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HomeMy WebLinkAbout0021 STONE BRIDGE LANE - Health 21 Stone Bridge Lane Marstons Mills A = 125 006001 1 J Town of Barnstable Health Inspector et►+E T Regulatory Office Hours or Services g y ces 8:30—9:30 Thomas F.Geiler,Director 3:30—4:30 iSTAB . : Public Health Division . 1639• Aim Thomas McKean,Director 'OrEn Mop 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 AMNESTY PROGRAM APPLICANT — SEPTIC QUESTIONNAIRE Date:November 2,2010 1. General Information: Size of Property: .64 acres Address: 21 Stone Bridge Lane Marstons Mills,MA 02648 Map 125 Parcel 006-001 Name:Jeffrey J. Camish Phone#: 774-238-8710 2a. How many bedrooms exist at your property now?0. 3 2b. Are you planning to add any bedrooms?NO If yes,how many? • 2c. How many bedrooms total are proposed at this property(including the amnesty unit)?` 3 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? NO If Qldwel-g is connlcted to public sewer,skip questions#4 through#9 below. j< cat 4. Lo6ftion of-:dwelling it INSIDE or OUTSIDE a Saltwater Estuary Protection Zone? 5 . Lucation of dwelling:s-- INSIDE or OUTSIDE a Zone of Contribution to public supply wells? U— Q .6. Is dw uIg conne ted'to an ONSITE WELL or to PUBLIC WATER? 7. Is 2isposal works comuction permit on file? YES or NO 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 ------------------------------------------------------------------------------------------------------------------= FO'R"OFFICE USE ONLY The Public Health Division has o objection ✓ bedrooms at this p erty. Special Conditions: �,� . , "�C_.�M V Signe � f>°i' Date: l Z' �p?4/J Q:\GMD-Housing\Accessory Affordable Apartment Program\ADWMFORMS&LETTERS\Blank Forms amnestyapp 1.DOC 1 cr 7• x Elk 250 e7CO P--9 335 -0-64294. a t DEED RESTRICTION WHEREAS', CANS 1 SH of (owners name) 2.1 S�aNE 13121.06E LAIC M A91`'1jU_r MA6zb�Fs (address) is the owner of 21 Via► .E j3Vjb6E LA located at 21 SI-Dat g e1D� (address)1-ru M«LJ Alf+ d Z b , MA (hereinafter referred to as .21 Mau€ 13 f2i pef L and being shown on a plan entitled "Subdivision of Land in g RV-14 StA 13 LE MA, Property of --J'E-FI= chm I Stt , et al, SOLE 0ksVEY,>,- duly recorded in Barnstable County Registry Of Deeds in Plan Book -4 - -7 , Page 4 1- I I ; Or on Land Court Plan Number WHEREAS, 00'f CA-M I S{"I as the owner of said lot has (owners name) 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 disposal works construction permit in compliance - with 310 CMR 15.000 State Environmental Code, Title V, Minimum Requirements for the-$ubsurface Disposal of'Sanitary Sewage; WHEREAS, the Town of Barnstable Board of Health, as a pre-condition to granting a disposal works construction permit for a septic system in compliance '°' ~= with 310 CMR 15.200, State Environmental Code, Title V, Minimum �,,� Requirements for the Subsurface Disposal of Sanitary Sewage, and authorizing the issuance of a building permit for the construction of a single family home on this property, is requiring that the agreement for the restriction on the number of bedrooms in any house constructed on the lot be put on record with the Barnstable County Registry of Deeds by recording this document, dear r Bk 25070 Pg 336 #64294 NOW, THEREFORE, OEr-F_ C rM I S�J does hereby place the (owner's name) following restriction on his above-referenced land in accordance with his �gr�'�Pdllenfi with the'�iq.of BaCRstabt� H9ar�okleah;whiet�es#�ietl8s� riE run with the land and be binding upon all,successors in title: MA OoLq-6, tAW 1kftjeSjtg °mxa 0 may have constructed (address) ���� upon the lot a house containing no more than (3) bedrooms: cO C++M1S;.H a rees t at thi shall be.permanent deed (owners name)�fov U'1e196i�lS (�L a?• restriction affecting_located on Mt 16A M1 LLr" MA, and . being shown on the plan recorded in Plan Book 44?. , Paged -1!4,�. Or on Land Court.Plan T For title of 2loNE SRID ,c`Lsee the following deed: Book21-7$ , Page V 9 7 Or Land Court Certificate of Title Number Executed as a sealed instrument day of V Ee-045' IRt 2 b D Own lgna u e owner's signature Owner's signature COMMONWEALTH OF MASSACHUSETTS ss 201L Then per o ily r ppear the above-named f Qtl'Y1�J known to me to be the person who executed the foregoing instrument and acknowl l� the same to be I S free act and deed, before me, nh6a ���: zq ,� . .. . Notary Z ` ,4�"O+ , << M ycomf ion expire O ♦• Ator j IC °�;•r4fty�0:• `;s ,, d a; i. 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OF BEDROOMS ) i BUILDER OR OWNER PERMITDATE: j L_I3—7,r COMPLIANCE DATE: :L ZV= 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 Feet within 300 eet of leaching facility) f Furnished by's I iMZ4 DY"LA _ 4 ( $_O � _w Qa'Aa M � i � . �S 2� �� : � . i i --a ��,-. (� ��' ��u i L ��� 4. i� r - _ _It ' LOCATION ®©� _ SEWAGE PERMIT NO. VILLAGE 1#9 INSTA LLER'S NAME & ADDRESS YCA BUILDER OR OWNER DATE PERIKIT ISSUED f � � j� ., 7S-) DATE COMPLIANCE ISSUED ci fGr IL 4 ( y Flfs............... THE COMMONWEALTH OF MASSACHUSETTS + y OAR® F HEA T .......OF...... :................... Applira#ivit for Mipasal Works Towitrnrtion Vamit Application is hereby made for a Permit to Construct ( ') or Repair ( ) an Individual Sewage Disposal System at: Q1G A Z A �1 F� 'f>4'E (Z C � <litq .....r... __.. . ... .............................................. ..----- .� ,. z .................. Location-Address or No. G N2 2 ------....-. �3 � / � � � -uvl re- Owner Address _ Install'er ............... Address Q Type of Building -Size Lot_._-.. r-r_. ....`Sq. feet U, Dwelling—No. of Bedrooms............................................Expansion Attic Q%) Garbage Grinder (Ale) 4 Other—Type e of Building ___--_:e' No. of ersons......... .. _-- Showers — Cafeteria f1M YP g P r ( ) ( ) a' Other fixtures .................................. d _ --------------------•••-•••••--•-•-----------•-•••..........----••-----------•--••-- ................ Design Flow................. � ................gallons per person per day. Total daily flow.................3......................gallons. WSeptic Tank—Liquid capacity_/<G gallons2 CLength................ Width---------------- Diameter...----_----_--- Degpth................ x Disposal Trench—No........:........... Width........._...._.__.. Total Length-.%_�/-........ Total leaching area.6-- ---------sq. ft. Seepage Pit No..__._.._-?�_--_-- Diameter._--.t`-'i`-�y Depth below inlet..___._ Total leaching area._ q. ft. Other Distribution box ( ) Dosin ank ) Z Y � 7 7- Percolation Test Results Performed b -4[ ......... Date..,//..:- ,4 Test Pit No. 1................minutes per inch epth of Test Pit_ ................ Depth to ground water.--QX......_....... (i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ De ipti Soil_ 7 ... W --------------- -------------•---•-•--••--•-•••---------------•••--•••--•-----------------•------•-------•-•-••------•---------------•••-------•----••••-••---•••-••----•---------••----•---------_..... VNature of Repairs or Alterations—Answer when applicable----------------------------------------------------------------------------------------------- ------------------------------------------------------------------•---•-•---•--•----..........----------------........._..._....--------------•------------------•------------••-----•-•---..._.....-•-• Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITL: 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health.,13 / / igned rr u P.� r ``..---------------------- -•---�-_l-1 � 2 !, ilct�e Date Application Approved By......... •• --• .••-- .. -- •••• .--f��/ Date Application Disapproved for the following reasons:.................................................... .....-----•........................•. ......_..... .....----•-----------•--------------------•---••......••--------------•----•-•---._...----••-•--•-------.--•--------•-•-•-••----•-•----.•....._..-•-•--....••------------•-----•----•••-••-•••------•--- Date PermitNo......................................................... Issued... . ............................... Date No. ....- FAt............:�.�.�. THE COMMONWEALTH OF MASSACHUSETTS a • BOA•!RD F H E T Appliration for Dhiposal Worka Towitrurtiun ramit Application is hereby made for.a Permit to Construct (.k) or Repair ( ) an Individual Sewage Disposal System at: Ad Location Address d or r No ly, -• - Owner Address ..... Instal ler Address r / Type of Building ,t Size Lot.... ..._._.f.... q. feet V Dwelling—No. 'of Bedrooms t _....Expansion Attic (4) Garbage Grinder Wo) Other—Type e of Building .. i��..... No. of persons _..____ _. ..._... Showers ( )p� yp g ..._ __. p _......• (�,,,) — Cafeteria P-4 Other fixtures--------------------------•------ - - W Design Flow................. ...............gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity. gallons Length---------------- Width_............. Diameter---------------- Depth................ x Disposal Trench—No- -------------------- Width ....... Total Length................... Total leaching area.............r......sq. ft. Seepage Pit No.......... ......... Diameter...... .......... Depth below inlet.... ......... Total leaching area.,..Gt,4 ..sq. ft. Z Other Distribution box ( ) Dosin ank {0) Percolation Test Results Performed by.: ..le? -.`' �41 .---_w ............... Date../f_..'"1 �.._ _°_.... a a Test Pit No. 1................minutes per inch Depth of Test$Pit. /.........._.. Depth to ground water......................... Test Pit No. 2................minutes per ch Depth of Test Pit.................... Depth to ground water-___-______--....._-___. Description of SoI Q,._.. � __ ._ . . ..{ + W ------------------•-- .• _ ... ......-----.---------.--.------.--------------------.............. VNature of Repairs or Alterations—Answer when applicable,...................................................... ......._.._._:___.............. ,._ _ Agreement':-` The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLI: 5 of the State Sanitary Code—'The undersigned further agrees not to place the system in operation until a`Certificate of Compliance has been issued by the board of health. Si ned ✓ v esCO ��'�......--•----•-•--•---•- ..../. `/ 7 x V Date Application Approved By------ ��" . . --- °.... . f Date Application Disapproved for the following reasons:........................................ (,. ...i`r....................•--•------•---------...... Date Perri t No..-:...........---• ............................. Issued---- ....... !T'................................. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD O HEALTH L.y,7!L......OF.... ..... .: .................... Trrtifirair of Touiph r THI TO E FY, That t dividual Sewage osal. Syste strutted ('�or Repaired ( ) b ----- at...`., :..:. _------ .----;-. t ..-. d has been installed in accordance with the provisions of TITLE�5 of The State Sanitary Code as described i the application for Disposal Works Construction ""j '^Permit No. :.___. .._ ......... date d------ .2.= ? __ :f''" .___.__. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. / Inspector..:: ---- ..... ---------- DATE.. 7-. �g-----•-•-- ---------•---•--•------------••-•-- THE COMMONWEALTH OF MASSACHUSETTS BOARD O HEALTH ............ ,......OF.... .... .: ............................................. Ct'�� 0..... [ FEE....+ :•-. i �as�t1 r trur#' rrxtti Permission gra ted---•-•---. M ........ --------------------------••••. - ..... to Consoct (' ) or Relw/ ) an Individual Sewage Disposal ysteiz;, t at No:- - !{J ---------------ISt«eet 1 7/—, as shown on the a plication for Disposal Works Construction Pe I No.__---;. ,..... ted._./....... . .............. .. ...fY,.. ... . _ q r oard of Health DATE._ .... •---• •--l..--•----•-------•-------•--.....-•--------------- . . ` FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS ' � Town own of Bar'astable Health Inspector Office Hours ? P�ofj►+e rOtio Regulatory Services 8:30-9:30 Thomas F.Geiler,Director 1:00—2:00 MASS. i6349. A Public Health Division lm 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: Size of Property: t aC� Address: �� LJ�(�1l/ �d� C/ /V� Map/Parcel(COI Name: Phone#: - 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)? -*WILL- $E CoM6ItvlN& Twb TabN!N-i"- W)L '6014JMS 1" aN6 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 clear ly'on the plans. 3. Is the dwelling connected to public sewer? YES or . NO 1£fhe dweings couaeactedo pu��csewer;si}P 4nelins #4hrorzgb#9e1�w .,M ; 4. Location of dwelling is INSIDE or OUTSIDE 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 ONO 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 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 The Public Health Division has no objection to bedrooms at this property. Special Conditions: W4LL- LOC✓tTrP �' Wi aa/V Gimeooms-02_ t "-a zz,n AU_ G& Signed: Date: . 12 `f Q,-Aealth/wpfiles/amnesryapp Q (1psTAIOJ ,w 21 SIb0foSPOW IMC 00tA Top?too For t P . 1 kA"W AV. s 09% 4 _ 1 P t SE � ty0ats � W I G INS 1 H go 1N1boo� �►Ti 0 �. e B �3 Firif Ftwo 2-1 S7101PIC06C . IANC . �1tNE� _ dry MkbfwRy.. y�Nl� b ua Aso TOWNS TABLE V !.t L` S- SEWAGE # LOCATION l / VF,,LAGE ��� �� L�`S ASSESSOR'S MAP & LOT 2 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 1 LEACHING FACILITY: (type) (size) NO.OF BEDROOMS - BUILDER OR OWNER PERMTTDATE: /�-' /�l COMPLIANCE DATE:T=�`7r=�L_ 4 Separation Distance Between the: Feet Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet ? i. Edge of Wetland and Leaching Facility(If any wetlands exist Feet within leaching300Ge`e�c of � facility) c r = +( g© —(,J`aa�n��/� Furnished y /� n �Z- i ct j i LOCATION SEWAGE PERMIT N0. r - _ cat l;2s ; —vc7E VILLAGE I N S T A LLER'S . NAME & ADDRESS i BUILDER OR OWNER + DATE PE* M�IT ISSUED 72— DAT E ' COMPLIANCE ISSUED I - i r . V Town of Barnstable Health Inspector B Office Hours Regulatory Services 8:30—9:30 Thomas F.Geiler,Director 1:00—2:00 1619: a� Public Health. Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508.962-4644 Fax: 508-790.6304 AMNESTY PROGRAM APPLICANT— SEPTIC OUESTIONNAM 1. General Information: Size of Property: Address: APla/—l001- 1111S Map Parcel Name: A '4%-4/f w Phone#: - 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)? -*WIL- 36 C 6itviN& -rwo /Attu ONl � 2d. Please include a copy of the floor plans for the gagn 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 If the dwelIing:is:,connect®d to;pulllic sewer,skip quostiois.#4 through 09 below. 4. Location of dwelling is INSIDE or OUTSIDE 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 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 DLP certified inspector within the last two years? YES or. NO ..... .. .r......................o.................................................oa................... FOR OFFICE USE ONLY The Public Health Division has no objection to bedrooms at this property, Special Conditions: Signed: Date: Q;/hsa1thfwpfiles/amnessyapp biz'd z8b'ON 1N3Wd0-13A3Q'083/W00 319d1SNiNg Wdzb:TT b002'T 'AON Town of Barnstable Office of Community and Economic Development 367 Main Street,Hyannis,MA 02601 Kevin I Shea Office: 862-4695 Fax: 862-4782 Director FAX COVER SHEET Date: COMPANY: Timer ATTN. TO: Fax: Phone: MOM: FAX: 1-508 862-4782 Phone:1-508 862-4678; 8624683 Number f Pages includingr'gover sheet ~� MESSAGE: ' ------------- 9 rn q V/T'd Z8b'0N 1N3Wd0-13A3Q'033/W00 3-ISd1SNJds WU2V:ZT b002'Z 'A0N 21 C IAIvC m -- a. 0 v o IAz Mvb S Sam W C)0 A*wW*Y J W 7 W Q - O U W E O U W J PO Cl H Ora' f z cl CE cm v v m � m Samoa 0 z (PSTMOUs 21 SIbOf INC OD All 7 Zisle Z - W pip IkAtLW AY W 7 S"W 0 SRC w U W u 1N� 1N� O U W J CE W H ', Ul Z cc I � CQ lop cc � #3 m v -4 v m m N .4 O Z LO verify window size 8-0 x 8-0 E 6° E for L&V req. and for DECK " > o 0 0 egress n 9ir m o (new)3-0 �o m a r� m Full-view door o Ca N z CO a 16'-111 9' 22'-11" Note: as drawn door N a is not centered on N _ 10 t�4' existing window o opening U U (existing) 419 Bath o n `3 O CD L C) opt 2: stack 1N/D N in closet o Living Area I CL Co X N r (aj U) Cn opt 1: stack 1N/D I ,L 1P o v 0 g in closet I M > o (new)2-6 door I m � a \ \1 — o OJ, 2668 i 2068 p 2068 BY2R1'ciriU nge 2091/2WJ existing GIGS. 1236 W3018 W7536L -�vILI - -- 2266 26"06 6 tj P „ ` d v 3'-311 n 2D6B la 2066 N c A, N •W G 2666 U i; CO N W U) •� r o LO to V cV l CD 22! Date: 10-24-10 l Revisions: 11-1-10 Note:These plans are for the sole purpose and use of Capizzi Home Improvement and are not 2 to be distributed or used for construction other Existing Second Flo,or than by Capizzi Home Improvement. f . .."•AC C7� T T 4'' I D I S T Lj Box 1000 1000— G 1 GAL - E� OR SEPTIC I 6 BLOCK TANK i SEEPAGE P 20 MINIMUM F OUNDAT ION P.-d1 WASHED STONE / ` h ELEVATION SKETCH 4 ��� \ ✓ 46 Ica ° I r z,�♦ \ \ 4 Y (oco ` 6 _ 4 .fir r Y OV lia t ! \0 \� f I s ( � I Z-1, 42 1 N t � ` /J 4�s-7-i a,,,,TJLr, ,�ai4 y Fz.o(w..� .. - / ,.,...<.. t� ..., '""" • j f _ . t3 D,q. �u o• 6stk bL ,y',Q.1v'74 44) f 1 f �'" ' '•, � � - // y :.) /19�JX. fTLL.o��A L�..E Ugrc,Y A;:.L.O►V ' �} I + / � ��,'.k I ri ' 476 1I l oo Tow AV W0TZe_ AVi4/1.4414-AE To i � I l ._...___ /oo --- p�Q o Pit it.i7 G�wl.•�/'TDtJ.II! � a , � , v a o ' ✓ ,ti Fo c.+.v D L qi I RENWICK 1 q OIL L O�s ,+ cam! fir„�• `� / :..c.• '.;'3� CHAPMAN T lf�_ 4 , I----{ 2_0_i 90.E Ft EVATION• SCHEDULE ; PROP'OSEO MITE PLAN t .a zoSA-xc �o-1o '`� tiv A FOUNc:AT ,cN `GQ� SEWAGE SYSTEM DE81AN Arc Q = p INTO SEPTI TANK N Nv , 1 OF SEPTIC TANK �A•vJ' ���, '�'�` a ! a I N\, .T') 0 STRIBUTION BOX �s_a8 SCALE Nov, 19"14' 737 T, �i i3.1 T (? '# 2 N. IUT OF C'S'RIBUTION BOX � 1[RC. RATt � �y�'�� -�m'�/'"�•� CAPE C'00 SURVEY CONSULTANTS H INV IN' SEEPAGE PIT do ROUTE 132 TEST BY C, f. A-AV/7-,' HYANNIS, MASS ' T I TOWN INSPECTOR pAvt /!iY_4R.o,y BOT OM ;F P T A DIVII oft *ct`o.+ !Wv(. Co+eULTAN.A, MC HA:KHOE OPERATOR -VXc1,y, d44-s ,cV<7'1a7.y A BOTTOM Of STONE SAYER T� cT MADE ON 1120178 ,