Loading...
HomeMy WebLinkAboutMiscellaneous - 199 STONECLEAVE ROAD 4/30/2018 199 STONECLEAVE ROAD oad 210/104.B-0131-0000.0 �J NorthAndoverBoardof Assessors Public Access Page 1 of 1 1 pORVN Town Of 1400h w ido v ° ,��•' • "o ]Dowd of Assessors. 1 h � Property Return to the Home page click on logo Record Card Parcel ID:210/104.13-0131-0000.0 Community:North Andover New Search SKETCH PHOTO Sales Click on Sketch to Enlarge No P i t rPA Summary eAble Residence Awl I Detached Structure Condo Commercial Comparable Sales Location: 199 STONECLEAVE ROAD Owner Name: LEVIS,MARIANNE S Owner Address: 199 STONECLEAVE ROAD City: NORTH ANDOVER State:MA ZIP: 01845 Neighborhood: 7-7 Land Area: 1.22 acres Use Code: 101 -SNGL-FAM-RES Total Finished Area: 2544 sqft ASSESSMENTS CURRENT YEAR PREVIOUS YEAR Total Value: 567,000 517,500 Building Value: 328,700 301,300 Land Value: 238,300 216,200 Market Land Value:238,300 Chapter Land Value: LATESTSALE Sale Price: 1 Sale Date: 11/23/1998 Arms Length Sale Code:F-NO-CONVNIENT Grantor:JOSEPH LEVIS Cert Doc: Book: 05249 Page:0175 http://csc-ma.us/NandoverPubAcc/jsp/Home.jsp?Page=3&Linkld=990076 7/19/2007 I �v North Andover Health Department (ommunity and Economic Development Division 02/10/2017 Address: 199 Stonecleave Road G All North Andover Residents with Septic Systei Please note that due to a recent review of a Title 5 Report, y maintaining a working garbage disposal that is being used it The Health Department is concerned for the longevity of yo' N e S N Garbage disposals are never recommended where septic sys installed,the system must be specifically designed to handlc can not handle the waste as designed. Please note that conti quickly cause a pre-mature failure of your septic system, re,, replace it. The North Andover Health Department recommc home as soon as possible. _ Some information regarding regular maintenance of your septic system is attached. Please call the Health Department at 978.688.9540 if you have any questions, or e-mail your questions to: healthdeptgnorthandoverma.gov. Thank you for taking the time to consider the impact that your current setup has on your septic system and the environment. Sincerely, ti rian LaGrasse, CEHT Director of Public Health 120 Main Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.9542 Web http://www.northandoverma.gov • S��GED j�' • • North Andover Health Department (ommunity and Economic Development Division 02/10/2017 Address: 199 Stonecleave Road All North Andover Residents with Septic Systems and Garbage Disposals Please note that due to a recent review of a Title 5 Report, your property has been identified as maintaining a working garbage disposal that is being used in conjunction with a septic system. The Health Department is concerned for the longevity of your septic system. Garbage disposals are never recommended where septic systems are used, but if they are installed,the system must be specifically designed to handle the waste from them; your system can not handle the waste as designed. Please note that continued use of this disposal could quickly cause a pre-mature failure of your septic system, resulting in a large expenditure to replace it. The North Andover Health Department recommends that you remove it from your home as soon as possible. Some information regarding regular maintenance of your septic system is attached. Please call the Health Department at 978.688.9540 if you have any questions, or e-mail your questions to: healthdept@northandoverma.gov. Thank you for taking the time to consider the impact that your current setup has on your septic system and the environment. Sincerely, erianLaGrasse, CEHT Director of Public Health 120 Main Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.9542 Web http://www.northandoverma.gov µ0R711 7758 / F = F Town of North Andover HEALTH DEPARTMENT S4cwu CHECK#: ,05 DATE: '8",�0 0 LOCATION: /2 / H/O NAME: CONTRACTOR NAME: Oeaa 4 . Alno_0 Type of Permit or License: (Check box) ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ Dumpster $ ❑ Food Service-Type: $ ❑ Funeral Directors $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal(Septic)Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ SEPTIC Systems: ❑ Septic-Soil Testing $ ❑ Septic-Design Approval $ ❑ Septic Disposal Works Construction(DWC) $ ❑ Septic Disposal Works Installers(DWI) $ Title 5Inspector /'a e-/7L s ,70 — Title .70Title 5 Report $ ❑ Other. (Indicate) $ CQ roll/Y Health Agent Initials White-Applicant Yellow-Health ,Pink-Treasurer Commonwealth of Massachusetts v Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ► Q 199 Stonecleave Road Property Address Mike Corliss Owner Owner's Name information is required for North Andover Ma 01845 1/11/2017 every 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. P V. f.O Important: tl When filling out A. General Information forms on the Q computer, use 1. Inspector: F P only the tab key ` QFt�t1 SEN to move your Dean DynanOFN�F,QP� cursor-do not use the return Name of Inspector key. Company Name 2 Suntaug Street Company Address Lynnfield Ma 01940 � City/Town State Zip Code 508-726-9935 S112837 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 AnSpectorr-s V\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. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 17 f ��� �� �� t i I I� Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4�M ,•''p 199 Stonecleave Road Property Address Mike Corliss Owner Owner's Name information is required for North Andover Ma 01845 1/11/2017 every page. Cityfrown 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: ❑ 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: 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 Commonwealth of Massachusetts v Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 199 Stonecleave Road Property Address Mike Corliss Owner Owner's Name information is required for North Andover Ma 01845 1/11/2017 every page. Cityrrown 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): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ® distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): d box in disrepair not water tight/corroded needs to be replaced ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ 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 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 199 Stonecleave Road Property Address Mike Corliss Owner Owner's Name information is required for North Andover Ma 01845 1/11/2017 every 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 %day flow t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 199 Stonecleave Road Property Address Mike Corliss Ownfoner Owner's Name requirermad for is North Andover required Ma 01845 1/11/2017 every 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. l5ins-3113 Title 5 Official Inspection Form: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 199 Stonecleave Road Property Address Mike Corliss Owner Owner's Name information is required for North Andover Ma 01845 1/11/2017 every 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. ® ❑ 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 of bedrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 600 GPD provided t5ins-3/13 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 ,M 199 Stonecleave Road Property Address Mike Corliss Owner Owner's Name information is required for North Andover Ma 01845 1/11/2017 every page. City/Town State Zip Code Date of Inspection D. System Information Description: 4 bedroom single family dwelling 1500 gallon tank with two shallow pits Number of current residents: 4 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 d well water 9 ( Y 9 (9p ))� Detail: Sump pump? ❑ Yes ® No Last date of occupancy: occupiedDate 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 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 199 Stonecleave Road Property Address Mike Corliss Owner Owner's Name information is required for North Andover Ma 01845 1/11/2017 every page. City/Town 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: Homeowner/ Sytem pumped 10/16 Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: i Type of System: ® Septic tank, distribution box, soil absorption system j ❑ Single cesspool ❑ Overflow cesspool I ❑ 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•3/13 Title 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 199 Stonecleave Road Property Address Mike Corliss Owner Owner's Name information is required for North Andover Ma 01845 1/11/2017 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: installed per plan on file 1985 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 8"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.): building sewer in good condition no evidence of leakage Septic Tank(locate on site plan): Depth below grade: 12"feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) 1500 gallon concrete septic tank 12" of grade If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 11'X 58"X 58" Sludge depth: 2-6 t5ins-3/13 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 199 Stonecleave Road Property Address Mike Corliss Owner Owner's Name information is required for North Andover Ma 01845 1/11/2017 every page. City/Town 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 28" Scum thickness 0"-3" Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 16" How were dimensions determined? infield with measure stick and tape Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Septic tank should be pumped every 2-3 years depending on number of occupants and usage Septic tank is in working order inlet and outlet concrete baffle Liquid is at bottom of pipe on outlet line with separation from inlet and outlet tank was pumped 10/16 no filter 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 F v Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 199 Stonecleave Road Property Address Mike Corliss Owner Owner's Name information is required for North Andover Ma 01845 1/11/2017 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: ❑ 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts c usetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 199 Stonecleave Road Property Address Mike Corliss Owner Owner's Name information is required for North Andover Ma 01845 1/11/2017 every 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 liquid is at bottom of outlet lines 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.): Concrete d box 20"X 20"6 outlet D box with two oultet lines little evidence of solids carryover / evidence of leakage D box 24" below grade D box in disrepair/ not water tight/needs to be replaced 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 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 199 Stonecleave Road Property Address Mike Corliss Owner Owner's Name information is required for North Andover Ma 01845 1/11/2017 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® @ leaching pits number: 2 pits 14'X 11' ❑ 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.): 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 Pits are 24" from grade 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 u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 199 Stonecleave Road Property Address Mike Corliss Owner Owner's Name information is required for North Andover Ma 01845 1/11/2017 every page. Cityrrown 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.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments wM 199 Stonecleave Road Property Address Mike Corliss Owner Owner's Name information is required for North Andover Ma 01845 1/11/2017 every 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 t5ins-3/13 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 199 Stonecleave Road Property Address Mike Corliss Owner Owner's Name information is required for North Andover Ma 01845 1/11/2017 every 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: 90.1 + feet 0" +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: 1984 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: checked with health dept plans on file dated 1984 No sump pump Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 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 199 Stonecleave Road Property Address Mike Corliss Owner Owner's Name information is required for North Andover Ma 01845 1/11/2017 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 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 l ae Q .� v i as �a a h a PE w 04 ivy n Mwip"l, tz of 4 .. \ Al ��'�Y. as ggnkt+z i �, r q a- v '� a c ca a a '�.,a, \ _ x a- a ;a14 4 aaa s '31�s i, d-ap a�n, ,ry��^u .i ai 3,�y a a S t S & la b P .a-: �� �' a a a a a - �§ �\ s a ved e'A� Ma : a e .,e aA allaW ..� zo �'� �v \ -a '+*rF ffid&= � ..d � � a \ , q �\$"°reY t. 3' i � \° °���•�" x, a1. Al ter r. a?1a.A '-r Z a\a<> ORA _.a w a ate - me. a :-rr a• a\ re &r �.\r ��A',a` �� qa Ca?.w:\1 y e• �. •�•, ,Ua a,�a a� a a ar ea ka .'a atm �• � s aMOO s,a aa ,� ' a' is `� \ @�' a t•.�va' i & \a\fih4II �a 3 II•`L•P@� Nk Z �� a �. a s mora z a • �'sa Y as �re �zHOW a ' 4 area �q.a-a ides -yp 3 i Hin \ a a•i. Y°� \ a .� �,� far a a. °xaS. a a. rac IIa as i e \x >er e -0-aaz a a > �v ,ac aas i\ "u s­qe ,a. tea-• a� a spa• + k a �"�' a 3yi.a 9•as*, '\ a \ S•y: a ; �k a�e� a a rr AIIaa a x f 3 r*.•s, "� -a:a 3�c� a �a�\ � \ - \• F �Sv as \ � gwe a k too s � - a �s lk Ilot _ , , w'k� o o Aav r1l a ... yf F 1 9044444""w . <r i v� a' raa's _a. a 'Zi v .acv 444""w a as •,S °\ Y� £' ,o o TIME a vcc Sa s a k c v sl�aalr.a,*. -w: a `3 ha -e ,re�3, � � 3�� ,aa v h a x --a �,k,'��voea 0 Lk k a aka \� «" r ,,g; ka• �` •• ­0k `�3•^y-"$sz-a �` II ',ti-a Y L �•k� .a - •1. tsaa\��aa' \,air a a... ; a• r �a a a \ Ka a.a\ \i3a� a �. ,a 2.\ a�\a� M\\M ,. 3,kmax as a $ rg"I x a k�aa s'rn a \� mx s a xa.. a tma as e arF 2c :a4 c3a;y -. ra awT. 'r 'Q'•v� �Qa r \ \� .. a ,y a•agre � c atm;cs . a x- -ate\�y n II r-r" ak; rc.. b a '- p ~rx a ,. 3a '�va ar : �a aaa �-z�r3� a IIM��. a wax nswq m� ae�a .:,aa ik 0"�'r,'a r. rO "oe - ra ? �aTMZ�.` as m # aa aava,b�3a �s IIsa a ti .ate a Y Rik i Tv` 'Tuas- a a' ,� °a Pon a g, aab r"V ' �a„ev � x.a c a- rrff �i as �a \3ra lairv� a��a w E a".a -aY c `Fc ? re gA ra i V -a +aa�ryR xw S aAgh, aaa�,,. ;v tae Y� v �•� `? a` a � ;aa°az,w-a, �2 e e .a3 « a R i ,kN'. as 1.....� �: .a v v �a a ti." Aa a y" v 3 la�Av ro`� �a apw i� ar a —s _.as A a cs� ,'. ka'x 3 3S-4-a�y �.gY aaato � r aaa 1 .p 'E va A^4 a. �`1. OX �V a til .a a ?. Ki. =II e ' k., a3 �x\ ``r s •� '"'4 A§�r\ Ya�T \aa, rV.' < a ., v -a .. .aaYa a..� } raa,_ � Aya��AvO\���\ �.��a���aaca i��.3c•k' IIre.a:ak d k`^ a <�a 2�..0 �'`"` ....� a. �vaa�� v� �`..os, arc a k.c:,•� .,'�• ,'�,•c:. a �.., vva�� 3 YaV \ v�ti 0 ;.�v vxa. vA�� Avx yp,y�VAT�. akar . ..a ...:a:,:r em ova..,: A, a��yA"��."„ v �`V�\ V•a,<.A��v y.Az� A VAA\�. •.�a'z v. Av v. ..�:a�. SVA �� �.� A�,a.vAv y.�\� ���.���\�\\vovvA�\ yvv �i y� �a�`>.°�. y��•. A.vvv �... C.a•�,a.� �. � v E� �.�A�. ��?vV��Vvv�wv�vyyg��\� ,,O��.oVVAjt\a,A\\vv\��\��o O� •y A�oavQ����' '�� "��'. .:� ?.,v Av\��vv�y�\r\�`VAvav"3vvVA�� ��\ � \V����� ��:. ® �� V : �;»:;�••.p: a, ra � �,��Av A\AtivA��\VA .:Yv� ��`\AA���\���\:�\::�yA�����.. •...A. .�3�:•a.�v� `�>�..��r�. � a aaaV�v vV kr a�?y�vA v Vv A �. v a k v AVvap�*rvaak?V�. ��A � 0\VA \. so ate:. 1.4 s\ \ \ \ r\< Baa\ Vv a \\\ II , v Aav\vv s a II \�a ia, \ $ iZ SI l �4'� ..A C Mz PHis F "I'Eaa�i A$sA i � �'.; VIA 1,Z-1 sas i �pa to 1 F 3a5 A i x rte ., „yw cook wzAzKv=Tv 4*4 g & act \ ,ay.` �. 'a1 -� �# �; �° C ul AU it FYI sl Citic:. MAI M ��� l.ia-,e\ t.. :Z � y\\ro�tc.� gsqa �a `S Y� Y, at + - N� -� ' WtW sa^. y.3;e+$. '. ay�xekaa: Bv,A.0-ca ,�.�i� •R �' iC" �a, - C `a+ ak\ .3s.. a ... a..r; :. A .�.... \�. tit ' .. k3�ax 3 e ya�ekaR �' a y` ta ya�a ik .Z�� .aki Z< \}'y �a 'l r 3ICFa�' �a, 1. r °' vy�ci a o Yi a•y \ € C, s �i '� y l °�"a"� mak. ak' �t @Con. \` ''�.. `? a�a ,s�...z. aakt3 � w.aaa a �, as kap 4` ,.. .x �t \ax ym aata :t. QMQ ate a.Y Y. Ya< e .�,. + c• a 8 a�a AT C �i �W aC,r' y,. a Ak�aCc WIN ea ii e14. t.n a Ya to a \ # � tl i \ eeaS .. � .. � - �e Vis•`. va '' a\ a ;s SeS. a• � •:`'_ 3 t... ,k a i ys ` a�$.�.a.• a x e\e a,.?^*erea9 � l 'C,\10,0131\\��� Y � `i.. a�� t. •^gym Yk;�� & � �\ yad F ,ac :i. •g e\ e9a� - ' a�:a .e : m . ac�y � n � v `�• '$a € `Q y� ca \\� F�`4 $ 3 �yF gym e; 3t iRe i .,p, a et c \���� �\\\ •aft �w,_, �:. va Sola .�,y��. a .. 3, aY� \�k\k � �"y.\ ���•\'xF \ joy C �\��a� +.nC� F•'� tC i\ e-a H e asc aC 'aa"'� •a# & ,. sta �_ TMO , c��• � ��� � a t �.� .c � ' v "' x �9R �• e a sJaz' Pip � ei ��� � cA y` flak` 441 �R �a-pip:zea cn � � MIR s\\\iLt VA a r MAT tax C�.t V �,��a�4�,m, Y� 3c _ c Y t \L v 3 m v v , \ms s « 8� p you - �a i �e Cp�� R "' ae A.W a`6�a•.^FC x __ 40, a� .._x c�;� a\\y. 1t a RR,01,111 x ao ra$ a g '. A ILIA R'. WSW MIT t t C' ' ems a•e^ e=a.i - t "Ji\ t FSA�� "� 'a�'•a'"s�'sst '� h t �3'at� �aa@ t \t e a\` .k \�� \� czx t �� tee � �����axaa � � � y��\�� a aa�,R •$� ��������\� Is w a\ x x aC a � gay \ -Ru , Y Cel x C V�V Atea � a XI c- aa �a a s- �a v a air Y iaa T P a. ? ^x �. aaa:•.ra»x -,:; =a. ..x» ce �. �? "" aa a*� a a,� a #- a ...y - xa ..a- F 1 . wi ay e,.. s- MU � a 3 \ F is �� ea y ,},.d SYx,dzeN 3 s,v3Y `w 5 � �w ..P e• @ � mxi a s vzue�c,� y a77 x c.�'a,� a 7 x t a �z a� A ra. a�.e .A� .x a s 'zY vFa a` �� `a& c x a a` .a 3 n R a+ w g a;';lyaws-�naV A ;�'� a V.x' A R m.c.a.- 3� �`�a � a, x_ va `a3a � �o s ,� .a>a fi�a - sa \.Rr�va baa aaa, a�"x're . Vaha � :cv& a�.a a.. kqz .a`, �a a v �`a"cxa° a.ax asa„w� aYai4. a z 3 i a� x'c xw a ,:@a x. �a ��, as °`vac ' acAl � � �� ,`°gym .a � bZ;;Z,�V i. ��. mor .sA� xC :.?��� a.� F�',a3�;Y��a�>..�� a x ��a�,�ZF., y�� a .� e � r � a haeec'a �. a..'a?ti � �atua`xaSa aa�vy,; � 'a ..... ,a �,.y� :ah aae,.a a4w -wa xSaa v � '` �� � a� aha @ v3�\� \ v.� a`.� ue �q �c p� x a a aa°va a . a�' �n a ca i yo- cvV`a Amex as R r eaa\� aS _,:' sia \ x E tiY.:. »-Va a e �xg a � i a a � t a a. -tea eta . 3 e- Awa e $ S yea,. nal dpp�ay.., NCR` M° +aa K t ;i a a3 aka a `aaa aQ ��..,. " .�"� Y�yx�-:a.�'ae x� a�ya•@.ea°av_'.a a.» 'ac.�xw tF^' am �et s�ai ar s aa 4 €ba � .q � a x`a y a a �. a F es ew.aa ems« a tea . aCxx'-�a�l '? ta* -. taa x ,ary * a e' .ns Aafa 4 k '..o- a as v�.`�,, x x at aaa a. a,Ax e� a �: 3e �a V`�� '..o .a. 8 e `'° �eamx�.�. .. \ �- y\ qua � ;. a \a S �'*ax .�a,� �. -s - v 0.. aaa°� a ..aa .aae'x aA :'CWoava,1 xIIyfE xV �s .`F,- <\ Zra. a°� .s. \ wax aS. baa aw ,,'ri �'a -:ae.$ � �. �,•.l a �.. -• '"a,sea a ".�a »t�ww° w.,.:x. ..x:.gcva. :, a�3a� a x -er as I� a -- 1 a Awa .ay�.�' � v ��.r aaro3 �` ��a ,:,,a y w,aw..,..a a;.�.a..� x»»e:..`� a a a �a as v �� � v� w x`aa aw a� �a �� iia Ar ��a� �, aa � � 'A' 3xi; �,aFa��a: 11, `� a ae. i\ ,vaaxt e F` x a � '3a a- a .i sad a °aw °ec a aa`'ax �a 0 x �a,. aa.. z axb3 ��wa ova as a\ �V .\a a x ;'a aaa ,.. ° Xatia aas.� .x„ aha s 47..m sa3 :a� .a :tea awa sa \s ars a* 2 .a....w'v:e fa s a m.�.a r..a a� " a a � :� aka,e.. a:''A*tae q -aawx a.�•a: w ,r 1.. ._e �i-aa .. �cA `` ...NN . ,. £'4,k tl= Ti44 � a� a�� � . �� � aaatua,,�xi V �F. 5�e'a s .a a F e4a a a s z ..ap aaav, z ax Qe e. av Ia3 'a aaRy - a- `a .F �xi 8a s aha y' ., saga ,�s �! `\ $ da-k f a� s ww ra a a a� dam? atxa tev �; r ... �� E a. a .» a a�v4lk lo, � \� � �: A•�S� ayes �x �,.a.�'3 a�.. .c�� v,a :.�� wed aaq y�aei t.� �" ,r ,, a \a$ m. wc 9:;\ ^\ \ \ \a aaa` ��, a\ ' \ \> v \ w \\�. \ \\? oaf �a v t � aaa`•3a��"�e�\ � ,. aaxwa �a a aaya � ��xa ea eaw vaiae aaa�a ` Z as 2a Vz 77r v. \vya vA a a�, t Com, e , i } t i WlgLq Cox , 24/,,l "3 II- ( tl' J ^� V V , Q� wIAL J JUI.-N-20( THU 11 :30 Aft Frudential Howe Uoherty hAX NU U(84(bb1U1 P. U Tg Intl ,� D fi AL�AG41b Al l��.I�r'k&LeWI I F 14.1e 111 Not for Voluntary Assessments r % Subsurface Sewage Disposal System Form Inspection results must be submitted on this form or on the official Title 5 Inspection Form dated -- -_ / l�QQO lnspectimsrria�rrrot b'e�aitere�l ink= — - -- .--- - ---- ----..� A. CertificationqT . Important: When filling nut 1. Property Information: ra r - •JUJ 19 200farms ont eoomputsr,use r!� � _ " 1only the tab key Property Address v ARTME dot ------- ---- ---- --- _ � —- --- - - -- -- key- v Owner's Address CityiTGwn States-/ Zip Code Date of Inspection: T-i- �,"Ya7 ram , b Qate 2, Inspector: Name of Inspector Company Name company Address , f cityt7own State Zip Code eC Telephone Number C e rti'i cati o n•S tatern a nt: 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. t am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000).The system: Passes [� Conditionally Passes ® Paps Q Nees Furt er Evaluati n by the Local Approving Authoril:y {nspectar'e 5ipnature pate The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or D.EP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd orgreater,the inspector and the system owner shall submitthe report to the appropriate regional office of the DEIN.The original should be sent to the system owner and copies sent to the buyer, if applicable; and the approving fauthodty. `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. 1.5insp,d❑u-1112064 Title 5 Official Inspecton Form:subsurface Sewage Disposal system Page 1 of 16 JUI.-19-2007 THU 11 ;30 AM Prudential Howe &Doherty HX NO. 9(84(bblU1 Y U3 Title 5 Official Inspection Farm F NV O t �. t for Voluntary ary Ass+~ssments . =Y Subsurface Sewage Disposal System Form A. Certification (cont. Property Address - -....._......._. .. .. ._. ......_ ......_ ...-..._ 5t,ie Zip code owner's Name Date of in3pectlon 5 ti'ts�,��m�1�t;r�A,-�-t�rr—i��rt�va���l•1 A) system Passes, have not found any information which indicates that any of the failure criteria described in 310 CMR 15.3D3 or in 310 CMR 15,304 exist. Any fail,-ire criteria not evaluated are indicated below. Comments: 13) System Conditionally Passes-, ❑ One or mare system components as de cribed.in•the°Conditional Pass" section need to be' replaced or repaired.The system, upo completion of the replacement or repair, as approved by the Board of Health,will pa.ss. Answer yes, no or not determin (Y, N, D) in the❑for the following statements, If"not determined," please explain. ❑ Tha septic tank is metal and o r 0 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits su stantial infiltration orexfiltration ortank failure is imminent. System will pass inspection if t xisting tank is replaced with a complying septic tank as approved by the Board of flea h. *A metal septic tank will pa inspe lion if It is structurally sound, not leaking-and if a Certificate of compliance indicating t t the tan is less than 20 years old is available. ND Explain: Gnsp-doc• 1112004 Title 5 Ofllclei inspection Farm:Subsurface Sowage Disposal System' Page 2 of 16 JUI.-19-207 THU 11 :30 AM Prudential Howe 0oherty FAX NO. 9784755101 P. 04 J..-)PC;LoLIUJ I FUI III Not for Voluntary Assessments Subsurface S-wage Disposal System Form io cont.n.. Propelty-Addres-*i Mote B ys em an i Orta .y Passes con C Observation of sewage backup o break ut or high static water level in the distribution box due fa broken or obstructed pipe(s) or ue, , broken, settled or uneven distribution box System will pass inspection if(with approval o-Bo of Health): El broken pipe(s) are replaced El obstruction is removed El distribution box is leveled a re laced Nb Explain: D The system required PLIMping,more tha 4 times a Year due to broken or obstructed e t system will pass inspection if( ith app val of the Board of Health): pipe(s). The ❑ broken pipe(s) are repla ed ❑ Obstruction is removed ND Explain, C) Further Evaluation is Required by the B rd of Health: ation v t F�c Ll Conditions exist which require further eve b he i ation by the B(,and V Health in orderto determine K the system is failing to Prote public he h, safety of the environment, 1, System Will Pass Unless 13 rd o Health determines in accordance with 310 CMR 13 further r er c d e 0 e fv Health h e a rn SiM(1)(b)that the system is t f rictioning in a manner which will protect public health, safety and the environment-, EJ CeSSP001 or privy is within) 0 t of a surface water ❑ CE'ssP001 Or Privy I s within 50 feet o..a bordering vegetated wetland or a salt marsh Titie 5 OfFiQial Insperflon Form:Sun2mrfaue Sewage DlspDsal System- Page 3 of 16 JUS.-19-2007 THU 11:30 AM Prudential Howe &Doherty FAX NO. 9784755101 P. 05 - - u Title 5 Official Irispection Form Not for Voluntary Assessments Subsurface Sewage, Disposal SYStem Form A. Certfflc#�In ___- ........... Zip Code 0 iian Data of 1 5 ............ C) Further Evaluation is Required by the Board of Health (cont.): 2. systern,will fail unless the Board of ealth (and Public Water Supplier,if any) determines that the system is function no in a manner that protects the public health, safety and environment: The system has a septid N tank a d soil absorption system (SAS)and the SAS is within 100 feet of a surface water suppi or tri ulary to a surfac�3 water supply. The system has a septic t nk and SAS and the SAS is within a Zone I of a public water supply. E3 The system has I septic t and SAS and the',aAS 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 PdVatfl Water SQPP1Y Well Mothod used to determine distance-. This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered,A copy of the analysis must be attached to this form. 3. Other-, t5insp,doc- 1112004 Title 5 Difirlal Inspection Feirm,Subsurface Sewage Disposal SystM- Page 4 of 16 JUL-19-2007 THU 11 :30 AM Prudential Howe &Doherty FAX NO, 9784755101 P. 06 I I L1%i W %w# I I I to I Q I I I 10 JJ 19 to L1 V I I I 01111 Not for Voluntary Assessments Subsurface Sewage Disposal System Form jPC Ode 7 x , n ip nf Inq mlinn .. ... ..... D)system Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the followirig for LI inspections: Yes No ❑ Backup of sewage into facility or system component due to overloaded r 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 B" balow invert or available volume is less than "/2 day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times'purnped: Any portion of the SAS, cesspool or privy Is'hrlover high ground water elevation, L3 IT? 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 I of a public well. Ll in Any portion of a cesspool or privy is within 50 feet of a private water supply well- Ft Any portion of a cesspool or privy is less than 100 fee but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This SysteTp ,ipasses if the well water analysis, performed at a DLP certified laboratb*ry, for coliform bacteria iand volatile organic compounds indicates that the well is free from pol1lution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered,A copy of the analysis must he attached to this form.] Yes No The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 1:_`i.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure- t5in5p,dOU-1112004 TWE:5 Official 111--pectiOn Form:$uGwrfam Saw0ge Di.sposal System- Page 5 of 16 JUL-19-2007 THU 11:30 AM Prudential Howe 0oherty FAX NO,. 9784755101 P. 07 Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form A. Certification_(cont.__, Ki 7,ok- Cityrrown Stale 7jp Cade -6a— .or Winne' ie of In6pection E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,1300 gpd to 15,000 Pd. For large systems, you Mist indicate either"y s', or"no"to each of the following,in addition to the questions in Section D. YES NO E3 the system iXwithln 40 feet of a surface drinking water supply the system is w 11 In 2 0 feet of a tributary to a surface drinking water supply 0 the system is loca d in a nitrogen sensitive area (interim Wellhead Protection Area—IWPA)or a pped Zone 11 of a public water supply well If you have answered*"yes"to any questi n i Section E the 4ystem is considered a significant thr6at, "i or answered "yes" in Section D above th larg system has failed.The owner or operator of any large system considered a significant threat u der S ion E or failed under Section D shall upgrade the system in accordance with 310 CMR 1 .304,Th system oviner should contact the appropriate regional office of the Department. t5inep.doc- 1112004 Title 5 official ln5peotlon Form: sub5urfaresewaqe oi5posal system- Pop 6 of 16 JUI_-19-2007 THU 11 31 AM Prudential Howe &Doherty FAX N0. 9784755101 P 08 wo a a I — Not for Voluntary Assessments Subsui'ace Se\nrage Disposal System Farm B. Checklist:--- _�� - --- -- -- 04 rAvTeuato_ State _ dip Gode Ovdner's Name..._... - ----- -- .._ _ - ...__...._.._ ...._ CI1eCK IT eo ow�rr q`MMi eeri clone. YOU mu! In ICa e Tr no as o each otthe MINIM YES NO ❑ Pumping information was provided by the owner,.occupant, or Beard of Wealth ❑ /❑' 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? been introduced d to the s stem recent) or as art of Have large volumes of water b n in 5 Y p this inspection? ❑ Were as built plans of the system obtained and examined? (if they were not available note as NIA) Was the facility or dwelling inspected.far signs of sewage leack up? ❑ Was the site inspected for signs of break out? ❑. Were all system components', excluding the SAS, located on site? P/ ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles ar tees, material of construction, dimensions, depth of liquid,depth of sludge and depth of;scum? ar . © 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 (f any of the failure criteria related to part G is at issue approximation of distance is unacceptable) (310 CMR 15.302(3)(b)) t51nsp.doc• 1112DO4 Titlo 5 official inspection Form:Subsurface Sewage Disposal System Page 7 or 15 JUL-19-2UU( THU 1131 AM Prudential Howe YxUoherty hAX NU U(84(bb1U1 P U'3 � r Title 5 Official Inspection Form . 5 Net for Voluntary Assessment$ Subsuiface Sewage Disposal System Form C. System Information - • � -all C Property Hddres_, -- — —._� -- ^--- Cityr7ovrn state Zip Code �wner'6 tVam= �ai_e ction _ Number of bedrooms (design)' Number c)f bedrooms (actual): -� DESIGN flow based on 31 a CMR 15.203 (for example: 110 god x#of bedrooms)- Number of current residents: Does residence have a garbage grinder? ❑ Yes 7M No Is laundry on a soparate sewage system? [if yes separate inspection required] ❑ Yes 8� No Laundry system inspected? ❑ Yes U No seasonal use? ❑ Yes 2-No Water meter readings, if available (last 2 years usage (god))_ - Sump pump? ❑ Yes 9 ''No Last date of occupancy: pate Commerciallindustrial Flow Conditions: Type of Establishment: r Design flow (based on 310 CMR 15.2 3): Gallons per day(Opd) Basis of design t1oiN eatsfpersons! q.ft., etc.): J"T Grease trap present? \ ❑ Yes ❑ No Industrial waste holding tank p ent? ❑ Yes ❑ No Non-sanitary waste discharged o th Title 5 system? © Yes ❑ No Water meter readings, if avail NO-. Last date of occupancy/use- Date Other (describe): t5insp.doc 1112POA Title 5 official Inspection Form:subsurface Sewage Disposal System Page 15 of 1 E JUL-19-2007 THU 11 :31 AN FrUdential Howe Uoherty FAX NO, 9(841551U1 P. 10 � _ I me b utticial inspection I'morm Not for Voluntary Assessments Subsurface Sewage Disposal System Form C, 111tO q�tern-- --r.U0afLQ-n Igont-�. .......Property.Address ....... de 7 Owner G Name—w- —U-en--er-afffformatjon Pumping Records: Source of information: Was system pumped as part of the inspection? R--'�es F] No If yes,volume pumped: 0 How was quantity pumped determined? Reason for pumping: Type of system- Septic tank,distribution box, soil absorption system El Single cesspool ❑ Overflow cesspool El Privy EJ Shared system (yes or no) (if yes, attach previous inspection records, if any) El Innovative/AltEl-native technology.Attach a copy of the current operation and maintenance contrail(to be obtained from system owner) ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components,date installed (if known) and source of information: Were sewage odors detected when arriving at the site? EJ Yes �o t5lnsp.d=--1112004 Titic 5 Official Inspeutiop Formi Subsurface Sewage Disposal System- Page 9 of 15 JUL-19-2007 THU 11 :31 AM Prudential. Howe &Doherty FAX N0, 97$4755101 P. 11 =.� Title 5 Oficial Inspection berm = _ n Not for Voluntary Assessments Subsul•face Sewage Disposal System Form C. Svstem Information (cont,) ,. ----.._.._._....--•------_ f ro�erty F�ddresa CitvRavan r G' �/''cP Sfiatr f: u�<- _ ZIP code T Owner's Name tate f In @ectlon [DM 01 Sll"tff -.. �• Depth below grade: feet Material of construction: ❑ cast iron 21�0 PVC ❑ other(explain): �---- Distance from private water supply well or suction line: comments (on condition of joints,venting, evidence-of leakage, etc.): 4 C � Septic Tank(locate on site plan): Depth below grade: - feet Material of construction: Woncrete ® metal ❑ fiberglass ❑ polyethylene [] other(explain) If tank is metal, list age: yein Is age confirmed by a Certificate of Compliance? (attach a (ropy of ❑ yes ❑ No certificate) Dimensions_ -- Sludge depth: - --� Distance from top of sludge to bottom of outlet tee or baffle Scum thickness f I Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or barite How were dimensions determined? t5lnsp-doe•11/2004 Title 5 Official hzpl!etlein Form:Subsurface Sewage DlspasaI System Page 10 of 1E JUL-19-2007 THU 11 :31 AM Prudential Howe &DoherLy FAX NO. 9784755101 P. 12 11 141G V %J11 I Itoldl 11 MPULAIL111 I ["Ut'11111 Not for Voluntary Assessments Subsurface Sewage Disposal System Form —e-,- State 'C AA f-.r.!5.N amp /�'ANO 144 1� 6633�25CY/ o""r/ Grease Trap (locate on site plan): Depth below grade: feet Material of construction: L1 concrete Q eta Q fiberglass polyethylene other(explain), Dimensions: Scum thickness Distance from top of s um top of outlet tee or baffle u t( Distance from bottom o m-to bottom of outlet tee or baffle Dale of last pumping: pate Comments (on pumping ec. mmendations, inlet and outlet tee or baffle condition, structural integrity, IT liquid levels as related to ow et invert, evidence of leakaget etc.): Tight or Holding Tank b must(tank pumped at time of inspection) (locate on site plan): k must b Depth below grade: Material of construction: D concrete El metal El fiberglass Ll polyethylene El other(explain): t5insp.dDC- 1112004 Title 5 Official mr-Pection Form:Subsurfpcp Sewage Disposal Sytiam- Page 11 of 15 JUL-19-2007 THU 11:31 AM Prudential Howe &Doherty FAX N0, 9784755101 P. 13 Title 5 Official Inspection F"orm )?1 �° Not for V0untary Assessments - Subsurface Sewage Disposal System Form C.�stem Information (cont-). - -- --- - - �—. - - rapotty Hddfess - - — --- o rid gtate 7iP Cade ` Dat�apWjori - Gwnet'sName... , — -- — tglit or Holding Dimensions: Capacity: S�cl�lDnS Design Flow: gallons r11'r day Alarm present: ❑ Ye-,! Ca No Alarrrl level' Alarm in working order: ❑ Yes❑ No Date of last pumping: ' pete comments (condition of alarm and floa switches, etc.): J Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 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.): n Pump chamber(locate on site plan):*., Pumps in working order: {� Yes 0 No Alarms in working order. ❑ Yes ❑ No t5lnsfa,doc 11120D4 Tlllu 5 Official Inspection Form:Subsurface:sewage Disposa�lu�yst f I! JUL-19-2007 THU 11:31 AM Prudential Howe &Doherty FAX NO 9784755101 P. 14 v S Not for Voluntary Assessments Subsurface Sewage Disposal System Form --- _ lzy5te. n_In.for-m.aicion_t.c_ont Property address —state dip-Gude GJ k-7 7 Ciw❑Ft''s.l�i�fne. — -------------•--'-------..._.:::-._ ---- PIofL-.:- -------- ------- -------- Carnments(r1ot6 condition o pump chamber, condition o pumps.and.apptarten, nces, etc. Soil Absorption System (SAS) (locate ❑n site plan, excavation not required): If SAO not located, explain why: Type: 0 leaching pits number: ` leaching chambers number. 'x 0 leaching galiedes number: El leaching trenches number, length: L� leaching fields number, dimensions: L1 overflow cesspool numb©r, — (� innovative/alternative system Type/name of technology: — Comments (note condition of soil, signs of hydraulic failure, level of ponding,clamp soil, condition of, vegetation, etc.),. , t5insp.doc- 11/2004 Tltle 5 rifficial inspeetion Form.Subsurface Sewage plsposal System Page 13 of 16 JUL-19-2007 THU 11 :31 AM Prudential Howe 0oherty FAX NO. 9784755101 P, 15 Title 5 official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (cont.) Property Address Zip Code CRY./Town Owner's Name P6�-Mu Number and configuration Depth-top of liquid to inlet inYell Depth of solids layer Depth of Scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow E] Yes El No 11,signs of yd clic Comments (note condition of soil,Signs of yd ulic failure, levet of ponding, condition of vegetation, Privy {locate on site plan): Materials of construction: Dimensions Depth of solids raulic failum, level of ponding, rorldKien of vegetation, comments (note condition of soil,signs of 6 tFi-f a urc, etc.)'. Title 5 Official InlipeCtiOn FQfm'Subsurface sewage Disposal system t5insp,doc-11/2004 Page 14 of 11 JUL-19-2007 THU 11 ;32 AM Prudential Howe &Doherty FAX NO. 9784755101 P. 16 I I LM V W I J ILvICtl 111ZOPULAW1116rs urrn Not for Voluntary Assessments Y Subsurface Sewage Disposal System Form —.. Sy �C11J1 In f on- t.3.- Froperl'y A dress._... ...... . .. . ....._ itWTGwn _ . --- •-_------ r-Nam. --------...__--- v .tr.,ryr t--. , _ • pafh�_tils�w�gtlon—�.----•,.,_.---=---..... Sketch Of Sewage is osal S r�stern_Provide a sketch of the sewage disposal sYstem including ties to at least two permanent reference landmarks or benchmarks vacate all wells within 100 feet. Locate where public water supply enters the building. t� Alts 'A;0 I . t5insp.doc•1112004 Title 5 official inspection rorm:Subsurface sawoge Disposal System Page 15 of 16 JUL-19-2007 THU 11 :32 AM Prudential Howe &Doherty FAX N0. 9784755101 P. 17 I I S Inspection F"or �1Title Off °) Not for Voluntary Assessments Subsurface Sewage Disc,)04 Svstem Form InformatLo cont. Property Addrriss state Zip Cade Rats o In6 ecti n _. slope Surface water Check cellar 1-641- shallow '"1shallow wells /1101 Estimated depth to ground water: if Please indicate all methods used to determine the high ground water elevation.. [ Obtained from system design plans an record .rs.r if checked,date of design plan reviewed: 0Ite (l Observed site (abutting prop ertylobservation We within 150 feet:of SAS) (l Checked with local Board of Health-explain: Checked with local excavators, installers- (attach documentation) [J Accessed USGS database- explain: You must describe have you established the high ground water elevation: t5inep.doc 11120NTitle s orr�oial In�pection Form:submirface Saw-,,ge Disposal 5Ys of t TOWN OF NORTH ANDOVER, MASSACHUSETTS OFFICE OF. . CONSERVATION COMMISSION , `'`` TELEPHONE 683-7105 o r 4SSACHUSE » i'ursuant 'to the authority, o.,f,; the 1%7,etlands -Protection Act, ,.;a.ssachusetts General Laws Chapter 131, '.Section- 40, as amended, grid the. Town of North Andover' s A-Jetlan.d Protection By Law, the North, :Andover Conservat :on..'Comm`ission iii l hold' a, -Public Hearing on September 26, 1984 at 8: P:M, at the Town Building AJC-' J.'ing Room', 120 Main :8tre'et, North Andover; MA, on the Notice a. o Intent -of . ":Thomas Lb-t1 ani to alter land at Lot 1 Great Porid' Roam;'' ' for .'purposes of t constructing a , single 'f'Ainily ,dwelling- and. associated structures.. Plans are- avdi. 1016 at the ' .C'onsorvation Commission Office, Town Building, 120 Main Street North Andover, 11A, on Tuesday from 12 :00 noon to 2:OO. p.m. and by appointment, By: A: Galvagna Chairman run once in the N.A. Citizenon,., Sept. 20, 1984 . - Copies sent to: , S Planning Board Board of Health Public Works Y Highway Dept. Applicant Engineer DT-QE Board of Health 4 North AndovervxaBs. 5EPTIC SZSTEH 5 INSTA=TIOK CMK LIST LOT ' - _ T (nTID DATg DISUPROMID X AVATIC81 01 FAIL easonst FAIL OK 1. Distance Tot % H(6N 5C2p(0,-"-1 L1JEL a. wetlands tctiG /45b. D Drains :.,. 2. Water Line Location 3. No PPC Pipe 4. Septic Tank a: -Tees --Length & To Clean Out Covers b. Cement Pipe to Tank - On Both Sides of Tank 5. Distribution Boa a. Covers & Box - No Cracks b. All Lines Flo-Ang Equal Amounts c. No Back Flow b. Leach .Field or Trench a. ' Dimensions b. Stone Depth - _-�— c: Capped Ends d. Clean Double Washed Stone` 7. "Leach Pits R% Dimensions ' b..' Stone Depth Splash Pads d. Tees. g. Cement Pipe to Pit - Both Sides f. Clean Double Washed Stone 8. No Garbage Disposal 9. Final Grading Inspection 10. Barricading Covered System 11. As Built Submitted a. Lot Location b. Dimensions of System c. Location with Regard-to Pere Test d. Elevations { F e. Water Table F x t f Health . . .judover,Xass , SUBSURFACE DISPOSAL DESIGN CHECK LIST J � LOT APPROVED DATE 12 -! •� DISAPPROVED . ' DATE v7 Provided: Reasons Ji, Title V FAIL CKK Reg 2.5 The submitted plan must show as a minimums a)'the lot to be served-area,dimensions lot #,abutters U b location and log deep observation ho; s-,tstance to ties location and results percolation tesi,s-& ,tanee to ties c P . d design calculations & calculations showing required leaching area (e) location and dimensions of system-includi­tg reserve area f) existing and proposed contours (g) location any wet areas within 1001 of sewage disposal system or disclaimer-check wetlands mapping (h) surface and subsurface drains within 1001 of sewage disposal ., system or disclaimer (i) location any drainage easements within L00' of sewage disposal system or disclaimer-Planning Board files (3) known sources -of water supply within 2001 of sewage disposal a system or disclaimer (k) location of any proposed well to serve lot-1001 from leaching facility (1) location of water lines on property-101 from leaching facility (m) location of benchmark (n) driveways - - -- - (o) garbage ,disposals (p) no PVC to be used in construction (q) profile of system-elevations of basement, plumb, pipe, septic tank, distribution box inlets and outlets, die ribution field piping and Otter elevations (r) maximum ground water elevation in area sewage disposal system (s) plan mast be prepared by a Professior.-1 : zgineer or other - - professional authorized by law to pr..,ar% such plans Reg 6 Septic Tanks (a) capacities-150% of flow, water table, tees, depth of tees, access, pumping (b) cleanout (c) 101 from cellar wall or inground s-v4mmdng pool (d) 251 from subsurface drains eg 10.2 Distribution Boxes (a) slope greater tAm 0.08 eg 10.4 b) sump Iee 1111 •, . ne Ieee■etee■ e Ieeeeeeeen 1 11 11111111111 1 nI1n11111111 1111 IIIIIe1I111n11111/e11111111 ,, 1111 11111/1'•11■n11■11111'■I'1'■t11 t 111111111/11/111 ®/1//IIIIIIIIe1/ Ieeeeeel��I��eerenl/1■eeeeeee ,� 1n1'1111/■■IIIIt�nIn1®1'■■111111 ME■������I������e� e•1111.1,■i/111IN1 1n e111111111e111 Itt/Ine//L1®■11111111111111■ 11I,111011111111mi ._....... � 1!.111.1 ee■eee1,� neeveleee 11„Iter► /1/ e111e111111 e�'IIIIIe1111/111 m� 1//11/IA/IIIIe1/■IIIIe1 y, /Ie//Iee/IIIIIe■EIIIIIIIIe111i fil n/I//I 111111 111 �� Ie1/ ®11/111111111/11 I 1/111111111111 111 ,.- � 1111111®1111111/1111 g �s 11l16� 11/11111/1 e111 ■•1��111/II,II!'! !tII■1goo ISO 1111 11�11111111'/I/`.1111M/CJI, 4t ®��moo���■��■�■ni■■■■.IIP/• 11/1111111111/11/;1�•••• • •■■I �� /1/11/11/11/e11 b F rtr :. ..' � � Y .' " f S• 'G '8 rr ...:,.. .: ". gyp, • t *} ^.r.-. n.< r r 4: h r .,T.L ..t�,?k .,,.P yyt �{4�F '' 'S�3 .".''r7 -d: L,. ' - -. _.. _..._......_.. a d o . 1 sfi� nr c L.e v-e R n � 5ce L U M �e_vc� 6 Am �1(I e Stevens Water Analysi's 38 Montvale Avenue • Stoneham, MA 02180 • Mass. (617) 438-6114 • Salem, N.H. (603) 893-3106 LABORATORY NUMBER: 14714 SAMPLE DATE: 4/2/85 SUBMITTED BY: Joseph Barbagallo 1 Westward Circle No . Reading , MA 01864 SAMPLE SOURCE: New Artesian Well/collected from well direct Joseph Barba alio No . Andover MA P $ > > ANALYSIS: According to Standard Methods of Water and Wastewater Analysis, 15th Ed. Total Coliform . . . . . . . . . not requested Chlorides . . . . . . . . . . . . 34 mg/L pH . . . . . . . . . . . . . . . 7 . 4 Hardness . . . . . . . . . . . • 62 mg/L Manganese . . . . . . . . . . . • 0. 28 mg/L Sodium . . . . . . • • • • • • • 24 .5 mg/L Iron . . . . . . . . . . . . . 5 . 60 mg/L Nitrate . . . . . . . . . • • • • 0 . 18 mg/L Nitrite . . . . . . . . . • • . • less than 0 . 10 mg/L COMMENT : The results of these analyses meet the required federal and state standards for drinking water. However, the iron, manganese and sodium exceed the recommended standards . Although iron and manganese are not harmful to your health, they can affect the taste, color and odor of your water. Iron, manganese and sodium are frequently found at elevated levels in new wells ; however, it is likely that the concentrations will decrease when the well is put into regular use . In Massachusetts the recommended sodiumstandard is 2.0 mg/L. emist/Microbiologist Stevens Water Analysi's :18 Montvale !Avenue • Stoneham, MA 02180 • Mass. (617) 438-6114 • Salem, tJ.l 1. (603) 893 3106 LABORATORY NUMBER: 161.526 SAMPLE DATE.* 11/5/8.5 SUBMITTED BY: Joseph Barbagallo 1 Westward Circle No. Reading, MA 01864 SAMPLE. SOURCE: New Well/collected from faucet Lot 416, Stonecleave Road, No. Andover, MA ANALYSIS: AccordInp, to Standard Methods of Water. and Wastewater Analysis, 15th Ed. Total Coliform . . . . . . . . . 0 per 100 ml I COMMENT: The result of this analysts meets the federal and state standard for bacteriological. quality in drinking water. ___1.,,111 Chemist MicioiioloPi.st aP wELL DATABASE AGE OF 7, —EL r '/J< wELL. D R E, -E v�r-rLLr oc,i.T-orr: D EF771OFFvrI.: TQFw _ a_ D r- b. DLG c uTINKISN0 - _ . . _ mi "VA=A.iYk=D N _ - CIffaN �N _ 0"r'.� 17y-=DA A-EA 17L A DDRE--SS: A -FOrwarI.: w- i DR H'`R, waLPEL FvF.L.L LOCA SON: 4' �4i% PEtiL�1'DA DEt 7H: OF � r t Or W"_;_I : z. D LED b. DUG c. L I\FL\i G Kq TYPE OF WA-1 BE kP,-\TG ROC: : �i ATS ANS YSIS DATE: EIGt tiL���i GA�v-ESE: Y r+ PIGH LRON: Y N OT1�R CON T A/MNA�iTS: N lap tv-pisw s a' U 7 7 t'9ti 9a'd Q h'd3S0 r1 Q .�r1/err s� Ag? v.�1�nbn� S:csgl S'G•S t/ S•S C/ -!0'/13T�i W011 pig I I I 1/ , rO/1 b�07 •1•°'�h •SS�' _ S 8 o F x • / S ��'tJ F o J �" 7 �n ivy rJ�/ o Qy OA/ v ` '7 n -VA 378Y1 a'31 pr/H '-S 8 0 = 'ti `/ !/ x '' � � 7 air b-1 9 L Or�► -___-------- _ � ��+/ � � � � ♦ � .. /vs9"s -7 iv59 �+s S�d�1 7/OS` •..J J �Q` / ( �� -s'� �'�� s•rF/ r�/11ri137� do .a� s � �'�-. N. � , +i��, t ` �t �'�• ��J 7-1 lea -LS31 ` O /•rijy ��"•pis• S .+•i/f, �i1N nim iy/w doa•p o i^ v /y,�y11►��T7� i✓a11gT 7 '� •rr / dam! For ZAP -iU#V r : b�a►f► /vcildwsi�d � ' �' o vs7 �✓Iyb►1 7/1d�7S � '� / �' •N :S.�/1/7/ .d '�iY/8t4/n7d �749&7 d1 dv oo, 100,fiy ' 9/ys�pd •oi Zj 'y 1' �►�rv1' t � .� .� s' t saa �' P Ss6+l� �-�H/ pva Al s 6/ /p r •. ,7•,J 7-Z y[ - � r ',gyp A r "+ .+.• 1 O7 41 p'�1 ,rte •a" ' . '��`+��r..+. � • :a/' ;_d o7-'...:v�,�rte--����M .e o ,�,„ y ♦ , _, � o N� o �++a�+reaudwarr '� ` Lf9A►9YAgaReotS:�ItlWtwRkr ,begy�oaxNrra�naRxawuk+verarv +r,,.r+c,arrtmri-rspeame+wew. ufaa. �' iuvvwvrasuarerc�sroNnrnn< "WErAS7- CONG, E7rE S'EEPgUE p17- WALSMW 572)M, • �B-'b '3a" l'�'ASNED G.eGCSi'+�ED STbtf6 , S si © – ---- O O O O O O O O O O O O O Q p 8r s6EP4GE P/T- �S'ECT/o.v B-,B ¢••��STleO,v, S .00� �EPACTE ,t�,EE,4 n /SbzJ 4S'41-, GO.vG2 ETE SEPT/C O B JQ. �T PES p/T. TA itl/C . if~ SCK/D 1.1/.C•, Sew-,s> TO/ i rS - 137 _ I I y o � I� �3e•7S I � , ! , I - I'x7 00, E PT — PL 44.1 �ROF/G E --- cSEEP.q(7tc P/T RGA A!' .Qit/p cSEC Tl=�.v<S 6 s� C L-Q q �NEET . •,.� Qf 2.,r, 4tv