HomeMy WebLinkAbout0164 MARSTONS LANE - Health 164 MARSTONS LANE
BARNSTABLE
A _ °350 031
:
IV
� 4 -
,
:
n " _.j
y �
ry
ry ., c .. .ter• ,,. '. .. .. w
r
i
k i
� t •
` a F
. •
♦
u ♦
,
•
r
L
.. Y
t "
.r
r r
•
u �• r M. .. a r _
b,
=v ra
Commonwealth of Massachusetts
Title 5 Official Inspection Form •
Subsurface Sewage Disposal System Form 1.Not for Voluntary Assessments
164 Marstons Ln
Property Address
Jeffrey Leib 529 Parker Rd Newton Ma. 02459
Owner Owner's Name
information is required for every Cummaguid Ma 02637 4-18-12
page. City/Town State Zip Code Date of Inspection
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way. Please see completeness checklist at the end of the form.
Important:When filling out forms A. General Information
•� I
on the computer,
use only the tab
key to move your 1. Inspector:
cursor-do not David J Burnie
use the return Name of Inspector '
key.
David J Burnie M9 mt Inc
I�11 Company Name
3 Perry's way
Company Address
Harwich - Ma.' 02645
City/Town State Zip Code
1-866-980-1440 SI 386
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 Moection. h'e inspection
was performed based on my training and experience in the proper function andtrxialntenan6 of onµsite
w W,':,
sewage disposal systems. I am a DEP approved system inspector pursuant,toSection_15.34"f ,
Title 5(310 CMR 16.000). The system:
® Passes ❑ Conditionally Passes ❑ Fails ._0
con
❑ Needs Further Evaluation by the Local Approving Authority
4-18-12 '
Inspe is Signatur 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.
LC
n. y 1:Z5 �7�
t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 17
r
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
,M 164 Marstons Ln 3
Property Address
Jeffrey Leib 529 Parker Rd Newton Ma. 02459
Owner Owner's Name
information is Cumma uid Ma 02637 4-18-12
required for every Q
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
Inspection Summary: Check.A,B,C,D or E/always complete all of Section D
A) System Passes: 4 .
® I have'not found any information which indicates that any of the failure criteria described
in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are
indicated below.
Comments:
The Property has been Vacant for 1 year+/- The system is a.1000 gallon septic tank a distribution
box and 2 500 gallon drywells.Installed and COC issued 10-1-01
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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
164 Marstons Ln
Property Address
Jeffrey Leib 5291 Parker Rd Newton Ma. 02459
Owner Owner's Name
information is Cumma uid Ma 02637 4-18-12
required for every q
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
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 o`r a salt marsh
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17
r
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
M 164 Marstons Ln
Property Address
Jeffrey Leib 529 Parker Rd Newton Ma. 02459
Owner Owner's Name
information is
required for every Cummaquid Ma 02637 4-18-12
page. Cityrrown State Zip Code Date of Inspection
B. Certification (cont.)
2. System will fail unless the Board of Health(and Public Water Supplier, if any)
determines that the system is functioning in a manner that protects the public health,
safety and environment:
❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within
100 feet of a surface water supply or tributary to a surface water supply.
❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water
supply.
❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.
❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or
more from a private water supply well**.
Method used to determine distance:
**This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal
coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal
to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must
be attached to this form.
3. Other:
D) System Failure Criteria Applicable to All Systems:
You must indicate"Yes"or"No"to each of the following for all inspections:
Yes No
® Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
❑ Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool .
❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less
than 1/day flow
t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17
r
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M 164 Marstons Ln
Property Address
Jeffrey Leib 529 Parker Rd Newton Ma. 02459
Owner Owner's Name
information is
required for every Cummaquid Ma 02637 4-18-12
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
El Area
system is located in a nitrogen sensitive area.(Interim Wellhead Protection
Area-IWPA)or a mapped Zone it 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 ti
regional office of the Department.
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17
l
Commonwealth of Massachusetts
Title 5 Official Inspection Form '
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
M 164 Marstons Ln
Property Address
Jeffrey Leib 529 Parker Rd Newton Ma. 02459_
Owner Owner's Name
information is required for every Cummaquid Ma 02637 4-18-12
page. Citylrown 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.
❑ _ ID 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 r -
Residential Flow Conditions:
Number of bedrooms(design): 3 Number of bedrooms (actual): 3
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd'x#of bedrooms): 330
t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 -
r
II
r
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
M 164 Marstons Ln
Property Address
Jeffrey Leib 529 Parker Rd Newton Ma. 02459
Owner Owner's Name
information is Cumma uid " Ma 02637 4-18-12
required for every q
page. Cityfrown State Zip Code Date of Inspection
D. System Information
Description:
1000 gallon Septic tank, distribution box and 2 500 gallon drywells. COC issued 10-1-01. System has
not been used for one year.+/-Information obtained at the BHD did not include a plan, but did include
a permit and coc for a new system installed in 2001,
Number of current residents: @ " Vacant
Does residence have a garbage grinder? ❑ Yes ® No
Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No
Laundry system inspected? Z Yes ❑ No
Seasonal use? " l ❑ Yes ® No
Water meter readings, if available (last 2 years usage(gpd)): yes
Detail: _
2010= 0 gallons............2011=66.000 gallons= 181god.................2012 0 gallons
Sump pump? - _ ❑ Yes ® ' No
Last date of occupancy: Date
Commercial/Industrial Flow Conditions:
Type of Establishment: {
Design flow(based on 310 CMR 15.203):
r, = Gallons per day(god)
Basis of design flow(seats/persons/sq.ft., etc.):
'`Grease trap'present? k ❑ Yes ❑ No
Industrial waste holding tank present? ❑ .Yes ❑ No
, • Y
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑- No
Water meter readings, if available:
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
164 Marstons Ln
Property Address
Jeffrey Leib 529 Parker Rd Newton Ma. 02459
Owner Owner's Name
information is Cumma uid ' Ma 02637 4-18-12
required for every q
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
4
Last date of occupancy/use: Vacant 1.year+/-
Date
Other(describe below):
Vacant
- General Information
Pumping Records: `
Source of information: None BHD
Was system pumped as part of the inspection? ❑ Yes ❑ No
If yes, volume pumped: 1000 gallons
gallons
How was quantity pumped determined? Truck site glass
Reason for pumping:. Maintenance -
Type of System:
® Septic tank, distribution box, soil absorption system
❑ Single cesspool
❑ Overflow cesspool -
s
❑ Privy
❑ Shared system(yes or no) (if yes, attach previous inspection records, if any)
❑ -_ Innovative/Alternative technology. Attach a copy of the current operation and
maintenance contract(to be obtained from system owner)and a copy of latest
inspection of the I/A system by system operator under contract
❑ Tight tank. Attach a copy of the DEP approval..
❑ Other(describe):
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 '
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
164 Marstons Ln
Property Address
Jeffrey Leib 529 Parker Rd Newton Ma. 02459-
Owner Owner's Name
information is required for every Cummaguid Ma 02637 4-18-12
page. Cityfrown State Zip Code Date of Inspection
D. System Information (coot.)
Approximate age of all components, date installed (if known)and source of information:
Permit date 6-29=01 COC date 10-1-01
r
Were sewage odors detected when arriving at the site? ❑ Yes ®' No
s
Building Sewer(locate on site plan):
"Depth below grade: 30.,feet
Material of construction:
❑ cast iron ®40 PVC ❑ other(explain):
Distance from private water supply well or suction line: 1
' feet
Comments(on condition of joints, venting, evidence of leakage, etc.):
Ok
Septic Tank(locate on site plan):
24"
Depth below grade: feet
Material of construction:,
® concrete ❑,metal ❑ fiberglass ❑ polyethylene-' ❑ other(explain)
Concrete baffles.
If tank,is metal, list age:
years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) . ❑ Yes'❑ No
Dimensions: ,
Sludge depth:
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17.
, t c
Commonwealth of Massachusetts
Title 5 Official, Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
164 Marstons Ln
Property Address
Jeffrey Leib 529 Parker Rd Newton Ma. 02459
Owner Owner's Name
information is
required for every Cummaquid Ma 02637 4-18-12
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Septic Tank(cont.)j
Distance from top of sludge to bottom of outlet tee or baffle -
1611
Scum thickness
3"
Distance from top of scum to top of outlet tee or baffle -
24"
Distance from bottom of scum to bottom of outlet tee or baffle ,
How were dimensions determined? ' Estimated
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Pumped for Maintenance. Tank should be serviced every 2 years
Grease Trap (locate on site plan):
Depth below grade: _ feet
Material of construction:
❑ concrete ❑ metal ❑fiberglass ,polyethylene El other(explain):
a
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-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17
ti
Commonwealth of Massachusetts r
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M 164 Marstons Ln
Property Address
Jeffrey Leib 529 Parker Rd Newton Ma. 02459
Owner Owners Name
information is
required for every Cummaquid Ma 02637 4-18-12
page. CityrFown 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.):
t
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: h 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•11/10 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
M 164 Marstons Ln
Property Address
Jeffrey Leib 529 Parker Rd Newton Ma. 02459 _
Owner Owner's Name
information is
required for every Cummaquid Ma 02637 4-18-12
page. City/Town 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 Normal
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.)`
none, minor roots. -
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.):
Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
Located and found dry
e
t5ins-11/10 Title 5 Official Inspection Form: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 y 164 Marstons Ln
Property Address
Jeffrey Leib 529 Parker Rd Newton Ma. 02459
Owner Owner's Name
information is
required for every Cummaquid Ma 02637 4-18-12
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Type: ,
❑ leaching pits number:
® 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.):
dry _
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-11/10 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
164 Marstons Ln '
Property Address
Jeffrey Leib 529 Parker Rd Newton Ma. 02459
Owner Owner's Name
information is Cumma uid Ma 02637 4-18-12
required for every 4
page. Cityfrown 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.):
dry
Privyn site lIocate o to
Materials of construction:
Dimensions
Depth of solids -
Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
E
t5ins-11/10 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
f
164 Marstons Ln
Property Address
Jeffrey Leib 529 Parker Rd Newton Ma. 02459
Owner Owner's Name
information is Ma 02637 ' 4-18-12
required for every Cummaquid
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
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17
i
t
i
i
s
i
Existing 1000
` gallon tank. fo
Existing Distribu ion
Box 2_New' 500 gallo
N Leaching
Chambers.
25 'X13 'X2 '
f
$ ' Dig out
Commonwealth of Massachusetts
Title 5 Official InspectionForm
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
164 Marstons Ln
Property Address
Jeffrey Leib 529 Parker Rd Newton Ma. 02459
Owner Owner's Name
information is Cumma uid Ma 02637 4-18-12
required for every 4
page. CityrTown State Zip Code Date of Inspection
D. System Information (cont.)'
Site Exam:
Z. Check Slope
® Surface water
® Check cellar
® Shallow wells
Estimated depth to high ground water: 19.80'
• 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:
t
You must describe how you established the high ground water elevation:
See last page of report. ground water using Town of Barnstable Form for Constuction with out plans.
dated 6-27-01
Before filing this Inspection Report, please see Report Completeness Checklist on next page. ..
t5ins•11/10 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.
164 Marstons Ln
Property Address
Jeffrey Leib 529 Parker Rd Newton Ma. 02459
Owner Owner's Name
information is required for every Cummaquid Ma 02637 4-18-12
page. Cityrrown 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
k '
. i
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17
i F
1
1
NOTICE: This Form Is To Be Used For the Repair Of Failed
Septic Systems Only.
CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL
WORKS CONSTRUCTION PERMTr (WITHOUT DESIGNED PLANS)
I, Joseph P.Macomber Jr., hereby certify that the application for disposal works
construction permit signed by me dated 6/2 7/01 concerning the
property located at 164 Marstons LaneA.9 �neets all of the
following criteria:
• The failed system is connected to a residential dwelling only. There"are no commercial or business
uses associated with the dwelling..
• The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch.
• There are no wetlands within 100 feet of the proposed septic system
• There are no private wells within 150 feet of the proposed septic system
• There is no increase in flow and/or change in.use proposed
• There are no variances requested or needed.
• The bottom of the proposed leaching facility will not located less than five feet above the
maximum adjusted groundwater table elevation. (Adjust the groundwater table using the Frimptor
method when applicable) .
• If the S.A.S. will be located with 250 feet of any vegetated wetlands, the bottom of the proposed
leaching facility will M be located less than fourteen(14) feet above the maximum adjusted
groundwater table elevation, ,
Please complete the following:
A) Top of Ground Surface Elevation(using GIS information)
B) G.W. Elevation + the MAX. High G.W. Adjustment.4,
Dl1TERENCE BETWEEN A and B
SIGNED : Zz DATE:6/27/01
(Sketc posed plan of system on back).
V:health folder cen
ti
-k' TOWN OF BARNSTABLE
LOCATION lGL� Mee-S�e3-1S SEWAGE # f `
VILLAGE du.m ev% A cA z`o ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE NO. �e
SEPTIC TANK CAPACITY
r
LEACHING FACILITY: (type)..1 CO-94(S (size)
NO. OF BEDROOMS Olt,-
BUILDER OR OWNER
PERM, ITDATE: c�`j- I COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility (If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by
Y
� I
� a
;59 r
;k e
50.00/
i/
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer. Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
f ltlftcattan for Mtgpogai Orztem Congtructton Vermtt
Application for a Permit to Construct( . )Repair kXX)Upgrade( )Abandon( ) O Complete System O Individual Components
Location Address or Lot No.1 6 4 Marstons Lane own s Name;Address and TeL No. - —
Cummaquid,Mass.02637 j Join & Pauline Shanahan
Assessor's MaplParcet �-�j �/ 164 Marstons Lane Cummaquid,Mass.
Installer's Name,Address,and Tel.No. 5 0 8-7 7 5-3 3 3 8 Designer's Name,Address and Tel.No. 5 0 8-7 7 5-3 3 3 8
J.P.Macomber & Son Inc. J.P.Macomber & Son -Inc.
Box 66 Centerville,Mass.02632 Box 66 Centerville,Mass.02632
Type of Building:
Dwelling XXNo.of Bedrooms XX 3 Lot Size sq.ft. Garbage Grinder( )
Other Type of Building - No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow 3 5 5 gallons.per day. Calculated daily flow 3 X 1 1 0=3 3 0 gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Existing 1000 Type of S.A.S. Sob
Description of Soil
11' x 3Z`x 3` ('`'l�'sin -�
Loamy sand to clay 3 'clean fine sand.
Nature of Repairs or Alterations(Answer when applicable)Adding two 500 ga 1 1 nn 1 Pach i ng
chambers to an existing septic system.Dig out will take place. 5' all-
around and under. .
Date last inspected: '
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the vironmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issue4by this f th.
Signed Date6/2 7 1-01 '
Application Approved by Date
Application Disapproved or a following reasons
Permit No. •" " Date Issued
THE COMMONWEALTH OF MASSACHUSETTS,
BARNSTABLE, MASSACHUSETTS
(Certiftcate of Comphance r..
t" THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed,({ )Repaired(XX)Upgraded
Abandoned( )by J.P.Macomber & Son Inc.
at 164 Marstons Ave Cumma uid Mass, h been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No CV1 — dated l
Installer J.P.Macomber & Son Inc. Designer J.P.Macom er & Son Inc.
The issuance of this permit shall not be construed as a guarantee that the sy`ste will funeti n as desi ned. ;
�,.
Date J I�- �- L 1 Inspector t
Fa.$ 50.00.
No. oy�� Fee$ 5 0.0 0
Entered in computer:
THE COMMONWEALTH OF MASSACHUSETTS Yes �>
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
2pplication for laiooml &p-tent Conotructton Permit
Application for a Permit to Construct( . )Repair OIX)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. 164 Mars tons Lane Own is Name,Address and Tel.No. — —
Cummaquid,Mass.02637 J0 n & Pauline Shanahan
Assessor'sMap/Parcel �j—b 31 164 Marstons Lane Cummaquid,Mass.
Installer's Name,Address,and Tel.No. 5 0 8—7 7 5—3 3 3 8 Designer's Name,Address and Tel.No. 5 0 8—7 7 5—3 3 3 8
J.P.Macomber & Son Inc. J.P.Macomber & Son Inc.
Box 66 Centerville,Mass.02632 Box 66 Centerville,Mass.02632
Type of Building:
Dwelling XXNo.of Bedrooms RX 3 Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow 3 5 5 gallons per day. Calculated daily flow 3 X 1 1 0=3 3 0 gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank E x i s t i ng 1000 Type of S.A.S. � 3 32 IX 3 i W 1��Sin
Description of Soil;
Loamy sand to clay 3 ' clean fine sand.
Nature of Repairs or Alterations(Answer when applicable) Adding two 13 0 0 ga 1 1 nn 1 Parh i n�_
chambers to an existing septic system.Dig out will take place. 5 ' all
around and under.
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the E vironmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issue by this ar f lth.
Signed Date 6/2 7 PP1
Application Approved byZ_ W9WDate
Application Disapproved or Ke following reasons
Permit No. Date Issued
f
�01 r x�.
7` Fee '
THE COMMONWEALTH OF MASSACHUSETTS 'Entered in computer: -----"
s r. i ti Yes
�} PUBLIC HEALTH DIVISIO_N,.rlTOWN OF BARNSTABLE, MASSACHUSETTS
Z plication for AiopoAA *p 6tem Construction-Permit
Application for aPermit to Construct( , )Repair(XX)Upgrade( )Abandon El Complete System ❑Individual Components
Location Addressor Lot No. 1 6 4 Marstons Lane Owner's Name,Address and Tel.Nop U 8—3 6 2—4 0 2
Cummaquid,Mass.02637 John & Pauline Shanahan
Assessor'sMap/Parcel 1 164 Marstons Lane Cummaquid,Mass.
Installer's Name,Address,and Tel.No: 5 0 8-7 7 5—3 3 3 8 Designer's-Name,Address and Tel.No. 5 0 8—7 7 5—3 3 3 8
J.P.Macomber & Son Inc. J.P..Macomber & Son Inc.
Box 66 Centerville,Mass.02632 Box 66 Centerville,Mass.02632
Type of Building:
Dwelling X)To.of Bedrooms 2X 3 Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons r iI :" '� Showers( ) Cafeteria( )
Other Fixtures "
Design Flow 3 5 5- ' T' r_ i gallons per day. Calculated daily flow 3 X 1 1 0=3 3 0 gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Existing 1000 Type of S.A:S. # 5O Ql Slw� t S
i
3z, l�'s ,
Description of Soil x X 3 w
P
Loamy sand to clay 3 'clean fine sand.
Nature of Repairs or Alterations(Answer when applicable) Adding two 500 gallon leaching
chambers to,.an existing septic system.Dig out will take place. 5' al`l
around and under.
Date last inspected:
Agreement: "
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the E vironmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issued this ar}�>`f ealth. ,t
Signed ! �1 w i Date 6/2 7,(!O 1
y r
Application Approved by t/ a �i��1/I�t/] i _ Date l rIY/
Application Disapproved- or tKie following reasons I v
Permit No. ''" •� ''` Date.Issued
——————————————————————---------- -
-------
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal System,Constructed( )Repaired(XX)Upgraded( )
Abandoned( )by J.P.Macomber & Son Inc.
at- 164 Marstons Ave Cumma uid Mass. has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No Q7 `' V ated '-2 p'—;Kg0 K
Installer J.P.Macomber & Son Inc. Designer J."I. acorn er & Son—Inc.
The issuance of this permit shall not be construed as a guarantee that the s},''ste }will function as desi ned.
Date j 0- I- (A Inspector
----------------------------------------
No. �G�-- 7 Fee 5 0.'0 0� .
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE. MASSACHUSETTS
oiopo.qar *pgtem Conotruction Permit----
Permission is hereby granted to Construct( )Repair(X13 Upgrade( )Abandon( )
System located at 164 Marstons Lane Cummaguid,Mass l
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 ollowing local provisions or special conditions.
Provided:Construco
must be co Meted within three years of the date of this pe 't:Date: / Approved by� l /
_ ,• JI
l/6/99
NOTICE: This Form Is To Be Used For the Repair- Of Failed
Septic Systems Only. ..
CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL ,
WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS)
I, Joseph P.Macomber Jr.', hereby certify, that the application for disposal works
construction permit'signed by me dated- 6/2 7/01 ;,concerning the
1'64 Marstons Lane - c�
property located at . U A'-N A y'f-/Aeets all of the
Mowing criteria:
• The failed system is connected to a residential dwelling only. There are no commercial or business
uses associated with the dwelling,
• The soil is classified as CLASS I and the percolation rate is lesstlUmn or equal'to 5 minutes pei inch. _
}
• There are no wetlands within 100 feet of the proposed.scpdc system
• There are no private wellswithin 150 feet of the proposed septic system -
• There is no increase in flow and/or change in use proposedl'
• There are no variances requested or needed.
• The bottom of the proposed leaching facility will not be located less than five feet above the
maximum adjusted groundwater table elevation, (Adjust the groundwater table using the Frimptor
method when applicable) • .
• If the S.A.S. will be located with 250 feet of any vegetated wetlands, the bottom of the proposed
leaching facility will not be located less than founcen(14) feet above the maximum adjusted-
groundwater table elevation,
Please complete the following:
• r �A) Top of Ground Stu°face'Elevation(using GIS information) °
B) G.W. Elevation ."� S +the MAX. High G,W,'Adjustment
D=RENCE'BETyVEEN A'and B
SIGNED : ti DATE:6/27/01
(Sketc posed plan of system on back).
Q:health folder.cent
i
I
4
Existing 1000
gallon tank.
Existing Distribu ion
Box 2-New 500 gallo
N Leaching
Chambers.
25 'X13 'X2 '
V Dig out
r i, x�-_i:.�,�Z - •�..zz�.a.t:.y asE OWN
"O
;. F$ARNSTABL WIN
LOCATION l_GL� MAe�Sk SEWAGE #
,. VILLAGE,.�t� M (,7 at n, ` " ASSESSOR'S MAP & LOT .�
INSTALLER'S NAME&PHONE NO.
"SEPTIC'TANK CAPACITY
LEACHING FACILITY: (type) (size)
NO:OF BEDROOMS 1jh -uL l�
I BUILDER OR OWNER
DATE. O
PERMITDATE ,I
. `j ...:,� COMPLIANCE DA ��--I
Separation Distance Between the:
Maximum Adjusted Groundwater'Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site,or within 200 feet of leaching facility] Feet
Ed e'of Wetland and Leac "n Fa"
lu cili If ari wetland
8
s exist
°wrLl:dn 300 feet of leachin facile Feet
8 ty�
Furnished by
-- — -- -
T ,
4_
f th a
r tc� Yf r
r^1
, � 110 0 \.�
LOCATION SEWAGE PERMIT NO.
°{
VILLAGE
CC'w, .-weq, ��`�
INSTAL/LER'S NAME & ADDRESS
5-8-
e UIIDE R OR OWNER
0
D, 3sLG1 V1.4 y
Yl;2 .s-/
DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED
.. _-_
/ / J h
r�� Y,
� - �;
�� /-wvs�
, .
z3� 3d.
vJ ����L' �q _
��
a
N' PG� 1�Jt�X
OP
s�
No........ .... Fps......
.. ...............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH SUBJECT To
SARNSTABLE APPROVAL OF
----------------��.<(.t!P .......... CONS
0F..............Z.1
i(,r{,r{ ......---•--.......
COPIMISSICP
Appliration fnr Diipnsal Works Tnnstrnrtion Permit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal h
System at: "F .
................_................................................................................ .......... L,R�✓ --- t.
ILocation-Address or•Lot No.
L..............................................................Jt'}n!
Owner Address
a !_'r fi�oLM l£ ..�f.✓JR-M_ AJ 6 `0 -------------------------------•--•-•........•---
Installer Address
UType of Buildin 3 Size Lot___________________________Sq. feet
Dwelling No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder QV6
a
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
1 Other fixtures --------------- --------------•-----------------------••--------------------------------------•-._-.._----------------------•-•----------•--•-•-----
W Design Flow------SJ ...........................gallons per person per day. Total daily flow......... 2.0......................gallons.
WSeptic Tank f-Liquid capacity.I.COgallons Length................ Width................ Diameter................ Depth................
Disposal Trench—No..................... Width:1t?..&........_ Total Length....;_k_...... Total leaching area....jjU.2 _...sq. ft.
Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing to ( ) n
Percolation Test Resul Performed by.._.a�'C-- !�,1.� � iy...-. _____ Date_. c 3_ '-__1f__..1..
,tea Test Pit No''l r'...._._minutes per inch Depth of Test Pit.................... Depth to ground water...
1�1 ....rK.
w Test Pit No. 2_._=.............minutes per inch Depth of Test Pit.................... Depth to ground water........................
9 ..................................;...,......................................................................................................................
0 Description of Soil.......z__A2D-.....1_!°....A-112...........L:7 5-..•..02 ° �D '�6 ntM Dfyn- rti
U -••---•-•••••-•------••••-------._...•---•------•-••---•-••-----------------------•-----•--......-------•----.-•••--•-•------•------------------•••••-------•--•------------•--------••---__._._
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 TITi";::. 5 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 the board of health.
Sied....... . •------•--....•--••-----------------------------•--•-•••--------....._..__
Date
Application Approved B 4 Date
Application Disapproved for the following reasons:.............................................................................................................
-•--------------•----.....--------•------....-•--••••••------•-•-•--•••---------......-----•-•••••-----...-•-•--•--------••----••------•---------...-•--•••-------------• ...............................
Permit No......................................................... Issued-•-- `l:_"°2=•-f- {
Date
4
No.. ........ .................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
............ ....................OF..........................................................................................
Appfiration for Uhipoiial Work,6 Tongtrurtion Prrmit
Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal
System at:
4.0
o Ivs le-je-
Location-Address or Lot No.
ba j q J.'r L _&4��LM ................................................ ..................................................................................................
I .# a jo Owner Address
K 0-
.......................T ... ..........................................
.j.JD...................................................
14 Installer Address
U
Type of BuHi Size Lot............................Sq. feet
%-
Dwellin;FNo. of Bedrooms...... 3................................Expansion Attic Garbage Grinder
Other—Type of Building ............................ No. of persons............................ Showers Cafeteria
Other-fixtures ......................................................................................................................................................
Design Flow.._ S..5..............................gallons per person per day. Total daily flow___....... 31 .......................gallons.
acityi.41—M.gallons Length................ Width................ Diameter... Depth..............1.9 Septic Tank Liquid cap ..........
W f
Disposal Trench—No.._...I.....I............. Width-0_4........... Total Len th....3.1p........ Total leaching area_4V.
Z 9 ZZ.....sq. ft.
Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. f t.
Z Other Distribution box Dosing to ( : )
C
Percolation Test Resu -k P - Y.
X '0. Date.a.]�*t6l----- ------------
,�ts Performed b�
Test Pit No. 1. ..Minutes per inch Depth of Test Pit.................... Depk\to ground/ ater.. 0,7
(Z4 Test Pit No. 2................minutes per inch Depth of Test Pit.__................. Depth tb, round water.__.........:.......____
04 .....................................I.........................................................................................................................
0 Description of Soil...... rA.0......rR....Ah,
...........4+X......a X&..:n... e�ur
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 TITLE, 5 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 the board of health.
Si T ed........ --------------------------------------------------------------------------- --------------------------
Date
Application Approved By..... ......Ic . ..
.......... ....�
...... ...... y ..........
Date
Application Disapproved for the following reasons:..............................................................................................................
.........................................................................................................................................................................................................
Date
PermitNo...................................................... Issued......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD 0.�4 SALT
�t1�?'
............OF............ ....te. .............
Tntifirate of Tomphaurr
T I CIS TO C T Y, That the Individual Sewage Disposal System constructed or Repaired
by 4 ... .............................. ............ ............................
n...........
s
at... � --!•---�---�.!���!•�'"'
has been instilled in accordance with the provisions of TO 5 of The State Sanitary Code as d 'bed in the
application for Disposal Works Construction Permit No. I . ................................ dated------ .............................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WIL FUNCTIOPI, SATISLFACTORY.
DATE
Inspector...... ... ..................................................................
............. .......c�..... ......--------
A
. . THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF
0_0 ........ ...... ..... HEALT
.............. OF......... FEE.2
............ . .. ...... . ....... .
Raposal or ttatrpion unfit
Permission is
a ..... hereby . .a..... ....... � ,....7�V-VA..O......-..0.V......-
..-....................I..d......a....l..-.A..l.....................................................................
to Const r ir an Ind*kidu I Sew. Dispos System .....
Street .
as shown on the application for Disposal Works Construction Perm No Dated... .............
Atleglee...................................
Board of Heayl"
DATE...... 7'51
7--- ..................................................
FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS
N Y
i ' � •M
It
�a
41
P l i-777�151-
-40
M »!At � iN yY � _.� --,T L!,@d_r►r � �, �1..� 1 1 t 1 _ �c4
77
,.,�1!' .�T t�� �._ ti—_._s:-_,._.,�;�:�._. FOVtJ�P,'1-;�p3 •�_. ., - r ... .. r ; --trTMr•
'yA ETCI K RLA�! n� �i� A.ti.�i !P,' � f��Z��
e
Fo
LOT /a A� . Eai�WA�^ 0�1 A.- PIAK 04: l.A1JD DATC..1
k;m 19Cx8 V-6K- LOPAlAA/-zISIP P-CAL_'T`Y t"R.� r .tom. _RTEa E�.iG►►al� R1wt i "« w
+� A�i3AR.Y',5, t9•`t q - . ,�CJIL:�-�t�,�r� � 2�
:i • MR*C14 s kq T
� r r � 2 ET Y � �•� : fy; �
-14
* It�T'c_.:x tom.,-_r�.i,p,Y•-'�J F:S S�'lO W►.� �d'�' ' /��'l=� I►.1 �G- A Q�Y+C Iv•d'•L'• ..t „r7 C`i
1 1 ....
t ` _
&;F—wr l3A.r<Qti ;T,d.KL _
4 t
Y
tv
Lit LA,Y
4
� T" P�Y'�i • .s i�
L _7r d
J< ,
SW MAW
FL
)9 7?
. '!T ,a.�{. r74'�- {.' r'a Y. lLk-- i�{1- g� !' •.'�y, a,�
' - r�`1•'�. 2lt,4+f.rR�r 1'`�.�w n rs G•',tf' - :Y. y�tF}' - r"��l'_ 'A '.s .•S!'�. rT�,
_� ✓,Ne+ L► �?Y YA' f .ir." e .1 f t f �`
ri ' �• ".�-� '�Fi.� f
T.
� t; ^4'•'= y ;.fit-� �Ak��:,-� r�Yfi :`�5� �p.:
�' .E� t, : ,7 + Frw • �,*�•f
'ice + '`� r i: �+ Z/ 1�p"`'' ( ; , _ ^.r.�,•� + 1M;, 4€O A w ' ., • 4
�Y;" -.� , Yr 'yP. i �-„f4{., �r� '� t;q.'� �{w* 9.- �•uY'3r' - '�'•n�; - �`� �t� �, ��,. . �, ..
Rl
-47
law T
jw
Lj
ow
lit
�'+': � .. �• +�tJ�¢'.T� T`Y. p .r r+ iK;._,��r 'y: Fa 2";�.; � '4. '..#' .t', -. �,r
, �?'--•� Imo. ;f � ,+ ,. `T Y ,. �.+'�.- .� c,.a,f
�4+ *a F 3� � t��, � �.. ,(� + r �� �d r r•a Y_ i; y �-� .��r1�`�•,,'s�,�� ••r .
d: ''X, #�s•• _, :,R'. •. r .+ ;, �.'��, � c -s,`-r .,lT _., �. r•A6� "° !g'.`:l''+C. ': ` '� .
_ �.,-- -
` -- 9 p
Ili j�� � �- • ----*-_ _ ,� ,;.,., �_" � �J ,
! 4t
•, � �. 1-.- "..�... t-..fir--�
«, L)k aw 137
. . --,..
uww ��