HomeMy WebLinkAbout0063 HARVARD STREET - Health 63 Harvard Street
Hyannis A `ad
A =`307 --169
I
Town of Barnstable Health Inspector
Office Hours
OFIKE ro Regulatory Services 8:30—9:30
o„ Thomas F..Geiler,Director 3:30—4:30
i RMMS'rABLE, Public Health Division
MASS.
9�p 777 i61'9• `0� Thomas McKean Director
200 Main Street,Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304
AMNESTY PROGRAM APPLICANT— SEPTIC QUESTIONNAIRE
Date:May 25,2010
1. General Information: Size of Property: 0.47 acre
Address: 63 HARVARD ST HYANNIS MA 02601 Map 307-Parcel 169
Name:JANET L LAGERGREN Phone#: 1-508-428-8001 617-293-0969 r
2a. How many bedrooms exist at your property now? 4
2b. Are you planning to add any bedrooms? NO If yes,how many?
2c. How many bedrooms total are proposed at this property(including the amnesty unit)?4
2d.Please include a copy of the floor plans for the entire property. Neatly use a straight-edge. Show all existing rooms in the
home and the proposed amnesty apartment. Provide width measurements of any open doorways. Please label each room
clearly.
3. Is the dwelling connected to public sewer? YES
If the dwelling is connected to public sewer,skip questions#4 through#9 below.
4. Location of dwelling is INSIDE or OUTSIDE a Saltwater Estuary Protection Zone?
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5 . Location of dwelling is INSIDE or OUTSIDE a Zone of Contribution to public supply wells? ' _E
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6. Is the dwelling connected to an ONSITE WELL or to PUBLIC WATER? 'r
7. Is a disposal works construction permit on file? YES or NO r
8. If yes,how many bedrooms were approved according to this permit? Bedrooms. W
9. Were any building permits obtained for construction of additional bedrooms? YES or NO CO M
10. Is there an engineered septic system plan on file at the Health Division? YES or NO
11. 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
The Public Health Division has no objection to 14 bedrooms at this property.
Special Conditions:
Signed: > Date: 7
Q:\GMD-Housing\Accessory Affordable Apartment Program\ADMIN\FORMS&LETTERS\Blank Form amn styapp 1.DOC
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