HomeMy WebLinkAbout0026 CIRCUIT AVENUE - Health 26 Circuit Avenue '` Sewer Acct # 3964
Hyannis
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Town of Barnstable Health Inspector
�WE Office Hours
Regulatory Services 8:00—9:30
,Thomas F.Geiler,Director 1:00—2:00
* RUMSTAHM » Only
MAE& Public Health Division
�E� s Thomas McKean,Director
200 Main Street,Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304
ANMESTY PROGRAM APPLICANT — SEPTIC QUESTIONNAIRE
1. General Information:
,
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Address: I rP'ai,6.I TL '. � Map3-a 4 Parcel
Name: f � h i sC i" DA Phone#:.bkk'"7 2 r 3 ;�,.3 D
2a. How many bedrooms exist at your property now?
2b. Are you planning to add any bedrooms? �J8-q If yes,how many?
2c. How many bedrooms total are proposed at this property(including the amnesty unit)? `f
2d.Please include a copy of the floor plans for the entire property-showing the existing
rooms in the home plus the proposed amnesty apartment and/or addition.. Please label
each room clearly on the plans.
3. Is the dwelling connected to public sewerOYES or NO
4. Location of dwelling is INSIDE or OUTSIDE a Zone of Contr_ilud u�blic supply wells?
5. 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? Bedrooms.
7. Were any building permits obtained for construction of additional bedrooms? YES or NO
8. Is there an engineered septic system plan on file at the Health Division? YES or NO
9. Has the septic system been 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
The Publi e lth Division has ob' onto be ooms at this pr *Signed:
Date: �
Inspector(Print): QQAIA
Q,1hea1th/wpfi1es/amnestyapp
1.