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Home My WebLink About1586 HYANNIS ROAD - Health 15 86 HYANNISRI? Barnstable A = 298 - 018-001 MAR. 17.2005 8:52AM n�AR ST BLE BOARD OF HEALTH NO.890 P.1i1 ' Town of Barnfikble Health Inspector S Regulatory Services s�0 930$ Thomas F.Geiler,Director 1:00—2:00 NAM � a�sAsrest� � �,f Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax; 508-790-6304 AIVINESTY PROGRAM APPLICANT-SEPTIC OUEQ:WI NIA 1. General Information: Size-of Property: Address: ff Parcel•4/d- 40 • Name: Phone#: 7,�•' �d 2a, How many bedrooms exist at your property now9 2b. Are you planning to add any bedrooms?— 1j 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 NO All 4. Location of dwelling is INSIDE or OUTSIDE a Zone of Contriv++++ion to public supply weIIs? S. Is-the dwelling connected to�n - z 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? YEAS or NO S. 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 certifiod'inspector within the last two years? YES or NO --w—........... —.owr----o-r-M-- --rrwn---..r---.--------- --��........ .................. FOR OFFICE USE ONLY The Public Health Division has no objection to bedroom's at this roe 24 S Special Conditions: property,* Signed: Date' Q,'/headtltfwpfiles/amrasstycpp - , Town of Barnstable Health Inspector oFIKE royti Regulatory Services Office Hours 8:30—9:30 Thomas F.Geiler,Director 3:30—4:30 , STAB . # Public Health Division MASS. Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 AMNESTY PROGRAM'APPLICANT -SEPTIC QUESTIONNAIRE' Date:November 14,2011 1. General Information: Size of Property.75 acre Address: 1586 Hyannis goad Barnstable,MA 02630 7 Map 030. Parcel 035 Name: Stephen A.Duff Phone#: (508) 362-2707 2a. How many bedrooms exist at your property now? 5 2b. Are you planning to add any bedrooms?,NO If yes,how many? 0 2c. How many bedrooms total are proposed at this property(including the.amnesty unit)?5 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? If the dwelling is connected to public sewer;skip questions#4 through#9 below. 4. Location of dwelling is OUTSIDE a Saltwater Estuary Protection Zone? 5 . Location of dwelling is INSIDE Zone of Contribution to public supply wells-WP and GP 6. Is the dwelling connected to an PUBLIC WATER? 7. Is a disposal works construction permit on file? 8. If yes,how many bedrooms were approved according to this permit? 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 ------------------------------------------------------------------------------------------------------------------- b. . FOR OFFICE USE ONLY The Public Health Division has no objection to S bedrooms at this roe SKr p p �'• Special Conditions: Signed: Date: 1 Q:\GMD-Housing\Accessory Affordable Apartment Program\ADMIN\FORMS&.LETTERS\Blank Forms amnestyapp 1.DOC ~ l ti s g • r ; 0` .. Y s f r M .. ti , F 2 + Jk 1 e + , �( + �em /r d/ A611# 1'i 21. 21,010hd/o- N& AW4 N/&- s _ry L • .,,,..�;.... a,z �!Un.,we�»eras. �, -on Town of Barnstable Health Inspector Office Hours o Regulatory,Services 8:30—9:30 • Thomas F.Geiler,Director 1:00—2:00 t • iARNSMLE Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 508-7 3 Fax: 90-6 04 AMNESTY PROGRAM APPLICANT=SEPTIC QUESTIONNAIRE l. General Information: Size of Property: oL dotL Address: -Map 027 0 Parcel /d' �� Name: 1' Phone #: 2a. How many bedrooms exist at your property now? . 2b. Are you planning to add any bedrooms?. If yes,,how many? Y 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) orNO� o� Ifxle dwelling is_conne�cted to public sewer,slap questions#4"through#9-below,, 4. Location of dwelling is INSIDE or OUTSIDE a Zone of Contr +ion,to_public supply wells? 5. Is the dwelling connected to an ONSITE WELL. or to i PUBLIC WATER?,,. 6. Is a disposal works construction permit on file? YES or NO 6a. If yes,how many bedrooms were approved accordineto 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 ----------------- ----- ------ ------ ----- ------------------------ ------ FOR OFFICE USE ONLY t < t The Public Health Division has no objection to bedrooms at this'.property. Special Conditions: ' Signed: - b Date: O;/health/wpfiles/amnesryapp , -� '�Lvltl Lojo ' Q c r It44, owl Ari4