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HomeMy WebLinkAbout0030 JOBY'S LANE - Health JE s Lane 90 e' ° ° • s a p ° s � o Commonwealth of Massachusetts z Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments �M 30 Job 's Lane Property Address P Y Paul Morgan Owner Owner's Name information is required for Osterville Ma. 02655 2/18/2011 every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: A. General Information When filling out .I forms on the U51D computer, use 1. Inspector: only the tab key to move your Robert Paolini cursor-do not Name of Inspector use the return key. Capewide Enterprises,LLC. Company Name r� P.O.Box 763 Company Address Centerville Ma. 02632 'ENO City/Town State Zip Code (508)477-8877 814454 Telephone Number License Number B. Certification C:> I certify that I have personally inspected the sewage disposal system at this address and that the, information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of.,on site sewage disposal systems. I am a DEP approved system inspector pursuant to'Sei tion 15.340 of ^ Title 5 (310 CMR 15.000).The system: -, ® Passes ❑ Conditionally Passes ❑ Fails n ❑ Needs Further Evaluation by the Local Approving Authority 2/18/2011 Inspector's t Ignature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Dispyal System•Page 0 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 30 Joby's Lane Property Address Paul Morgan Owner Owner's Name information is required for Osterville Ma. 02655 2/18/2011 every page. Cityrrown State Zip Code Date of Inspection Bo Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The septic system is in proper working order at the present time. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 C Commonwealth of Massachusetts w Title 5 Official Inspection . Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 30 Joby's Lane Property Address Paul Morgan Owner Owner's Name information is required for Osterville Ma. 02655 2/18/2011 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if (with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 30 Joby's Lane Property Address Paul Morgan Owner Owner's Name information is required for Osteryllle Ma. 02655 2/18/2011 . every page. CitylTown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health(and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded.or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments ^M 30 Joby's Lane Property Address Paul Morgan Owner Owner's Name information is required for Osteryllle Ma. 02655 2/18/2011 every page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,.therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. �t For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area— IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form- Not for Voluntary Assessments c,M 30 Joby's Lane Property Address Paul Morgan Owner Owner's Name information is required for Osterville Ma. 02655 2/18/2011 every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 2 DESIGN flow based on 310 CMR 15.203 (for'example: 110 gpd x#of bedrooms): 330 t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts W Title '5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 30 Joby's Lane Property Address Paul Morgan Owner Owner's Name information is required for Osterville Ma. 02655 2/18/2011 every page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ® Yes ❑ No Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 ears usage d Na 9 ( Y 9 (9p ))� Detail: Sump pump? ❑ Yes ® No Last date of occupancy: NA Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 30 Joby's Lane Property Address Paul Morgan Owner Owner's Name information is required for Osterville Ma. 02655 2/18/2011 every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments a6,M 30 Jobyi s Lane Property Address Paul Morgan Owner Owner's Name information is required for Osterville Ma. 02655 2/18/2011 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2411 feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line. 10'+ feet Comments (on condition of joints, venting, evidence of leakage, etc.): joints appear tight.No evidence of Ieakage.System vented through the house vents. Septic Tank(locate on site plan): Depth below grade: 2 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 gallon Sludge depth: 5 t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 30 Joby's Lane Property Address Paul Morgan Owner Owner's Name information is required for Cisterville Ma. 02655 2/18/2011 every page. Citylfown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 27" Scum thickness 3" Distance from top of scum to top of outlet tee or baffle 5" Distance from bottom of scum to bottom of outlet tee or baffle 11" How were dimensions determined? Measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pump tank every two years.lnlet and outlet tees are in place.No evidence of Ieakage.Tank appears structurally sound. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 30 Joby's Lane Property Address Paul Morgan Owner Owner's Name information is required for Osterville Ma. 02655 2/18/2011 every page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day . Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): * Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•11/10 Title 5 Official Inspection Form:Subsurface'Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 30 Joby's Lane Property Address Paul Morgan Owner Owner's Name information is required for Osterville Ma. 02655 2/18/2011 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert No Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Box is Ievel.Box has two outlet Iaterals.No evidence of solids carryover.No evidence of leakage. Pump Chamber (locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: I t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 r Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 30 Joby's Lane Property Address Paul Morgan Owner Owner's Name information is required for Osterville Ma. 02655 2/18/2011 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 2 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Sandy dry soil.No signs of hydraulic failure.Chambers were dry at time of inspection.Stain line observed 14" below invert. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments °M 30 Joby's Lane Property Address Paul Morgan Owner Owner's Name information is required for Osteryllle Ma. 02655 2/18/2011 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): J t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Map n Page 1 of 2 Town of Barnstable Geographic Information System Parcel Viewer Custom Map Abutters Map Size Zoom Out In �e r 3 2 �g o 9 k f•1 WOO A' 1 � � rt� - tt � 6 d � i Set Scale 1" _ 20 I :Aerial Photos ��,.I� I MAP DISCLAIMER (—winht 7001;.9010 T-Ain of Rarnetohlo AAA All rinhtc—Qani, http://66.203.95.236/arcims/appgeoapp/map.aspx?propertylD=120090&mapparback= 9/19/2003 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 30 Joby's Lane Property Address Paul Morgan Owner Owner's Name information is steryille Ma. 02655 2/18/2011 required for O every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: Bottom of LC 21' feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health - explain: As-Built ❑ Checked with local excavators, installers - (attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: USED:USGS Observation Well Data.USED:Technical Bulletin 92-0001 annual ranges of ground water elevations. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments °wM 30 Joby's Lane Property Address Paul Morgan Owner Owner's Name information is required for Osterville Ma. 02655 2/18/2011 every page. CitylTown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 H�O�OS�b 3 V\50N PORCH 12' X 1�' ( APHPDX) 5TUb10 5TU ML05UPT 3" �P5 + H P00F 5Y5tm C 12' 5PM) =111-III=III=III=III=III-III-III=I L I=� 1=I I I 1�111111111 IIIlilllllllllll��lll=1 ' i �IIEll f111Fl L_J O C 2) NEW 6'n00p5 MOM FOpCH (NOf SHOWN IN THIS VIEW) EXISTING Pee SHOWN PAM, FOR CLMIIN I. 111=1 I I=111- .I=1 I�I�I�i �=111=1 11=1 li i 1 1111=1 � 4 " . I—III—I I: II—III— I i d—I i —III-1 rl I—III— b i I—III—I —I I—I hI 11 1-� 1 1=1 1=1 I Ia i1-1 1=1 1I 11 1 �J= IIL= L_J L_J L_J L_J— project: Scale;1/4"-1'-01, nrawirq: etterl ivi n MOI?GAN F�51P%C� 30 J0�'5 ME A— SUNRO0MS 051UVII. MA02655 78 Turnpike Road Westboro,MA 01581 Phone(508)870 1900 Fax(508)870 5756 - 17ate:6/22/09 Sheet Z of 2 'on —O f 1,101104 MX 11%6' POOP From HOU5E i EXI5MCA DECK n, (SHOWN pAP.TIAI.) 26' PPOF05EP NEW PACK 12'X0'(APPFOX) 1.2XI0 PT MAW @ 16"O.C. 2,LFPCZF(OMP 1/2''X5"LAG5'52''O.0 5.J015T HAN6E6 @ LEUk 4.2XI0 Pf 1RIPLE END P9 AM(HIDDEN) 5,12M 5117E J015f5 6.(�) IT O X 48''DEEP F165 W/ANCHOp5 7.3/9"f&G PLY OVE, AY a.6X6 P05T5 Project: 5cal e:1/4"-1'-0" Draw inq: et terliving MOF6AN FE5MNa 50 JOVY5 LANE A-1 N ROO M S 05VVILLE,MA 02655 78 Turnpike Road Westboro,MA 01581 Phone(508)870 1900 Fax(508)870 5756 Date:6122104 5heet I of 2 i TOWN OF BARNSTABLE ETHET� OFFICE OF m � 31MUSTAM i BOARD OF HEALTH NAG& p op 039. `�0 367 MAIN STREET OMp� HYANNIS,MASS.02601 December 1, 1999 Stephen Wilson, P.E. Baxter & Nye, Inc. 812 Main Street Osterville, MA 02655 RE: Lot 21 Joby's Lane, Osterville Dear Mr. Wilson: You are granted a variance on behalf of your client Cheryl Tuttle, from 310 CMR 15.214, restricting sewage flows to one bedroom for every 10,000 square feet of land within Zone II districts. You are granted permission to construct an onsite sewage disposal system at Lot 21 Joby's Lane, Osterville, with the following conditions: (1) No more than two (2) bedrooms are authorized. Dens, study rooms, finished attics, sleeping lofts and similar-type rooms are considered "bedrooms" according to the Massachusetts Department of Environmental Protection. (2) The applicant shall submit house plans to the Board of Health. Every room in the proposed dwelling shall be labeled indicating it's proposed use. (3) The applicant shall record a properly-worded deed restriction at the Barnstable County Registry of Deeds limiting the dwelling to two (2) bedrooms. The deed restriction shall be signed by the property owner. A copy of the recorded deed restriction shall be submitted to the Board of Health rE to obtaining a disposal works construction permit. 21jobys This variance is granted because it is the Board's policy to grant applicants approvals to construct no more than two (2) bedrooms on lots of less than 18,000 square feet in size. Sincerely yours, Susan G Rask, R.S. Chairperson Board of Health Town of Barnstable SGR/bcs 21jobys r -�pFTHE TQtf, , DATE: / t FEE: * BARNSfABLE MASS ///Y �$ i639 `0� REC... BY prFo�ya Town of Barnstable �y SCHED: DATE: O��g Board of Health 367 Main Street, Hyannis MA 02601 / Office: 508-790-6265 Susan G:Rask;R.S. FAX: 508-790-6304 Sumner Kaufman,M.S P.H. Ralph A.Murphy,M.D. VARIANCE REQUEST FORM LOCATION Property Address: Assessor's Map and Parcel Number- t-20 PCL. Ci b Size of Lot: (�.j,"I 5�= Wetlands Within 300 Ft. Yes Subdivision Name: ()STMVjUzL(�nDDS No X' Business Name: APPLICANT CONTACT PERSON Name: dd �L UTTL& Name:�A- E 4;i;rr �11� Addresslw:54aiw— iJfs�- Z,-- lu$/ZmmD llil lLleS Address:9a Mim Z,�yr 0,,,T R V1 L,Lz Phone: �2�' rj'?."lZ Phone:. FAX: FAX: VARI.ANCE FROM REGULATION(List Reg.) REASON FOR VARIANCE(Ma attach if more space needed) 5 SC�T�fl4 lsaI4 4 Ig"11 51M,0iV)Crs10�1 4 - Ul"S cANuOr BF, M Abe LAR•lsC= �3y�c.'t V PflN Checklist(to be completed by office staff-person receiving variance request application) Four(4)copies of plan submitted(including septic system plans and/or restaurant floor plans) Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense(for Title V and/or local sewage regulation variances only) Full menu submitted(for grease trap.variances only) Variance request application fee collected(no fee for lifeguard;modification renewals,grease trap variance renewals[same owner/leasee only],outside dining variance renewals(same owner/leasee only],and variances to repair failed sewage disposal systems[only if no expansion to the building proposed]) _ - Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED Susan G. Rask,R.S.,Chairman NOT APPROVED Sumner Kaufman,.M:S.P.H. REASON FOR DISAPPROVAL Ralph A. Murphy,M.D. Q /WP/VARIREQ SETTS . . Ole ,7V '27— i P b-A 4 � r ®.Aim .65 as s'' r , $,�.� � jr o f V ja pp 24 -/ •' 0� .36,�' -SOS •troAdAttAe . a , u� 33�c „Olog ASSESSORS MAP BAXTER & NYE, INC. 812 MAIN STREET OSTERVILLE, MASS., 02655 (508)-428-9131 BAXTER & NYE, INC. 812 Main Street OSTERVILLE, MASSACHUSETTS 02655 DATE JOB NO. (508) 428-9131 ATTENTION TO RE: nn Board of Health T ZI u Town Hall 367 Main Street Hyandis,-Ma. 02601 WE ARE SENDING YOU 1C Attached ❑ Under separate cover via the following items: ❑ Shop drawings `4 Prints ❑ Plans ❑ Samples ❑ Specifications )4 Copy of letter ❑ Change order ❑ COPIES DATE NO. C DESCRIPTION Iz_ IY''O/r 5/x, 'r J G THESE ARE TRANSMITTED as checked below: For approval ❑ Approved as submitted ❑ Resubmit copies for approval ❑ For your use ❑ Approved as noted ❑ Submit copies for distribution ❑ As requested ❑ Returned for corrections ❑ Return corrected prints ❑ For review and comment ❑ ❑ FOR BIDS DUE ❑ PRINTS RETURNED AFTER LOAN TO US REMARKS _57X&Uli.Q 16ZS rYt�c flu r 4:2arylic. C��/ �Kli- iY D e 9 /'GS�LC f_7L�J Si i�tm.� s2tr7'� ,� _GCJ✓7�//'!O ��'�[r COPY TO SIGNED --� If enclosures are not as noted,kindly notify us at once. I_ y4 A I►�I41ILE FAM IL`( l3sDizz5I1 14 ao Ga¢ti3q�c G¢�ter ( �1it Ly Fi ow =: i is 3 �-oT .'.:;;zi �0' ti 'S (,! ao STa2-v 1 - u5� 1500 GAc L. l.�dCt}It,IG . 5`(ST>`�i �ES�11 fL 4'Pvc P�� o . 1i. GAMON A26A 26C�;D Stout FIST. - t�°t--t GPD o-i4 5�=dsF � tQ.-t1° ,cPYuG1iT�0�-i .A1zFA 'Dr516 N 51tEuiQL.L PLaN y:«w: zka ct�AM$�es:-. OTTOM. A>MF-=4 _ 2,G7g 1L = ° G��oi.�.Tlo�! QdTE L S Mr�t/r.� SOIL CJ_ASj I 1JA OF Al, 5ro64E Of .. O�. STEPHENA. Cif _1..� STUN I. SOD-�OOE� � NO.302 O V/SlE C1- ,4itnpjl=7- - N FG= 33 t;- i. EL F& T , 54'BS�II� CHAMiZS'tut 'T7►►rl 5; -..1 .R �^ PAe*iUvV� W� `No " �cetbr C RGDPLOTPLAN 1-oc�iT tti p •i • Ste. t FY ..nl T T9 E .'`�0>7 t 71C,� 5t 14ult� PLACE 1217- �•F�N CZMM'-IS. wtTK Ti}E :S1DEUN AISv 52r7B�� ~ ,iv►2tssn6drr Dl �t-�ts. To ii/N. aF 3A +J5 ►ro is ��za.-r�-n , wir4ir SF6�J4L .FL �D:. HA71�S� : Z ENE. �AXT� Ny>= 1lJG "I ` t� ZA11D S(J¢vti`/tY�S • lui r,tl OSTr-2YiLLrr of F 3e�•S ;:=OM '50 r LLD t ls, _sNaXt> NO'r Biz c USED,"Tb i`i,Tbbc s F?Rfl y Lr►.Ji=S APPIJG4NT. � 0 �BoO 58:oa �\ .,ljj DD 3 p .56 OL 44 _ 040 -31 - �Jogy s LAJ�- . . Lam f. No.3021 E c FSS�ONAL 9 � 13AXTt2 Gott"' 1� , Mass _,x • ���o9GY ;, FIRST FLOOR PLAN B- 't0'15 HomeStyles Publishing&Marketing I .I RUBIN i 0 . .: vaulted � ,.. �illlilll911 - Kit l,!691111,�11 i i P Oh L I u �1lfill Rd1111„i _ x �89D98�� Li ing R l� \\, Wxo i � N ' � I I. HOWS' YEs® DEED.RESTRICTION WHEREAS, .Cheryle .R. Tuttle, formerly known as Chery'le R. McHenry, of Jackson; Mississippi.is the_owner of Loi 21 .located at .30 Joby'§ Lane, Barnstable` (Osterville),�Barnstable County, ,Massachusetts '(hereinafter_referred to :as Lot'21) :and being shown,on a. plan entitled�"Plan of Land in Barnstable,;Massachusetts,:-`Osterville Woods' Property of the Lanza.Corp." dated May.,;Il 1971, drawn by Robert G. McGlone. .. duly recorded in Barnstable'County Registry of Deeds in Plan B6ok.247 Page 13T WHEREAS, Cheryle R Tuttle,"formerly:known as Cheryle R. McHenry as the owner of said lot has agreed with the Town,of Barnstable Board of Health to a restriction as to the number of bedrooms which can be included �in any home built on said lot as a pre-condition to obtaining a, variance from the State Environmental .Code, '_310 CMR 15:21.A and to obtaining a building permit for this lot, WHEREAS, the Town,of Barnstable Board of Health, as a -pre conditioq to ..granting the variance from the State Environmental' Codes 310 CM 15.21.A and . authorizing the-issuance of a building permit for the construction of a single.family home on this lot is requiring that the agreement for the restriction,on'the number.of bedrooms in any house constructed on-the`lot be.put on;record:withthe Barnstable,County Registry.:of , `Deeds by recording this document. NOW, .,THEREFORE; Cheryle aR Tuttle, formerly known as Cheryle `-R McHenry;:does hereby place:the ,following restriction on her above-referenced,"land in accordance with her agreement with the Town of Barnstable Board of. Health; which restriction shall run with the lan.&and be`bindmg.aP on all,successors;intitle: 1: Lot 21 at 30'Joby's.Lane;`Osterville may have.constructed upon the lot'a house containing no more than two (2) bedrooms until such time as the Barnstable Board'of Health shall change its regulatioris and allow further construction on the premises Cheryle R. Tuttle, formerly known as Cheryle R McHenry; agrees that this shall be:a permanent deed`restriction affecting Lot 21 located on` 30 Joby's Lane;. Osterville, . Massachusetts, and being shown on the plan.recorded;in Plan Book 247 Page,137 . For title of Cheryle R. Tuttle, formerly known as.Cheryle R McHenry see the following:deed:: Book,9574 Page 217 Executed as a sealed instrument thisday of. /��,�;N,,(r� , 1999 „ .CHERYL R:TUTTLE 'STATE .OF MISSISSIPPI.. s November 2 1999 Then personalty.appeared-the above-named Cheryle R. Tuttle, formerly known as Cheryle R. McHenry, and acknowledged the foregoing instrument to be her free act and , deed before me Notary ubhc My commission:expires °AISSIStIPPI STATEWIDE NOTARY PUBLIC ; AMISSJON EXPIRES JULY 23r 2000" n. y.. � 099_DATE: FEE: a �STAH� - Y✓'l n t�yin s� REC. BY Town 0f Barnstable SCHED. DATE: g Board of Health 367 Main Street, Hyannis MA 02601 Office: 508-790-6265 Susan G.Rask,R.S. FAX: 508-790-6304 Sumner Kaufman,,M.S.P.H. Ralph A.Murphy,M.D. VARIANCE REQUEST FORM LOCATION I Property Address: � L.A`.0 �`o 3-1 S - 6 e mil✓ice= Assessor's Map and Parcel Number:llAO I&) QcL Ct D Size of Lot: Wetlands Within 300 Ft. Yes Subdivision Name: 0 S j M—V ILLS L 180D Sl No X Business Name: APPLICANT CONTACT PERSON Name:`..��. `fir.- 2 , I v"j'1_'L Name:�� -si ige,. Address:_o:&jCTEe IJ�c� JIh&gpgS 11AK. S Address:9I2 MJJW �r 0ex5p=.tl1L-k. Phone: k1Z0 - 52`7� Phone: FAX: FAX: VARIANCE FROM REGULATION past Reg.) REASON FOR VARIANCE(May attach'if more space needed) 1 Tlrc -3 5GGT t 04 i`a,2i4 Wit i i 5 h3a w 1 4C;e Oil DL4►J r I-C't'S r-A N ue r v pow Checklist(to be completed by office staff-person receiving variance Pequest application) Four(4)copies of plan submitted(including septic system plans and/or restaurant floor plans) Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense(for Title V and/or local sewage regulation variances only) Full menu submitted(for grease trap variances only) Variance request application fee collected[no fee for lifeguard modification renewals,grease trap variance renewals]same owner/leasee only],outside dining variance renewals[same owner/lessee only],and variances to repair failed sewage disposal systems[only if no expansion to the building proposed]) Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED Susan G. Rask, R.S.; Chairman NOT APPROVED Sumner Kaufman, M.S.P.H. REASON FOR DISAPPROVAL Ralph A. Murphy, M.D. Q:/WP/VARIREQ 4 SETTS . \ . 11C 44 No Q r � L� x we Q " : a �i^ .79 kr ®\ 4A r R ti XX c 7 � a roe oii � r` 4 1A r .34 9 "•;,r C� LOCUS "" p o o t � a ,� © 3 ' aM © "\ On 64G lo ASSESSORS MAP BAXTER & NYE, INC. 812 MAIN STREET OSTERVILLE, MASS., 02655 (508)-428-9131 S{�E1r� OF 251u4LS FaMILY g ac�wt � PL A4,1 014 BAD u � ff l.r�To S� v i u 50o GAS a=30-Z Ito FVC PIS L�AGI}Ii.IG .5`f STEM DES�11 �.�Q-.�%N4�'-►s`t ,:; ' ;r,E 3 cuLzEc ��330e4 ST aFpU r-AroN A2EA 2�'D eX .ippL16411ot-4 AVE& Stb� 2� FL 1u - L �F�t� cI4AM8Ee5 S1tE1yALL AWF,4= �rl xS x2- NSF 80 oM A `zG 1L. TT � pT1u- sF Goc &T(pJ.. SOIL CJ_A� .I PST AF A,Jq sroNE OF: o o a; CuLT�G v O STEPH.EN. y No 30216 Us" � q o�F FG(SXER`�.`��c, SSJ�NAL ENS' IJ?,�l b— lbir 14 tl SANS 5t,'fsSCli✓ Lsdul 77 �� n e . �n sa+✓� � 19 �� ��se � 1,0 Sam. i 4` �� eP�Nst � .A t ' r So,�.ro�,�,��tietTis��VE11�P'4� �¢OFh.� f Are j Flo 2- 1ncT►v" m i'sue 1 U 5i10�UN. PLA Rh1C Rry LII8�g9 4aZEOW F�`f5 w tTu -> s4cN Alm 1 : F 'T TBACIC VIZEME T Di4s. 12b.WN 4F 13A"5 .A► V i s ice"Lo�TE W I Tu l e .MAT 2,0. P .�(6 SP AL Fts17D HAz H\/S IhtG 149D 102V CZ669 c CQ lySZD � GKmI54.IsA P 2cpE=-ry LtOLN4, QU G4NT ITL� ;" -56 To Trl�t- o =° yN; t L072 l 71 �� ,r NI LEAc4 ' {J tiv Bob 's I IA4, '. IRXI ... ti - LW �'OF S ®RIM A� aOOeIa No.3021E 9� r JF Gvw4G l V. ISTEF c� �SS�ONAII E , '� // 9 B�xitr� f NY+✓ Imo:.. _ 99o9G w FIRST FLOOR PLAN B-91015 HomeStyles Publishing&Marketing \ •ni�lluir `I i - vaulted pa 6 i �i1111111911 l• x. 00 �V6�Ong I ° , v i HOWSMES DEED RESTRICTION WHEREAS, Cheryle`R, Tuttle;`formerly known as ,,Cheryle R: McHenry„ of Jackson;. Mississippi. is the owner of`Lot. 21 located:at, 30-Job 's Lane` Barnstable PP Y , (Osterville), Barnstable County, Massachusetts (hereinafter,referred to as,Lot-21) and, being shown on a plan entitled "Plan of Land..in Barnstable,' Massachusetts, Ostervi.11e Woods' Property of the Lanza Corp.". dated May 1,.1971, drawn:by Robert G.:McGlone, duly recorded in Barnstable County Registry of Deeds in Plan Book 247 Page 137. WHEREAS, Cheryle:R. Tuttle;_formerly.known`as.Cheryle R.McHenry as'the owner of said lot has agreed with:the Town of Barnstable Board of Health to a restriction as to the number of bedrooms which can be included in any home,built.on�' iid:lot as a. pre-condition to obtaining.a variance from the State Environmental'Code;- 310 :.CMR 15:21.A andto obtaining a building,permit fort his lot, WHEREAS, the Town of:Barnstable. Board:of "Health, ,.as a pre=condition to granting 'the variance from:the State Environmental<"Code, "310 CMR 15:21.A."and authorizing the.issuance of a building permit for the construction of a sing Y le family.home on,this lot is requiring that the agreement for"the re the number of.bed rooms in any house constructed on the lot be put`on record:with the Barnstable. County Registry of,. Deeds by recording this document NOW, THEREFORE, Cheryle R Tuttle; formerly known as Cheryle 'R McHenry, does hereby place the following.,resiriction`on her above-referenced land in accordance with her agreement ;with.the Town of Barnstable Board of'Health, which restriction shall run with the land and be bindingupon`all successors in title _. 1: Lot 21`at 30 Joby's Lane,-Osterville may have constructed upon.`the lot a house containing no more than two (2)'bedrooms until:such time as the,.Barn of Health'shAll change its regulations and alloWfiurther construction-on the premises: Cheryle R. Tuttle, formerly:knowii as Cheryle R. McHenry, agrees that this shall be a permanent deed restriction-affecting-Lot`21 located on 30 Joby's Larie, Ostervlle, Massachusetts, and being shown on the plan recorded in Plan Book 247 Page 137 For title of Cheryle R. Tuttle, formerly known as Cheryle R. McHenry.' see the e following deed: Book 9574 Page 217 Executed`as a sealed instrument this_., as of. . /�,n,L„�;(,.� , , 1959. CHERYI; R.-TUTTLE s • STATE OF MI:SSIs.SIPPI : November. 2 1999 Then personally appeared the above-named Cheryle R. Tuttle; formerly known as Cheryle R. McHenry,.and acknowledged the foregoing instrument,to be her free_act and deed before me : Notary ubl>c 1VIy commission expires: "11SSiSSIPRI STATEWIDE NOTARY PUBLIC r v,"uiAb11ISSION,EXP RE-S I1131Y.,23.2000 S } S: .. ,.. - p. ! I sc6.-X VA r4 ► Q� ,rQ�s FA IL S»Rc�wt E pt_A t� otJ B ut�� v 1500 GAc-. INC PiPtE I�AGt}I1.lG 5`�ST��K �'ESiGJ.l �. CuLTE� ocitaw+ ssTout — - - -- - -- ` AFFUCATION .AmA ZQVD DUST O-�14-tppU,! lATo,-1 A¢FA t c e V^ - E 5 L t L t� bN (_ � E4A 8 t;D ToA,l AYE S5'� 1Z' TL 7r� �: sF FiN�s►a C��� PEZ oOL TLo44 ►L cis: I " j�jkH OF 5 mot= P. s T y�: 9 a OF �. . G' o , r a Cuc/ G SA PY EN yN 'J • 330 a N oo ,. NE -' N -.302216 )4Aility� 1� n E _ SS10NAL TG- � SAW) zlvaWV CKAti+ RS tiut ;' 3�G tcl� �L- 144` � 1 i�o 1- Ln ATto ! O —0 t t.-�-c `�za�os Rw ►I�:8�99 �} NtFt`f5 w[ZK - siuN A►ID GfC v121s�V16d3T DF . 'T1tS TlVJKI eF L�'T Zir✓ zd 7 P� 13'] Ar 15iA A�ro is i 17T-.1oe-ATE vJIT.741 W d P IZca Pam- p SPJ 4 L F ls�P HAZ1N>= BAXT�2 NyE 1�1G LAf1D StJwE='ft�S - >�I�i�16i� �y r, ` MA6 mcm by t L DI I,"6 -!;PC XD Nor B 1z L>>aT> Tb 56TWELASIA PRD Ty 'LraJ£�5, . Ci Pi..c - V T 56 •o�- - o� 0 av `ii o 3a Zont 40 _ D ° _ i s 2a 38.op o � !i7 DD<. l II Lh �► ,� �._: NI ...LsA�. ��b-Bob � .TSAR, I 33 A ' Th, r i I � -� - �� (O po OF STEPHEN G% AU T NLUM 0.3U4.E S 0 T 1J� � FSS/pNAl,E G azr�,'�►(Q Mass FIRST FLOOR PLAN B 91015 HomeStyles Publishing&Marketing 53-0"': ID 9 ; 111�lilllli II I _' j I KiR o I p DI` I� L 11J 111 h11940t11 L n Uviopg RM., ®0�18�11� I - I r d,7 I HTYLE S lv S -. : 'DEED RESTRICTION WHEREAS Cheryle. R. Tuttle formerly known as Cher " Jackson, Mississippi is the owner of Lot 21 located" at 30 Joby's,Lane, 'Barnstable (Osterville); Barnstable County; Massachusetts>(hereinafter referred to as Lot 21) and being shown on a plan entitled "Plan of-Land in Barnstable; Massachusetts; `Osterville Woods' Property of the Lanza Corp." dated May 1,1971; drawn,by Robert G. McGlone, duly recorded in Barnstable County Registry of Deeds in Plan 247 Page 137. WHEREAS;-Cheryle R- Tuttle, formerly:known as Cheryle R. McHenry as the owner of said lot has agreed with the Town-of Barnstable Board of Health to a restriction as to the number of.bedrooms which can be included in any tome:built'"on said lot as"a pre-condition to obtaining' a.variance from the State:Environmental Code, 310 CIA, '15.21 A and to.obtaining.a'building permit for this lot; '•WHEREAS; the Town of Barnstable Board" of Health as apse=condition to granting. the variance from the State Environmental Code,:310, iCMR 15.21-A and authorizing the issuance of a building permit for the construction;of asingle family home on this lot is requiring that the agreement for the'mstriction on the number of bedrooms in" .. any house constructed on the lot be put on record with the Barnstable CountyRegistry:of Deeds by recording this document. NOW, THEREFORE. Cheryle :R Tuttle, .formerly known as Cheryle R. McHenry, does hereby place the following restriction. on 'her.above referenced land in accordance with her`:agreement with the:"Town`-of Barnstable Board of Health,. which restriction shall run with the.land and be bin ding'upon`all. successors,in title wi 1: Lot 21 at 30 Joby's Lane, Osterville may have constructed upon the lot a.house containing no more-than two. (2) bedrooms until :such;time as the Barnstable Board of, Health shall change its regulations and allow-further constructiomon the premises. Cheryle R. Tuttle; formerly known as Cheryle'R.'McHenry; agrees that this shall be"a permanent.deed restriction affecting Lot 21 located on.30'Joby's Lane, Osterville, Massachusetts; and being;shown on the planrecorded in PlanBook 247 Page For title of.Cheryle'R: Tuttle, formerly known as Cheryle R. McHenry, see the following deed:. Book..9.574 Page 217.. Executed as a sealed instrument this�day'of /�a., �_ , 1999 CHERYht R. TUTTLE y , STATE.OF 'MISSISSIPPI ut @X November .2',, 1999 . Then personally appeared the above=named,Cheryle R.',-Tuttle, forinerly known as Cheryle R. McHenry, and acknowledged the foregoing instrument,to be her free act:and deed before me t tits Notary bl'c My commission expires. MISSISSIPPI.STATEWIDE NOTARY PUB11C.. F I SSIOf:.EitP,xE5.ai1lY 2..3 20D0.,: Y r ,a SAFET .. . O� . .�Sil�-� DATA Ott 1Gt_� FSOL AMGA¢f3AL i�� LOT �I ° irk. 110 p'PvG USA A/ ou. E4 y, cuL-� : kpP Li &Jwt.4AQ.F� ��5l6� pLb.N Vlt=1� - L��}It�Y, GE-1AM8EQ5 Sit�V1A[1 Aw-A x'Z x2= 14'�SF 3 W)c go �Z . STEPNEN yG ZN A Y N l�No:30216 12` . f 9 � � An�� E�- a O C ne �— aoa� F 4 056 .5 I - FSS�ONAt ENG Fz 31 _/ F T, A wv Iva �$5dB5c1(a. LFAGiI' C41AMS�R5 cut �`, 41r.4jo_ ' 12 POT - �.-t LnGATlt t Os i ''' p � PIZ ip-� Qs + �'. . pL1I TVIA T Via:T�:o. i3� 4 IT" ,m 44 aF J4 AP I'�D. - ctc 2H9v12�nn6 '1' w t�1 N + . ..ice: t 5 �L�G1aT�D �`/E '`� A ZONE• • G1�iE16 Sp6uAl: Fts�7D HA71v LAJD 5V¢v - oSTl; Nor e� ppvcaNY -� _ . „AA au t�J t� s�lax �i(E `l l.t To7, --1— .56 •cam- ��j�,,ff +-�:-- _ - t ' L To � 4, o:�G• f� o D• U��•� a a R� ,b wo0D5� 2a�p N�,•4_ r x t •` 30 N.�� e N� rAcg t . ( �-► ? - SWIG 32 l 1 � S; ,.E J P JogyS Lai= OF aA.� �Y�FH_t� 5G Ww+a� + AL' T, vpam r.y Nn.3u216 BAxT�2f NY6 ,i�� I G51Zv�,,ti� ,_.rY?ass 9 go99 DATE ti FEE: MASS. • SA MASS LE • n�l ///• �$p i639. ,0� ' REC. BY own of Barnstable SCHED. DATE: / Board of Health 367 Main Street, Hyannis MA 02601 Office: 508-790-6265 Susan G.Rask,R.S. FAX: 508-790-6304 Sumner Kaufman,M.S.P.H. Ralph A.Murphy,M.D. VARIANCE REQUEST FORM LOCATION _ Property Address: La-1 -)A 3$�1 is LA CAST -i1 i � Assessor's Map and Parcel Number:kOf Ilk) Pb- 9 O Size of Lot: t S,'1 , 57 Wetlands Within 300 Ft. Yes Subdivision Name: QS��V 1i-LE Chinn_D S No X Business Name: APPLICANT CONTACT PERSON Name: dd L& iTj'T L& Name:� `4'Nrdi=: We, Address:300 Ahj15 4j 11AK.L� Address:917- MJJW �r 0 ST5Q--V1 LAG Phone: 41Zei- S1Z-1 Phone: 4ZS ` 1� 13 FAX: FAX: 4-7.6 - 1 5J VARIANCE FROM REGULATION(List Res.) REASON FOR VARIANCE(May attach if more space needed) 1TLc 56G1104 6,24 (i) Ig11 5t_rk1ai tCs10J PL_4►J 1-ors cAtJuer, 3E M Abe sari.A, A�J Aga Rr�vp w?,T BilIL.T y�ON Checklist(to be completed by office staff-person receiving variance request application) Four(4)copies of plan submitted(including septic system plans and/or restaurant floor plans) Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense(for Title V and/or local sewage regulation variances only) Full menu submitted(for grease trap variances only) Variance request application fee collected(no fee for life3vard modification renewals,grease trap variance renewals[same owner/lessee only],outside dining variance renewals[same owner/leasee only],and variances to repair failed sewage disposal systems(only if no expansion to the building proposed)) Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED Susan G. Rask,R.S., Chairman NOT APPROVED Sumner Kaufman, M.S.P.H. REASON FOR DISAPPROVAL Ralph A. Murphy, M.D. Q:/WP/VARIREQ LJ / 93 411 . 70• i 9 �l 92 �R•t a2.a t.5 117 >; 66' y 11 91 ' _ Y,23 .1 5 88 . 84 ' l6_ J � 87 6 \377 l- \t' 1 J C i 3t.3 79. i 4 i14 •.V { 36.7 _ 100 10 . 134.6 �• 4 2 ^3 f 47 �45.7 - 46. - \ Q 38 �1. :/4e.7 42. _ i\153 'j/40.4 138-3 >. ...- - 13 ASSESSORS MAP t SAXTER & NYE, INC. 812, MAIN STREET OSTERVILLE, MASS., 02655 (508)-428-9131 ,. �S£TTS . 4L. L .w ` -- 1 '`> O \ p Ac 1 � AG Air Al 441C �, s Jsi.a a yo o i' � i Y" ✓ Y y v j 41y d • ,� t r p $,b v t LOCUS _ � t AV :y ie,_ Cav 9O tf 4 '^o �, a a �� a At ASSESSORS MAP BAXTER & NYE, INC. 812 MAIN STREET OSTERVILLE, MASS., 02655 (508)-428-9131 TOWN OF BARNSTABLE LOCATION d ab VS La SEWAGE # y"793- VIILLAGE ZZVI R—k ASSESSOR'S MAP & LOT U6— 90 INSTALLER'S NAME&PHONE NO. S �eU✓Z� a Ca ti SEPTIC TANK CAPACITY /r— o LEACHING FACILITY: (type) j:/ C-"' Q S (size) /3 oL NO. OF BEDROOMS UI :DER R OWNER PERMITDATE: COMPLIANCE DATE: O� 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 on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leaching facility) Feet Furnished by Q c,(c 3 ® m soo ► --33.� No. ( � i f _ Fee 0 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS `9 Zipplicatiou. for Migooar 6potem Construction Permit Application for a Permit to Construct pC )Repair( )Upgrade( )Abandon( ) Complete System ❑Individual Components Location Address or Lot No. -30 �5 S ". �o-r Z O Owner's Name,Address and Tel.No. e✓vf Gb�cr�` tc 1Z, ToVAc_ Assessor'sMap/Parcel ' pC+ lRo. (4OK 3LO CIO iu Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 41255—C11 3 t J. �.�►(s--����9 �.�1 f�xkr I.D�e c 1-lto�w�j�r,., ����/�:IlC- �a-b' d�GSTZ.1�t G✓l� v�G �tZ ��n Sf, Oslra..ai i In Type of Building: Dwelling No.of Bedrooms �t,�rri s Lot Sizesq.ft. Garbage Grinder(�{1®) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow //0 90el/6c61rorw .gaUons-per4ay. Calculated daily flow ZZjQ gallons. Plan Date -7--7 "-99 Number of sheets 7Z n Revision Date 1112,965. Title O / F 1,21,C4 (7� t Size of Septic Tank /SRO $EeApo Type of S.A.S. jy_' Glfamlarrr Zs'X 11'kZ� � Description of Soil to m 4-o S G T 1 l c-,91,0 c.-, 12 l r i," io- t� tr Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the constructs and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the v' ental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued b this B th. P Y .. Signed Date Application Approved by Date /p ZZZ Application Disapproved for the following reasons Permit No. Date Issued /-- No. / / t _ ., �-------�7� 1 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes q� PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS application for jBioozar- *patent Congtruction Permit i Application for a Permit to Construct X)Repair( )Upgrade( )Abandon( ) ($Complete System ❑Individual Components Location Address or Lot No. '30 ;T o S ". L,0 r Z 0 Owner's Name,Address and Tel.No. OST e, �rLe Gr,�. �� rr. -1-4jt)Jr_ Assessor's Map/Parcel I mo ' Pc 1 5 0 p O otc 310 Installer's Name,Address,,and Tel.No. Designer's Name,Address and Tel.No. 42Fs—r-(13 1 • � J. �,,�.,��L..G-L t,2..�1 �-c��J f �xkf N� f 1-to1 w��vt•-� ��. �_v. rS�c Ca = r�itsi� c rN1�4 vas �1z mates sr) ostr-voitia-- Type of Building: -Dwelling No.of Bedrooms Tl�rt� Lot Size sq.ft. Garbage Grinder(Ale) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures f�• Design Flow //0 g nW 1hcc/iaewt gal onoi4or-may. Calculated daily flow ZZ J gallons. Plan Date 5 Number of sheets 7Zm Revision Date 9 Title //a f 6/Gy Size of Septic Tank /SoU /G�te Type of S.A.S. e-A Mhwy ZS to 121 X2-1 `si� Description of Soil P sz J,, 4-ce _s o i 1 l o 4,o a-, ,ram L o," 19- 4 q 8 Z Q 10 all- Nature f Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: r .``• The undersigned agrees to ensure the constructio and'maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the 11vii '�e`ntaT Code and not to place the system in operation until a Certifi- cate of Compliancehas been issued by this B the ..--- Signed 1^ Date 1l Application Approved by C• 100, Date ��Z Application Disapproved for the following reasons Permit No. `7 5 7 Date Issued /- -——————————————————————————————- --—————— THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( �epaed( )Upgraded( ) Abandot�d( )by at S d 6 ' > Gti•A U S ---ld has been constructed in accorance with the provisions of Title 5 e for Disposal System Construction Permit No. _7 7 dated Installer z��� Designer The issuance of this pe t shall n9t be construed as a guarantee that th sys will f t& as,esiged. Date � � -t Inspector L J No. / l Fee THE COMMONWEALTH OF MASSACHUSETTS / 6 U ?0 PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS M!6po!6ar & 5tem Conotruction Permit Permission is hereby gr ted to Construct( Repair( )Upgrade( )Abandon( ) System located at U T-o 4J f f l a"--p , �-f e-, 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 in be c mpleted within three years of the date a tOrmit. r , r- e, Date: �r Approved by r. fi FAIL`{ 17M L-y, w Z .,c`i to-`22 o L.j. G:TAN 220 X-?cam = .440 u 15op GAS 4 PVC PIPE t=ACt. tIIG . 5 STtAI VEIL& ;-,E 3 `cum AT CAM Alm Q61�'D vlsT. E 220GFD 4 0-� 5F=299 F tQ tl tppLA64 atz� p�5tb 5tr�wau_ AAA= `?xx2 � PLAN _v►tyv +lt.>j cAM8�e5 TToM -rnr�A/ ��s ,�_•�� �, r� �' . .�I FII'SL� �12A�'L:a g�/ � I REWO W;4 M?E �-S V��` �.T z 3%uax SOIL CL1i� I P�TN OFgS srouE or STEPNENA. - No:30216 gFGl$7E��o �FS�o N�� �K'riaN of Clannv� � f!r 3- � IFIVV . 14 5�1'B5c1cr Lr�lGtt CHA IE�;Ze - Ti�VEL�CIP.4� •�OFIL�-`. Nv - ►J� w' Lnc1�T io�t p s;t'.-)�-v I rtJAT T14E `-Ot7t W St�oSt/N P!_11�f - Y.Eti1G�- v ir(i�( _ 4�-Cr4 crmpt.�'5 wrrA S�iBJ1�X. �vti2�sn61�iT DF T�(s TO KIN."of MAP A"S;A A►-ro t s ->_:rxa r� 1�J 1 T1-L,N A SP -j 4L aA)CT s Hym _ t tJ�63 1:t' 0-.'T-E zv ILL& LAt•tD SVevti`1r�S • ��i F.i� ,�_ . OFFSeT--, V=O/A. $V 1CAA 066 -!;gc xj:, NOT 8� VStD � l� .. �V G4NT' 3 � .. Tn�casy Pfzay Li,JE'S, Colt- To 64 i�tr,- S � f� o D' /•i�% c a n 6 Gj �. a Woo >5 2aa ' �� ✓ tii p _. ► � / r Inc 1 � \. r - 0 X �.� 'hgo o 0 0 �' Jog y s LAB -` v �i1 OF sTEPHEN tip, o�TE A. AL No.30216 rn/i U-0 c. � SS/ONAE Gertz-,^u.il0 , Mass � s9o9G Y ' Y TOWN OFSARNSTA:BLE LOCATION 34 a6V� Lam SEWAGE # 9f"793 A VILLAGE �'3�—T�r CL-Vti 4 -� ASSESSOR'S MAP & LOT 126 O INSTALLER'S NAME& PHONE NO. CIO-A, SEPTIC TANK CAPACITY LEACHING FACILITY: (type) — (size) 12;r 1 s'X pl- NO. OF BEDROOMS "ROR07WNER.t� ,/, ��`^"�PERMITDATE: COMPLIANCE DATE: Separation Distance Bgetween the: Feet Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Private Water Supply Well and Leaching Facility (If any wells exist Feet on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility (If any wetlands exist Feet within 300 feet of leaching facility) Furnished by uc,(c t -33.6 a 3 -.z 2 s.,C 3 y i lFee THE COMMONWEALTH OF MASSACHUSETTS &neredincomputer.— Yes PUBLIC HEALTH DIVISION-TOWN OF BARNSTABLE,MASSACHUSETTS Zipplication for Bigo5al 9pp5tem Con5truction Permit Application fora Permit to Construct K)Repair( )Upgrade(, )Abandon( ) CK Complete System D Individual Components Location Address or Lot No. '30 U- _-Ok S I.J13. l oT'2l� Owner's Name,Address and Tel.No. Rke- Assessor'sMap/Parcei RU• tom` Installer's Name,Address:and Tel.No. Designer's Name,Address and Tel.No. 9 Z4s a1Z (Yk.�h SI't Osfr=.v�i'l(a �� l Type of Building: // 1 Dwelling No.of Bedrooms 'TL�m Lot Size 15 07 Fr4 sq,ft. Garbage Grinder 5 Other Type of Building No.of Persons Showers( ) Cafeteria( ) u Other Fixtures Design Flow //'[t Sne/��Jc��oe..f • gallon&per-day. Calculated daily flow ZW gallons. 1 .1 Plan Date 4:-7— Y 5' Number of sheets 7Z n Revision Date /TvyS J(f Title 0,,- Size of Septic Tank 15CM a /Gre Type of S.A.S. Descripti, a- S of I lc r,n a3, olo t.t 9 w Nature of Repairs or Alterations(Answer when applicable) AW Date last in JU r Agreement: The undersigned agrees to ensure the constriction 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 cafe of Compliance has been Issued by this Board of Health. Signed Date Application Approved by Date Zt Z Application Disapproved for the following reasons I Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS / . Certificate, of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( Repaired Upgraded( ) Abando ed )by at Tcl yJ Z has been constructed in accof ce with the provisions of Title 5 and the for Disposal System Construction Permit No. —7 7 dated /(—Z(/—7 Z Installer Designer The issuance of this permit shall not be construed as a guarantee that the systerri will function as designed. Date Inspector ---q— — ----------- -------------------- No. �/ �7l� Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION.BARNSTABLE,MASSACHUSETTS mi5po5al tem QCon5trUction Permit Permission is hereby.gr ted to Construct( rRir( .)Up ade( )Aban on( ) System located at ^e rJ � 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. a Provided:Construction must be completed within three years of the date of this permit. Date: Approved by TOWN OF BARNSTABLE BUILDING PERNdIT APPLICATION Map Parcel d TOWN OF BARNS ABLE Permit# Health Division 0 ��1 ��� p� Date Issued Conservation Division o �- 46 7 ���N `�NY i t Fee V Tax Collecto DIVISION SEPTICSYSTEM Treasurer INSTALLED IN COMPLIANCE Planning Dept. VM TITLE 5 (/0Date Definitive Plan Approved by Planning Board 7 - 4 7 RONMEIf�TAL CODE AND( 04 !� ,z e e cs e / _.� TOWN ItEGULATIOfV$ Historic-OKH Preservation/Hyannis ' � Project Street Address ?0 5©6 vJ S `Lame (� -F 2I Village 0STer Vi//C_ Owner C k-e Lc4 l-e— K, I NIT e, Address 9_01 M c A G 11 e n &C>T ? R, Telephone /— 727 — CO- It q6 It 3.9 aEea,wctTer Permit Request TO c e o S7su cY o� 2 5eJ-o ow` 2 t Car o,.a,,raw , oo.,•t 0 SarrJl Ow.,e Sact1 br- Cot�dehitr�r� (lam- (-'.ruw�eJ< <Nf `,LX�f S on 70� co�C r� 60YU21010y'? Square feet: 1 st floor: existing proposed 1176 2nd floor:existing proposed -.-- Total new I G Estimated Project Cost'�'l a, Zoning District Flood Plain Groundwater Overlay a _ Construction Type ry-aw, Lot Size t 5 7 se,F-r Grandfathered: M/Yes 0 No If yes,attach supporting documentation. Dwelling Type: Single Family I/ Two Family 0 Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes JNO On Old King's Highway: ❑Yes XNo Basement Type: )�Full 0 Crawl 0 Walkout 0 Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) 1174 Number of Baths: Full: existing new Half:existing new Number of Bedrooms: existing new Total Room Count(not including baths):existing new First Floor Room Count Heat Type and Fuel: Gas 0 Oil 0 Electric ❑Other Central Air: 0 Yes 0 No. Fireplaces: Existing New--�- Existing wood/coal stove: 0 Yes O No Detached garage:0 existing ❑new size Pool:O existing 0 new size Barn:0 existing ❑new size Attached garage:O existing Q new size 3 09 Shed:0 existing 0 new size Other: Zoning Board of Appeals Authorization O Appeal# Recorded 0 Commercial ❑Yes O No If yes,site plan review# Current Use RatV ate, Proposed Use S; f_ Fa es ' PAC t BUILDER INFORMATION Name 9ct✓yt�1 Too Uo fn Ps ,T 4 hY-7 6a 4,,C Telephone Number 1l— 7717 Address F.0, 8©k t�2�( License# C S — 001511 #(!�-avie);S MA_ O`.LC1 Home Improvement Contractor# 1 O 0©°I Worker's Compensation# We ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Res©u rc R�co�r,� C4J lop, 6OUrn e iMHvl;c (, SIGNATURE Pr 01 r,T_ DATE _ ��vLo�-- Proposed New Construction in Osterville MA. Prepared For: Hamilton Homes Assessor's Map: MAP: 120 PARCEL: 90 Baxter, Nye & HOIrngren, Inc. Community Panel Number: 250001 0016 D Registered Professional F.I.R.M. Map Zone: C Engineers and Land Surveyors Plan Book 247 Page 137 812 Main St. Deed Book 11,479 Page 67 2002 Osterville, MA 02655 Owner: Timothy E. Tuttle (per Assessors) Job No. 4994-073pc.dwg Phone — (508) 428-9131 Fox — (508)-428-3750 Scale: 1" = 30' Date: 07-29-2002 C;" N 89'35'14" E 65.83' TD N 84.40 30 E 15 00 35.83' 30.00' 58.08' NOTE: OVERDIG REQUIRED — 15,963+/—' SO., FT. 2 CONSTRUCTION IN FILL —0.37+ ACRES 31.6 / 310 CMR 15.255 RESER— x 30.5 33.0 x_ -- L 12' x 25 I 3231 32.9 � 31.3 x Z N O L O o' 32.8-x o o x2 33.2 _ C' 22 4. x 32.4 DESK 50 Cv Ln PROPOSED 32:7 x � cr x 29132.3 _ DWELLING PROPOSED GARAGE W 32.3 x CB/DH FND x 29, x 31.6 EL = 31.30' 32.0 A=1 �5. 00' .3 CB/DH FND R=342. 79' A=1 80. 04' —J 30.9 29 9dge `of pavement 30.3 o30.2 J, 0 B Y S L AN E { , a 30.7 ssq 5 EPHEN CyG CP elu0216 0NAL .I CERTIFY THAT TO THE BEST OF MY KNOWLEDGE THE PROPOSED CONSTRUCTION SHOWN HEREON IS IN ,COMPLIANCE WITH THE APPLICABLE BARNSTABLE ZONING DISTRICT, SIDELINE AND SETBACK REQUIREMENTS, IS Of Mq LOCATED IN RELATON TO THE-MONUMENTS SHOWN, AND IS NOT LOCATED, ��� JOHN c WITHIN A SPECIAL FLOOD HAZARD AREA. R y THIS P AN IN NOT TO BE RECORDED NOR IS IT TO BE USED TO " No 74 H ESTABLISH PROPERTY—LINES. fCISI'E� (EGISTERE� PROFESSIONAL LAND SURVEYOR DATE v tT D tsi s N DATA 1-1.5" WASHED STONE Slrycslc F•aw\a1.�. GarbaSc Grindcr 12 Daily Flow ? Z x ll0 ,3pd/jm*., Sya�c?anlc _ .Zzo .135E !500.GAuo�•t TA�stc LEhCHUJG 6Ys-MM DE5I6N RC canon Arca.. v,r v PLAN OF LEACH CHAMBERS App to — Z'2.0 GPa- 40,74 GPD/SF _ 2 t 7 SF NO SCALE Ar+licahm, Arca Ucsi�r� Saatewa Il Ar-a -OV.. }ZS')x Z' x Z =. 14 S.SF .12• FlNISHED GRADE - .. 36 ,F- AC FILL A 'MAX-- T 2 MIN. \\/�/\-�l?�\ \�\�\\\/�/ COMPACTED !1 TO�I Arcd 4�t! �t- 2 --- -- - PEASTONE Pcreslsf�ara R��c iG S rraaw�Iwda ws O 3/4'TO 1/2 " DWBLE 13 WASHED STONE i\�P\5N OF�V1gs�S'�C sEcnoN ST am EPHEN �N r No SCALE m, i 2s y GISTEp FSSIONAt E 7 O� TC5T HIGLC- FG 33.0 r 34,0 s„b 73o4 =7FC ii,✓6 i�t�a 72q5- Osterville,30.!to GAL. z Snat.�� S�rr�c ►vt c�,�wi. 'r � c i3a.0 Dey i_o PED Vk-Ft LE 144'1. No wmtsc SITE .{ SEPTIC PLAN Thy, {ot �s restr�c eSl {� a i'wo bedr�or,� LoCAT1oN : 30 1_00YS hANE house. R��=�... i � Oc.riccMC-C �.�,�cea b� SCALE= 1�s .Qo�0 DATE : JULY 36, UX)L �t2e t3oar4 o H..C-ulih oh IZ�t � 1gel4 Pm Pt.AN REFERENCE P,l?i::Z4l� ��9 13) . AS5L550R5 MAP_ IZ,p P19RGEL: 9 0 Dcc�i i�=stYLchort w^eLoreQcrlt i� ;•Lt,.0 77� Pacsc 'F APPLYC'ANT: HAOIL:�a V4oVV% Baxter, Nye & Holmgren, Inc. 812 Main Street Mass. 02655 -Tob No : ?_001_ 0377 DEED RESTRICTION WHEREAS, CheryhR_Tuttle;�formerly known .as Cheryl, R McHenry of _ -- Jackson, Mississippi is the owner of Lot`21 located at 30 Joby's Lane, Barnstable (Osterville), Barnstable County,:Massachusetts (hereinafter referred to as Lot 21).and being shown on a plan entitled "Plan of Land in Barnstable, Massachusetts, `Osterville Woods' Property of the Lanza Corp." dated May 1, 1971, drawn by.Robert G. McGlone, duly recorded.in Barnstable County Registry.of Deeds in Plan Book`247 Page 137 WHEREAS, Cheryle R. Tuttle, formerly known"as Cheryle R..McHenry as the owner of said lot has agreed with the Town'of Barnstable Board of Health to a restriction as to the number of bedrooms which can be included in any home built on said lot as.a pre-condition to obtaining a variance. from .the.State Environmental Code, :310 CMR 15.21.A and to.obtaining a building.permit for this lot; WHEREAS, :the Town"of Barnstable Board of, Health, 'as a pre-condition to granting the variance..from...the State Environmental Code, 310 CMR 15.21.A and authorizing the issuance of a building permit for.the construction of a single family home on this lot is requiring that the agreement for the restriction on the-number of bedrooms in any house constructed on the lot be put on record with the Barnstable County Registry of Deeds by recording this document. NOW,>.THEREFORE, Cheryl, R. Tuttle formerly known as Cheryl, .R. ' McHenry, does hereby place the.following restriction:on her above-referenced land in accordance with her agreement with the Town of Barnstable Board of Health, which restriction shall run with the'land and b'binding upon all successors in title: 1. Lot 21 at 30 Joby's Lane, Osterville may`have constructed upon the lot a house containing no more than two'(2) bedrooms.until such'time. as the Barnstable"Board of Health.shall change its regulations and allow further construction.on the premises Cheryle R_ Tuttle, formerly known as Cheryle R. McHenry, agrees that this shall, be a permanent deed restriction.affecting Lot 21 located on 30 Joby's Lane; :Osterville, `Massachusetts, and being shown on the plan recorded in Plan Book 247_Page 137 For title of Cheryle"R. Tuttle,"formerly known as Cheryle,R. McHenry, I see the following deed:`Book 9574 Page;217. Executed as a sealed instrument this � day of 1999. 'AA CHE RYIYt R. TUTTLE A STATE OF,MISSLSSIPPI November 2 1999 Then personally appeared the above named Cheryle R. Tuttle, for known as Cl eryle R:McHenry, and,acknowledged the foregoing instrument to be her free act'and deed before me. " No 'bh y commiscJ N1sion expires '.IISSISSIPPi STATEWIDE NOTARY PUBLIC E%pIIIES JULY 23 200C , . r t, FIR yir � BA`r;�'�!'�TABL r ^^111�1.TY ' REGI .TrY. � ii F. r: REGISTER RECEIPT # .13C9.: 3S 4'9S , � 1.r �r• PRINTED MC,N 11/;22�� �9 .`10 , 34 20 - B A TC Hs C 11gT0MER ��/A AG 2 -,,K--PAGE : 12, ,7'. �. n1It,�,,, FEE 1Q', 00 IiJ T�;��.i}9c�JT 1 E90 C ` MTA —'E': RECORDING CRATE : MClN 19 �' 1 0._:'3 1 P1�.RO..I��AL E� :F:EE . 00 ACCRE 30. `r EY, LM.C4 OF'.V . ROE ; 00 TATE EXWI E , 00 ,TONAL' !'MC-JNT`'DUE. 10-; 3J C�U�'�7Y ��`wI .E : ; OC R'.AIC� oY HE, 240On1 TGIF:/c;TEc � rUP 001 T,--',Wll : EARN BARN STA:ELC IPd01'RUi1E��T: = '3T ICTIC��Y C i�CICEF',�..T, IC�� : 00 T A T E EXC C NS'IC `-- , 00 a rui_iNTY N'W,IF : , C0 GRANT, ,R : R'ANTEE DE'-SCrr-IPTIO.N 21 2.47 13T. rA:RwI[�AL REF ,C2r F'/: GRANTOR:: TUTTLE 2HCR;YLE ��F'HEV', : CHERYL : GRAP'TEES' NCIJE R1 C:CRC�EC t'etur,n addIRE'u BAXTER, NYE. 1HC-LMG EN = ' 8 1 2 ,MMIN TREET. CSjTE.'RVILLE MA 0265 / i w. _ 191 -- ^� - 508.428-6 1 - deViin ss - - J. _ u signs c opyrigh[©7999 All Righ[S Reserved r _ i is i- C . •-M v-r`-a�a--z�o� 6 ` t ;.. .. 1.... , . �_—. }1gKllt-'taN HOM6s cL.Aas ic_ y . Z J AI E - Pt eliminary plans and layout? by DC.D.are for the use of their customers only.Arty 0ther use is strrc[ly Pronioite . i p • _IZEAIL_ELE VATIOr.I- r - - -�- - - =0 1 t I - 'Q 9'±7HK.COS-0C:StRH _ a - - - - • 2682'X 1'lHK FTG.FOR J 112' _OI v f�T.__ 4 CONC.FILED LALLY COL_ kl.2a_ro" rrAh 6191 Meviin d �szsT�F��xtlyc_10 r I rlis T � Teac�1c-CeuT�� —. 2001 X'pxs FIGONO IU N• _ _ .ON o TUB ' 'p 6 p� i; -- I b AZ 24:O' .. .'...24 iPreliminary plans and layoutz by DC D.are For the use of their customers only.Any other use is strictly Prohibit t - 117E •. i rh_SHFJIT+IINS-.__. ... . �L-x TfSf�[DC,E'.-.. .l • �� ' .��3i�eLrali.'K . ' 2�s_-BYIICtIa I . I ..:1.<3'-51RL+PP/RYCr_�:. • -Vs:SNEETED Y-. E Sip'-F.C,t�SHEETEVCC .. .e'o:- _.-_� -..:-.-.-....B:o' ._ �� spa-F•.-,,m.-_=T.... o- 1 , a:o- rla:re' a-rd S:O 4: " !-i - ----- --- i I ATTIC - i — ! i Z r 1 Q AT400A�_.. rx.�- TMAM -SOFJ=17�u rlE, �� 2 4.r�dTAy@ecJE¢s eexr?..vEr tr - - ,• - - T '! 1�ztYTIn CIICC—TIl-�-frs..� . 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