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HomeMy WebLinkAbout0191 JAMES OTIS ROAD - Health 191 JAMES OTIS ROAD Centerville A = 170-206 S M E A D No.H163OR UPC 10259 smead.com • Made In USA YOU WISH.TO OPEN A BUSINESS? For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate.) usiness Certificates are available at the Town Clerk's Office, 16`FL 367 Main Street, Hyannis, MA 02601 (Town Hall) F DATE: 2 Fill in please: " APPLICANT'S YOUR NAME/S: L�4 ct/�a s //�7��12 7 Y BUSINESS YOUR HOME ADDRESS: U�/s R tr ::try ?6711Y1 Cpti�Q�y�l/n �/1I� ��7�;Z TELEPHONE # Home Telephone Number -5 CS 412S ©s` e/ NAME OF CORPORATION: NAME OF NEW BUSINESS 4 Ryt-Iyi:y TYPE OF,BUSINESS_ f�y,6 IS THIS A DOME OCCUPATION?—'=- . ;Y_ES NCr ADDRESS OF BUSINESS MAP/PARCEL NUMBER_ V-20 )-06 (Assessing) When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. &Main Street) to make sure you have the appropriate permits and licenses required to legally operate your us nness in this town. 1. BUILDING COMMISSIONER'S OFFICE r This individual has been informed of any permit requirements that pertain to this type of business. Authorized Signature* COMMENTS: 2. BOARD OF HEALTH This individual has _ e i orme e mit r it.pmen t pertain to this type of business. Authorized Signat ** f "'`y M COMMENTS: UST COMPLY WITH ALL 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature* COMMENTS: D TOWN OF BARNSTABLE . �07- ,LOCATIO D ¢. SEWAGE# . i6 VILLAGE ef� �[" ASSESSOR'S MAP&PARCEL-OS-"'-:�' INSTALLERS NAME&PHONE NO.LP," SEPTIC TANK LEACHING.FACILITY.(type) % (size�-'X� NO.OF BEDROOMS OWNER �� � PERMIT DATE: -� a ®�' COMPLIANCE DATE: `�� � 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) j/ Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) / Feet FURNISHED BY Q5�t/ ,O� � � 111SPIr X/I T® No. . LOO`7- a 16 t, Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2pplication for Digogal *p6tem (Cott.5truction Permit Application for a Permit to Construct( ) Repair(Upgrade( ) Abandon( ) ❑ Complete System It Individual Components Location Address or Lot No. /9/ f_40*AOZt O-77S OV 4 Owner's Name,Address,and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder ( ) Other Type of Building el No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided yp gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank �X�J`J''�� �j I� a Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction 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 Certificate of Compliance has been issued by this Bo d of Health. 2-j— Signed Date Application Approved by Date 5— te2--0 —7 Application Disapproved by: Date for the following reasons Permit No. 9-0'0 7 Date Issued ————————————————————— ;,+..w,r---�.,...:�.- -• ,;,,:,.,,: .,..,.r=.......:.,, f kr „r-..- .v-.,t�e+a,... +..:iw':. 'rr_ h*�i. t-"...n;.n-.-r....-t;.«''°"',a.` -.,i..,... ,., -...,.--.„ .. ' �a� aoo 7— a i � ,� .�. No. � f Fee THE COMMONWEALTH OF MASSACHUSETTS '' Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ZIpprication for ZiOpo-gal 6p5tem Construction Permit Application for a Permit to Construct( ) Repair(Upgrade( ) Abandon( ) ❑ Complete System L—J Individual Components t J-�dlji tt J O T/S , +�? Location Address or Lot No.gip/ CE � Owner's Name,Address,and Tel.No. - Assessor's Map/Parcel. 0 �T Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of'Bedrooms Lot Size sq. ft. Garbage Grinder ( - ) Other Type of Building ��'�� No.of Persons Showers( ) Cafeteria Other Fixtures Design Flow(min.required) !J gpd Design flow provided gpd Plan Date Number of sheets Revision Date 'C r. Title , Size of Septic Tank /.1`T•�d' c+ Wit'® ® Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: .- s, The undersigned agrees to ensure the construction 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'Certificate of Compliance has been issued by this Bo rd of Health ' Signed Date r Application Approved by I _ Date 7 - -7 Application Disapproved by: " Date for the following reasons Permit No. o*?-oo 7` fq Date Issued 5`02 2'c>7 ., THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS t Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired (�) Upgraded ( ) Abandoned( )by jj Ce C�CE`G at / y'/ (JA hi �`f p/�1ti/' �? e"`.�.J'' has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 7 dated Z- u7 Installer Designer #bedrooms �` Approved design flow _ gpd The issuan�o hi e/s : "iitt shall m will\fu ytt not be construed as a guarantee that the syste asfddsiigg e_d. 111 e* 5 Date "/ ( �'/! Inspector /f��f�" No. 900-7- 21 (p Fee — THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS Xigpogal *p5tem Construction Permit Permission is hereby granted to Construct ( ) Repair ( A00') Upgrade ( ) Abandon ( ) System located at 9/ l�'•d i?ij f",n O y"i.r �°dJ C c`'•�1` and as described in the above Application for Disposal System Construction Permit.The applic t r cognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this,,peta�ak Date ©-y Approved by g Town of Barnstable' � .r. Regulatory Services h Thomas F.Geiler,Director Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office:.508-862-4644. Fax: 508-790-6304 Installer&Designer Certification Form Date: 2 � Designer: 1 Installer: -I 1'"/ )_,PBLF SqpC Address: . Address: y /�1 On� Ira lamas issued a permit to install a (date) (installer) septic system at based on a design drawn by ,,y� / (address) (8. ?VG & A ,PkS dated {designer) _ certify that the septic system referenced above was installed substantially according to e design, which may include mini approved-changes such as later i4o0ation of the dts button box and/or septic tank I certi _filzat the septic system referenced above was ins cd with mdJ4 charges greater fl? �l0' lateral relocation of the SAS or any vecal relocation of any.compon�tlf of the-septt` ys#em}but in accordance with State&Local Regn]aiions. flan revisoxit o cefified as b t`Dy designer to follow. pOF o� y (Installers k0' a_; 9 No---"66 r . (lle ' er s Signature} (Affix MTNea's Stamp Here) PLEASE RETURN TO BA]�NSTABI�E PUBLIC.$EA]LT$ D ION. CERTMCAT'E OF COMP 3ANCE WILL'N® 7�E IS,SUEI3 BOTH -TIMS FOLtM ArLD AS- BUILT KA-RD ARE REMAWD RY THE.RARNSwAnLE PUBLIC SAL -1}MI N TRANK YOU. Q:Healtb/Septic/Designer Certification Form I - q q t 224' j jcparatron of eians and JDeetncanu­ r7 V,- i •. +— f` �.• c,',� - r — r The plans and specifications .for every on-site system shall be prepared,as follows: (1) Every system shall be designed by a Massachusetts Registezed Professional Engineer or a MassacfzuSetts Registered Sanitarian provided that such Sanitarian shall Mat-design a. system designed to discharge morn than 2,000 gallons per day pursuant to 310 CMR 15.203. y other agent of the owner..rnay prepare plans for the repair of a system.designed to discharge not more than than 2,000 gallons pet day pursuant to 310 CMR IS_203 provided they are revicwrd by:a Massachusetts Register..Sanitarian and•approved by the.approving a ' ority; (2). .Every:plan.submitted for approval must be dated and bear the stamp and signature of - ths designer, -(3) Every plan for a new systems or plan for the upgrade or expansion of ail a istitig:systc n - ' w ich requires a variance to a property Mine setback distance,must:also reference'a plan ,Arhich bears the stamp and signature of a Massachusetts- Licensed Land Surveyor in accordance with M.t.L. c: 112, § 81D, 4) of suitable seal: Cone inch =40 feet or fewer for plot MEvery plan for a system sfia11 be ans and one inch=20 fect or fewer for details of system componenis), td.shall include. : de cti.on of: the legal boundar'es of the facility to be served. (b) the holder and location of any easements appurtenant to or which could impact the gem; c) the location-of the all dwellings)or building(s) existing and proposed an the facility L;Aand idcntifigatidri of those to be served by the sysmm; " d) the''iacation of ekisti�g of proposed imperviaus atcas; induhzng:driveways and g areas; - _ .__... - e) - location and dimensions of the system (including reserve area);-. ystcm design calculations, including design daily sewage flow, scgtic tank capacity <"quircd and provided); soil absorption system capacity (required and provided); and er system is designed for garbage grinder; North arrow and existing and pzoposed contours; L (h) ovation and'log of deep*observation hole tests including the date of test, existing de elevations marked on each test, and he names of the represen=vc of the 2app In authority and soil cvaivator cation, and results of percolation tests izdLding the sate of test and-the names of approving authorit and so1_cvaluator, . represcrtative of the a g 'y --- } name and cerrficati number-of-of S�c�Evaluator of record-.- -on- (k) location.of every water supply,public and-private, 1. within 400 feet. of the proposed system location in the easy of surface water supplies'and gravel packed public water supply wells, 2. within 250 feet of the proposed system location in the case;of tubular public water supply wells, and 3. within 130 feet.of the ,proposed~system,location in the case of private water supply wells; 1) location of anp surface waters of the Commonwealth, rivers, bordering vegetated wetlands, salt marshes, inland or coastal banks. regulatory floedway, ysIocry zone, surface water supplies, tdbutaries to surface water supplies,certified vernal pools,private : water supplies or•snction lines, gravel packed or tubular public water supply wells, subsurface drains, leaching catch basins, or dry wells; and the location of any nitrogen sensitive area identified'in 310 CNLR 15.215 1 withLl which poittions of the proposed rn are located. location of water lines and.other subsurface utilities on the facility; observed and adjusted ground-water elevation in the vicinity of the system; a) a complete profile of the system; (p) .•a note an the plan listing all variances to the provisions of 310 CNIR I5.000 sought Ail ranjunction with the plan.; (q) . the location and elevation of one benchmark.within 50 to 75 feet of the facility which is trot siabjgct to dislocation or lcss.4itrirg conssuctiois on the facility, (r) when dosing is-proposed, 'complete design-and specification of the.dosing system proposed including.but not limited to dosing chamber capact}� (required an.:proyide3),' crap curves and_specifications, number of d'esiz0 cycles and depth per.cyder s) when a Reci culating Sand Filter or equivalent alternative technology is required or pr catior.for the system,including a hydraulic profile; posed, a complete plan and spec.fi I locus plan,to show the Iocation of the facility including the nearest existing strt' the street number and lot number, if any, of the facility. and __M the materials of const:rnction.and the specifications of the system. THE COMMONWEALTH OF MASSACHUSETTS Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at: 15S 's Installer Address Type of Building Size Lad�5.a#_ _01M.Sq. f Dwelling—No. of Bedrooms.............3..........................Expansion Attic b f Grinder ( i_0 Z Other Distribution box ( ) Dosing tank ( ) he undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with t owlons of'r, the State Sanitary Code—The undersigned rther agrees not to place the s stem in ra i, of Compliance Has b�,:ee�n�iby he ee, Y ate Date Date -------------------- _____________ __ _ No...................�...1�, Fi$........1F................... THE COMMONWEALTH OF MASSACHUSETTS • BOARD OF HEALTH ..............-r. ... ................OF........................................ Appliration for Disposal Works Tonstrurtion Frrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: J /q m eS OTIS • •--••-'------•--._......................... --- ----:---: ...._... --•..................'-••-..........--•--• ----'----•-•'---'----•-................-- ..:.. . Location-Address or Lot No. f 41 •-•-"---......•-'-•-._.......................................................................... ................----...---.........---.._......................................................... W Owner Address Installer Address Type of Building Size Lot..................."' . Sq. feet ........ g— .................•.__......Expansion Attic (>'''>)` Dwelling No. of Bedrooms................. Garbage Grinder .—I aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures -----------•-------------------------------------------•••--•---•-••-•---•-•---•-•-••----•--•-------••......-•------ R, 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....................sq. ft. Seepage Pit No----_-------------- Diameter.-="........___._.__ Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water-___.--_________•--_-__. Gz, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.-....---............... 0 ---•----------------•-----••---------•-------•----•-....------......------........----•-'--'....------•--••'-----•------------.-------..... --------- 0 Description of Soil.................................................................................................................................................... ........x U w ---------------------------------------------------•----------------------------------.....------------------------.---------------------------------------------------------------------------------- U Nature of Repairs or Alterations—Answer when applicable-------------------------------------------------------------------- -'-------------------•------•----..........'--•------------------------'...'--•------•'-•-........••----....----------------------------------------•------------------•------------------...--•••------ A ement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with nth rrov sions of L T� f the State Sanitary Code— The undersigned further agrees not to place the system in ra n t to of Compliance has been issued by the board of health. r„ Signed.. '` ----------------- rr D to ca ion pp oved By................ •-.1...... -�i ' ' i Application Disapproved for the f ollo�ing reasons:---•--------------••---------•-•---- ate ... ------•-------------••-•-•-------....-----•-'---.._...••-•---•.....•--•-•.........-----.....-•----............_.........--•----•--------•--••--•-•---•-•••-••-•---------•-••-----•-•-•••--•--•.........._ Date PermitNo......................................................... Issued..... ................................................ ay Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... Trrtifirab of Tontpliattrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( or Repaired ( ) by - — c In . -> ..........................................................`l has been installed in accordant wl�'tl�i.l�4�provisions l of TITL.� �b.......................................................... of The State Sanitary Cod as d cr'bed in the application for Disposal Works Construction Permit No------- �`.. .._------ dated _-- _)_'2- _.. -..-.---•------ THE ISSUANCE OF THIS CERTIFICATE SHALL'NOT BE CONJRUE® AS A CBJA AN E THAT THE SYSTEM WIL 10,7 SATISFACTORY. o. DATE............. 2 •. ............................... Inspector---• .................................................................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .........................................O F.................................................... 4 No...... ... ' FEE... ..........�.. Disposal Works Tonstrwt n 11nmit Permission i hereby granted......------ t` .` ....-----1 U.. .. ......................................................................... to Construct ( or Repair ( an Individual Sewage Disposal System -- reet 76— , as shown on the application for Disposal Works Construction Permit No. ...... 7 Dated.... - - .•....•-_• M1 . � --...-- L 1 I � of Aealt d Boar - DATE ------ ......�•- 9---•-- FORM 1255 A. M. SULKIN, INC., BOSTON DES IG4\1 D►� "�c� N �, SINGLE FAM1l..q 3 f3C01ZooP� , No GA\Z13AG--E G12(N�DCg.. SZ nor DA i L-Y F LavJ = I I o x 3 = 33o G.P D. � 1 S6P-n r TA Q le- = 3 3 o n i Solo - 44 s G.P. O• ' USE 1000 GAL. TAr�I�, b3q� N CASPoSAt_ P+T loco C AYAL. /; Q�;4�� } �v 37S Cr.P. O. y°- .� \ ,�� ,I to v So-r cM AREA = so 5.fr. Go-r cS - N TnTA L QESj&Q 42S y ! — u G. P. �. � V! �8. `, ? �P lip TTAL J AILIJ F-LoW 3SO G. P. O: �P ' M^9s Tion.) 2p►Te ,N z M,Aj .orzUEsSa- �. �, A OF SULLI.UAN -I'- RICHARD `��N/ Lc r Ib No. 29133 A. G��r 5 < a BAXTER y �P w Z'+I S.F A��,e•.1� S T La�O ��. .. Na 24048 FSS�QN � N L s OT,S Sze i?-�A•0 T'E s-r H o l.;r~ V 2^779 eL:. SL.o FG. 61,Z Lo .ve) t /coo GAL ,Box rfb /.vK G.4 L,4 Ceqw/ 49.6P.7-T'14 13/it "ro /�i 9.2. 49.�} G'.E,2T/F/ED PG o r 'ec7l-411 VZ.43.o LoC,GT/oy CG'J7 VIU PRO 0�1 LE ._.. , too SCALE Z-07 va.�T'o�lSHow.v UT AJi�NZ,4,V 3 f/E,�Eov GOMPGY.s W/Tf/ A//�.S�T•!�/•1G,� ,e6-Q!J/�EHIENrS of Th'� `TOW.v of ,C�E6is�.eE�,G4No.SveYEyo,P,s' . AV /S Gocar�.o W/Tiy/y .cL4A:vvvG.4liti :14,c3a,G/cay7r'- A Gaw ,LL�L_0 LNC 7"Pz odx" /s tea'?- er4 aEo a/v.4 iv/'oysT,tz-- - -d�EiS/T.S!/,2�/,Eyi4it/O.T.S/E p�FS.�l Sh�K/Nf/E.eE4N.S.4/o!/G�ypT-p,E US.E"p i, '� l+ Tl0 ,: x `� � CYE PERMIT Hrr-2106 V19LLAGE HSTA LLER'S . NAME ADDRESS ®vim On CW d chl _ U i L D E R OR OWNER bDATE PERMIT I S S U 0- iv-- . r LaT lL �b 3 ASSESSORS MAP: ABBE / TEST HOLE LOGS o� 4— PARCEL: # 2_0.c, NOTES: /ti// �9/�- PL I C { SOIL' EVALUATOR: FYI • �I L/v �O FLOOD ZONE: 'q r-- -� � _._------- -- WITNESS : l/t (� • C IrT� /�h �crCST q� �p4e 3 1 The installation shall REFERENCE: _ _ _ DATE 212W. ) a comply with Title V and Town of Barnstable Board of ? Health Regulations. l3 ��XT�+2 _ !4X �(.� PERCOLATION RATE: L wii u J - -1--�- — — 2" 2) The installer shall verify the location of utilities, sewer inverts and septic 0- � tJ � - components prior to installation and setting base elevations. TH- I TH-2 3 All gravity septic piping to 4 i „ a - ) g Y , P p p g be inch Sch 40 PVC at 1/8 per foot. The first g shall b two feet out of the d-box to the leaching level. e e v e . 4) This plan is not to be utilized forproperty line determination nor n P o any other Gaw+s+ ,a t m apt .SilylJ _ purpose other than thepro proposed system instaIlation. P Y 5 All septic components must meet Title V specifications. ,� ) p p Lo+"tti+.t 44 � ,�..: S 14' J � 6) Parking shall not be constructed over H10`septic components. LOCAT i �N MAP �•.5 _ io C 5 �J 7 The property is bounded) p P Y d by property.corners and.property lines. wc9, - � 8) The property owner shall review'desi n considerations to approve of total p P Y g Pp t to 1 �n ` design flow and number of bedrooms to b' considered t C ( i g e for design. Receipt of Dy , t payment for the plan and installation based on the plan shall be deemed [ p approval of the design flow h r pP g by the owner. 9) The existing leaching or cesspools shall be pumped and filled with material (� per Title V abandonment r �Z � ZO 3� P t procedures. Those within the proposed SAS shall be Wl? t w l 4jc QH removed along with contaminated . 4 h �1/'�f�'(► g to ated soil and.replaced.with clean washed sand. _. per Title V specs: 10)System components to be 10 feet from waterline. Sewer lines crossing the SEPTlC. SYSTEM DESIGN water line shall be sleeved with 4 inch SCH 40 PVC with ends grouted if applicable. 11 If a garbage grinder ) b g g de exists it is to be removed and is the responsibility of the FLOWI EST 1 MATE owner to ensure such. p Y ' - 12)The installer is to take caution inexcavation around the as line if applicable. 1 BEDROOMS AT PC GAL/DAY/BEDROOM - g pp` � ��O GAL/DAY - _ ot2 b SEPTIC TANK b L — GA.L/DAY. x 2 DAYS GAL JS)E /�JD GALLON SEPT I C TANK 1xt<W SOIL ARSORPTION SYSTEM � I i _Q.� io c U5 z 5 XfZ1CGl 'D'r'L UJ �l.L w1 i -�. AIP o / Lg ! 1 �.XO�-L�SIDE AREA. '�� �l 4- ICR a.. 1 52 o BOTTOM AREA, � 4 , *5 SEPTIC SYSTEM - SECTION FbLX40 MIL � 1A A— W -Z to ►ua1 M,e, X- 3c .. Qob3 �B,e i M Y \ /000 GAL518Z r4 TIC n .'1 R / - f 6 �e \ - SEPTIC TANK' � Lk�ftht�h5 „ .; N OF �y x r3 \. •c M W 4s _ �•• DAVID , y G T� • , All, O \. el r MASON ems"! 1✓v'v 8 No.1066 J 9 p F 4 � STE sS' l /1 - � \: � SITE .. AND SEWAGE PLAN f _ I (� LOCATION . G 1 WN1�� z�T'1.� 20 W 2� .: Z FOR ,: 00 PREPAREDN LYE B ! '2 SCALE: DAV i D B . MASON � DATE: � DBC ENVIRONMENTAL DESIGNS W - EAST SANDWICH . MA Z DATE HEALTH AGENT ' Zt ( 508 ) 833-`2 177 -