
o-Oef ----------
----------------------------------------------
Installer Address
Type of Building Size Lot---------------_-----------Sq. feet
U
Dwelling—No. of Bedrooms-_ ;�------------------------------------Expansion Attic,QUA Garbage Grinder el�
Other—Type of of persons-----_5--------------------- Showers Cafeteriao)
Otherfixtures ..... ---------------------------------------------- ------------------------------------------------------------------------------------------------
Design Flow-----------:�. .......................gallons per person per day. Total daily flow---------!�/0_47-------------------_gallons.
9 Septic Tank—Liquid capacitv,/aZ�ogallons Length________________ Width............._.. Diameter__-_---.._... Depth__.-_--_-.----.
xDisposal Trench—,,No. .................... Width-__-_---_---__.--_-- Total Length-------------- ---- Total leaching area------------------..sq. ft.
Seepage Pit No. --------- Diameter....lAa. ----- Depth below inlet----/0--------- Total leaching area.-_mil_ V_sql ft.
Z Other Distribution box (/) Dosing tank ( ) /
Percolation Test Results Performed by----er� AlW17,1141V......7------------------- DateA�7:_? 7-4,
Test Pit No. I---Al;.-<--------minutes per inch Depth of Test Pit..--If--------- Depth to ground
(14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-_---.-.-__.-_-----.._..------------------------------------------------------------------------------------------------------------_------------ - ... . .
0 ---------------------
Description of - ------
J-7.....................t-------------------------------------------
U
---------------------------I--------------------------------------------------------------------------------------------------------------------------------------------------------------------------
-------------------------------------------------------------------------- ---------------------
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 Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issue I b at board of health.
S* rre ----- - ----------------------------------------------------------------
ate
ApplicationApproved By.....` ---- --- 4Ze N ------------- _13;7Z
_ K--—------------- Date
Application Disapproved for the following reasons:-------------------------------------------------------------------------------------------------------------
..............................................................................--------------------------------------------------------------------------------------------------------------------------
Date
PermitNo........................................................ Issued.---------------------.................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEAL H
1; OF.... A + .... .............................
IWITIrdifiratr of Tlimphattre
TH�I IS TO CERTIfY, That the Individual Sewage Disposal System constructed (1,14 Repaired
by.... ....................................:._1.................................................................. ..............................
Installer
a,--- -----------------------------------------------------------------------------------------
lias been installed in accordance with the provisions of A',e* XI of The State Sanitary Q,4e as d cribed in the
.................... ...
application for Disposal Works Construction Permit No.V�! X .. dated 17 ZAi-77-
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY. ? / 0
DATE--- ..... ....................... Inspector------4----------------------------------------
- ...............................
THE COMMONWEALTH OF MASSACHUSETTS
(,7- BOARD OF HEA.
L.T
7 ...... 15 ..�.. OF....... .6 j? ........ .......................
No......... .... FEE......= ........
%svvfiaTf 71ah-q ancrtrurtiou Prrntit
Permission is hereby granted_._...
------- -- - ------ ------- --------------------------------------------------------------------------
to Cons (6uo Re a�r a nd' i Sea,!aVsposal S stem,
t I
.it -e . ...
at N _ ------------ _4 -------
- --------------------
Street V/
/ ? /�,/' 7
as w sho' n on the application for Disposal Works Construction PrerfRit N ..... ......... .. Dated-e-.
--------- .... /---------------
--- ...........................
DATE---------------------- ........................ roar of Health 1;7
-----------
FORM 1255 HOE38S & WARREN. INC.. PUBLISHERS
F .,ti t .• _
<
13'
3�
o
° STA
L off" A �a
AcReS
qV
► .2.93
r 13 z3 E .�
30 0�, t/
sib aSo 9
ce ,.
1 HEREBY CERTIFY THAT THE PLAN OF LAND a STRUCTURE
•- STRUCTAME SHOWN HEREON-WAS LOCATED
< BY AN ACTUAL FIELD SURVEY ON 1 (: T A
., JT,0,,/1! 6.1977 AND CONFORMS TO THE' y
ZONING BY-LAW OF THE TOWN OF
8R1PNS7-A3j.e , MASSACHUSETTS. IN
W. 13ARNsrAl3L� , MASS.
REGISTERED LAND SURVEYOR
SCALE /e0 JAN,1977
OF ltlq`Ss\ C- say
t DATE
o� JAMEs CAPE COD SURVEY CONSULTANTS
H.
'o WIS',NELL "' A DIVISION OF BOSTON SURVEY CONSULTANTS,INC.
•p^1o.11 :.? p ROUTE 132
,t.
FGISTE� o� HYANNIS, MASS.
j, ti
ter.
625 w; 11o=w s�" —
LA _QT1.O_N j, 5 _Q,_c-�E PER MI 0.
1.1`►_ST L E-- - -► W,A—E-�-A-D DQE
DlaT-E PE-R_IsA T I-55-U-ED-
D ACE—C.O M.P_L_t_Q,.t`l
J Y�
�G
a
J Q>
No...�-3 l 4--------. ............
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
_ !1_..........OF............................... -------- ------------
A.ppliratinn -fur Di-gVaoul Works Cnowitrurtion Punift
Application is hereby made for a Permit to Construct (V10"or Repair ( ) an Individual Sewage Disposal
System at:
� tL � - -4a ---
'- :._ �_u T G ----------------------- ----- -------------------------_--------------
Location-Address or Lot No.
V.0- --
l i�.._.. ----------------------------- ---------------------- �''�F -------- ---.....--------------------- ................
' O ner Address
W -----•------------4VNjo�P, ----. ./9.c Y........................... ------------------------C�256-le.k,1Z --------
Installer Address
d Type of Building ;M Size Lot----------------------------Sq.' feet
U Dwelling—No. of Bedrooms----------- _ .........................-_..Expansion Attic 0/0 Gar>ge Grinder
aOther—Type of Building ---------------------------- No. of persons........J------------------ Showers ( — Cafeteria ( )
dOther fixtures ----------- •-•-----•--•--------------------------•--------------------------- -----•------.--•--•--••--•-•------------------------------------------
x Design Flow......................................... ..gallons per person per day. Total daily flow-----------------------------------........gallons.
P4 Septic Tank—Liquid c,,al acity�0Dd__gallons Length...� .' Width../w...... Diameter---------------- De)tll................
W Disposal Trench—No.-4_'�'_ _ idth--------_--------- Total Length.................... Total leaching area--.�---.-sq. ft.
x
Seepage Pit No..................... Di� er.................... Depth below ' le .... __........... Total leaching area------__-_____--sq. It.
z Other Distribution box ( ) Dosing tank ( ) - '® 2 V
Percolation Test Results Performed by-------- ----------------------------------------------------- Date------------------------------ --------
Test Pit No. 1__:__� ______ ..minutes per inch Depth of Test Pit____________________ Depth to ground water..-__-_-..__-_-__._.._
Test Pit No. 2________________minutes per inch Depth of Test Pit.................... Depth to ground water__.__--_________._____..
----------------------------- •-••---•----. ...--------- _---•-........
---•----------•---------- --- _ --
Lei - - - .........Descri t' n of Soil ° 71?.c��. .r. . N — .��A ---
---- ---- -...--
W Y
U a z
w +_- � � �d � � ' --� ------- ----------------
U Natur f Repai s or Alterat' rfs—Answer when applicable.__....) _ts'................. L�.�?.....:
--..----- ------------------
Agreement: ' C✓C
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article \I of the State Sanitary Code- The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has b en issued by the board o ealth. -y
Sign Wit'. �``� //Z 7
- ....
. .- Date "
Application Approved By---• ....�- o -� ----
/.q
Date
Application Disapproved for the following reasons----------------•---------- ---•---------------------------------------------------------------------------------
--••••-•-•-------•--------•---------•-------------------------------------••-•---------------•---•------------••-••--------...---------------------------------------------------•----------------------
Date
/' -7
Permit No.--•--•--•--•---•--.-•----•-----•-•-•----------------- t =- ----------------
Issued_--------
'
Date
No.13110............ Flms.. .......,_.............
THE•'COMMONWEALTH OF MASSACHUSETTS
,i
BOARD tOF HEALTH
O F. (
_... ......... --- --- -.-......._.
f{ lirmlion `for. 4 ispaii tl Works Tous#rurtion Vrrmft
Application is hereby made for a Permit to Construct or Repair,( ) an- Individual Sewage Disposal
System at
..................... .......................................
;
Location_Address or Lot No.
.417/ Jy tll�►Ja�i'Q..Atj- E............................................................
wne Address
r
w0�141?• li L' 1 �~. .....-- -
Installer Address
Q Type of Building Size Lot............................Sq. feet
____.-__Ex ansion Attic/A Garbage Grinder
Dwelling—No. of Bedrooms.-._.___ ___.....:............ P O) g
e of,Building a • Other—Type g -------------------=-------- No. of persons......1------------------- Showers Cafeteria ( )
PaOther fixtures ------------- # -0-------------------------------------•-•---.__.-_----------•------------
W Design Flow....................................A:___--gallons per person per da y. Total daily flow............................................gallons.
WSeptic Tank Liquid cap acit aQ _..gallons Length__�i.�_____ Width_/ ?'_. ..... lliameter___._..._______ D nh________________
x Disposal Trench—Nc __ �. idth____________________ Total Length________..._________ Total leaching area_:� :_____sq. ft.
a: Seepage Pit No_____________________ i .______._.__................... Depth below nl, .............. Total leaching area-------------------sq. ft.
z Other Distribution box ( ) Dosing tank
aPercolation Test Resul s Performed, bY,.--------------------------------------------------------------------------- Date_-=------------------------------------
Test Pit No. 1___U._____minut�s per inch -Depth of Test Pit---------------------Depth to ground water.-___.___________-__--
(s, Test Pit No. 2________________minutes per`mch Depth of Test•Pit.._._._.__.______._. Depth to ground water........._--------------
--------------------------I� -
- --------------=----•------•--- --- -- - - •-
0 Descrip •on of Soilj '/j 7A1t1 `raIf1 - 41
�
= -- -- ------------------------- -, . .::_.:._.
- U Natur of Repa' s or Altera isms—Answer when applicable._-___ Q.'_-__:__,___- d._.._ __ -:- ___--.. `-
------------------------ --
Agreement:.
The undersigned agrees to install the aforedescribed Individual. Sewage Disposal'System in accordance with
the provisions?,of Article XLof the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board 9filealth. X
siV ---- ----------------- -•-- ;;w
_ Date 5.1`
Application.Approved BY •,,,,� �;�/ ' ------------- ----- ` ' 7� '
• �• Date
k x' Application Disapproved for the following reasons;-
......................... ........-...................................................... ---•-•----------•---•
`.-------•--- ---••----•---------•--
Date
I
PermitNo._;.--•----------------------------------•- Issued------.................................................
Date
't THE COMMONWEALTH OF MASSACHUSETTS
`BOARD OF HEALTH
_...N,�,��; ;Lw
...........OF........ im""`� ! ........................
c
.. %Entif ira#r of f11nmpliaurr
TA '' �
IS T CERT,-"IFY, That the Individual Sewage Disposal System constructed {...�') `or Repaired
by.. c - --•------------------------------------------------ ---• -
4t e� staller1.
� ..
n �!
has been installed in accordance wifh the provisions of Article XI of T e State Sanitary Code as described in the
application for Disposal Works Construction Permit No--------_.7{- --/--- ----------- dated................................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE.............................................................-.................... Inspector......................................................................r.............
+'t THE COMMONWEALTH OF MASSACHUSETTS
BOAR/D� OF HEALTH
........... .. ....-...............-.........- ---------------- �.,.�►
...
NO.-- __ �y._._... FEE i�.T-- --/ �
Btriv>ali nr ii Tons#rurfifin ramit
Permission is hereby granted.......... _________ C____._____
to Cor'}ptruct,•( or Repair ( ) an Ir>�ividual Sewage D' posal Syst
at Nd"- T---f_1�----•--••--............. _.._...W..
Street '
as shown on the application for Disposal Works Construction in N ______ _____ __ ated___ f_" 7y_..__.
•- - -_---• -----
Board o Health
I ;
DATE.................---------------------------------------------------------•--•
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
, • 111
__-
SUED/VISION o f LAND in WEST BARNSTABL: ,MA5S. • ~^�+
P o,- °R EF7 TY OF °
E DI Tr1
5ca/e: /inch•60{eel - Ocroazc /8,1963
'I Eo. kELLOciC C/V/L E-/ .�
4Q Abe Wy//
/ ° P lb
9
f I,/ !,•'- w57 47 --- of-�� � g0 Ct to
J.. ...'o •c�/� .L• z"",o. `/3j�'s :e. �f 3A DF
CAP i
1F �kE t
D£RIrKe '2uYN
z
F Z
eRobcrl F/eux
O SFE C.1, ce. 4S3'32'4["E �gkx'
Remains gr 1
i a 2.7 ACR
D
V q
CA sa 1 1
8.6 UPLAND
iG�+Qo 7 Gf BJ:e � • 6� J� �i r�
L f
'4 11L1
9AO/ I�
� ISdG/•/d 7� y- Oa� 4O 5 i�i1i
/mod p0
r
�•� a a° ao'
OE ry � i
D rvGV 1
Dee -ao- -- no c-- --------
ooe0000•eo ,�•�oo 290.00 66.00
u p N
i rq
_ 12 I
MID CAPE �ry