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�'('`��'�MryrTACHE 9s "x Telephone (508) 398-2231, Ext. 241 — Fax (508) 760-3472
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B O A R D O F H E A L T H
NOTICE OF DEED RESTRICTION
RESIDENTIAL '
Notice is hereby given of the applicability of the Towr�of Yarmouth Board of Health for a deed restriction,to
206 White Rock Road , shown in Town Assessors Book dated 2005 , Map 114 , parcel 12 . As Deed is
recorded at the Barnstable County Registry of Deeds,on the Deed Book 8151 ,Page 257 .
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� As plan of land is recorded at the Barnstable County Registry of Deeds on a subdivision plan titled "Port-O-
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� Yarmouth Subdivision Plan of Land in Yarmouth MA for Salt Meadow Realty Tr." dated Januarv,1967,and
� recorded on the Plan Book 2U9,Page 135 .
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� The engineered plan prepared by TADCO Environmental Consultants ,dated September 15,2005,approved
00 by the Hea.lth Department on March 22,2006 ,requires a maximum,not to exceed:
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� (1) the number of bedrooms not to exceed Two (2 );
°' per design restrictions,Title V, Section 15.214,Nitrogen Loading Limitations,
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Zone II Areas of Wellhead Contribution.
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� Bruce G.Murphy,Healt ' ctor,R.S.,C.H.O.,M.F.H. Date
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� t Audrey cCluskey,owner Date
Kelly Jas ,Administrator
206 White�Rock Road,Yarmouthport,MA 02675
COMMONWEALTA OF MASSACHUSETTS
Barnstable County
On this the 2 gday of M a r r�h,2006,before me, T a r a T�. B a z a r e w s k y , the undersigned
Notary Public,personally appeared Ke11y S. Jason ., proved to me through satisfactory
evidence identity,which was/were MA dr i ver ' s 1 i c en�e the person(s)whose name(s)is
signed on this preceding or attached document,and acknowledged�'o me that he/she signed it voluntarily for
its stated purpose(s). �
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� NotaryPub ic Tara L�azarewsky
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March 22, 2006
Audrey M. McCluskey
c/o Kelly Jason
206 White Rock Road
Yarmouthport, MA 02675
RE: Two Bedroom Deed Restriction for 206 White Rock Road, Yarmouth,MA
Dear Ms. Jason:
Please find enclosed the Two Bedroom Deed Restriction for the above address which is required
as part of the septic system approval process. The Deed Restriction must be signed and dated by
the owner(s) or legal designee in front of a notary. There are several notaries available at
Yarmouth Town Hall. Once the restriction is signed and notarized,please make a copy and have
both the original restriction and the copy recorded at the Barnstable County Registry of Deeds,
Route 6A, Barnstable. The copy of the recorded Restriction must then be returned to the Health
Department as proof of the recording.
If there are any further questions, please contact this offce at 508-398-2231 X241. Thank you
for your prompt attention.
Sincerely,
;�
C�C,���=�
Amy . von Hone, R.S.
Assistant Health Director
cc: file
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BOARD dF }# � ALTH
HEALTH DEPT.
APPLICAT�ON FOR TITLE V QEED RES'�7.tICTION
The information roquested belaw must be accurate and completed in�u11 to ensure the deed restriction
can be completed prnperly and in a dmety manner.
]. Town of X outh Assessor's Book(most current):
Map // Lot��Address�?D[� /.[�i�//T�' ,�G�'/�bR7�
2. T6e properiy deod is record�I at thc Barnstable County Registry of Deeds in �
Ueed�oc�k pIS/ ,Page �7 or L.and Court Certificate �
3. �'he lot indicated abave is shown on a plan of laud entitled:�-p-5/r��arrrtt, ,s�avnv�a�
���G/o�_1�4MD�.v ya�a�F�l t,�.e _Ssxr�aw_�,7Y�, dated >/�'�? � .
The plan af land far the lot is recorded art the Barnstable County Registry of Deeds in Plan . � .
�ook � Pag� /�� or Land Cau�t Plan : �
A. The eagineered septic plan has been prePared by ����I";�:ir'�re,�tsusa�r�s .
and dated SE o r, i s,z ct�s'_ . �
5. Board of Health approval date � �
6. T'he number of bedrooms is restricted to A2
7. Owner Name: . At�asQf3r� /_�e �/�'�"'�r _
Address: .,�OG l�Jfl�"�vc�C �DAD
yi9r@�40urif �D�T�,f/l� G�b7� �
The required intormation supptied to this department for the app[icatian of a Title V Deed
Restriction is corr�ct as shown abuve. �
Applicant �/!�/5����ate_�1��� � �
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TOTAL P.01