HomeMy WebLinkAbout0162 CINDERELLA TERRACE - Health S-2 Cinderella Terrace
Marstons Mills P
047.112 - - -- - - -
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COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
V
DEPARTMENT OF ENViRONMENTAL PROTEC
EIVED
David B.Mason,RS,Certified Title V Inspector,508-833-2177
5" OCT G 6 2004
TOWN OF bArtivSTABLE
HEALTH DEPT.
TITLE 5
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address: 162 Cinderella Rom,Baposta'ble,MA ,,_�I"
Owner's: Reid p`2S vl J S
O-r
Owner's Address: M%lo`S
Date of Inspection:August 26,2004 @ 8:00 AM
Name of Inspector: (please print)David B.Mason
Company Name:—N.A.
Mailing Address: 4 Glacier Path
East Sandwich,MA 02537
Telephone Number:508-833-2177
CERTIFICATION STATEMENT
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 Section 15.340 of Title 5(310 CMR 15.000). The system:
X Passes
Conditionally Passes
_ Needs Further Evaluation by the Local Approving Authority
Fails
Inspector's Signatur • Date: 8 1211n
The system inspector shall submit a copy of this inspection report to the Approving Authority( oard 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.
Notes and Comments: System as inspected appears to have operated based on occupancy level. Increase in
occupancy may cause hydraulic failure.There is no info. on file with the BOH re;dbox. None could be found on
site. The information as identified represents only the condition of the system on August 26,2004 at 8:00 AM.
****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.
2e�a3
Page
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 162 Cinderella Road
Owner:Reid
Date of Inspection: August 26,2004
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
A. System Passes:
_ inX_ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303
or 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below.
Comments-
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.
Answer yes,no or not determined(Y,N,ND)in the 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.
ND explain:
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
obstruction is removed
distribution box is leveled or replaced (THIS IS REQUIRED TO BE
COMPLETED)
ND explain:
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
obstruction is removed
ND explain:
Page 3 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 162 Cinderella Road
Owner: Reid
Date of Inspection:August 26,2004
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
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 I 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 coliform
bacteria and volatile organic compounds indicates that the well is free from pollution from that facility 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:The primary cesspool is not a typical configuration for a cesspool. It appears to be a pipe
cylinder with an inlet pipe and outlet pipe with tee connected to a pre-cast 4'deepx6'diameter leach
pit with stone. Permit on file with the BOH for the pre-cast leach pit.
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
Page 4 of 11
CERTIFICATION(continued)
Property Address: 162 Cinderella Road
Owner:Reid-
Date of Inspection:August 26,2004
D. System Failure Criteria applicable to all systems:
You must indicate"yes"or"no"to each of the following for all inspections:
Yes No '
_ _X_ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool
_ _X_ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or
clogged SAS or cesspool
_ _X_ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or
cesspool
_ X Liquid depth in cesspool is less than 6"below invert or available volume is less than `/z day flow
X_ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).
Number of times pumped
_ X Any portion of the SAS,cesspool or privy is below high ground water elevation.
_X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface
water supply.
_ _X Any portion of a cesspool or privy is within a Zone 1 of a public well.
X Any portion of a cesspool or privy is within 50 feet of a private water supply well.
X 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 coliform bacteria and volatile organic compounds
indicates that the well is free from pollution from that facility 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.]
No (Yes/No)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.
You must indicate either"yes"or"no"to each of the following:
(The following criteria apply to large systems in addition to the criteria above)
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.
Page 5 of I 1
OFFICIAL INSPECTION FORM-.NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 162 Cinderella Road
Owner:Reid
Date of Inspection: August 26,2004
Check if the following have been done.You must indicate"yes"or"no"as to each of the following:
Yes No
X — Pumping information was provided by the owner,occupant,or Board of Health
X _ Were any of the system components pumped out in the previous two weeks?
X Has the system received normal flows in the previous two week period?
X_ Have large volumes of water been introduced to the system recently or as part of this inspection?
X Were as built plans of the system obtained and examined?(If they were not available note as N/A)
X Was the facility or dwelling inspected for signs of sewage back up?
X Was the site inspected for signs of break out?
Were all system components,excluding the SAS,located on site?(INCLUDING THE SAS)
_X _ 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?
_X_ _ 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:
Yes no
X_ 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 CUR 15.302(3)(b)]
Page 6 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 162 Cinderella Road
Owner: Reid
Date of Inspection:August 26,2004
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design):_ Number of bedrooms(actual):
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): (448 gpd capacity)
Number of current residents:_0_
Does residence have a garbage grinder(yes or no):NO(Not Allowed)
Is laundry on a separate sewage system(yes or no):NO [if yes separate inspection required]Per owner
Laundry system inspected(yes or no):NA
Seasonal use: (yes or no):NO
Water meter readings,if available(last 2 years usage(gpd)): 2003:8,000 gal. 2002;9,000ga1.
Sump pump(yes or no):No
Last date of occupancy: (current)
COMMERCIAL/INDUSTRIAL
Type of establishment:
Design flow(based on 310 CMR 15.203): gpd
Basis of design flow(seats/persons/sgtetc.):
Grease trap present(yes or no):_
Industrial waste holding tank present(yes or no):_
Non-sanitary waste discharged to the Title 5 system(yes or no):_
Water meter readings,if available:
Last date of occupancy/use:
OTHER(describe):
GENERAL INFORMATION
Pumping Records
Source of information:Property owner
Was system pumped as part of the inspection(yes or no):
If yes,volume pumped:_gallons--How was quantity pumped determined?
Reason for pumping:
TYPE OF SYSTEM
X Septic tank,distribution box,soil absorption system(6'pit with 2' stone)
_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)
Tight tank _Attach a copy of the DEP approval
_Other(describe):
Approximate age of all components,date installed(if known)and source of information: Approx. 1985
Were sewage odors detected when arriving at the site(yes or no):NO
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS .
Page 7 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 162 Cinderella Terrace
Owner:Reid
Date of Inspection:August 26,2004
BUILDING SEWER(locate on site plan)
Depth below grade:Approximate;34 Inches
Materials of construction: cast iron _X_40 PVC_other(explain):
Distance from private water supply well or suction line:_NA
Comments(on condition of joints,venting,evidence of leakage,etc.): Appears in good condition. No evident
leakage.
SEPTIC TANK:N.A.(locate on site plan)
Depth below grade: 12"
Material of construction:X_concrete_metal_fiberglass_polyethylene_other(explain)_
If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of
certificate)
Dimensions: Typical 1000 gallon tank
Sludge depth: 6"
Distance from top of sludge to bottom of outlet tee or baffle: 14"
Scum thickness:2.5 inches
Distance from top of scum to top of outlet tee or baffle: 15"
Distance from bottom of scum to bottom of outlet tee or baffle: 12.5"
How were dimensions determined: Actual measurements with tape and scour stick.
Condition of tank(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid
levels as related to outlet invert,evidence of leakage,etc.) Recommend maintenance pumping,tank appears in
operating condition.,Precast outlet tee in good condition,Effluent level with outlet tee.
GREASE TRAP: N.A.
Depth below grade:_
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:
Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels
as related to outlet invert,evidence of leakage,etc.):
Page 8 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 162 Cinderella Terrace
Owner: Reid
Date of Inspection:August 26,2004
TIGHT or HOLDING TANK: N.A._(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/day
Alarm present(yes or no):
Alarm level: Alarm in working order(yes or no):
Date of last pumping:
Comments(condition of alarm and float switches,etc.):
DISTRIBUTION BOX: (if present must be opened)(locate on site plan)Could not locate dbox. Believed not
to exist.
Depth of liquid level even with outlet invert:
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.):
PUMP CHAMBER:_(locate on site plan)
Pumps in working order(yes or no):
AIarms in working order(yes or no):
Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.):
Page 9 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 162 Cinderella Terrace
Owner: Reid
Date of Inspection: August26,2004
SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required)
If SAS not located explain why:
Type
X leaching pits,number(1)6'wide x 6' deep w/approx.2' of stone around
_leaching chambers,number:
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)no indication of staining.No effluent in bottom of pit,no ponding or damp soil,no vegetation over pit.
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 or no):
Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.):
PRIVY: N.A._(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.):'
3
Page 10 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 162 Cinderella Terrace
Owner:Reid
Date of Inspection: August 26,2004
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or
benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building,
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• Page 11 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 162 Cinderella Terrace
Owner:Reid
Date of Inspection:August 26,2004
SITE EXAM
Slope
Surface water
Check cellar (crawl space)
Shallow wells
Estimated depth to ground water 20 feet
Please indicate(check)all methods used to determine the high ground water elevation:
X_Obtained from system design plans on record-If checked,date of design plan reviewed:
X_Observed site(abutting property/observation hole within 150 feet of SAS)
_X_Checked with local Board of Health-explain:Recent Test Holes Existin en meer records with BOH
X Checked with local excavators,installers-(attach documentation)
Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
Utilized existing site design information on file with the Board of Health. Additionally,existing site and abutting
site topography does not indicate ground water to be within 5 feet of bottom of leaching facility.
i.
Barnstable Assessing Search Results Page 1 of 2
y ;
Home: Departments:Assessors Division: Property Assessment Search Results
6
Owner:
REED, MELVIN K&VIRGINIA M Property Sketch Legend
Map/Parcel/Parcel Extension
047 /112/
Mailing Address
REED, MELVIN K&VIRGINIA M TRS I
REED REAL ESTATE TRUST
a
159 DONEGAL CIR
CENTERVILLE, MA. 02632 w/ R
r 77
2005 Assessed Values: a% >
Appraised Value Assessed Value ux
Building Value: $ 110,900 $ 110,900
Extra Features: $2,700 $2,700
Outbuildings: $0 $0
Land Value: $ 121,400 $ 121,400 Interactive Property Map: Ma re uires Ply in:
Totals:$235,000 $235,000 1 have visited the maps before ra ;
Show Me The Man n�Ir
April 2001 photos available
Sales History:
Owner: Sale Date Book/Page: Sale Price:
REED, MELVIN K&VIRGINIA M TRS 3/15/1984 C95851 $55,000
SMITH,JAMES K C85927 $0
Tax Information:
Tax information is currently not available for this parcel
Land and Building Information
Land Building
Lot Size(Acres) 0.46 Year Built 1983
Appraised Value $ 121,400 Living Area 816
Assessed Value $ 121,400 Replacement Cost$ 124,592
http://www.town.barnstable.ma.us/tob02/Depts/AdministrativeS ervices/Finance/Assessing... 10/18/2004
Barnstable Assessing Search Results Page 2 of 2
Depreciation 11
Building Value 110,900
Construction Details
Style Colonial Interior Floors Carpet
Model Residential Interior Walls Drywall
Grade Average Heat Fuel Gas
Stories 1 3/4 Stories Heat Type Hot Air
Exterior Walls Wood ShingleClapboard AC Type None
Roof Structure Gambrel Bedrooms 2 Bedrooms
Roof Cover Asph/F GIs/Cmp Bathrooms 1 Bathroom
Total Rooms 4 Rooms
Extra Building Features
Code Description Units/SQ ft Appraised Value Assessed Value
FPL2 Fireplace 1 $2,700 $2,700
Property Sketch Legend
BAS First Floor, Living Area FST Utility Area (Finished Interior) UAT Attic Area(Unfinished)
BMT Basement Area(Unfinished) FTS Third Story Living Area (Finished) UHS Half Story(Unfinished)
CAN Canopy FUS Second Story Living Area (Finished) UST Utility Area (Unfinished)
FAT Attic Area(Finished) GAR Garage UTQ Three Quarters Story(Unfinished)
FCP Carport GRN Greenhouse UUA Unfinished Utility Attic
FEP Enclosed Porch PTO Patio UUS Full Upper 2nd Story(Unfinished)
FHS Half Story(Finished) SFB Semi Finished Living Area WDK Wood Deck
FOP Open or Screened in Porch TQS Three Quarters Story(Finished)
http://www.town.bamstable.ma.us/tob02/Depts/AdministrativeServices/Finance/Assessing... 10/18/2004
��°FINE r�ti
Town of Barnstable
9� WSTABM
"9. ,� Board of Health
ArEDMA'�A P.O. Box 534, Hyannis MA 02601
Office: 508-862-4644 Susan G.Rask,RS.
FAX: 508-790-6304 Sumner Kaufman,MSPH
Wayne Miller,M.D.
December 6, 2004
Mr. James LeBoeuf
71 Beth Lane
Hyannis, MA 02601
Dear Mr. LeBoeuf,
You are granted permission on behalf of your clients, Melvin and Virginia Reed,
to finish a second floor room of the existing dwelling in order to construct one
additional bedroom at 162 Cinderella Terrace, Marstons Mills. The total number
of bedrooms at this property will total three.
This permission is granted with the following conditions:
(1) No more than three (3) bedrooms maximum are authorized at this
property. Dens, study rooms, offices, finished attics, sleeping lofts, and
similar-type rooms are considered "bedrooms" according to the MA
Department of Environmental Protection.
(2) The applicant shall record a properly worded deed restriction, signed by
the owner of the property, at the Barnstable County Registry of Deeds
restricting the property to three (3) bedrooms maximum. A copy of the
.recorded deed restriction shall be submitted to the Health Agent prior to
obtaining a disposal works construction permit.
This permission is granted because the home was originally constructed as a
two-story dwelling, with plans to finish the second floor sometime in the future.-
Also, the existing septic system has adequate capacity for three bedrooms. A
certified system inspector reported that this septic system "passed" an inspection
on August 29, 2004.
Sin VMillI5*rv,_
a D.
tI DATE:
' PER:
+ 13,MSfAI=
bUft
� 039. 10�
AtEo MAC a REC. BY
Town of Barnstable
SCHED. DATE:
Board of Health
200 Main Street,Hyannis MA 02601
Office: 508-8624644 Susan G.Rask,R.S.FAX: 508-790-6304
Summer Kaufman,M.S.P.H.
Wayne A.Miller,M.D.
VARIANCE REQUEST FORM
LOCATION
Property Addtess: <O/1-169eR e
Assessor's Map and Parcel Number: Size of Lot:
Wetlands Within 300 Ft. Yes Business Name:
No ,t Subdivision Name:
APPLICANT'S NAME: Phone
Did the owner of the property authorize you to represent him or her? Yes ✓ No
PROPERTY OWNER'S NAME CONTACT PERSON
Name: /�dE��vo� f�/. 0 �1✓i� e�� Name:
Address: Address: :7
Phone: Phone:
VARIANCE FROM REGULATION(List Reg.) REASON FOR VARIANCE(May attach if more space needed)
NATURE OF WORK: House Addition ❑❑❑❑❑❑ House Renovation ❑ Repair of Failed Septic System ❑
Checklist (to be completed by office staff-person receiving variance request application)
Please submit copies in 4 separate completed sets.
Four(4)copies of the completed variance request foam
Four(4)copies of engineered plan submitted(e.g.septic system plans)
Four(4)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans)
Signed letter stating that the property owner authorized you to represent him/her for this request
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 variance requests only)
Variance request application fee collected (no fee for lifeguard modification renewals, grease trap variance renewals [same
owner/keasee 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 Wayne A.Miller,M.D.Chairman
NOT APPROVED Sumner Kaufman,M.S.P.H.
REASON FOR DISAPPROVAL Susan G.Rask,R.S.
Q:\HEALTH\Application Forms\VARIREQ.DOC
l
October 26, 2004
Town of Barnstable
Board of Health Department
200 Main Street
Hyannis, MA 02601
Dear Sir:
Re: 162 Cinderella Terrace, Marston Mills, MA
This is a request for a hearing regarding the property at 162 Cinderella Terrace, Marstons Mills,
MA. The house was purchased in 1984 as an unfinished three or four bedroom Gambrel. The
upstairs two bedrooms were to be finished as needed. At that time the rough plumbing and
electrical work had been brought up to the upstairs level and the floors were plywood covered.
An inspection of the septic system has recently been done and it past the inspection to
accommodate the added rooms. Your assistance at this time would facilitate acquiring the
permits necessary to complete the house.
Sincerely,
Melvin K. &Virginia M. Reed
i Y
Doc=®988P853 12-16-2004 3m17
,. BARNSTABLE LAND, CO, URT REGISTRY
DEED RESTRICTION
WHEREAS, MELVIN K. REED and VIRGINIA M. REED, TRUSTEES OF REED REAL
ESTATE TRUST,of 159 Donegal Circle, Centerville,Massachusetts 02632 is the owner of Lot
20, 162 Cinderella Terrace, located at Marstons Mills, Massachusetts and being shown on
subdivision plan 36301-C(Sheets 1 &2)dated December 4, 1972, drawn by Charles N. Savery,
Inc., Surveyor and filed in the Land Registration Office at Boston, a copy of which is filed in
Barnstable County Registry of Deeds in Land Registration Book 468,Page 65 with Certificate of
Title No. 58305.
WHEREAS, MELVIN K. REED and VIRGINIA M. REED, TRUSTEES, as the owners of
said lot have 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 precondition to obtaining
a disposal works construction permit in compliance with 310 CMR 15.000 State Environmental
Code, Title V, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage;
�J WHEREAS, the Town of Barnstable Board of Health, as a precondition to granting a disposal
cJ 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 the 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
s Registry of Deeds by recording this document;
n NOW,THEREFORE,MELVIN K.REED and VIRGINIA M.REED,TRUSTEES do hereby
place the following restriction on the above-referenced land in accordance with said agreement
with the Town of Barnstable Board of Health, which restriction shall run with the land and be
binding upon all successors in title:
- - 162 Cinderella Terrace,Marstons Mills,Massachusetts may have constructed upon the lot a house
containing no more than three(3)bedrooms. MELVIN K.REED and VIRGINIA M. REED,
.: TRUSTEES agree that this shall be a permanent deed restriction affecting Lot 20 and shown on
Land Court Plan 36301-C.
We,Melvin K. Reed and Virginia M.Reed,certify that we are the sole trustees of the Reed Real
Estate Trust and we have been authorized by all the beneficiaries to sign,seal and to deliver to the
Town of Barnstable Board of Health a deed restriction relative to the real estate described in said
deed. We also certify that said Trust is in full force and effect and has not been altered,amended,
rescinded or revoked in any manner other than amendments recorded in the Barnstable County
Registry of Deeds prior to the date of this certificate. t
For title, see Certificate of Title No. 155791.
WITNESS our hands and seals this day of &e 2004. e € _
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1 REED REAL ESTATE TRUST
By:
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MELVIN K. REED, TRUSTEE
VIRG A M. REED, TRUSTEE
COMMONWEALTH OF MASSACHUSETTS
Barnstable, ss.
t
On this A/day of 2004, before me, the undersigned notary public,
personally appeared Melvin K. Reed and Virginia M. Reed, Trustees as aforesaid, known to me
personally to be the individuals whose names are signed on the preceding or attached document
and acknowledged to me that they signed it voluntarily for its stated purpose.
Notary Public
My commission expires:
BARNSTABLE COUNTY
REGISTRY OF DEEDS
A TRUE COPY,ATTEST
JOHN F.MEADE,REGISTER
BARNSTABLE REGISTRY OF DEEDS
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