HomeMy WebLinkAbout0749 OLD STRAWBERRY HILL ROAD - Health 744 OL- `STRAWBERRY TALL RID
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�wn of Barnstable op, Health Inspector
Ft r Regulatory Services Office Hours
g yD 8:30-9:30
o� Thomas F.Geiler,Director . 3:30-4:30
BARNSTABLE, Public Health Division
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ArEo��A Thomas McKean,Director
200 Main Street,Hyannis,MA 02601
Office: 508-8624644 Fax: 508-190-6304
AMNESTY_PROGRAM APPLICANT — SEPTIC OUESTIONNAIRE
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Date:February 17,2011
1. General Information: Size of Property: 0.94 acre
Address: 749 Old Strawberry Hill Road nnis,MA 02601 Map 253 Parcel 010-H00
Name:DAVID G LOTUFO Phone#: 617-953-8157
2a. How many bedrooms exist at your property now? 4
2b. Are you planning to add any bedrooms? 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. 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 or NO
If the dwelling is connected to public sewer,,skip questions#4�,hrough#9 below. -.=--
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4. Location of dwelling is INSIDE or OUTSIDE a Saltwater Estuary Protection Zone "
5. Location of dwelling is INSIDE or OUTSIDE a Zone of Contribution to public supply wells? Gi,
6. Is the dwelling connected to an ONSITE WELL or to PUBLIC WATER?
7. Is a disposal works construction permit on file? YES or NO
8. If yes,how many bedrooms were approved according to this permit? 4 ; . Bedrooms.
9. Were any building permits obtained for construction of additional bedrooms? YES or NO
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 '
------------------------------------------------------------------------------------------------------------------- l,1
FOR IC USE ONLY
The Public Health Division has no objection to bedrooms at this property.
Special Conditions: ,
Signe Date: 13 10,4 Z/
Q:\GMD-Housing\Accessory Affordable Apartment Program\ADMMFORMS&LETTERS\Blank Fo amnestyapp 1.DOC
TOWN OF BARNSTABLE
LOCATION SEWAGE #
VILLAGE IPtd`1d'S1 S ASSESSOR'S MAP & LOT ttj 1
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY tNF1ow C"-4V 0\ 'dK-I a
LEACHING FACII.ITY: (type) <uZLT\bLy(4A-oX�ml _ (size) 16 X b
NO.OF BEDROOMS
BUMDER OR OWNER
;PEDATE: 18 `b"'�''�� . COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the 30 Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) N Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
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NO.OF BEDROOMS
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Separation Distance Between the: ,
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility , Feet
Private Water Supply Well and Leaching Facility (If any wells exist
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TO STABLE
LOCAT1oN SEWAGE#
VII.LAGE 1 �1�I'S1 S ASSESSOR'S MAP&L01 oZ,
INSTALLER'S NAME&PHONE NO.
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SEPTIC TANK CAPACITY %tNF1ow.Cg,"V00\
LEACHING FACU-rrY: (type) (size) 6 X 43.E
NO.OF BEDROOMS
BUILDER OR OWNER AAMP I I
PERIMMATE: A8tCt ---- COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the
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Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) N
Edge of Wetland and Leaching Facility(If any wetlands exist
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http://issgl2/intranet/propdata/prebuilt.aspx?mappar=253010H00&seq=1 2/17/2011