Loading...
HomeMy WebLinkAboutTitle V Inspection Report - 2001 SALEM STREET 12/11/2017 | � ������������ ����K�����nV�ea�h of Massachusetts w���~�"��� ~�°� Title 5 Official Inspection Form Submu �uu �� a�aQ���o��| @y�t�mnFprnl - NotfnrVo|un�oryAa�eeonnantoTD�0�FNORTHANDQV�� � vv ' HE�LTHQEPART�ENT 2001 Salem Street Property Address 'Isaac Blanchard Owner Owner's Name information is required for North Andover Mo 01845 11/15/2017 ----- every pmgu. City/Town State Zip Code Date o{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 mfthe form. Important: A. �������K k��m����t~K�n vvhen�|Ungou* ~~~ General Information = forms onthe computer, use 1. Inspector: only the tab key mmove your Dean Dynan oumur-dunot use the return ''~^'~`^^'~"~~~' _', ----------- Company Name 2 Sunt* Gtreat Company Address Ma 01940 City/Town State Zip Code 508-726-9835 ' S112837 Telephone Number License Number B. Certification | certify that | 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. U am e DEP approved system inspector pursuant hoSection 15.340 of Title 6 (310 CMR 15'000). The system: �O Poseaa Conditionally Passes Fl Fails �] Needs Further Evaluation by the Local Approving Authority I�sp16ctor'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 o design flow of 10.000 0pd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DER The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. °^°°TM/s report only describes conditions atthe time of inspection and under the conditions of use a1that time. This inspection does not address how the system will perform in the future under the same wrdifferent conditions oyuse. ^om"'o,x Title nOfficial inspection Form:Subsurface Sewage Disposal System'Page,u,r . Commonwealth of Massachusetts R7 Title 5 Official Inspection nspecionForm Subsurface Sewage Disposal SystemnFmrnn - Nnth»rVn|untoryAsoessmenCs 2001 Salem Street Property Address Isaac Blanchard Owner Owne/aNem� information is required for North Andover Ma 01845 11/15/2017 every page. QtyfTmwn State Zip Code Date ofInspection B. Certification (cont.) Inspection Summary: Check AvB.C.DurE/always complete all ofSection D A> System Passes: | have not found any information which indicates that any ofthe failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: 4 bad single family dwelling with system in working order B) System Conditionally Passes: One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The ayatem, upon completion of the replacement or repair, as approved by the Board ofHealth, 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 immetal and over 2Oyears old* orthe septic tank(whether metal ornot) ie structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will peao inspection if the existing hank is replaced with a complying septic tank as approved by the Board ofHealth. ^ A metal septic tank will pass inspection if it is structurally sound, not leaking and if Certificate of Compliance indicating that the tank ialess than 20years old is available. [l Y N NO (Explain below): t5i" .ano Title nofficial Inspection Fo=Subsurface Sewage Disposal System'Page rofo Commonwealth of Massachusetts u = Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 2001 Salem Street Property Address Isaac Blanchard Owner Owner's Came information is North Andover Ma 01845 11/15/2017 required far _ ......___... _ every page, Cityfrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont,): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): [❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): i ❑ 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: 7 ❑ Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3113 TRW 5 official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts .... W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 2001 Salem Street Property Address Isaac Blanchardw Owner . ......_..__ .___....__ __ Owner's Flame information is North Andover Ma 01845 11/15/2017 requiredfar . ....._.w. ... ._._...._.. „.a_...._.._.___�_.... .__. every page. CityfTown 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 ❑ z Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Z Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System�Page 4 of 17 Commonwealth ofMassachusetts 0�ff=cia0 Inspection Form tN� 5 u Subsurface Sewage Disposal System Form ~ Not for Voluntary Assessments � � 2001 Salem Street Property Address Isaac Blanchard Owner Owner's Name information is required for North Andover K8o01845 11/15X�O1� � � every page. CityfTmwn State Zip Code Date ofInspection B. Certification /OODt.\ Yes No [l D� Required pumping more than 4U 88 m�a /nUl� |oc�yeo[ OTdu8hoc|oggedOr �� "� obstructed pipe(s). Number oftimes pumped: [l �O Any portion of the SAS, cesspool or privy is below high ground water elevation. [l �B Any portion ofcesspool nrprivy iswithin 1OOfeet ofa surface water supply or tributary toasurface water supply. El M Any portion nfecesspool orprivy iswithin oZone 1nfapublic well. [l El 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 ifthe well water analysis, performed mtmDEP certified laboratory,for fecal coliform bacteria indicates absent and the presence ofammonia nitrogen and nitrate nitrogen isequal tmorless than 5 ppm, provided that nmother failure criteria are triggered. Acopy nfthe analysis and chain ofcustody must bmattached to this form.] �� �O Theaystemiaaoesgpmn| servingefaoi|ityvv|thmdes|gnf|owof2DO0gpd- `� "~ 10.000gpd. Fl �� The system falls. | have determined that one ormore ofthe above failure criteria exist mndescribed in 310 CMR 15.303. therefore the system fails. The system owner should contact the Board ofHealth bodetermine what will be necessary tOcorrect the failure. E) Large Systems: Tohmconsidered mlarge system the system must serve afacility with a design f|mvx of 10,000 Qpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions inSection D. Yes No F1 El the system iewithin 4OOfeet ofasurface drinking water supply El Fl 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—|VVPA) oramapped Zone || cf apublic water supply well If you have answered "yes" to any question in Section E the system is considered maignificmnt thraat, oranswered "yes'' inSection Dabove the large system has failed. The owner oroperator ofany 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 ufthe Department. � � Commonwealth ofMassachusetts ` ficial ciaN Nnsecion Form Title 5 Of Subsurface Sewage Disposal System Form ~ Not for Voluntary Assessments 2001 Salem Street pmpedyAdaress Isaac Blanchard Owner Owner's Name information is required for NorUo4ndover Ma 01845 11/15/2017 every page. City/Town State Zip Code Date n[Inspection | � C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yeo No N El Pumping information was provided bythe owner, occupant, or Board of Health [l N Were any ofthe system components pumped out inthe previous two weeks? Has the system received normal flows in the previous two week period? Fl �� Hove 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 nnbs as N/A) N [l Was the facility ordwelling inspected for signs ofsewage back up? Z Fl Was the site inspected for signs Of break out? E [l Were all system components, excluding the SAS, located onsite? �� [l Were the septic tank manholes uncovered, opened, and the interior ofthe tank inspected for the condition of the baffles or tees, material of construction, dimenVionn, depth of liquid, depth of sludge and depth of scum? Was the facility owner/end occupants ifdifferent 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: Z 1:1 Existing information. For example, a plan at the Board of Health. �� Fl Determined in the field (if any of the failure criteria related to Part C is at issue approximation ofdistance isunacceptable) [310CMR 15.302(5)l D. System Information Residential Flow Conditions: 44 Number ofbedrooms (design): -------- Number 0fbedrooms kaobua0: -------'-- DESIGN flow based un310CMR 15.2OO (for example: 1108pdx#ufbad440 GPD --------- ,sm.unu Title nOfficial Inspection Form:Subsurface Sewage Disposal System'Page om1/ Commonwealth of Massachusetts u Title Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ' 2001 Salem Street Property Address Isaac Blanchard _ ...... ,,., .- Owner ----- Owner's Name f Information is North Andover Ma 01845 11/15/2017 required for ___...__..._ -__— ....__ _......____ _.-_-- �. every page. Cityfrown State Zip Code Date of Inspection D. System lni'urn-elation 1 Description: 4 bedroom single family dwelling 1500 ballon tank with infiltrator field 14.2'X 48' Number of current residents: 8 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes [9 No information in tIiis report.) Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter r, .ir9ings, if available (last 2 years usage (gpd)): well water _ — Detail: well water Sump purl)p? ❑ Yes ® No Last cl,)le of occ;tl 7anc occupied I Y� Date Cornmercial/Industrial Flow Conditions: Type of Estah!i,hr-nent: Design flow (kJ�(A on 310 CMR 15.203): Gallons per-day(gpd) _----- Basis of desit,ln flaw (sea ts/persons/sq.ft., etc.): Greaere trap pry.,< ,,nt? © Yes ❑ No Indr.lstiial w:1� I r>Ir.iing tank present? ❑ Yes ❑ No Non- sanitary <<. ,te discharged to the Title 5 system? ❑ Yes ❑ No Water meter I if available: .___.....__ t5ins-3113 Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Comrnon,,,,i(?,OI:t of Massachusetts Tit � ficial Inspection Form (5t Subsurface Sevv,-iqo Disposal System Form Not for Voluntary Assessments 2001 Salem Street -Properiy�Addiuss Isaac Blanch,, rd Owner Owner's N ,,, . information is required for North An,!or Ma 01845 11/15/2017 every page. City/Town State Zip Code Date of Inspection "','i nri a o n (co nt.) D. Sy.,�,, Last 0 of o(�, pancy/use: Date ----------------------- other elow): General Information Putnpl �wkw ,ids: Source: ok)kriination: Homeowner/ Board of Health tank pATpedafter inspection /regular service Was pnped as part of the inspection? El Yes 0 No If Yes, aped: gallons How v,, '"y pumped determined? —-------- Rease�, i, ii)ping: Type 1: ",eptic tank, distribution box, soil absorption system tingle cesspool E] I)verflow cesspool L Privy ,;iated system (yes or no) (if yes, attach previous inspection records, if any) innovitive/Alternative technology. Attach a copy of the current operation and iinintertance contract(to be obtained from system owner) and a copy of latest ;,asp( (,!ion of the I/A system by system operator under contract tank. Attach a copy of the DEP approval. F (A,,her (describe): t5ins-3113 Titie 5 official inspection Form:subsurface sewage Disposal system-Page 8 of 17 Commonwealth of Massachusetts u Title 5 Official Inspection Form = Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 4,v 2001 Salem Street ^l Property Address Isaac Blanchard Owner Owner's Name information is North Andover Ma 01845 11/15/2017 required for .__ _.._ _T___�...._ every page. CityfTown State Zip Code Date of Inspection D. System Information (cont.) j Approximate age of all components, date installed (if known) and source of information: installed per plan 2012 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 18" Depth below grade: feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet - Comments (on condition of joints, venting, evidence of leakage, etc.): buildin sewer in good condition no evidence of leaks Septic Tank (locate on site plan): 261" Depth below grade: feet _.-- Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) 1500 gallon concrete septic tank If tank is metal, list age: ___ �_......._ years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No 11" X5"$"X5'8"" Dimensions: 6" Sludge depth: 15ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts ' Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 2001 Salem Street ------------- Property Address Isaac Blanchard Owner Owner's Name information is required for North Andover Ma 01845 11/15/2017 every page. City/Town State Zip Code --- -----n D. System Information (cont.) Septic Tank (cnnL) 2�' O��noe�mb� ofo|u��� b��mufm���eorb�� �l-3" Scum thickness S" Distance from top ofscum to top of outlet tee orbaffle 16" Distance from bottom ofscum t0bottom ofoutlet tee nrbaffle infield ith measurestick and tape How were dimensions determined? Comments (on pumping recommendations, inlet and outlet tee orbaffle condition, structural integrity, liquid levels aerelated tooutlet invert, evidence ofleakage, eh:.): Septic tank should be pumped every 2-3 years depending on number of occupants and usage Septic tank ioinworking order inlet and outlet PVC Tingood ound Liquid is at bottom of pipe on outlet line with separation from inlet and outlet Tank shows noevidence ofleakage Zable filter in tank/filt | d during inuotion Grease Trap (locate on site plan): Depth below grade: feat Material ofconstruction: Fl concrete 0 metal El fiberglass polyethylene Fl other(explain): Dimensions: ---- � Scum thickness � Distance from top of scum to top of outlet tem or baffle Distance from bottom ofscum hobottom ofoutlet tee orbaffle Date Vflast pumping: �o�m Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments N5% 2001 Salem Street Property Address Isaac Blanchard Owner Owner's Name information is North Andover Ma 01845 11/16/2017 required for every 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: El concrete El metal El fiberglass F-1 polyethylene El other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: F] Yes El No Alarm level: Alarm in working order: F-1 Yes El No Date of last pumping: Date— Comments (condition of alarm and float switches, etc.): ------------ ------------- ------ Attach copy of current pumping contract(required). Is copy attached? F-1 Yes FI No t5ins 3113 Title 5 Official inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts ' ���°��0�� �� �~���'������0 N��������^��°���� ����N�0�� Title �� ��y� � ������� Inspection 0—��mmmm Subsurface Sewage Disposal SystwmnFmrmm -NotforVn|untaryAmaeesmento 2001 Salem Street Property Address Isaac Blanchard Owner Owner's Name Information is North Andover [Na 01845 11/15/2017 required for -- every page. ^"r'"w" State Zip Code --' of Inspection' — D. System Information (cont.) Distribution Box (if present must beopened) (locate onsite phan): liquid is at bottom of outlet lines Depth ofliquid level above outlet invert Comments (note ifbox |slevel and distribution hmoutlets equal, any evidence ofsolids carryover, any evidence of leakage into or out of box, etc.): Concrete dbox /box ielevel with equal distribution / noevidence ofcarryover/ noevidence of leakage into orout ofbox/ speed levelers; inbox D box is 20" below qrade/ d box in qoodoond|Uon Pump Chamber(locate mnsite p|un): Pumps inworking order: D Yes [] No* Alarms inworking order: [l Yea Fl No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): | ^ |fpumps oralarms are not inworking order, system is aconditional pass, Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 2401 Salem Street Property Address Isaac Blanchard __._...._.._---___ ._ Owner Owner's Mame information is North Andover Ma 01845 11/15/2017 required for _ �_.__ __...__— __..._- every page. City/Town State Zip Code Date of Inspection D. System Information (cant.) Type: ❑ leaching pits number: - -- ❑ leaching chambers number: - ❑ leaching galleries number: - - ❑ leaching trenches number, length: -- ® leaching fields number, dimensions: 1 48' X 14.2' ❑ 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.): SAS in working condition/no evidence of breakout / no ponding SAS located in green grass area with no damp soil and vegitation in good condition located in sloping lawn area chambers have a loop vent 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 —_._.._,___ I Materials of construction _. Indication of groundwater inflow ❑ Yes ❑ No 15ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal Systema-Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments .2001 Salem Street Property Address Isaac Blanchard Owner Owner's Name information is required for North Andover —--------------- Ma 01845 11/15/2017 every page. CityTrown 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.): 151ns-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 2001 Salem Street Property Address Isaac Blanchard Owner Owner's Name information is North Andover Ma 01845 11/15/2017 required for every page. ut_yrrown__ 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 15ins•3113 Title 5 official inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments yw 2001 Salem Street Property Address Isaac Blanchard Owner Owner's Name information is Ma 01845 11/15/2017 required for _N�o -—--------- North Andover every page. City/Town-— State Zip Code Date of Inspection D. System Information (cont.) Site Exam: Z Check Slope Z Surface water Z Check cellar Z Shallow wells as" per plan on file Estimated depth to high ground water: 60feet 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: 2012 Dat-e 0 Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health - explain: El Checked with local excavators, installers- (attach documentation) 0 Accessed USGS database -explain: You must describe how you established the high ground water elevation: checked with health dept plans on file dated 2012 System is a gravity mound ---------- Before filing this Inspection Report, please see Report Completeness Checklist on next page. 15ins-3113 Title 5 official inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts — _ -- - -----m. r Title 5 Official Inspection Form ------ NotSewage Disposal System Form -Not for Voluntary Assessments 2001 Salem Street Property Address Isaac Blanchard --------- _ Owner _... ..... Owner's Name information is North Andover Ma 01845 11/15/2017 required for . _ every page. City/Town 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 l5ins•3113 Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 17 of 17 i { sullmJ,Yk m� r ' ✓✓Off,yNll/0',� 1 ✓ ✓' ✓ o i 4 aj P �? 14 ✓ M�✓ r' ✓ ✓�,. ww/�i gf � ✓, r u.� ✓ ✓ V �f �� � �" ✓ ',i �� �V�lr���//��✓f�¢i�t✓✓ ' ✓ ✓� � � �'��t 9�,I�I✓ rj9' ,l„4� 1 1 � �J� � � ��✓ ,�r I � / , '✓ � ✓�llf�r�,���1/�Il ,;✓� ✓r f�'Pr�f, ✓l ii, -✓ r'f � ,�'� r 'r-i a�ry.�'i �,� i „�� � ” !' '6666 %, ,: ",;. , „ p��,, �"✓,it � r, r 1 r Fi ✓ l r �* �y �/ �y �y i- ✓ s k {',,; .✓ ��!r;7rR�AS"�IY; i, ,,;; „1'�i�"� ,✓''„ ✓ ,;✓/ ✓/il�„ib,.M„a�,.,/,G,,,,, /✓„Lha ,. l,� ,a, (✓r ,i x ✓�f✓/,ls✓ �, v(i �//'l,✓' ✓/✓✓,;u y, j. C„- ,., ,;.0 ,.�, l..I,,<�; ', ,.�,✓ �i��,✓ a !/'✓�. �,., 'i✓ i �,; „,,,„�*,✓. ,�.,,✓,,,,,,I ,, ;,.,�,„�,r, � ::✓ //✓ k�H/✓f f. ..�/�:o�/✓✓✓✓1��1� �i I4xY (�Sl. f � 7 1 ✓. l✓ ✓ ✓�{'P f�✓. .✓,,,:� ,�Cl,l,,1'„ A?('%tp�'I� %��,�, ''�r;,,,�, #�"F z'v ✓ i ,:,.✓1 (i/ l/r... ..� .: �� ,, ✓. ,,✓: �✓ �✓,. ✓ (� ,�ti 1A ,,., ADM!ru- � ,,, ��/1 ✓ / � l✓ F/�,� I1 e, � ,,��7,'77,r � 1 '✓ ✓ 1;,/ 1�,I'✓✓,,,N� /� %t� ✓ �( 7 ✓ ✓✓✓✓� ✓ a, �, �✓ + real,1. l✓�✓ ( ✓l✓✓✓-i�;,�✓�- ✓ ✓ r✓ ✓✓ ✓ 1. f �i✓✓/� ✓ 'ii �l ✓ ��✓✓ ,✓� ,.; �✓ I"�. '1 ✓ 7�/ ,✓;, ,✓-s,��.. ✓ � ✓✓ ✓�,tsr' `1 r �� r ✓+ J', �t ✓ g l ✓�, ✓', r t,✓ f/ ✓ ✓ �f „, ,,, ✓ r, a ✓ 1 � �,,� ✓ ,o{� ✓l � ✓,� ,/cry �r✓ ��, � y ,� �c^�irv,,///,r ,,..,. ✓.. /.. ✓/�, ✓, 1 l ,..a ,. ,..��/��, 1 ✓✓ e ,...., 1,,, , ,...✓✓✓.r .,r�. 1 . ,✓D�✓'l'. ��., f �. ,,, ✓.7f,, . /. i. /✓,� ✓,/ ,�✓ ✓,✓ / �9, -, ,: ,,,.. -. '. :. ,,„, i ✓ ..,.�,. f.✓, ae ,r.., ,�. �, y✓��. ✓/, ✓., i..✓. �fl? / � � las. .�..,. ', a oi. /., Jl �. � ✓ ..✓✓ / �.,. J ✓ ✓, �r. �-.,i ,. .�. � ,i,/, ,. „' „, 1,r, ✓✓ir ✓ ,,,�. ,�✓ . ,r. �. i�,rrryr ✓ .,�,;� A �,✓tir�✓,,f✓ ✓,. �✓ ✓f✓�, �� !,, r�✓ ;,✓ � /✓lt, 4' ✓�,rr��,..✓ ✓ 16l if,/✓1�„r . ,✓,tr�;l�N,✓�1.. �✓�ri �✓;rr, l✓4✓i;�ll ✓ t✓✓ r ✓� , r r �;i � ,,it { �✓i, � �. !/�✓ J ✓ ,1,.1i.✓✓ 1,i,(✓ /n /f lw-✓ -�� �!i/ ,.✓✓i ,> ✓ ,, rJ ✓✓.. it �. , � ✓✓ �' �, ,,, /, r � ✓✓✓?, �✓'s ri �✓✓✓, ✓ ✓ i,, ,.✓ ,� � 1 , ✓ 1 , � / ,✓✓i � ,r, , rr..,,.. ��;,, ,,,✓, ,,: ✓,,,.. ✓, uO. .✓, /r✓/ ,.r/✓ „�, //fir. ;✓ /lf%i y,i✓. .l ✓� I,� �. t 'i✓ ✓,✓ I ,.,: ” `� ,,;, %.�✓ � 1. J .,. ..rl/r� ✓ �11.)� l✓ �✓,9/� ,��. �r �,.,�,. i �.r ✓ , -✓;. u✓� r ✓. .. ,✓�d� i, :,i, �,i .,F, ..,. .. ,...,i, i„�r✓.. ✓//✓ ✓ / �/. (. 1 i✓ ✓ 1 �./ � ✓/i. � ,� 1. ✓ F! � �,J ✓ ,...,,, „_;,, „✓; ,,, ,., ,. ,., ✓„ I✓'✓,. l✓/, ✓� ✓�i.�'�/1.11 l.✓,.�o✓/. ✓.1✓ ✓, ✓�- ,/ � ✓ , G✓f9 ✓ i r,i 1 ,✓J a ✓ 1 f /r ✓, ✓1 � r ,_ ,, �„ „_ ;; ✓ .ry r�„/ ...✓ � al.,a. ,, ,Y i r.,�,ia- <Li ll ✓„r,.✓�i..l..,,1 ,�✓ is f. �✓/f r ✓7 ,., ,, .,,, ,., .,< ;-,,,� ;., „,✓ is 1 .N/ r M is-i� .�.:�; r✓ ✓ ✓ /. /�.,, ✓,. ,r✓,1.>� �`l� .f ,r/ „r/ !' � ,,,-� ;,,.,,; ;� �1, ::-, '`�' � �' ✓,�,,;;✓ ✓�i% l ✓, ✓. ✓ r if l�;,i �. Fid ! ar �/�✓✓✓����✓ ��i'✓�;✓�1����fq(� �r ��i/l� ,�✓ .•'•i ' �:'„ �, �„ '".' „�,"', � „�'�";,� „",,, � '% fx sib„ ,✓q✓✓r�✓„i✓ i✓ i✓ i ,,, ' f ,,.:.✓+ / .✓✓9 ✓r(✓� �e ✓�✓� ✓, ��/y� / ✓ ✓. p f✓..../ ✓ ✓iy rt ✓/r✓ i✓✓ ✓ ,,r,.✓,, ✓ ✓'✓fir �b� �,/ ;�y✓✓i✓ti, "�i��✓ ✓b✓�ji/�� ,.. ;'i,, ;, � ,,;s;. ,, �,,,.`” ,. ', ,x:. I✓ tr✓' �, !,rr✓ ✓ ( + i ✓;; /� y�1✓/✓ t ✓�G/✓i v✓�✓�✓jJl✓ ���j r'��"�✓✓1�/��/���, ,,, � � �, ;,, ✓ 4✓ ✓ ✓d✓ a r e✓� ✓ ;,ria /I✓!N� �� //✓✓✓��✓✓�� l; ✓ /� n✓� t ri ✓ //� ✓ r1 r J✓ ✓ ✓✓�l✓✓✓ 1�% � lrr,✓ll�,'�L;✓ ✓✓✓�1✓i�!�1,��✓✓ ,,,,: ,,„,; ';, ,,,;, � � '� ;,,r✓l�i r/i ✓ ✓ i? i ✓✓1 hl//✓ r Ji l/✓ ✓/ lLi,f i�r/i f✓ yr✓ � ,.<o, r✓� i P >✓ ✓ � �✓ ✓j✓ i✓ r4i /1G,✓.� ✓✓rot✓��r� � ✓� ,�li��✓` .✓,x-u; ,,,;��, -,",, ;,,,,,,-, ,✓;, .',+.; ,�, � ,,; i r .., �' /✓✓� ti' r i, i /:- r/l ? i ✓ / !a ✓ ! / ,/f✓'%��s1�V�l,w.,�✓� �l"i��,f✓✓i5 ✓ iii -✓ ✓� ✓✓ ✓ /,.:✓ �.. f r r/`?I ✓.+} ✓r✓✓ i ✓✓�✓;�i .;, �, ,, ✓ ., / ,/ //r +� �✓r ✓ f l ✓ r✓ r/,✓.ro.yrr ✓/ r1✓� �✓✓✓,� r 11���1✓u, �,:✓,;,,✓ ✓,,,,,;.. ,'";✓ ;,,✓✓✓,G, ,y; .,,;.�, ,,,,,✓ ,,; ,,�,,✓; p..rj%/✓/y 1f✓✓1✓✓✓✓r' /6✓.../rG -,✓.✓✓✓ ✓✓/ ... ✓l✓/1. i. / /i. / ✓✓/ l ,��1�, ✓ 7, r,,, ,.,✓ ✓ ✓.✓. /A✓v rfi. ..✓" U✓✓�G,.� I✓. ✓ ✓l�✓✓/Y/✓ ✓ / il� ✓ G" ,✓✓ ��d;4 <, - .:, .,... / r ✓ ✓,: /{ ✓ n. a ✓.,�✓ d ii,.. is i l✓ f,✓ � -0 ✓✓✓r l��J ��� it ✓/ �✓,,'; t ;,r '; :.� �,,, - ,�� ,r, �,., ,,,, �`,,, ✓;,,� „'„�"' ;,.::✓ b ✓ ,✓, „!✓ra ,y;�NY'`i ,i„ ,' ,l ✓, ✓✓✓ ✓1a ✓/�✓i I'% WUL77 ,: � ,r � rr f Pi 1 <er �' � r i rt '� � �, rig✓ /� f r rX � � �ardrdi ri t� r� /i� fry i✓ ��rr ,r r i fr r r r f ' rr i rr �rr r i i� r ie f �it ! t ✓ t /r ! � I r v r r r� °3 r it r y // l / Nrr�r f ,4 F ,�,�pp, ,, �, r r r r � n�{�,r ,j[�+�{% i �i f �� 1'yr�" +' - r �V �7 s �/j �- 'VALi�. per r�r' P7mr" J 1 r r / � fk�J!WIWt�p4 J A rt4 iz r �. r e� a«wwvrpw«w,v+w r, r �Wuu,�w�cr�auwJR�✓rrawFwrArr�f�'Zwiy/yr 4 ,M d�-�' . f 0 s.�� RZ, O r ' :,;' � ��i�%rrfi�J,�,,i1✓�li���f�/�✓l/lyif r�1 �.�' i '^ if r lir � G�✓i%��ilAp r. l�r r,/yr��/�✓��/ .,, r�r„ rr�i F /iii / rr"��r�"��l�d��%/i��r/rjr�lrj h i ;:, r ," f ,,,, ;;,'„ '9'e /'. q f�/r✓r° i rJ/rlr�l �i/r/ Ir / r//dip/rt 1r 1/ r?r1✓!rr,�,� r � �� , Vii r Io✓//ii r/� �/l�f fr /�l,�i�} J% I r r ✓ r n/ f„ ,,: � ', ; '„ � ,,, `,,, is� „', - s ' �� r, r ,.,;i,��/ r.. l rlrr nl Ir�rri.>l�rr i;.i ✓.,� ,r� '� ohr,,;' �, ,' - �„ �� 'r� f, „�� ;,; a ;, -',, � ,,;, '�' r /riw f �/1,.//lif ri �,rr rAr /r,.,r7Jfr ✓, r%. �� ��, / ,,1�,/Y„ d �,,,, ��, ,,,��:� �„ ;,, ';,, � ,�„- ;;,,.. ,,,„ 1r. ✓.,, r ,, 1�r//�✓ F/ ri /rr� i/r�✓//iii rr i ✓ �i� �' r „�/,r✓/ / ,,. ✓ ✓ r/ r/.�/, d<i✓/ /:l r✓ l % 1�r�aK f „rr,„>5 Pari � „� � ,,, �„�_.,,,:;;. ' r r,-4f/l arl�! rY l i./«!��%/ / ,Y r f 1rJ..>r xi 5.., /'1 r ii��...,r, � �, �r ,,.,,,r, ,"- 1 r „:,a „�b„ ,,,,,- ;r,;� r .✓h l/ /�nvi� /�, 1 i rvl/rJn�r�� e.� �✓i✓. !/f „r.r r//�� /,r ,^, ,' �'�,� �� ,,. „o ,,, d. „�; ,, ,,,�,,,, ,,... ,,, �,:;; ,./,, ��/Za,ir r�i/M./i,. r /,rid l/:./.,r „�'�r� i/i; ✓- -;, ;,�� tiw,: i .:.�7� �;., ,o�,; ,,.r,. �, -,,: � ,. �,;, r, �, r7� irl i r. �r1r, r n,rri r f i 1 rl J iii �, � , r/,�, �I ,t��,�l,�,rr/ //1r ani ,. ,>, - �- ;..,. :,> �,,,,„ ;� ;,,,,.�, '- i � u✓„ �. i,�>✓, /f�Alr�, �. /1�,�� rle/.r�/l/�/h,./�I ✓l� �J � � „ Fr ,,: / r-� ,, A �� r� r„ r r )% l�f /✓/ rl r ✓.,,, „l - ', .' �,a, ��, ,,,, ,r �ro-�,,,,i ,�,✓, a.�� �. ��,�., r.n1d /Il�.1%f /✓1 ,.-✓ ,,. � � /: i 1... ""��' li f'/,, ,: P ;,,; /n✓/�.'r., u���, G/✓I,r�„/„r /i,� � tir ✓�r,l;��,/,r rr / N rt r r � rr, ,��,..� eYl✓,r„r. uf� „i�i� �r. ,,I,J !<��fr ,1.�, „'�r- l®� i � ,�� :/l.-.i ���, '�'^,,,II lr�rorw,' ;.1 i r , ;;�,,, ,,,/ .rr i !�,/,A 6'�i,i r/,.,. ✓�rf� r e t��l r �.,„If r I rf, rl /„ ,G.� � N, ,,.,; � r, ,,,,:.i r I�r / t r � �,��, UG% �, r ?, r rr i r .,,,,,,r„�„r„, „� „✓ � 6 v.,,, � r / 9ei r/ �r i✓ ,�Xr ,,, /��>r/,,i cul F i// 1, ,/ r�i%ii 1.,. i� / „ i r r �r� r/ ,, ,,/ f r � ��i�r,, ✓ 1,, �,,,,� /�, n�, , „-, ,,,,, ,. , „ ';,,,, iii n,lc ri� �r �/„ �lil � r� r� 1 � �, r ✓; c„ 1, �„ �//r l �. / r✓,i,�i - �r ..1�/f .� �. ,1��f l�. /„% / ,�,,,, ,, 1, rr, ,.,, r” r ,, ,. .,..,„ -, I � .l. /, 1, � 1 ,. ..����i.✓�, i„ r e ,., t�� �,✓. ,.,-,; ,,, ,,..,. .r -,�, ,,,�„ ,:. ,,:,,e. ,,,, r„ ,, ,,,,;,,, ,,,,,,,,i i/ ✓' ,�i l /i„rnr,i,.„9,.,. .i.�r. � ,;*,, .Ifs,,.. �, r �.....,i, r,. r r .,, „ ' ,., ., lai � l 1 r „'.r✓ r . � l ,/ ✓� � r ,. fir r. /.,.. ..///G, � ,,, „a., ,,,,,,-,-,: . �„-,,,,,, r/.. �,l ,� ,G r , r� ✓ � ,r l f. r r r.., i y /,/� Yyy � �r l ri nlri r y r�r�r�, , //,r�r /,�Y%! � Gi 1�,�,,✓/�� �ri ;, ,;, ,, c „ - ,,-,, � ri li �l,,,l,�,�� �r% /�/�i�rrtl ,,./' ci.�/ rp //�,�� rr�. ,r�l ����.,✓1//fir r,:�. ,i/i ., �,, .,., r. .,,. ,..„ u:,..� y ,i� �„tr:�r/I � r,, � -r 1 rr- „�, ,fl ?7r i,,,J✓ ,,, ,' , i ,,,c ,r., ,-,,.,, ;;,' „� „F, ,,,;fi ��,.F�,,,,n, 7,. ✓fir,r,�,r f�/// / r G,/ ii Ih� !., i, ,�,. �r/L ,�.,,,,, ,,,;, � �,. a ,;,,; ,,, ;.. �,';+„ rr ,f,/,� k,�!%�✓>�'r Il,✓l%,ii/ lr`yr nir.yvi//%,�1��„r � r,!;,✓> 1 -,,�; lr�i�. ,,,,,,n.� :� ,,,,,,, y,-;,,7' ,,,,,;�” ,. ;,�:, r r, ,�r G,91 ��/< �:-4i /..�.f !//iXrP�l✓i 7�. ,�,A �; �a,. � r „i,¢„s ,; .,, �;- ,',;, :,,,, '� ,;: i, ill/, ,�� lui �rr,.,�iif/r/rin/r rr!h jai �iar1,,,Y ,� �' ,�1� r✓ s�,..;� , � ,, r „- ",- �;,,; it ,Jr/ric, �� rlf,' 1 r✓/J��il „s-, i /i rnra/f ril //.196 �a,fl, ✓� �<��/ r -, i „ � .- �, r / i !/ r ,,�,,,r„r,1 iiiin r fP i/`rrir fi�r,��P/6✓rd rri/�ffi,i i/X r/i,�/^I/!;l/„c, of i,.r�s, ��r X`,:- r,'F ��, "„;, i�rrr r��%r,;�1 /1,,,1 tteNr�v� ry lii rr � l .✓ 1 ,Ii, ,6i, rl ✓� �v /�v /, �r t/H � � r r �r ✓ /, ri r ,f , l Y 1 i �, r� NtJ � 9 l r r �/ F fl i, / � � ✓ r r r I i � r 6 .n {t ✓ „r <, l G �'i, �.�(���!� I,n1f�G����r�r'�u„r�/����� ��h��fr��./�Jrir/���XGir�n�,u��r.<,r„�r4��c�ar,Gu!�cri�/ri��ru�1�/i`X 1,r�✓��c,O�eXa,r�✓�A/�9r��yi.�r��"fK�r1�?lraij�.%'�9/'4,�1�✓��� �L�r, � o- Ill 1 r � it r s CgA / / r- u ✓ ✓ 7 ✓/(///✓ �' r it l r y ,�r r e, ,' `-;', -, ,, i, v 'y ✓ ,l r ✓ r j �c 1 3 lyi� � / ��� � z �, l s� I F i. � ', 777777 i �^ x a � `, � 1 r�,; �� / n � c / f sF ✓ t 1 Ery r/ l fi / / P / g T / fl + � / i r/3 � e ✓ 6 s v / ' � ,, ;�� nr/ ,, /,. 7 //1� r x r {r i/ r, /yYl � '.l / r / a i f// � )1 ✓ / �7 / r ;� r� fr �' / ie / 11 <„ / �r/ 1'ai�1/ i J %n �.1s nr ,ri � i/ 1°/ //f s/ �1/ � /�yy✓i � � , �, ,a„/ii,.; � ',,iii����i%r6 r'/ ,o ,-;�� I /✓r4ti'S°� ,:. G11 ✓, � ,,," �., „�:,, t u,;-# !/i � � „/��/ k�G/ F rlr� rG x i. (. ✓ /i6p� / lr, ✓ r / rrf i / /i ��U�VIVIi r7 i gig i��R�GP f� ri✓ u r�. /i �i� ,, i-, t f ry / �6 r f /J 9d lb✓ / a /1 a n/ / now / � �rn�r ✓ r Irl f i ! s, r t / I 'l � f 4 y ✓//� � art t r r n (4 i � rr / , �t�i i/ /� ✓ �� r r ,6 ✓ � �r � �; �' ' / r f � l /v n r :.t j�4 F r i rt n a ! ly r i/✓r ,: �ti ;� � i✓ G i ✓r r r ✓dr 7 /n��✓✓ tyr t 1�n,,�, „�?,,, ^�,`rrr,;ts � ,v., � r r ,t ,; / „r� 1 �,�` � A, ;' �fl i✓ii:ia%��� 'r�flr%rl ��" u,, /,., f/✓i,,; ,R r � / ,/ G,,,,„,,, „ >;,,,;,r F ,' r r�/ ,,,r ti,�.�," ,� ,,il � ;,„�.,"` ! t .,!/ %���,,;;/i��1���9nr�'r f� / Y./ i � i 1� iia..✓,. i//.. r /.. r /. , 1:.. �.:.; ,,, ,; I I. �.l � ,�,...,,ni i i. ,/1 ,.., ,,,r-; i / � � rt ✓ i u I r i, i J lf, ,// ✓ /r n ✓. � V e �..,. r, / /, l i , r ✓ r- / l ,. �, � 1� „ .,1 1. ,.,, i� , � f �,, I r y i ✓" v i °1 ti � i / / m „ / l � r� r/ ✓ / it ,,. r i it i ilF,. ✓, c /, / C /, /�,,< ✓, /� i � �, ✓,�ir / �r/ ,,1 r, f ( ,,� F ��r,,. r „„ t s I d � ��, ,,�r 1, 1 � / �� .i r- I y� �/r ✓r✓ b/ l lnf G i !„ s ,f � ,� ,�, / 1 ., �- n�� 1,f f ,,,,r f/,,,: 11 / r,,,. l� 7 ✓ fG.f „, .,r „ ,r ,i� ,f' �„ ///�/ i,r, ./ �yn',. f` ! i � ✓//. r -,. � r. / ii / ,./ H r/ .,, 1... 4 //.f1.. r < ,.r ,.. ..�,. ,/ f. �i/ ,..,„/i I i IJ lr // a,r �„ <fl, A G�r f „ / / /iii , ✓,,,,. -„r �� ,/ r. l// r .v i:OGr ✓„ ,� ri,f / ��.. .e./,✓,,,, / i /r..., r n, .,.., ,. .,,,, ;; �, �, ,,.� f./l, .r..,�l/i/ /�l /i. r:;. ur'',IJ>ty r��r �„ ,i,i„r, ,,.,.�nr � ,:, �✓�� ,il/�r� .i ;n it ,,,,� // // 1 Cr✓:�� /i ;.:rr „e ,,,..,r 1 �,n, i�/ ✓,LJ,�/'���r 'I/,..�J Cy �,,,: �1. 1� .r/n/i / .l ,.�� / /, ,s v.,. i/>�--,.� r ✓i/. � /.r1 (, ✓r' e, 1�,:. if4 .f ,.f�i 7 li/ �,-/ / r ✓ f/ / 1. „,c,l / ,,, ,,:. � � v / r r' � 1 q �:,4,IJ�/'/i l:.r/''�/' ny�rfn✓� -�,� �;,o�,Y� /�I �1���r !1,1, i / 1 0 11 �1 ,, � ,!;�; is r,, ,,,, ,.;i ,r; „1 r, � r�(�,,�✓�, Fl,/i�'r�'i��!��`� r %�� T%�l' � Gd�i�f� � 'G /%,�✓� / / ,i, 1, r< / 1, r ✓//i� / yf/���1/. ������llf� (i ///�j��r// n ;,.ofii��✓„�„ //i/ Y„' �� r ,,,., �� ,'r � >�', i f � „4 Y /,, t� � �>e �// 1/ /,!I/�1:7g1' /t� {�� %fin', f!i i� i��� rJ„ /f l / ✓ i / 'IMk f+��t' � �J� u/ r Jl�//r��/ ]��yy r i ,ff i / ,, , / ✓ it � �, / � / � y 1,�r I✓6, .i, y G ,Y,� 1 �r r ✓ i� �, l l�i✓ �� n/ � 1. � f,/ ,� b / L � �., / P A .l r l rnf, �� � l � �, / l ✓� / � � r, 1, 51 / r ,b 1, � ,, ,/ � ,. ,: r/ ✓� ,. +,,,, � � F�� / �„� //, �l' i mi /l ,i Jli., � ,�, r .� ,., it rl ,,,.,.,/ i r t,_.,.. / ,.- �_,., .,,. ,, ,, .,%,. //�,,..�,ir.�,.✓ rf i ,;!..,-,,,, ,r l „i//� ,� lel , 1, .,1 A ,✓ l of-. i ),. r ,n, .:� �J ( r c✓.,,, ,�. l,+J,t ,� / ,�,, //., >✓ ✓ ///,,it � /, � it � �,/ / ✓ rlot: 1 1 ✓ , /. � ,l i� / u/ / /.�.r„/. i 9.1i �T, �.U,/u,,,,.%i/,,!/ ✓ l.. / ,� ,,,. ,r ,; :.,,.,� �Il /r�, / / � r� A f l�/,„ fir n✓l l � ri, r ,,-,, rn„,, ,,, ,. �/�,�✓/1, ,F�rr,m ,,,�� �,� 1./au. l/ al+,. fi i ,�% ,r �., .,;.,. � .', ,.,. �i r�,. ll�u e(� '�. � �, ✓. ,xi/i, i „„i � ,f l� �� k i r �, ,: it r� / l ✓�� .,ir ✓�,..,- .u, r � ,f,.if ,� ,,. ! ./ l,r r/ /.�..ry r r . , .,, n,,, ., ,. �..,. ., 1, /,.... ,. ,��. ✓l , �,, � / /U, � �, ,ill,.i � ,�,,, 1, rs,,,, .,, r,. �, i � o,l„ r s:, jai," ,,,,1r9�/ �� h/ /, rl/ C r ., � �; a/ l�.�ls, l ,✓ .,,, ✓ / ,/,,/ , r,�n f�' � i,- � .�✓ �i.. /��1�/�/1�//,u. ;.11��(/�i,/ /,�; � � 4 ,z, t. ,i � r`1✓. 1 ,F ti�s,�,✓,i �✓ ��/�/ fir. / /� ,N i�f,,,�,i � t ,�, ,,, ,,,, 7 ii r,. //�.r ✓ ✓,1 ,, /, �„.i r r��..,,. r;. ��, /,.,. ,., rnl, x o,,,rrr t 1„9�,!✓r,A 1 n�. ,,.,,is 9i F „/ ,,:., 7 ir,r./, 1 l .�..., /„ .,,,,. l:, ,, r / v,r/✓u: r 11 r / ✓ ? r Ux i , ,.,, , / l r � i ,,✓ / � r, l .t a !✓. J �r. /✓:. � ,. 1, i � i, � ., / / i., ,,r.,,r l/5,,,,„iil.;l� // ��/,,i f � l ,� f n, ,, � l � � ,P,/ ,,, ✓/ �,,, ✓r+ r/>//r", ltiJ / .,,, /1 � r ,. � 1 r r, tl., �./r,,.i c,.,7�,i��d � �l,/i ✓., >�,., „� ,., .1 i ,. ✓ f 1 ,-/ o r ..,,,,,...,�„ ,./. �/f'�.. r r. ./ // � � ��.� r. ,� ri. ✓,G"r � i.. ,,,, n. ,., r. r„<d..2,/�„ ,I /�l..r.r' �, „.l„1..,, n � ✓ r G �/ /:, � ✓., /�; r, l � 1, r 1 � �„ ,o✓.. �-../. r��( t,.,�,..,�1.,,' ..1�� 1, �/ / Ir, � ✓/� ✓ � , -✓,.� ,,, 1- ,, /.� .� 1. / /. / /, .,. / ,. „l� � ;,,� c, �, ,,;;, J i. � � 'r1� .... ,. r,i. � i /� / ( � 1. / ,,.a l .,. ,.1,,.✓..fA /�/: .,/ iii �i / r „„,, 1,/,.. ✓ ,moi i., , ., .i,,,,. „e,,,,,.; / /.;/1,�,p,.;,. �,,,. Y/>G ,1�� r1 ,.r,. d ,h<Y I 1, 1 �u�i9� ,/� - ,,,- ✓/%'.✓ /�1 ..✓,�.:,,/;i., �jyf/./„l�'e,. l/. ,,.,;; ,,.:,: r,i, y /r ,e-,; ;�! �� � ,. ,� ,, ,./ � /. ,M/r, P�r..,xr ,,,;,,.. 7 ✓/ fr �?n 'iiv / /;/T,� !�/v ., / ; ip,,. l u�., l ' 1, �.,.. �.�., �/ :.< l �cr�v rrr /r- �� it 1;✓ ;,P:r,�� !„� ,/. �. ,. i r,, // r / ,..✓ ✓ r„ �:, „r� i l.! „l� ��p.;r rl r I 7, �„�%, � r..,f�r��� d /��.�l�/ fa. i ,;,, fir,,, -r <,; �/f , �;�„ r,/!�✓,,,rfi�� /✓//ir��l./� ,n;� i, r � /i A �Jl� f� /�� lYr / rrl ,,. .✓ � ✓. „- r� I,. .n r,,,,,, ✓1 Frrv�