HomeMy WebLinkAbout0063 SECURITY STREET - Health 63 Security Street <'' � f , R
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Town of Barnstable Health Inspector
-VE Q tp� Office Hours
Regulatory Services 8:30—9:30
Thomas F. Geiler,Director 1:00—2:00
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9�ArF1639. � Public Health Division
Thomas McKean,Director
200 Main Street,Hyannis,MA 02601
9
r` Office: 508-862-4644 Fax: 508-790-6304
AMNESTY PROGRAM APPLICANT.- SEPTIC QUESTIONNAIRE
1. General Information: Size of Property: 2--b
Address: !�A W�' MapZ6� Parcel /1
Name: J 1`_ Phone #:
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2a. How many bedrooms exist at your property now?
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 - 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? YES or DO
If the dwelling is connected to public sewer,skip questions#4 through#9 below.
4. Location of dwelling is NSI or OUTSIDE a Zone of Contribution to publi' supply walls?
5. Is the dwelling connected to an ONSITE WELL or to P LIC TER? ca
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6. Is a disposal works construction permit on file? Y or VO cc
6a. If yes,how many bedrooms were approved according to this permit? Bedros.
7. Were any building permits obtained for construction of additional bedrooms? YE or YVO 03
8. Is there an engineered septic system plan on file at the Health Division? YE 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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lQ-�P ��� OFFICE USE ONLY �l Public Health Diviisl�o section to bedrooms at this property.
Special Conditions: NO ffiV,9 `Z'l� 'Two �5 ,
Signed: Date:
/healthhv iles/amnes a i
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LOC4�I0N v im, __ 5EWO.C4E PERMIT _MO.
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BUILD 5_ V.J 4t, ADDRESS F _
Dli►TE PERMIT ISSUED
DATE COMPLI &MCE ISSUED :
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