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Miscellaneous - 60 SHERWOOD DRIVE 4/30/2018 (2)
j 60 SHERWOOD DRIVE 210/105.C-0061-0000.0 ive A A Y J 31 •.f �' u , tj^n�r .t'�iF`°1,}.f�. + N ,,,f' '�fa r' 1/ � 1Y t � a F�� T �`..Lr'`Sy y " st''�J ,'" t't °X •�v7,+; Y��+ , Ji . .,. MAP # 6 � LOTS # ,,; '. . �j. -- PARCEL # r T STREET / QO.NST RU.CT I ON-APP RO HAS PLAN REVIEW FEE BEEN PAID? .E5 NU PLAN APPROVAL: DATE APP. HY _ _ DESIGNER: ,���� PLAN DATE. -(� CONDITIONS WATER SUPPLY: TOWN WELL WELL PER DRILLER WELL TESTS: CHEMICAL DALE APPROVED HA • RIA I DALE 11PPRUVED BACTERIA I DATE APPROVED COMMENTS: FORM U APPROVAL: APPROVAL TLI ISSUE YES NO DATE ISSUED j /Z 7 BY CONDITIONS: <' FINAL APPROVAL: . ALL PERMITS PAID YES NO WELL CONSTRUCTION APPROVAL YES NO SEPTIC SYSTEM CONSTRUCTION APPROVAL YES NO OTHER YES NO ANY VARIANCE NEEDED YES NO FINAL BOARD OF HEALTH APPROVAL: DATE: BY: ti Rrlru.moi •i....,;'\.•,,.f•: J'• ♦ 1.? �; '.+:�••'.J :. +. :'r:...� :�°.1 1 A (r ;i1 \ _ 'a••'� .j. '- - ,' _ ^^: IS'THE INSTALLER LICENSED? NO NREPAIRTYPE. OF. CONSTRUCTIO NEW CONSTRUCTION: ,.. CERTIFIED PLOT PLAN REVIEW YE NO f _ CONDITIONS OF:.APPROVAL Yom' NO _ �- (FROM .FORM U) _ !: ISSUANCE OF DWC PERMIT r YES NO DWC PERMIT- NO. 1 . INSTALLER: BEGIN INSPECTION NO EXCAVATI�ON , INSPECTION: ; NEEDED: A-7 0 PASSED BY :CONSTRUCTION INSPECTION: NEED ED 1 AS BUILT PLAN SATISFACTfl-9 YES: ` 7/vel APPROVAL TO BACKFILL: DATE: :..Q BY -- ' DATE �� '. .,FINAL . GRADING APPROVAL: FINAL CONSTRUCTION APPROVAL: DATE: BY .'.11.1'••• ` =1 �. .. '�• ' -. - ` '• Commonwealth of Massachusetts W City/Town of No Andover System Pumping Record Form 4 DEP has provided this form for use by local Boards of Health. Other forms may be used, but the information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority within 14 days from the pumping date in accordance with 310 CMR 15.351. A. Facility Information Important:When filling out forms 1. System Location: on the computer, use only the tab r ---- �-A� R key to move your Address V=Ly cursor-do not No Andover Ma use the return key. Cityrrown State �iJ�Y ( f1��9 Zip Code 2. System Owner: TOWN OF NORTH ANDOVER V\Q�5 HE=ALTH DEPARTMENT Name moon Address(if different from location) City/Town State Zip Code Telephone Number B. Pumping Record - 1. Date of Pumping U r 2. Quantity Pumped: + Date p Gallons 3. Type of system: ❑ Cesspool(s) eptic Tank ❑ Tight Tank ❑ Grease Trap ❑ Other(describe): 4. Effluent Tee Filter present? ❑ Yes,?r No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: 6. yS stem Pumped By- lk ` h Name V Vehicle License Number Stewart's Septic Service Company 7. Location where contents were disposed: Stewart's Pre-treatment Plant, 20 So. Mill Bradford, Ma 01835 Signature o le u " Date r eceiving Facility Date t5form4.doc•03/06 System Pumping Record•Page 1 of 1 FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. *****************************APPLICANT FILLS OUT THIS SECTION*********************** APPLICANT_AA��T- �% PHONE_____ LOCATION: Assessor's Map Number _ _ PARCEL SUBDIVISION____ ________ LOT(S) STREET_fQ ` ( D�'-�U�. _____ ST. NUMBER___ ********************** **** ******OFFICIAL USE RECOMMENDATIONS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR DATE APPROVED __— DATE REJECTED COMMENTS____ TO N PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR-HEAT DATE APPROVED DATE REJECTED_ _ c PTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTEB_� COMMENTS PUBLIC WORKS-SEWER/WATER CONNECTIONS______________ DRIVE W PE IT FIRE DEPARTMENT__ RECEIVED BY BUILDING INSPECTOR___ _____ ____DATE___ Revised 9197 jm HEARST ADDENDUM ywer HAROLD 8 KIMBERLY ,HEARST - ........._ _ ---- +tr'ropertyAddress .60 SHERWOOD DRIVE City NORTH ANDOVER County ESSEX State MA Zip Code 01845 Lender/Client SOVEREIGN BANK FIVE WHITTIER STREET SECOND FLOOR FRAMINGHAM MA. 01701 _i .610 .:..: 3 AT ► ; .. a� G AAA 4C 2d 3 2 w40 f ' 21'-3 5/8" m N I T --------------------------- 32'-2 7/8" I ' i i I � Fridge , I !.. I � N j Utilities 22'-315/16 ----- m _ F i BORZOI! `gqT h � t 2 Storage ' I --I� ------- F -- � I Water 2 Electrical f - - At X i --- - ..9U1 S•.6t I -- - -- J i y N � I m I ,f P P a fi'f J d +•,PJ'i F! J t" ! ' le I saM flln � I w e AIL z,zs N , 19 ___-- �_. --- ------_____ n � �CI b / � qtf Ori f r / 45in. // ff// // F /r : /��r 1. .�•!�l _. rF•�fr'/�r'1/ � 1 Should leave. 30 rec/21 min " in front of Toilet 36 rec width/30 min V J a\ 1 p � I� r C� 00011", I 2oow � 1 = � M Residential Property Record Card PARCEL ID:210/105.C-0061-0000.0 MAP:105.0 BLOCK:0061 LOT:0000.0 PARCEL ADDRESS:60 SHERWOOD DRIVE FY:2013 PARCEL INFORMATION Use-Code. 101 Sale Price: 624,900 Book: 05989 Road Type: T Inspect Date: 08/03/2006 Tax Class: T Sale Date: 01/26/01 Page: 0034 Rd Condition: P Meas Date: 06/03/1998 Owner: Tot Fin Area: 3369 Sale Type: P Cert/Doc: - Traffic: M Entrance: X HEARST JR, HAROLD T Tot Land Area: 0.82 Sale Valid: Y _ 'Water: Collect Id SGC KIMBERLY BRUEWER HEARST Grantor. . PHILIP CRABLE Sewer: Inspect Reas: M Address: - - - - _: . _._ - - - - �-- a 60 SHERWOOD DRIVE Exempt-B/L% / Resid-B/L% 100/100 Comm-B/LP/o Indust-B/L% / Open Sp-B/L% / NORTH ANDOVER MA 01845 RESIDENCE INFORMATION LAND INFORMATION Style; CL Tot Rooms 12 Main Fn Area: 2298 Attic: NBHD CODE: 9 NBHD CLASS: 9 ZONE: R1 StoryHeight: 2.00 Bedrooms:_ 4 Up Fn Area: ' 1071Bsmt Area: " 1479 Seg Type '-Code Method Sq-Ft Acres Influ-Y/N. Value Class ' Roof: H -Full'Baths: 4 Add Fn Area: Fn Bsmt Area:'700 1 P 101 S 35824 0.820 121,271 Ezt Wall: FB Half-Baths: 1 Unfin Area: Bsmt Grade: VALUATION INFORMATION Masonry Trim: Ext Bath Fix: 3 Tot Fin Area: 3369 Current Total: 630,300 Bldg: 509,000 Land: 121,300 MktLnd: 121,300 Foundation: CN Bath Qual: M RCNLD: 508956 kitch Qual: M Eff Yr Built: 2000 Mkt Adj: Prior Total: 586,900 Bldg: 471,000 Land: 115,900 MktLnd: 115,900 _ Heat Type: FA Ext Kitch: Year Built: 1098' Sound Value: Fuel Type: G Grade: V Cost Bldg: 509,000 Fireplace: 2 Bsmt Gar Cap: Condition: V Aft Str Vail: Central AC: Y Bsmt Gar SF: Pct Complete: Aft Str Va12: Att Gar SF: 614%oGood P%F%E/R: ///95 Porch Type Porch Area Porch Grade Factor W - 368 SKETCH PHOTO 14 368 Sq.Ft 11774 32 9 =yam 3 y FM/B 17 408 Sq.F1 17 FUIFM/B 1071 Sq.Ft = _ 34. 33 -3 — V0.75/FM - 819$q.Ft 31 32 60 SHERWOOD DRIVE 1 Parcel ID:210/105.C-0061-0000.0 as of 7/22/13 Page 1 of 1 TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSL SYSTEM FORM PART A CERTIFICATION Property Address: 60 Sherwood Drive North Andover,MA 01845 Owner's Name: Phil Crable Owner's Address: 60 Sherwood Drive North Andover.MA 01845 Date of Inspection: November 16,2000 Name of Inspector: (please print) George Norris Company Name: D.F. Clark Inc. Mailing Address: P.O. Box 265, Ipswich-MA 01938 Telephone Number: (978)356-5638 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: X Passes Conditionally Passes Needs Further Evaluation by the Local Approval Authority Fails Inspector's Signature: kl�5 Date: � ' +b 1 C0 The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP) within(30)days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments 27 ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6115100 page 1 Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 60 Sherwood Drive North Andover,MA 01845 Owner: Phil Crable Date of Inspection: November 16, 2000 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: X I have not found any information which indicates that any of the failure conditions 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. Answer yes,no or not determined(Y,N,ND)in the 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. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): _broken pipe(s)are replaced _ obstruction is removed _ distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced _ obstruction is removed ND explain: 2 Page 3 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 60 Sherwood Drive North Andover.MA 01845 Owner: Phil Crable Date of Inspection: November 16.2000 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Nater 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 vrithin a Zone 1 of a public water supply. _ The system has a septic tank and SAS and the SAS is nithin 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance **This system passes if the well water analysis,performed at a DEP certified laboratory.for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: 3 Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 60 Sherwood Drive North Andover,MA 01845 Owner: Phil Crable Date of Inspection: November 16,2000 D. System Failure Criteria applicable to all systems: °° following for all inspections: You must indicate either yes or"no' to each of the owi g fo _ spe Yes No X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged AS or cesspool spoof X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool X Liquid depth in cesspool is less than 6"below invert or available volume is less than''/z day flow X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s) Number of times pumped _ X Any portion of the SAS,cesspool or privy is below the high ground water elevation X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply X Any portion of a cesspool or privy is within a Zone 1 of a public well X Any portion of a cesspool or privy is within 50 feet of a private water supply well _ X Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from the facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] No (Yes/No) The system fails. I have determined that one or more of the above failure criteria exist as described in 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 large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"ves"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. 4 Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 60 Sherwood Drive North Andover,MA 01845 Owner: Phil Crable Date of Inspection: November 16, 2000 Check if the following have been done: You must indicate"ves" or"no'as to each of the following: Yes No X _ Pumping information was provided by the owner,occupant.or Board of Health X Were any of the system components pumped out in the previous two weeks? X _ Has the system received normal flows in the previous two week period? X Have large volumes of water been introduced to the sy stem recently or as part of this inspection? X _ Were as built plans of the system obtained and examined? (If they were not available note as N/A) X _ Was the facility or dwelling inspected for signs of sewage back up? X Was the site inspected for signs of break out? X _ Were all system components,excluding the SAS.located on site? X _ Were the septic tank manholes uncovered opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid depth of sludge and depth of scum? X Was the facility owner(and occupants,if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes No X _ Existing information_ For example,a plan at the Board of Health. X _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [3 10 CMR 15.302(3)(b)] 5 Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 60 Sherwood Drive North Andover.MA 01845 Owner: Phil Crable Date of Inspection: November 16,2000 FLOW CONDITIONS RESIDENTIAL 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): 440 Number of current residents: 2 Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system (yes or no): No ; [if yes, separate inspection required] Laundry system inspected(yes or no): Yes Seasonal use: (yes or no): No Water meter readings,if available(last 2 years usage(gpd)): Sump Pump(yes or no): No Last date of occupancy: Currently Occupied COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter reading,if available: Last date of occupancy/use: OTHER: (Describe) GENERAL INFORMATION Pumping Records Source of information: System has never been_pumped according to home owner Was system pumped as part of inspection Lyes or no): No If ves,volume pumped: pllons—How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM X Septic tank,distribution box, soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes, attach previous inspection records,if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) Tight Tank Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: System installed in 1998 according to home owner Were sewage odors detected when arriving at the site(yes or no): No 6 Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 60 Sherwood Drive North Andover,MA 01845 Owner: Phil Crable Date of Inspection: November 16.2000 BUILDING SEWER(locate on site plan) Depth below grade: 21" Material of construction: cast iron X 40 PVC_other(explain): Distance from private water supply well or suction line: 25' Comments:(on condition of joints,venting,evidence of leakage,etc.): —Building sewer pile is in good condition.no evidence of leakage. SEPTIC TANK: X (locate on site plan) Depth below grade: 15" Material of construction: X concrete_metal_fiberglass_polyethylene _other(explain) If tank is metal list age_ Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 5'W x 4'D x 10'L Sludge depth: 5" Distance from top of sludge to bottom of outlet tee or baffle: 29" Scum thickness: 5" Distance from top of scum to top of outlet tee or baffle: 4" Distance from bottom of scum to bottom of outlet tee or baffle: 12" How were dimensions determined: Measured Comments(on pumping recommendations.inlet and outlet tee or baffle condition structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Inlet tee is missin&outlet tee is in place liquid level is at outlet invertno evidence of leakage. Tank is in good condition_ GREASE TRAP: No (locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass_polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments: (on pumping recommendations,inlet and outlet tee or baffle condition.structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): 7 Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 60 Sherwood Drive North Andover.MA 01845 Owner: Phil Crable Date of Inspection: November 16. 2000 TIGHT or HOLDING TANK: No (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass_polyethylene_other(explain): Dimensions: Capacity: gallons Design flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no):_ Date of last pumping: Comments(condition of alarm and float switches.etc.): DISTRIBUTION BOX: Yes (if present must be opened)(locate on site plan) (Depth below grade= 15") Depth of liquid level above outlet invert: 0" Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box. etc.): Distribution is equal minor carryover no signs of leakage into or out of d-box. D-box is in good condition. PUMP CHAMBER: No (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances, etc): 8 Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 60 Sherwood Drive North Andover,MA 01845 Owner: Phil Crable Date of Inspection: November 16,2000 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) If SAS not located explain why: Type _leaching pits,number: _leaching chambers,number: _leaching galleries,number. X leaching trenches,number,length: 2 trenches 46long_ _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.): Soil&vegetation is normal no signs of hydraulic failure or ponding present Inspected SAS with inspection camera found system to be working well CESSPOOLS: No (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil, signs of hydraulic failure.level of ponding,condition of vegetation,etc.): PRIVY: No (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.): 9 Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 60 Sherwood Drive North Andover,MA 01845 Owner: Phil Crable Date of Inspection: November 16.2000 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. A- 1 = 36'10" B - 1 = 33' A—2 = 106' Driveway B -2 = 106'9" er ter Brick Steps B A #I —Septic Tank #2—D-box 2 Leach Trenches 46' long 10 Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 60 Sherwood Drive North Andover MA 01845 Owner: Phil Crable Date of Inspection: November 16,2000 SITE EXAM Slope Surface water Check Cellar Shallow wells Estimated depth to ground water 8' feet Please indicate(check)all methods used to determine the high ground water elevation: X Obtained from system design plans on record—If checked, date of design plan reviewed: _Observed Site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: _Checked local excavators,installers—(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: According to the soil testing performed on April 20, 1995 by Neve Associates groundwater was determined is 96". Bottom of leach trenches are 30"below grade. Basement is 6'below grade,dry and with no sump pump. 11 I, �o� �G� �2/� �� ���'`' � i 1 t � S�o � � �v /� �� �i�� �G%C�" �: � � ���� d L J�� ��� Town of North Andover F „ORT„ O 41�ai,°qti Office of the Health Department Community Development and Services Division William J.Scott,Division Director 27 Charles Street 4SSACHUS�t Sandra Starr P ( )978 hone North Andover, Massachusetts 01845 Tele 688-9540 Health Director Fax (978)688-9542 I-Ar North Andover,MA 01845 Re: Application for 7ci L 5 Dear: lye. AE'x9p S%M Your application for -�,A4-J 61�kwtat W `�^"°� has been reviewed by the Health Department. The application was denied on -4-I I61 o1 ,2001 for the following reasons: g - 1. ❑ Missing information 1 to Nkva 2. ❑ Passing Title 5 inspection of septic system required 3. ❑ Location of structure not acceptable f To address the problem(s): If#1 is checked, please supply: a. Floor plan of existing and proposed addition b. Certified plot plan showing house,septic system and proposed project in scale If#2 is checked: a. Have the septic system inspected by a certified Title 5 inspector to determine the size of the system and whether it is operating properly: OR b. Tie-in to municipal sewer If#3 is checked: a. Relocate the project Please feel free to call the Health Office at 978-688-9540 with any questions you may have. Sincerely, Reviewer Cc: Building Department File BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 NURSE 688-9543 PLANNING 688-9535 F SORT 1-,0 T104— ® of Andover No, Z , IAJI * � 19 ' dower, Mass., - LAKE �` .9-COCMICHEWICK L�'�` E D�pP�y SS mink BOARD OF HEALTH PERMIT TFood/Kitchen 14 q t Lip Septic Syste Lqtdvd ,,QtdAC THIS CERTIFIES THAT.................................... .......,�.�,al.1../�.��..�....................... BUILDING INSPECTOR Foundation has permission to erect....................f.................. buildingfon ...... .. ......... ... ..�...... .� / �` -/ tobe occupied as........................................... ..,�d�1. .. ...................................................................................... Chimney provided that the person accepting this permit shail in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMB G E R VIOLATION of the Zoning or Building Regulations Voids this Permit. ^fou Final PERMIT EXPIRES .IN 6 MONTH-I ELECTRICAL INS UNLESS CONSTRUCTION Ra". , l y � ................ ... ... .. ........ .... ....................................... B DING INSPECTOR Final Occupancy Permit Required to Occupy Building GASINP TSO — ou j� h Display in a Conspicuous Place on the Premises Do Not Remove Final No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENT. Burner Street No. Smoke Det. Form No.4 Town of North Andover, Massachusetts BOARD OF HEALTH January 5 , 1 g 98 CERTIFICATE OF COMPLIANCE This is to certify that the Individual Soil Absorption Sewage Disposal System constructed ( x) or repaired ( ) b _Bob Innis y INSTALLER r at Lot 4 Sherwood Drive SITE LOCATION has been installed in accordance with Board of Health Regulations as described in the Design Approval Site System Permit No. P lE dated Aucus_t .6.,-19 97 The issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. 01 BOARD OF HEA177FH Form No.3 Town of North Andover, Massachusetts BOARD OF HEALTH LORTH 1)0.9/� 6! 1 g- o ! �1 "�:�` DISPOSAL WORKS CONSTRUCTION PERMIT '�•,, �,SSACHUSEt Applicant ©b y A)tJL5 NAME ADDRESS TELEPHONE Site Location L Permission-is hereby granted to Construct ( or Repair ( ) an Individual Soil Absorption Sewage Disposal System as shown on the Design Approval S.S. No. � CHAIRMAN,BOARD OF HEALTH Fee 7`S, D.W.C. No. Address 64> 5k"wvoa p a,, Title of File Page of Date File Open: Date file closed: Doc Document/Action Title Date of Refer to other Purpose of:Document/Action and nates; action Document/ document/ Num. Action Department Board of Appeals -- Board of Health - Planning Board --Conservation Commission —Building Department 1 hr's I. -{l: The Delmo-m—C- 0 ,44-05 , Lot Number-4 I ) BEDROOM 3 B2 BEDROOM 4 j ,2T*x ,2-0 X„'. The Delmonico offers a touch of Eu, I elegance and comfort in every corner. SomE EXERCISE/ III STUDY MASTER SUITE Wx 12'-O•x 1r-7• I _ MW ,, most engaging aspects of this home are a firs BEDROOM 2 12'-O'x 17'-r I Ill�l 11llrilli 12'.4'x 17'-3" FOU.0 study and lil MAS MR BATH �_' spacious SECOND FLOOR PLAN q N �1 9 L� 1 room, a si TIICIE Cl4 MEi4xT 4'OxIFM xOTI°OTNEpW ItE full-size KITCHEN FAMILY dinin, DINING FAMILY I ! DINING zo•o ■ 4 21'-4•x 1B'-O' I _ SUw(EM 4 v,EurEo 1 Y I J and alu, ° 0 PR LAUN master suite.You'I EI LIVING 12:-0'x 1e'-0' STUDY 12'-0'x 1r-O' 3—CAR GARAGE every unforgettable minute in The Deln . FOYER 24'—O•x 29'-9• TWO-STOAT FIRST FLOOR PLAN ' eioaE ecnou°esax Iill ppurn pEeEpvED. t Town of North Andover, Massachusetts Form No.2 MORrM BOARD OF HEALTH o F w p ♦ s DESIGN APPROVAL FOR MpSSOIL ABSORPTION SEWAGE DISPOSAL SYSTEM • Applicant l Test No. : Site Location (,,T (4 Reference Plans and Specs. "V—& VVI ENGINEER DESIGN DATE Permission is granted for an individual soil absorption sewage disposal system to be installed in accordance with regulations of Board of Health. CHA RMAN,b9KRD OF HEAITH Fee 1,00 Site System Permit No. 3 APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE: �Z�Zq? CURRENT INSTALLER'S LICENSE# LOCATION: L e ! h, d r LICENSED INSTALLER: (Sol M n. rs SIGNATURE: TELEPHONE# 6-o F 4'63 CHECK ONE: REPAIR: NEW CONSTRUCTION: l IF NEW CONSTUCTION, PLEASE ATTACH FOUNDATION AS-BUILT. Administrative Use Only $75.00 Fee Attached? Yes !i- No Foundation As-Built? Yes No Approval Date: O b 'P ,�•� � r 'i w:dt, - vF ��1�I �(�t I(��`�a E 1 i A i �t fk�� PA7,4{i �t•TpL -�1 Tt y tray ti j,,,lr c 21i,'ar'r qgz Y }J,,_tJfir JitYw i e e on—IC-0F, :a Lot Numbei-4 �• x NAM BEDROOM 3 B2 BEDROOM 4I t 1 12..4-,11.-4. — 12.-a-,11..4• The Delmonico offers a touch of European #. -•.,,., uuu ra r" m�x n�rail!e' elegance and coinfort in every corner.Some of the 3 EXERCISE! � 5 STUDY MASTER �� r7• .LJ s !� SUITE __ .k t ;,�,;;;�� most engaging aspects of this home are a first-floor , ;t , DV BEDROOM 2 u'-o•x Tr-r pniii - 5 12 a•x tr-2' town l�l�j����llI� 4�� I or[n ro - tt--�` study and library,a i, •;: ,� T� MASTER Bew : SECOND FLOOR PLAN ( tucn c spacious family room,a sepal:tte Lilt+y _ s�EfS#tzt3G }']tt^t jit'+�g4tit!;t rt. full-size formal � ,',J� .. ;..,t..,.;l,r. t(&�J,'it�,• — ., ye:{�tf7i[.:••;�.:a:��,,.j.gq"�f}r.-;!. yyJ#: .rr<tzn;a.. ..r�i.�lis:SoF•,(iE:,i+.;x.;r z EA�MI��V dlmJl roomQ',xYJr t t}rf u Y ' t7 tt'r; t } r i tl 55Y KITCHEN DINS FAMILY g r • , ,3 j 1fu fr z aC •Y DINING ' � a-o•c 1a-4 w2«1-Ee.•YT,1s-o wiu12-0•E 15.-0. J�. and a luxurious Y :7Y�l�,gS'RF'•'w: fiu ii>,t s`{jam ..J. -4d TPR t' DLAUN .` tiJJi; j t� a t2'-o•a ta'-o• �I master suite.You'll enjoy � 4vydY{ia;7 LIVING FY 1 f. every unforgettable minute in The Delmonico. FOYER 12'-0.411•.0. 3-CAR GARAGSR E b 1( 24'-O'a 29'-9' lip FIRST FLOOR PLAN � k �w. Si'k� 4 , A,,. M FORM U - IAT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or' requirements. ****************Applicant fills out this section***************** APPLICANT: Phonea12)- r3 LOCATION: Assessor's Map Number Parcel �4 Subdivision � � R ED ,= Lot(s) 4 Street �2 �21�C� " c� r� S o� St. Number C00 ************************Official Use only************************ RECOMMENDATIONS OF TOWN AGENTS: Date Approved Conservation Administrator Date Rejected Comments Date Approved Town Planner Date Rejected Comments Date Approved Food Ins tor-Health Date Rejected Date Approved d� 3 9-7 -Se is f'nspector-Heafth Date Rejected Comments Public Works - sewer/water connections C 1,21/F7 - driveway permit Fire Department Received by Building Inspector Date 03-21-1996 14:36 517 932 7615 DEP NORTHEAST REGIONAL P.02 FORM 12 - PERCOLATION TEST Location Address or Lot No. '`-1J4_ 1 COMMONWEALTH OF MASSACHUSETTS i' mv(►k Ad,1 X162, Massachusetts .. .,Percolation Test' 4 . Date: c — c3I1S Time: J:q2 ,p►rv1 Observation Hole » ,, Depth of Percn Start Pre-soak off• �Z AM End Pre-soak 1 Time at 12" 9 Time at 9" Time at 6" 1 ,•35 Time (9"-6") 2?f Mia Rate Min./Inch ` Minimum of 1 percolation test must be performed in both the primary area AND reserve area. Site Passed Site Failed ❑ Performed By: A,7-Tej Witnessed By: 1�7OPY _ Wl7j Z�r—_ Qu Comments: _.. DIP A MOVED!'ORM•U'97/71 FOR:NI 11 - SOIL LVALUATOR FOFUNJ Page 3 of 3 Location Address or Lot No. pe-Aye Determination for Seasonal High 'Water Table Method Used: x.10 ❑ Depth observed standing in observation hole........... ... inches ❑ Depth weeping from side of observation hole.......... 'inches ❑ 'Depth to soil mottles inches Ground water adjustment .................. feet Index Well Number ........_......... Reading Date ....._ ..... -Index well level ........ Adjustment factor .................. Adjusted ground water Level ...... ... . .................. ........ Deoth of Naturally Occurrino Pervious Material 4 - Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? If not, what is the depth of naturally occurringpe'rvious material? Certification I certify that on 11/94 (date) I have passed the soil evaluator examination t approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training, expertise and experience described in 310 CMR 15.017. Signature Date 5/1/96 i . DEP APPROVED FOR.V- 12/07/95 FORM 11 - SOIL EVALUATOR FORM Page 2 of 3 Location address or Lot tJo. " `jN6Ul� 'Dt�1VE On-site Review Deep Hole Numberg3j. Date:. .Time: AtA Weather r-q%YZ_ Location (identify on site plan) Land Use Slope (%) Surface Stones Vegetation, Cvkrz*�ta..osrp -, S}Itr2�pyS LandformESXC*Q— Position on landscape (sketch on the back) S� SF'''"T��'� s�-?S-� stv� (I 6CA Distances from: Open Water Body. ?fir{' feet Drainage way 1No"xl feet Possible Wet Area 240feet Property Line \*�'/- feet (Vftc�rn t✓FZ LQ-* u1'2) Drinking Water Well feet Other DEEP OBSERVATION HOLE _OG Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface (Inches) (USDA) (Munsell) Mottling (Structure,Stones, Boulders, Consistency, % Gravel) fit►`B u bf 6 istS -•-`oP So►t� . i i Scs r.ne-- Cw 'Tc (.d o.1 ) MINIMUM OF 2 HOLES REQUIRED AT EVERY PROPOSED DISPOSAL AREA I Parent Material (geologic) (4 SA DepthtoBedrock: NOvs� Depth to Groundwater: Standing Water in the Hole: NAowc Weeping from Pit Face t Estimated Seasonal High Ground Water: DEP APPROVED FORM- 12/07195 i 1 FOR 111 - SOIL EVALUATOR FORA Page 1 of 3 No. 1449 - 4 -- Date: Commonwealth of Massachusetts Woe.-rA � � , Massachusetts Soil suitabilUy Assessment for' On-site Sewage Disposal • 5�► 193 Date: Performed By: ...................................... . ............. . Witnessed By: 0—er's Namc, ��rnvc-ALJ-+-"—s,� �'l��L .s � L•• L=uon Address or G fC ..-�/� Address,and 4-0 -so" LO( V l� • Telephom f - V"s4f-r �L'l`F�3•>D _ "C tj dot C $.1 O ew construction L9 Reoair ❑ C50� 4-15 S-115> Office Review Published Soil Survey Available: No ❑ Yes Year Published \. ............r... Publication Scale 1" _ • Soil Map Unit N�� .'�,��`�, �XUESISw SEV�ft-E Drainage Class p¢a1e-�6a.. --- .... Soil Liimm,it/ations ........................ .S I.AP ............................................ Surficial Geologic Report Available: No Yes ❑ Year Published - Publication Scale GeologicMaterial (Map Unit) ..............................................................................................................................._ ....---...... . m .................. ............................................. Landfor Flood Insurance Rate Map: ,,/ Above 500 year flood boundary No 2/yes ❑ Within 500 year flood boundary No �'es ❑ f Within loo year flood boundary No Ry"es ❑ Wetland Area: National Wetland Inventory Map (map unit) ................................. Wetlands Conservancy Program Map (map unit) Current Water Resource Conditions (USGS): Month Range :Above Normal ❑Normal ❑Bela•/ Normal ❑ Other References Reviewed: DEP APPROVED FORM-12/07/95 Town of North Andover Ot HORTM OFFICE OF c COMMUNITY DEVELOPMENT AND SERVICES ° : A 146 Main Street North Andover, Massachusetts 01845 � +;;;o-�:a��y} SSACHUS� June 10, 1996 Thomas Neve Neve Associates 447 Old Boston Road Topsfield, MA 01983 Re: Lot 94 Sherwood Drive Dear Tom: This is to inform you that the proposed plans for the site referenced above have been disapproved for the following reasons: .Design flow less than 660 GPD and 165 GPD per bedroom. .Insufficient soil tests (see N.A. 4.02 & 4.09 and 310 CMR 15.102 (2) & 15.104 (4)) .Wetlands disclaimer missing (N.A. 6.02 0). .Tank not 25 feet to foundation. .No perc elevations (N.A. 6.02 j). .No map & parcel. If you have any questions, please do not hesitate to call the office. Sincerely, Sandra Starr, R.S., Health Administrator cc: Bob Janusz BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 FORM 11 - SOIL EVALUATOR FORM Page 2 of 3 Location .Address or Lot iso. On-site Review Deep Hole Number Date:. Time: .. PI-A Weather Fqu2 Location (identify on site plan) S 4!5-,A \-TP6M-r p\SPoS... S SS.'t�f-� rjEstv�.1 Land Use Slope (%) Surface Stones .Vegetation Wim=;— oIL .,vc„a J�.►-n..� �.�l�1tu85� Landform Position on landscape (sketch on the back) "S, d"'%-T�"'t D\SP�asa�. 5`CS'tt� s�stcx.� (,Wcvz) Distances from: Open Water Body 2AC>4 .feet, Drainage way Uwe feet Possible Wet Area ,240+ feet Property Line (ad 'y-feet t tri styes Drinking Water Well ►.t0\.tfz feet Other DEEP OBSERVATION HOLE !OG* Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface (Inches) (USDA) (Munsell) Mottling (Structure,Stones, Boulders, Consistency, % Gravel) tt - 3� S1r1� �`S1�- t!J Ota '!c\N E �✓An�p"( to AH 13s,L STos�°'S 4 ) a- " G 5/4 1�0 C.yeav�tirt_�-c sa*-+v-f uCaM MASSIVE �tAL$� ( Parent Material (geologic) CA-1WP&A DepthtoBedrock: ,` Depth to Groundwater: Standing Water in the Hole: ,v6� Weeping from Pit Face: Estimated Seasonal High Ground Water: Nd DEP APPROVED FORM-12/07/95 i FOR'1.1 11 - SOIL EVALUATOR FORM Page 1 of 3 9 4 Date: bio. 1 �c Commonwealth of Massachusetts Massachusetts Soil Suitabili f Assessment or On-site Sewage Disposal �+� a Date: Performed,By• , Witnessed By: _. ................. ..._ Owner's Name."�1�.J��f�l..► �O W�_""�— �N� ' t,ocivan Addrus a _r ..• .! - Addrus.Z d Teiephom ew construction Repair ❑ Office Review Published Soil Survey Available: No ❑ Yes C u,— Soil Miae Unit�3Zv� 1�g, Publication Scale .•.. - Year Publishedc Ess�J��'.... � l� . ......................................... .. Drainage Class pV-(4"s�............. Soil Limitations ..................................................... . Surficial Geologic Report Available: No LJ Yes . Publication Scale Year Published t Geologic Material (Map Unit)� _ ...........................................................:...........'...................'..'.... ...................._-�.............:... Landform ........................................ ......................................................::............. Flood Insurance Rate Map: �—�/ Above 500 year flood boundary No- U Yes'`7 � : � L'J Yes ❑ Within 500 year flood boundary Noy Within 100 year flood boundary No Yes ❑ Wetland Area: National Wetland Inventory Map (map unit) ................... Wetlands Conservancy Program Map (map unit) ........................... . Current Water Resource Conditions (USGS): Month Range :Above Normal ❑Normal ❑Bela•/ Normal ❑ Other References Reviewed: DEP APPROVED FOR.'tit-12/07/95 03-21-1996 14:36 617 932 7615 DEP NORTHEAST REGIONAL P.02 FORM 12 - PERCOLATION TEST Location Address or Lot No. COMMONWEALTH OF MASSACHUSETTS.- i' NpQ-CtA M-�CZVe , Massachusetts Percolation Test" Date: Time: 10: 5 b P" Observation Hole 4, Depth of Perc CQbu Start Pre-soak End Pre-soak �l. V:�> PWA Time at 12" Time at 9" Time at 6" Time (9"-S") a Rate Min./Inch Z f ' Minimum of percolation test must be performed in bath the primary area AND reserve air Site Passed d Site Failed ❑ Performed By: Witnessed By Comments: Der Armov=row► -w07n1 FORM 11 - SOIL LVALUATOR FORRZ Page 3 of 3 Location Address or Lot No. �- e—��'� `D's✓��(� Determination for Seasonal High Water Table Method Used: ❑ Depth observed standing in observation hole ........... inches ❑ Depth weeping from side of observation hole inches ❑ Depth to soil mottles inches ❑ Ground water adjustment .................. feet Index Well Number ...... ....... Reading Date . . .: Index well level ...... Adjustment factor .................. Adjusted ground water level. ....... _ _...........__..... ......... Death of Naturally Occurrina Pervious Material Does at least four feet of naturally 'occurring pervious material exist in a_J�areas observed throughout the area proposed for the soil absorption-system? `tt If not, what is the depth of naturally occurring pervious material? Certification I certify that on 11/94 (date) I have passed the soil evaluator examination j approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training, expertise and experience described in 310 CMR 15.017. 9 ' Signature Date 5/1/96 DEP APPROVED FOP-M-12/07/95 h .....� 77711 c lrfa ..i 1 ---._-- Y' L. - •• X003 � , ,n — ------- -- SY51 aM p �c.eoc � '1,v�7 ,,.lea � y�tr�ll�F 1 •�'` +' ,�, '1 , . (. 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AIVDOVER� MA SSACHUSE mRecord '':h, �• ,'+'i �1n �, y ti:�tr,a:�5,r ' .,:j.,?t:� ` '' ..f'(Q �,.1•��/ ::a,h•,•4'Y•':�Y,i�'�y?�!• tt:l.'r.�,�� .. '%.< ,",f a •� ti L,:�,-Y:.)�;r'.M�. �v.Y �41. ,:(.. t:�l�i ,.''r'{.�l.,r;..'r':ItJjU�y�r, (• ,.;i�l..:e..i: ., „�.•..T1'tY'.::f'c .. .. EP .,ha: provided this form for use by local Boards ba 4 bmltted to the.local'Board of Health or other �h� umping Record n, s; A Facllit}r InfoCrrtlon 1 ;;.ttnRorta„t. DEC 0 7 2007 J:rWher,'fa out .1,. System Location ut8l ISL1 C Pf1 ANDOVE liSe ,L UtP MENT only the tab key Address , to move your;; ar:or•do(1qt ` `usi the rtitiim •'�.' Clty/rown y u,,. �•;:;�;�:,• ,':` ;'.::;"c''!fe',,,;>:'•';.'.'^., ; `' ! 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Pum P�n9. Cele 2 Q' 'h� / 6� 3• Typ of oyalam,. L7Cas9pool s %a O Sap0c Tang 7 .-, ,, ',,':,' • , �. ._�.:• � Ian! 7an� __.,� ''lOhar (describe): 4, Et�uan.l 7r�sa,Fll,l.af.1Pt(9senCl 7 Y as, o� Yes was i! c,aana Ylf ��„r.r rr ''•' Irl'/r Y'. - ---------------- e.' sy p�,mpe�l/el, G :, .::.'•;,�:•.',�,:('j� ung zw.•;} �;; w. ��,,, ,ti�I. // � �l f,��`/�'((��.lV' j•!('. Nu) ''f(,I' �•�!� }y'�1 '''/I•'11 f!� ,.� I /� 1'eh�NB elm� . .. iJ. 11 Jf�',11j '4�� Y:�' 1�i '''f� � / � '}/•(///'r�'/y/y/�� ��)n/je ri�..l� 'e/ �-._.. _ •'�;��•`�.'.'.f���'�,.;/��:�1 , . /•',i�Y,'.yj'!�' ',11J'� �11' ,rig, % on.whVe'oonlent �• . ,,�'.a I., •.,,., <<. ,W deposed: ,,..( Y./ni.ma 34. ov/dapJwal9r/app oYaJs/lblorms,r�nxlnspac! �e��