HomeMy WebLinkAbout0051 CHASE STREET - Health 51 Chase Street Sewer Acct # 2622
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Town of Barnstable Health Inspector
OF THE Tp� Office Hours
ti Regulatory Services 8:00—9:30
HP ��
Thomas F. Geiler,Director 3:30—4:30
* BMnxsTABLE, Only
MASS.
i639• Public Health Division
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ATfO �s Thomas McKean,Director
200 Main Street,Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304
AMNESTY PROGRAM APPLICANT QUESTIONNAIRE
1. General Information:
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Address: t�.( � ��jnG7 �q�N i S Map ;j Parcel I
Name: F1)111) -Phone: -' ho-- q`i'-7 3
2. How many bedrooms exist on your property now?
2a. Please include a copy of your floor plans for the entire property.
3. Is the dwelling connected to public sewer? YES or NO
If the dwelling is connected to public sewer, skip questions 4-9 below.
4. Location of dwelling is INSIDE or OUTSIDE a Zone of Contribution to public
supply wells?
S. Is the dwelling connected to an ONSITE WELL or to PUBLIC WATER?
6. Is a disposal works construction permit on file? YES or NO =
6a.If yes, how many bedrooms were approved according to this permit? CP
Bedrooms.
7. Were any building permits obtained for construction of additional bedrooms? YES or O co rn
8. Is there an engineered septic system plan on file at the Health Division? YES or NO
9. Has the septic systep4en inspected by a DEP certified inspector within the last two years?
YES or NO
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FOR OFFICE USE ONLY
TO BE SIGNED BY A HEALTH INSPECTOR/AGENT ONLY 2-G 2.2•
The Public Health Division has no objection to 3 bedrooms at this property.
Signed: Date:
Inspector (Print
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