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0034 HINCKLEY CIRCLE - Health
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'n''fIH....L ..a • • 't.. . „.. •,✓,HAS-i:'n.S Jri!/. .,}+. .. ,..i L ,u. ,:f."' ':,:: ! = 'U.ir� _ r'rr .. � . �,_ �� � - , ���' +ter � � 217{" 92{• 138}- 147.1ne'wall length �. � 1 I .. bathroom- � tA� .Ilv@g roorr,`r, +! - gerego., � d •' 61%2'bwsrthen UAng room Fl It rubber roor I c ��i\+•1tV InA, wffhw. need4g beaM - -. 2 t 6i `f '• i r tlborto • a- FIRST FLOOR - t50• - TT 17 2�" 2 2W When 7 All dimensions size designations This is an original;design and•must given are subject to verification on not be released:or=copied unless' , job site and adjustment to fit job .0applicable fee has been;paid or job conditions. order placed. t .. -4R'"? r�' w�. ua.�?�.Ilabx123de C�`tr � - . Mama- 5t. ' All TOWN OF BARNSTABLE LOCATION 34 14106k C mil.— SEWAGE# VILLAGE V ASSESSOR'S MAP&PARCEL ZO 1!9 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY.(type) (size) NO.OF BEDROOMS 3 OWNER Lu K8s; PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY o _ &4/DN g - I 't) -all R, 3�i i1 JS'B®d8 g �a 49 -5- v G®vElc Tb Ov-rlS�F TEE ' Aho f)4o No. W % r / v Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01pplitation for 13isposal *pstem Construction permit Application for a Permit to Construct( ) Repair(X Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.34 41N d K`*YC'Pab G- Owner's Name,Address,and Tel.No. W'44,a)OD LJl<A5 Assessor's Map/Parcel 14 0(5 (g;z G®Lotiv �?- (a;)A/(Eiu,e MiA Installer's Name,Address,and Tel.No. 5ola-417_8S T1 Designer's Name,Address,and Tel.No. C Oc(,J(D&-, � L4-c- S-r M.A5&WO;� Nla Type of Building: // Dwelling No.of Bedrooms Lot Size 1`r ?S sq.ft. Garbage Grinder( ) Other Type of Building L-7:;(Z�,j7'( s No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) L-we 6144-Nes,_ TKO yd l-bW� M A&;p Zt) e a �ceJ Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by�thisBoa�rd � _ Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No. 4 l Date Issued L k * No. a04 Fee �J W /vv THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: — Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 2ppfication for Misposal *pstem Construction Permit "^ Application for a Permit to Construct( ) Repair(k) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.34 µ1 N CK C t —tA-G Owner's Name,Address,and Tel.No. _ RAVko1.)D LUKCA5 Assessor's Map/Parcel 1(4 0t9 ph (,9 a GOL0rjV Installer's Name,Address,and Tel.No. 5f�4�C7-a&71 Designer's Name,Address,and Tel.No. "606w(D6 s5 M N/A Type of Building: Dwelling No.of Bedrooms Lot Size �� sq.ft. Garbage Grinder( ) Other Type of Building PU;c:; No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd i Plan Date Number of sheets Revision Date `Title Size of Septic Tank Type of S.A.S. Description of Soil I . Nature of Repairs or Alterations(Answer when applicable) L-!urn 6144 N w--- :FP-U cq_ I:k-,6 r= m2 !ao¢!Xj C',,�s Ac zx, AdL;p F�U.? 11) P0,:9C 7b aA59.R!!�OceJ Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of x h Compliance has been issued by�thBoardol Date S'� O( Application Approved by Date Application Disapproved by Date ' for the following reasons Permit No. �(")� — t' f Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(*-k) Upgraded( ) Abandoned( )by < /A&-1, 1� 6 ug_- at ` b Jt L 4A9 has been constructed in accordance )/4-1 with the provisions of Title 5 an the for Disposal System Constructionf3ermit NoX)L/ dated Installer dWavl D6 G1�4�,67 Designer !"/7"'C #bedrooms Approved design flow gpd The issuance of this permit shall not be construed as a guarantee that the system will rf inctioon as�designed. Date J:,!! / -7- Inspector ------------------------------------------------------------ No. �/�i 1 L( - ' LI �— Fee Q THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS misposai 6pstem Construction permit , L`'eA'lp� Permission is hereby granted to Construct( ) Repair(� Upgrade( ) Abandon( ) System located at _34 P4(kJ d,(L.0 LP G� l�c L•C ens -l)�u•� [ and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be co pleted within three years of the date of this Cb Date �/� Approved 7 lay 151411:27p p.1 Commonwealth of Massachusetts Title 5 Official ;Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 34 Hinckley Circle Property Address Raymond Lukas Owner Owner's Name' information is Ostervilte MA 02655 5-12-14 required for every page, Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way.Please see completeness checklist at the end of the form. Important:When A. General Information filling out fos OF on the computer, use only the tab 1 Inspector: key to move your ;o== •'•yG cursor-do not 3�. JAMES 'srn James D.Sears =�: use the return — - Name of Inspector key. CapewideEnterprises LLC X'. _ ICY Company Name t%�����. TTF...0 153 Commercial Street ---__-- ���du uH��ut),%l Company Address Mashpee MA 02649 Cityrrown State Zip Code 508-477-8877 S 1623 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 -� 5-12-14 z0hispector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, i`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 .:toes not address how the system will perform in the future under the same or different conditions of use. t5ins•3113 Title 5 Official Ins i ortn:Subsuham sewage Disposal system-Page 1 of 17 . I/ May 151411:28p p.2 Commonwealth of Massachusetts Title 5 Official '.Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 34 Hinckley Circle Property Address Raymond Lukas Owner Owner's Name information is required for every Osterville MA 02655 5-12-14 per. CitylTown State Zip Code Date of Inspection B. Certification (cunt.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The system is two block c.pool's. i 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.3113 Title 5 Official Inspec'ion Form:Subsurface Sewage Disposal System•Page 2 of 17 May 151411:28p p.3 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 34 Hinckley Circle Property Address -•----.....__,_ Raymond Lukas Owner Owner's Name mquiredifo Is Osterville MA 02655 5-12-14 required for every i page. Cityrrown State Zip Code Date of Inspection B. Certification (cunt.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required purn;ping 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 15.30(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-M 3 Tolle 5 Ofcid"ection Form:Subsaface Se-sage Disposel System-Page 3 of 17 lay 16 14.01:27p p.1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 34 Hinckley Circle Property Address Raymond Lukas Owner Owner's Name Information is Osterville MA 02655 5-12-14 required for every page. CitylTown State Zip Code Dale 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 0 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: a D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" r" "o 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 NA ❑ ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool El ® Liquid depth in cesspool is less than 6" below invert or available volume is less than'/z day flow t5ins-3/13 Title 5 OELdaI Urspeditm Fonrt Subsurface Sewage Disposal System•Page 4 of 17 r lay 15 14 11:31 p p.1 Commonwealth of Massachusetts Title 5 Official Inspection Form IM Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 34 Hinckley Circle Property Address Raymond Lukas Owner Owner's Name information is required for every Osterville MA 02655 5-12-14 page. Chyfrown State Zip Code date of Inspection B. Certification (cons.) 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. r El ® 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 11 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 t5 ns•3113 Title 5 Official Inspection Fonn:Subsurface Sewage O spasal System-Page 5 of 17 Fmay 15 14 11:31 p p.2 Commonwealth of Massachusetts .U .Title 5 Official 'Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 34 Hinckley Circle Property Address Raymond Lukas Owner Owner's Name information is Osterville MA 02655 5-12-14 required for every page. cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You midst 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? Ej ® Has the system received normal flows in the previous two week period? El ® 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 SopME1111111110 manholes uncovered, opened, and the interior inspected for the condition of the 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 size4nd location of the Soil Absorption System(SAS)on the site has been determined based on: 9 ❑ Existing information. For example, a plan at the Board of Health. ® Determin'.ed.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): NA Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 15ins•3t 3 Title 5 Official Inspection Forn.Subsurface Sewage Disposes System-Page 5 of 17 i r May 151411:32p p.3 Commonwealth of Massachusetts Title 5 Official :Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 34 Hinckley Circle Property Address Raymond Lukas Owner Owner's Name information is required.for every Osterville MA 02655 5-12-14 page. Cltylrown state Zip Code Date of Inspection D. System Information' Description: The system is two block cesspool's_ Number of current residents: 0 p 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? i ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage (gpd)): 2012-12,000Gals 2013-9,000Gal's Detail: i Sump pump? ❑ Yes ® No Last date of occupancy: NA NA Date Commerciallindustrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons perday(gpd) Basis of design flow(seats/personsfsq.ft., etc.): — — Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non sanitary waste discharged to the Tide 5 system? ❑ Yes ❑ No Water meter readings, if available: 15ins•3113 Tllle 5 Oflidal Inspedon Form:Suosurtece Sewage Disposal System Page 7 of 17 May 151411:32p p•4 Commonwealth of Massachusetts Title 5 Official Inspection Form M Subsurface Sewage Disposal System Form- Not for Voluntary Assessments ' 34 Hinckley Circle Property Address Raymond Lukas Owner Owner's Name information is required-for every osterville MA 02655 5-12-14 page. City/Tom 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: NA Was system pumped as part of the inspection? ❑ Yes ® No If yes,volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ; ❑ Septic tank, distribution box,soil absorption system ® Single cesspool ® Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Altemative 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 1/A system by system operator under contract ElTight tank.Attach a copy of the DEP approval. ❑ Other(describe): l inns•-via Title 5 official Inspecuon Form:Subsurface Sewage Disposal Srstern Pape 9 of IT i May 151411:32p P.5 Commonwealth of Massachusetts Title 5 Official .Inspection Form !_ ay Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 34 Hinckley Circle Property Address Raymond Lukas --- Owner Owner's Name information is required for every Osterville MA 02655. Dateof I page. Cityrrown state lip Code Date of nspedlon D. System Information (cont.) Approximate age of all components, date installed(if known)and source of information-. NA --- — Were sewage odors detected when arriving at the site? ❑ Yes 0 No Building Sewer(locate on site plan): 3' Depth below grade: feet Material of construction: ®cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting,evidence of leakage, etc.): Pipeing is cast iron and PVC SCH 40. Septic Tank(locate on site plan): Depth below grade: feet Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: Sludge depth: 151ns•W13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 d 17 May 151411:33p p•6 Commonwealth of Massachusetts Title 5 Official Inspection Form - a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 4 34 Hinckley Circle Property Address Raymond Lukas Owner Owner's Dame information is required for every Osterville MA 02655 5-12-14 page. Cily(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 Scum thickness Distance from top of scum to top of outlet tee or baffle i Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Grease Trap (locate on site plan): Depth below grade: feet a 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 t5lns•3113 Title 5 Official Inspection Form:Sutsurface Sewage Disposal System•Page 1 D of 17 f May 151411:33p p•7 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 34 Hinckley Circle Property Address Raymond Lukas Owner Owner's Name requir dlfo is Osterville MA 02655 5-12-14 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: — Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons r da 9 De Y 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 15ins•W13 T1:le 5 Official inspection Form:Subsurface Sewage Disposal System-Page 11 or 17 . May 151411:33p p $ . Commonwealth of Massachusetts Title 5 Official Inspection Form -- Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 34 Hinckley Circle Property Address Raymond Lukas Owner Owners Name information is required for every Osterville MA 02655 5-12-14 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 --- 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.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No" Comments (note condition Dfpump 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): F If SAS not located, explain why: tS:ns•3N3 TRe 6 Otrrc9al Inspection Form:Subsurfaces Sewage Disposal System-Page 12 of 17 May 151411:34p P•9 Commonwealth of Massachusetts Title 5 Officiai :Ins ection Form . P Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 34 Hinckley Circle Property Address Raymond Lukas Owner Owners Name information is required for every Osterville MA 02655 5-12-14 cage City/rown State Zip Code Date of inspection i D. System Information,(cont.) Type: ❑ leaching pits number: ❑ 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.): Leaching is a 7' deep block pool w/cover at 10". Pool is dry. No sign of over loading. Wall's are clean w/clean sand in block!holes. Cesspools(cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration 1 Depth—top of liquid to inlet invert Depth of solids layer � Dry Depth of scum layer Dry Dimensions of cesspool 6' Materials of construction Block Indication of groundwater inflow ❑ Yes ® No 1. 15ins•3/13 Tilla 5 Official hapecGon Forth Slbsurface Sewage Disposal System•Page 13 of 17 May 151411:34p p.10 Commonwealth of Massachusetts Title 5 Official 'Inspection Form 11 Subsurface Sewage Disposal System Form-Not for Voluntary Assessments . 34 Hinckley Circle Property Address Raymond Lukas Owner Owner's Name information is required for every Osterville MA 02655 5-12-14 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.): Main pool is 6' deep wt cover at 2", In and outlet tee's.Pool is dry. . 1 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.): t51rs•3/13 Title 6 Official Inspection Farm:Substeane Se%age Disposal System•Page 14 0117 May 151411:34p p.11 Commonwealth of Massachusetts 1 Title 5 Official, Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 34 Hinckley Circle _ Property Address Raymond Lukas Owner Owner's Name information is required for every Osterville MA 02655 5-12-14 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below. ® hand-sketch in the area below ❑ drawing attached separately s f� A eW A a =33_3 + I3:a= o � } a- o t5ins•3113 mile 5 OBidal Inspecticn Forty:Subsurface Sewage Dispasal System•Page 15 of 17 3 May 151411:35p p.12 Commonwealth of Massachusetts Title 5 Official 'Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r 34 Hinckley Circle Property Address Raymond Lukas Owner Owner's Name information is required For every Osterville MA 02(i55 5-12-14 page. city/Town State Zip Code Date of Inspection D. System Information,;(cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Pit 14' Estimated depth to high ground water: feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Hand Auger T.H. 14'. Bottom of pool at 9"below grade. Bottom of pool at 5' above Auger Hole. A. Before filing this Inspection Report, please see Report Completeness Checklist on next page. L`Iro•3/13 Tide s ofrrclel inspection Form:Subsurface Sewage Deposal System-Page 16 of 17 May 151411:35p p.13 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments h 34 Hinckley Circle Property Address Raymond Lukas Owner Owners Name information is required for every OsterVllle MA 02655 5-12-14 page. Cityfrown 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 15ins•W3 Title 5 Official Irapeclion Fcsm:Sutsufface Sewege Disposal system•Page 17 of'.7 II V 1 MO J D r Cf) W LO - - -- --_- - - _ _ LO - - W O U < n Front Perspective N� O clu co "1 (� �• � . co m. z cn w i LO =-� LO N O U < —0 z a) 0 C) W n Rear Perspective CCI� c co l OJ m W C c OW � o Top of Roo 77' - R IIA Existing Roof ht 20' - 1 9/32" 2nd Ceiling 4-P HE 2nd Floor c`' ' - 4FM F HE 1 st Floor oun(l, _ 0„ `O Garage rloc N -1' - 6" o U � a) South � ry m [^W T i a) U r d' M I A102 2 � J -Fr1 A102 Stairs LO to ^, N VJ O U < 1 2nd Floor — � m L.L � 1 v_ A106 � U U c 7-3 r— - 4 BEAM su4CvkA-C 2 i Q- i9'ss�M� qxrsr. w$xzq- a,c. wroxtL ✓..I. -- -- LONGFELLOW I D E iS 16'N w B U I'L D :d= 1✓Ew r-wSR SK EL 66AAA w8xr8 oa IWro ------------- ------ - d= ;- ZX1O.$ ------------ .A - - --- ®� Ay5vmo Tixi5T WBXZI Ca kJJoy-sL VI.F. epurposedwindowfromDiningRoom aXtOe /~ G. �{p O• LONGFELLOW DESIGN18UILD M , A Main Street,. 02540 PALS t W y M S Y f Cam! ,45SUM 6-V V 15T A14 f Lvf H g uv ii A� P Ci reour edwindow`romDinin Room N4533 "4 13J'AM LockripN3 t�. Ezistin Gara a Cellln all-Roof to be emolished S'S/OtA�: NC'� FlC ^ `, _ ei'o r CA-,�� walls to be extended to dew floor o r a ov k ti Z,Xl0 SPi✓' t/ Z 4)(4 PSl i i �'' D s ! repurp d window,from Dining Room j Existing family Room no changes i zisti g Di ing oor i O # ex.Bath I pQ U�J"L rSf nzz z nochanges 'j I E emo flat o6fi nd c Min( ab e,a d n w fl or d a gn ilin will:ex ing r � I d o wall add structural beam Sit v u: 1 oor abb rai d to fnat,h ... r - l xisd g fir t flo r Y;.,... --___• ._-- <N: v No. Descrlpl on' oaie, aa, i II© 1K ! 3k ,A w oo( let m ch itch ;A4A6 r,Vla. r ew oor F -___ _ ` !•� �� loc ted ntra e AIh(L 7v gx(ST. 2Y.4 S .............- _-- to AC exiSino Living Room no:chonges S w }{dtdwir of 6m6,r ?acaG ------------ .existing.Kitchen no changes - --- 13f¢X Mayne Residence At IV, O-C. 34 �SYAR-A L.VC PROPOSED FIRST FLOOR PL F,:: -` `` Projec tuber Dare ' _ Date tuber OI prawn by `,Author -.. cbecked by 6hecker a. f;l i.st`loor New a22 2 �'LpDQ /�/►,N/_ A 1 .1 - -` '�i scale LONUELLOW D E S I G N Z tj I L D i LONGFELLOW DESIGN/BUILD I - 367 Main.Street.Falmuth MA 02540 -. (774)255-1709 I } I �. � s'-aura• y s•,.:rlvr- �. is--!iie- - - ._... •__ __ A 0 � 1t ALA' new MastE Bath existing Bath remodeled. Nsw 2xia 1 i, m new Master Bedroom T j t.. s ro &.}c,t m m • Nc� ZXi2 �/OG.E ,gosRD e._ .-ti..• 15'-81/4- Ion - Date I No. DesM l y � - b9AM .gcEFrvut.E I a..' existing Bedroom _ : ._....:: -:, existing Bedroom no changes nocha ges: � NG� jcLvlll YLoaF $,4W14 ,t}F ---- L oL4 pav OF o t-D R)041r jj ;.� --------- Z- !3/4�"14-.. 4VL wow CAA,r7l.E VOC 1 M WE wl- K _u OZ. �3� aC �17�8 G Ul. I�IDW� Ed a- /,� Mayne,Residence IA\ 3• ZicB's DoVbt a Jaws PROPOSED SECOND 1 /� FLOOR PLAN q � u/INGte.�. I�GL� Prcga t�ameet Project Number ' o C� o•a Issue Date D.—by Author n �e - - OSTTcI��/�+ le MA cneokedny n N ,00we Checker A 1 .2 _ J-06 571 Rnor-Affou* .Scale . . 3/8 I