HomeMy WebLinkAbout0047 CEDAR STREET - Health 47 Cedar Street Sewer Acct # 2921
Hyannis
A = 327 — 199
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Assessors office (1st Floor) MxvP #
Assessors Map and Parcel #
Building Department (4th Floor)
zoning
INSPECTION FEE $ 40-eo
RE-INSPECTION FEE $15.00
Request For A Housing Inspection For Certification Under the
MA Rental Voucher Program
Your Name
Affiliation (Circle One) Owner Real Estate Agent Tenan
Your Address . r _5 w, zy." S
Telephone Number (Day) (Night)
Address of Property Where Inspection is Requested
Unit/Apt.# � C
Name of Owner
Address s jS_
Mailing Address (if different)
Telephone Number (Night)
Will there be any children under the age of six (6) who will
be occupying the rental unit? (circle one) Yes J-P
Was the dwelling constructed prior to 1979? Yes No
FOR OFFICE USE ONLY:
Certification
The dwelling dwelling unit or rooming unit located at
was 'nspected on
`3 -30 OLI by Health
Inspector for the Town of Barnstable and was found to be in
compliance with the provisions contained within 105 CMR
410.00, State Sanitary Code II: Minimum Standards of Fitness
for Human Habitation. However, this certification does not
include a determination as to whether this unit contains any
lead paint because under 760 CMR 49.02 Massachusetts Rental
Voucher Progr a separate lead paint inspection must be
conducted.
I
Inspector's Signatu
Date D)30/0
L O C A T ION WAGE PERMIT 00.
vIL—LA 4 1 3a,7 -/99Cfi
—
I N S T A LLER'S NAME i ADDRESS
BUILDER OR OWNER
DATE PERMIT ISSN E D
DATE COMPLIANCE ISSUED���---���
1 � lk
OIQ C o
�1
.:No .
.--•••-•---....-�- i Fes$.. ................
• ; THE COMMONWEALTH OF MASSACHUSETTS
B®A R D !-d E T F-�
--------------- -------OF......... . ... .. - ..............................
Allp iration for Uiipaia1 Workii Tnnitrurtiun ramit
Application is hereby made for a Permit to Construct ( ) or Repair ( } an Individual Sewage Disposal
System at:
L d or Lot No.
;� Y�� �
--_-- w�nfer ----------------------Address
W ........kr- . ' a,---------•--•----------------------•-----•- ------------------•-• ------------------•...... ------------
Ins Address //
Q Type of Building Size Lot!_&_591_�______Sq. feet
V Dwelling—No. of Bedrooms..........��_...._ __._.Expansion Attic ( ) Garbage Grinder ( )
. Other—Type of Building ............................ No. of persons---------------------------- Showers ( ) Cafeteria ( )
Other fixtures ................................. �
W Design Flow...........,/_0............... gallons pe 4erse% pe�ayy. Total daily flow_____-__-_-_ ...............gallons.
WSe tic Tank—Liquid ca acit _._ allons Len th.� (ea_2^_ `Vidth�_4?. Diameter________________ Depth_
x Disposal Trench—No..................... Width........... ....... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No------Z........... Diameter._ZG?e..�... Depth below inlet_.6„5:'�..... Total leaching area..$_6.C_s ft.
Z Other Distribution box (✓j Dosing tank .off
Percolation Test Results Performed by._.e/V-_-- .................... Date_&_ _.2-0 . ..........
a
,a Test Pit No. 1_�_Z_minutes per inch Depth of Test Pit_/--Xf.1`._ Depth to groun water___,oy.t.e*t.
�Tq Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
19
O Description of Soilj. ?__:.ls ...._w....................
�-- r -----------------.................................................
V _.... 1•-G y-_,C1rY~--�---CC ��..�..�Yl f ^!' �0. _S2 d r
W -----------•-----------------------•---•------•----••--•---•----------- 03;l/_lleC�
U Nature of Repairs o lterat' s—Answer when .pp ' ...................... .
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of:TTLE y g g p y
5 of the State Sanitary Code— The undersigned further agrees not to lice the system in
operation until a Certificate of Compliance has beeu.issued by the board of health.
Sig ............................................................... •-••--••--•-•..................
Date
Application Approved BY E41
.....-•--•-•.............•-•-....V' 7�---...
t � / Date -
'Application Disapproved for the following reasons-...................--------------------------•----- ...........................................................
._..-••-----------••---------•-----•-----••--•--••---••••-----•••---••------•-•..............•-----••---•--••---•--•-••••••--•--•••--•-••.............................................................
/ Date
Permit No......................................................... Issued__;_ :-C-/-�.mr.� --------•---
Date
, pinr'"I
r..
• I THE COMMONWEALTH OF MASSACHUSETTS
. r
BOARD F HE TH
r"t
" :. O F
:61irafiou for Bhgpoii al iVorhii (foutitrurtioaa .eramit
Application;is,hereby made for-a Permit to Construct (. ) or Repair ( ) an Individual Sewage:,Disposal
System at
CC:, I iQCn or Lot No
.». o!`«'-'1-+.:' --•• i.wr +:�%""--
a • �'--------- o .---------- --_-- ------------
owner
r•e-s-s-
owner ............................ ---------------•----....---.-_.-- ....----..-`.-_-'------------✓-!-i?----:---✓..a._.2-_A.�-,-...--•-
Address lerPa
t
d Type of Building Size Lot,/ _dl. q.:_._Sfeet
Dwelling=No. of Bedrooms........:. .......:.....................Expansion.Attic ( ) Garbage Grinder ( )
Pk Other—Type of Building ............................ No. of persons---------------------------- Showers ( ) _ Cafeteria ( )
Q' Other fixtures ............................................._ ----- -------------------•------•------------
d �' 6 —"�"
W Design'Flow__.... f'`f _...... ..gallons pe j on pe; ay. Total daily flow___.___.. _-�............................gallons.
WSeptic;Tank—Liquid capacity....;.?gallons Length_r'`. _._G. Width _ ._ Diameter---------------- Depth f'`___-___---
x Disposal Trench—No. ..................... Width........... ........ Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No........ .......... Diameter../0' .!__.57 ` Depth below inlet:_.4=...s ;..... Total leaching ft.
z Other Distribution box (, )" Dosing tank
Percolation 'Test Results Performed by._ .:•.£.�':�*'_��._ �.��..................... Date.�`�
Test Pit No 1 ° 'Z.;.,tinutes per inch Depth of Test Pit./.Y.L.`_._ Depth to
fX4 Test Pit,1To 2....:. ...:...minutes per inch Depth of Test Pit._.___.__._________. Depth to ground water
P: r`
O Description of SoiL�!e.. _ w �~' ' '
U --- •. -------
••• ---- - ------------------ - -- ' ..........! � '<,�'lt?.41 e:...`. h. , ..
U Nature of Repairs o ltera ' s A swer when ,PP ----- ---•-• �------------
---------------------------
rr4f�L d ----.....--••-------
Agreement: ti a
r The undersigned agrees'to instal the aforedescribed ..Individual wage Disposal System in accordance with
the prop isioiis of iT 5 of the State Sanitary Code—.The undersign d further agrees not to place the system in
operation until a Certificate of Compliance has'been issued by the board of health.
Sig .d _-. .--
: Date A Application Approved By•... �- = --• ------------------------
Date r
-"'• ^'Application-Disapproved for the following reasons:............. .......
--------------------------------------------•--------••---•••- •------------------------•----• -------------- --- ----
ate
PermitNo........................... ------ Issued---- : ..._... ( - - }-•--------•--•- Date -----. _._ `_._�f#
THE COMMONWEALTH OF MASSACHUSETTS
BOARD O HEAL
T
...............[..., ...OF..... ....
_sr Trrfifir atr of Tompliaurr
THI I. TO RTIF , T t the Individual.,Sewage Disposal System constructed ( ) or Repaired
ti
nstaller �.
aat �. -------------------------------------
�.has been msta11 in accord nce wit i the provisions of TITLE j of e State Sanitary Code as described in the
,application for Disposal Works Construction Permit No_________________________________________ dated-..... -
T1�9E:ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONST UED AS GUARANTEE TBiAT THE
S1STEtA'19lIILL FUNCTION TIS ACTORY:
DATE....:... .........���...:.�... ...... ............................. Inspector.... ....... ----- ../:.
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