The URL can be used to link to this page

Home My WebLink About0063 LOUIS STREET - Health 63 LOUIS STREET I NZ 309-205-',i� , . 'EWER F t ee Town of Barnstable Health Inspector oFt Office Hours Regulatory Services 8:00—9:30 Thomas F.Geiler,Director 1:00—2:00 ■nxivsrnBLE, : Only '""SS. Public Health Division Thomas McKean,Director' 200 Main Street,Hyannis,MA 02601 Office: 508=862-4644 Fax: 508-790-6304 AMNESTY PROGRAM APPLICANT— SEPTIC QUESTIONNAIRE 1. General Information: Address: i MapiR Parcel CD S Name: p Phone#: �)08 3 ot 0`"1&2,3 2a. How many bedrooms exist at your property now? 2b. Are you planning to add any bedrooms? Y1 0 If yes,how many? 2c. How many bedrooms total are proposed at this property(including the amnesty unit)? 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 sewer ES or NO If the dwelling is connected,to,golic sewer,skip questions 4-9 below:. 4. Location of dwelling is INSIDE OUTSID a Zone of Contribution to public 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 0 8. Is there an engineered septic system plan on file at the Health Division? YES or O)WV6� 9. Has the septic system been inspected by a DEP certified inspector within the last two years? YES or -------------------------------------------------------------------------------------------------------------------- FOR OFFICE USE ONLY TO BE SIGNE BY A HEALTH INSPECTOR/AGENT ONLY The Public He a o 'ection to bedrooms at this propeyty Signed: Date: Inspector(Print): Q;/heal thlwpfileslamnestyapp --------------------------------------------------_....._-... 0 5-0„x 6-8" �- co 5-6" 8`-4„ 2-8" - J 2" 2-3"x 4=4" '-0"x 6- 2-3"x 4-4" cnv� " Lo N 01 BEDROOM N LI VIN ROOM " N � - '-Qrr x 6, rr M 1 6 _ -1 co d ------------------- --__ O v, _6_4„ rn CV N , co O " ni k o o, Lo N co cl y O - ao ,- N 8`:10" - °= cn 1=9" `- 1" o N = ND/NNER00 x =6"x 6- „ w co x KITCHEN " 54"— 704 BEDROOM '^ 5 ' 5„ 4=11" 2-6"x 4-9" " �- 5-0 x 3-9 3-5 6-9 8'4" 10'0" T 8„ ,�2-6" �KITCHEN BEDROOM o BATH j 5,4„ o X "' k O Co ' O 5n N i '� 5, 6„_�, rn IV r N Co O W O � _ 3'6" L/VIN ROOM BEDROOM 6'1" 5-1" 2=10"x4=11" 2'10"x4'41" 5,0"x 6, 8" 2,5' ,5, X-2" 0' 0" deck No. d00,3— IIS_ Fee �J THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 2ppiication for 30igo0af *pgtem Conotruction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon V) O Complete System ❑Individual Components Location Address or Lot No. 6 3 Q Loo J Owner's Name,Address and Tel.No. Assessor'sMap/Parcel Sac o,3 sue , QS Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of B ding: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. 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) 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 Certifi- cate of Compliance has been issued by this Board of Health. a Signed Ct,, Date Application Approved by o i' A,,.Jzl Date 0 Application Disapproved for the following reasons Permit No. 900 3--lSa Date Issued l z v f No. ?oo,3- S Fee a � � THE COMMONWEALTH OF MASSACHUSETTS Entered in computer. ✓ Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS 01ppYication for Mt!5po5a1 *p5tem Con5tructton Vertntt Application for a Permit to Construct( )Repair( )Upgrade( )Abandon(�) El Complete System O Individual Components Location Address or Lot No. G 3 6 Lo! S Owner's Name,Address and Tel.No. Assessor's Map/Parcel f �y��"s ? y 2 se .7 J c,✓�S Installer's Name,Address,and Tel.No: Designer's Name,Address and Tel.No. Cf'c'�; ��; s Type of B ding: . Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil A J A � L Nature of Repairs or Alterations(Answer when applicable) 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 Certifi- cate of Compliance has been issued by this Board of Health. Signed Date Application Approved by _ CrIJil s7oj rd i 6� Du n�F/�/. Date y/1 D� Application Disapproved for the following reasons Permit No. 003-152 Date Issued 51 1-2 THE COMMONWEALTH 07ASSACHUSETTS BARNSTABLE, MASSACHUSETTS r Certificate of Com*tarite THIS IS TO,CERTIFY,that the On-site Sewage Disposal System Constr icted( )Repaired( )Upgraded( ) Abandoned X)by Cl'A� M \ at 6S 9 L001' Sl- 11 MAA, has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. at, -/Sa dated n,Ta err -1 esigner The issuance of this permit shall not be construed`as•atguai'antee that the sy tze will unction esi�neL� Date �. Inspector 1 No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS 1=tfspoga1 *p9tem CoriWtruction Permtt Permission is hereby granted to Construct( )Repair( )Upgrade( )Abandon( ) System located at and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date:_ Approved by No. L / :3 Fee — 5 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZppYication for Migpogaf *pgtem Congtructton Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon" G ❑Complete System ❑Individual Components Locati dre r Lot No. Owner's Name,Address and Tel.No. ,-a , s �T /� x4 � t/ Assessor's Ma /Parcel 3� J d/ 3 y f G �d 3 7 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. � Type of Building: Dwelling No.of Bedrooms Lot Size - sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. 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 n applicable) 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 Certifi- cate of Compliance has been i ued b Board of Health. Sig Date Application Approved by Date �� , _ Application Disapproved for the following reasons Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS CERTIFY that the On-site Sewage Disposal System Constructed( ) Repaired ( )Upgraded( ) Abandoned( by at `� �a A� v/' has been constructed in accordance with the provisions of Title 5 and the for Disposal Sy tern Construction Permit No. dated Installer Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date ?� Inspector No. y—— " ✓ Fee ' Entered in computer: THE COMMONWEALTH OF MASSACHUSETTS Yes PUBLICHEALTH DIVISION-TOWN OF BARNSTABLE., MASSACHUSETTS - cat on for Migpogaf*pgtem Congtruction Permit Application for a Permit t6Construct( )Repair( )Upgrade( )Abandon(Qr) ❑Complete System ❑Individual Components Locationlddrep.or Lot No. ) Owner's Name,Address and Tel.No. 6, �-,) v 1 5 S'-i �,-6 XA tj Assessor's Ma Pm. �al 3 rQ se,-t- G, n�Gs 4�3� Instttaller's Name,Address,and Tel.No. I Designer's Name,Address and Tel.No. �ID� V C �,- 01 Jc/✓J S 7 Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. 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 Wbdn applicable) 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 Certifi- cate of Compliance has been i9sued b `his Board of Health. 1� Sig �d i� Date Application Approved by - Date Application Disapproved for the following reasons ti Permit No. Date Issued e� 3 i THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS O�CERTIFY that the On-site Sewage Disposal System Constructed( )Repaired ( )Upgraded( ) Abandoned( by �'��/ L/R at �� S has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer Designer The issuance of this pepmt shall not be construed as a guarantee that the system will function as designed. - Date 5f- / / �O 3 Inspector L No. 3 J �.. Fee d S I THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS WizpogaI Mem Congtruction Permit Permission is hereby gra ed to Construct )Repair( )Upgrade( )Abandon(� / System located at 1 t'�'7�v /� S e ,-X a"C� 31� )r� i �7` ��t>/ and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date—of,his_permit. Date:_ 4 ) d 3 Approved by ^_�