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HomeMy WebLinkAbout0186 ARROWHEAD DRIVE - Health , ���-M� yIAf 1. TF 1�186tiA° rro K&i d. Drive Hv'Hyannis A �270'1T`48 y s TOWN OF BARNSTABLEL LOCATION /�6 A�R o cy/r A� 't SEWAGE # 0-2 —2�07 VILLArE �7 '���✓^�' S ASSESSOR'S MAP & LOT � - . INSTALLER'S NAME&PHONE NO 4�1"'Sit ,SG E 2 7J i 3 IsrZ SEPTIC TANK CAPACITY LEACkNG FACMrrY: (type)(Z Sao 4f j" n,�6 2S - (size)f3 x NO.OF BEDROOMS BUILDER OR-OWNER �� ' l/°g - �l/`-5 PERMIT DATE: /3/a � COMPLIANCE DATE: 2 5 D 2 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 j' Furnished by 09 Bc A J _ B E TOWN OF BARNSTABLE LOCATION /�!�/.✓ �r� /�SEWAGE# o�v�I `_ 3� VILLAGE ASSESSOR'S MAP&PARCEL INSTALLER'S AME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY..(type) 4 OO �il Qe�rt b�i��size) �C NO. OF BEDROOMS OWNER PERMIT DATE: U 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) Feet Edge of Wetland and Leaching Facility(If any wetlands existwithin ,' 300 feet of leaching facility) i� � ''� � Feet FURNISHED BY ���1 f A 4' e2,r4W "� i i t t t t t c t VS clq M T b o � t � o o r P � 0 Z i i No. ? � � Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: f; PUBLIC HEALTH DIVISION - 1OWN'OF BARNSTABLE, MASSACHUSETTS Yes 9ppfication for Misposal bpstrm Construction j3ermit Application for a Permit to Construct( ) Repair( ) Upgrade(� Abandon( ) ❑Complete System ❑Individual Components =' r. Location Address or Lot No Owner's Name,Address,and Tel.No. Assessor's Map/Parcel r? Installer's Name,Address,and Tel.No. Designer's Name,Add ss,and Tel.No. yp? of B. ding:. 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) l(� gpd Design flow provided 4 a?Ro gpd Plan Date— (3 Number of sheets o� Revision Date Title Size of Septic Tank 0o 4 7x-�% Type of S.A.S. — Oa 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 Boar f Heal Signe Date Application Approved by - Date Application Disapproved by -Date w6; for the following reasons Permit No. zay - 37i6 Date Issued 8 No. / .X�n Fee Entered in computer:_ THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION YOWN� OF BARNSTABLE, MASSACHUSETTS Yes cU application for Disposal 6pstem Construction i9ermit Application for a Permit to Construct( ) Repair( ) Upgrade()Q Abandon( ) ❑Complete System El Individual Components Location Address or Lot NoW4 � d fti Owner's Name, (Name,Address,f and Tel.No. 1 Assessor's Map/Parcel �Q /C/f� ,,, ( `i Ir,�' art 1-,n Pr�_ �JA 4� {FEU Installer's Name,Address,and/Tel.No. tr Designer's Name,Address,and Tel.No. V ju Type of Building - ( ` r Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures :r Design Flow(min.required) /j G gpd Design flow provided „1 (J gpd Plan Date :�- -�.tT ( Number of sheets Revision Date Title Size of Septic Tank 1 .j c7U .� ,�1I u n Type of S.A.S. `j�j�� !��;( a,�ijj� L/ t•�: ,y Description of Soil t Nature of Repairs or Alterations(Answer when applicable) /�Q!i/-�,� 4;E 6e C '^-0 Date last inspected: tr Agreement: pe 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 D Compliance has been issued by this Bo of Heal Signe Date'".,f Application Approved by x Date 8 ? Application Disapproved by r Date for the following reasons . r Permit No. I C22. 1 -]7—L Date Issued -------------------- COMMONWEALTH OFMASSACHUSETTS-----------•----------•------------------ l BARNSTABLE,MASSACHUSETTS r Certificate of Compliance THIS IS TO CE ,TIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded! ) L Abandoned( )by /r../ at �ira %r1?+/.,,�„ fi.!/l j''yl,1.,�� has been constructed in accordance I with the provisions of Title 5 a`�n�d th�or Disposal System Construction Permit No.90Z 1-3?6 dated. Z, T/'I J jZ f Installer r,1 i, ., ,r, � (^,,,4 Designer #bedrooms Approved design flow gpd .` The issuance of this permits altnot be construed as a guarantee that the system wt ill func on as designed. Date � +!�, p�.J Inspector"^-- -_ _- - -- -- -- ------------------------- -- - -- ----- --- -- -- ------ -- - - -- -- ( ------------ No. 20 - ��p Y Fee IJIJ THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS MIsposat_6pstem Construction Permit Permission is hereby granted to Construct( `) Repair(t? ) Upgrade( ) Abandon( ) System located at r UV and as described in the above Application for Disposal System Construction Permit. The applicant recognizeed his/her duty to-comply with Title 5 and the following local provisions or special conditions. fp r Provided:Construction must be completed within three years of the date of this permit. / Date - Approved by ��� Town of Barnstable Regulatory Services Richard V. Scali, Interim Director M AM Public Health Division i639 rub" Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-8624644 Fax: 508-790-6304 Installer & Designer Certification Form Date: b�1 2 Sewage Permit# Assessor's Map\Parcel Designer: A4 Em �m, Installer: ,& " Address: (� �c/v� � .Address: O 7� V. pn r-J' 2u21 was issued a permit to install a (date) // (in ler I' (� f�,_Ay) septic system at ta hryow � ,i R.J D r used on a design drawn by (address) CO Y-P—A M",P,—r dated O j� designer) I certi at e s c system re erenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the' distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with.State& Local Regulations. Plan revision or certified as-built by designer to follow. Strip out(if required)was inspected and the soils were found satisfactory. I certify that the system referenced above was constructed in compliance with the terms of the M approval letters (if applicable) OF ., RARRi (Installer's Signature) J: ko. 1140 AI D(_Designer's Signature) (Affix ere) t PLEASE RETURN TO B STABLE PUBLIC HEALTH D bN. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:\Septic\Desigier Certification Form Rev 8-14-13.doc No. �W — "f V b f Fee I e THE COMMONWEALTH OF MASSACHUSETTS Entered in computer. Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 01ppYication for Migool *pztem Construction Permit Application for a Permit to Construct( )Repair( /f Upgrade( )Abandon( ) Complete System ❑Individual Components Location Address or Lot No. n /y/ y y� Owner's Name,Address d e. o., I�'grsG/11A , S Assessor's Map/Parcel Z 70 s9 vh is Installer's Name,Address,and Tel.No. Designer's Name,Address aAd Tel.No. Type of Building: (ay.�✓ o y� Dwelling No.of Bedrooms Lot Side sq. ft. Garbage Grinder Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow __3 C-) gallons per day. Calculated daily flow 3 33 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank /.5 O O Type of S.A.S. 60 S',o C 4 - !f le� Description of Soil; Nature of Repairs or Alterations(Answer when applicable) /'s T/e A" CS /q t� l e O .S% 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 C de nd not to place the system in operation until a Certifi- cate of Compliance has been is s Bo d of Signed sue Date _Application Approved by ^ _ Date J'1 Application Disapproved for the ollowing reasons Permit No. ud Z-W Date Issued d 'Si, No. qA w­- 0- Fee SD THE COMLNWEALTH OF M.ASSACHUSETTS Entered in computer Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE MASSACHUSETTS ;tpplication for 3k5pozal *psstem Cowaruction Permit Application for a Permit to Construct( )Repair(1-1/upgrade( )Abandon( ) 2rComplete System El Individual Components Location Address or Lot No Owner's Name,Address d-Tej,,.No. _;e Assessor's Map/Parcel installer's Name,Address,and Tel.No. Designer's Name,Address aud Tel.No. s- 0 Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder A-1 e. Other Type of Building P? F,5 No. of Persons Showers Cafeteria( Other Fixtures Design Flow- —gallons per day. Calculated daily flow Plan Date Number of sheets Revision Date gallons. Title Size of Septic Tank / ,S_00 -------Type of S.A.S. -S-0 064 4 45 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 se'wage disposal system in accordance with the provisions of Title 516f the Environmental Code-and not to place the system in operation until a Certifi- cate of Compliance has been issued Board of Hqalffh� Siened-z:f-' Date Application Approved,by 4,j- �DJte Application p _i�e licati6ii Disappro for lo&N�i1ni.rea'son!A1, Permit No. 9-go 2 - !10 k Date Issued Vd ------------------------ -------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS.IS TO CERTIFY, that the On-site Sewage Dispo al System Constructed Repaired Upgraded Abandoned by 42 e I—J S 7 at 6 2 e)ct,-, 4,1;,Adl Z/Z been constructed 17 accordance with the provisions of Title 5 and the for Disposal System Construction PermitNo. a00 YT dated 61 _A:2 Installer /-)JZ - /-/ (� "5--r- -Designer _00_�l a — ' ��c' >', The issuance of this permit shall not be construed as a guarantee that the syste w. I fu on as de .........— Date i U Inspector 4li C7- --------------------------------------- NO. 1)0 Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS mizpoal bpg;tem (C6n4truction Permit Permission is hereby granted to Construct Repair Upgrade grade Abandon System located at /-),02 q .0 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 must be completed within three years of the date of this t Date: / 3/6 3 Approved by t TOWN OF BARNSTABLEL LOCATION /�6 AR o cy/��A� a2 d SEWAGE # VILLAGE- ASSESSOR'S MAP & LOT 2 D - t INSTALLER'S NAME&PHONE NOo�� SEPTIC TANK CAPACITY LEACHING FACILITY: (type)rz SooC�� ,g E 2S (size)(3 NO.OF BEDROOMS /lie/:�f �n�� Se 4.tr � -��n Zany p�Co BUILDER OR OWNER �R ' PERMITDATE: /3�D COMPLIANCE DATE: 2,> ., 2- 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 CAR��� f 52 OR Health Complaints 04-Jun-02 Time: 10:00:00 AM Date: 6/3/2002 Complaint Number: 3454- Referred To: David Stanton Taken By: FLORENCE SMITH , Complaint Type: TITLE V SEWAGE Article X Detail: UNSANITARY CONDITIONS - Business Name: Number: 186 Street: Arrowhead Drive r " Village: HYANNIS- Assessors'Map-Parcel: 270148 - Actions Taken/Results: DS VISITED THE LOCATION, THE OWNER WAS NOT PRESENT, BUT THE LADY THERE , "v LET ME WALK OUT BACK TO LOOK'FOR , -SIGNS OF FAILURE. I DID NOT NOTICE ANY SIGNS OF SEPTIC'FAILURE, SO I , SPOKE WITH THE NEIGHBOR THAT , COMPLAINED, AND SHE TOOK ME OUT " BACK AND SHOWED,ME THE AREA. -, -THERE WERE SIGNS THAT WATER WAS PRESENT THERE AT ONE POINT, BUT SHE ' ..SAID HE FILLED IN THE AREA WITH DIRT. THE HOMEOWNER (JIM ELLIS) SHOWED UP, AND I SPOKE WITH HIM. HE TOOK ME OUT BACK AND SHOWED ME HIS SEPTIC LOCATION, AND SAID THERE WERE NO PROBLEMS WITH IT. HE SAID HE HAD' WASHED SOME OLD CARPETS OVER IN THE CORNER, AND THAT IS WHAT SHE' THOUGHT WAS SEPTIC WASTE. THERE ►a . Health Complaints 04-Jun-02 WAS ALSO SOME DOG DROPPINGS PRESENT AT THE LOCATION, SO I TOLD HIM TO KEEP THAT CLEAN, THAT COULD ALSO BE A CAUSE OF ODOR. I ALSO TOLD HIM NOT TO WASH HIS OLD CARPETS NEAR THAT CORNER, BECAUSE HE IS NOT ALLOWED TO LET THE WATER RUN ONTO HIS NEIGHBORS PROPERTY, AND HE SAID HE WON'T BE DOING IT AGAIN. JIM IS SELLING HIS HOUSE, SO IT WILL HAVE A TITLE V INSPECTION DONE ALSO. Investigation Date: 6/3/2002 Investigation Time: 3:00:00 PM I { 2 a j '�. ASSESSORS MAP : TEST HOLE LOGS NOTES: 2� PARCEL : �{'$ 1) THE INSTALLATION MUST BE IN SUBSTANTIAL COMPLIANCE WITH �LbU� FLOOD ZONE : SOIL EVALUATOR : - Il�i � R.s- GC THIS PLAN, 1995 MASSACHUSETTS TITLE V & TOWN OF I S _ � -�`/ �: ..ti;; l � BOARD OF HEALTH REGULATIONS. WITNESS : REFERENCE : l5�- LtLtiL DATE I-gar , j - �21/ � F pG - �`►`' I 1 7_( 2) THE INSTALLER SHALL VERIFY THE LOCATION OF UTILITIES, 2�� PERCOLATION RATE: SEWER INVERTS AND SEPTIC COMPONENTS PRIOR TO 1 wry,] L I LTJt �= �j ►°� i _ INSTALLATION. � — �t 30,Z � N -3 S j _ TH' I (.2.�f.Z.S � _��•ZTH-2 3) THIS PLAN SHALL BE USED FOR SEPTIC SYSTEM INSTALLATION l �': At p�5 ONLY, AND SHALL NOT BE USED FOR PROPERTY LINE '� 1,U�M IoY�. Z S�vny iOl' 11 I 4Na tc�`1 DETERMINATION /,/GT It GER:nF_ji� PL,4'r pLA.4 } v _ _Zb,5b 9 L H M 2 .� u l J 4) ALL PIPING TO BE 4" SCHEDULE 40 @ 1/8 "/ FOOT. (UNLESS /C)Y $ 50 IUY>Zb; " g �'( �` � SPECIFIED OTHERWISE) 3�, / L OCA T I ON MA P lid 1 �� _ -Z ` -� 36 /� Z7, 20 S) THE DESIGN OF THIS SYSTEM DOES NOT ALLOW FOR THE USE OF A MaDwm C 1 (Vy 54f4u) ^� C MED, S nAp GARBAGE DISPOSAL. C, S�V�� Z S/ j Z`�•Z� 2 `t, /U {off." z•S,� G/(. Zy.70 6) SEPTIC TANKS AND DISTRIBUTION BOXES (WHEN INSTALLED) MUST BE PLACED ON A MECHANICALLY COMPACTED BASE OR ON L3 7� 2 co a' co 0--cam A BASE OF 6"OF CRUSHED STONE. IZS E. 7 A-N 1v S�10 C _S/ u _ ,� 7 7 z i ,` L 9 2 -5 �� i�� z �y /y IY 7,0 x1sn c.6ssPooL s rG 86_pVM, E, , c - , �1 /tic C.l,2vUNr ofs�. iJp &-vj n/d 6-N �ru.��_ P�k._T�� ,, // -- 8.� 416 '^1 F Pj U47 �ALLs w f i nl / 'off ' - tttn fY SEPT I C SYSTEM DES I GN 4� � w7L OJI>7- /t V / JOFP,4et&5Eo ��/��' lo�FLOW ESTIMATE LG AcH C144mid?s T6 P6 H�'Zo, _✓BEDROOMS AT GAL/DAY/BEDROOM ZU GAL/DAY ff' / • / 5 Ff: V,-A 7 310 Cm lS.111 �2l14; _- SEPTIC TANK �^ L ---/ _� 7U �} L L o 1N rJ Y�1lJ. LI✓AL}f i 1VI� TO /3 E 4,/ Z _ 13tLoW 3 GAL/DAY x 2 DAYS ," GAL 'e- ►J _ pftUo USE , GALLON SEPTIC TANK 'ISi- P/�it,1 c1e c� j .SOIL ABSORPTION SYSTEM _� � _� _. {t� I7,.,, � �Q.tv��� �:�� ^/�:..± ,Jla/ P�_��f}c'' �,�/�• '"� �J,G`:i'" � � _ ..,a,,.,.n...... ss_. I...i� R � Zs �U �. Z ttEI�4 AREA: BOTTOM AREA:_ - — Z Z-Z coI \ zz� l } \ � ._- —Zy SEPTIC S Y � ��v ,�� ��� STEM SECTION C� r; ill - �2 Ey 6,, l9 1�j S�Pr �Tr N�t - p'Do u 6te kkc5{wd S{�( �h1Gt� MAWJ OF I%o�^�� GAL 25 / D-BOX 2�. �b - -- I� 6L V ZZ Tc� vkT70d 3b 6 Lcet FY., SEPT I C TANK fvr level„ ) 3, ESuME�) 4 �Z Dovr3c.� FXIS77 N(� 1 l� 2 a} Iti'�4SN - 3s ZS X 13 � ----� SITE AND SEWAGE PLAN L•0 C A T I ON : PREPARED OR �L.( S`�D�? jL ,/1. P DARREN M. MEYER, R.S. SCALE DATE _--- --%'I 43 VINE STREET -- W I L1t,.� I 'ZS�BS f_ DUXBURY, MA 02332 L �tC - Nth ruTN R P- r � R S dl-7C 77vrJ rvy St✓I c DATE HEALTH AGENT (781 ) 585-0293 �sv� 360 - 331/ ASSESSORS MAP: TEST HOL- LOGS NOTES: 2� PARCEL: Lzt$ a A 1) THE INSTALLATION MUST BE IN SUBSTANTIAL COMPLIANCE WITH FLOOD'ZONE: X SO I L EVALUATOR - IDPCe•EQ M . MeyEp,,RS, CSC THIS PLAN, 1995 MASSACHUSETTS TITLE V & TOWN OF s WITNESS : A� BOARD OF HEALTH REGULATIONS. REFERENCE: 5> - 44tL DATE: PsL<,�OST 12,)2�00 42) THE INSTALLER SHALL VERIFY THE LOCATION OF UTILITIES, PERCOLATION RATE: �d SEWER INVERTS AND SEPTIC COMPONENTS PRIOR TO &,AS5 1.. �jO 11. L.17`t'K-=0.,2,q �. INSTALLATION. 3 S 6+i TH- I �,2�.Z5 TH-2 3) TM PLAN SHALL BE USED FOR SEPTIC SYSTEM INSTALLATION ONLY, AND SHALL .NOT BE USED FOR PROPERTY LINE �0 DETERMINATION(/\/0?' A- G E fc Tt Fl t3)� Pt�Ac t la's 4) ALL PIPING TO BE 4 40 SCHEDULE" @ 1/8 "/ FOOT. (UNLESS SPECIFIED OTHERWISE) LOCATION MAP >� S� Ir Z NIA 5) THE DESIGN OF THIS SYSTEM DOES NOT ALLOW FOR THE USE OF A C GARBAGE DISPOSAL. Z•s!y 2-q-2x" 6) SEPTIC TANKS AND DISTRIBUTION BOXES (WHEN INSTALLED) t0 1-Z3 1� MUST BE PLACED ON A MECHANICALLY COMPACTED BASE OR ON COARSE Z -7/ 1 A BASE OF 6"OF CRUSHED STONE. 7� XtS ._C-ESs}'ooL �v C�2auNbwl� +af3& --- g% S E P T I t. SYSTEM DESIGN A0j Ab—V-4LeJ1W4CS- IWM. . 71 R-E V gte-- FLOW EA I MATE '� �? c�1�- 7 , zc BE)ROOMS AT I l0 GAL/DAY/BEDROOM - GAL/DAY 12C'� X15171 SEPTIC TANK { / r .,...• , ,� GIN vP ,/ 3 �; ( S GAL/DAY x 2 DAYS - 6�VD. GAL 30' µ� USE j,' } GALLON SEPT I C TANK -A4- C-W57 S 30 SOIL A3SORPTION SYSTEM f 7 '>p o � � ` ��/� , �� ,� ,y,..�j.`a..�J /✓Iy�G't'T �+� =j r�j �:I.L�""'%•`_ 'r,�✓�._ _ - __ __ _ _ _ _ ... I DE AREA 2-5 z+ z u 2 v n '�► b zs (N BOTTOM AREA: 25 k 12.- k 0.2 _ 2 2 S�Z I � o 33r/ > SEPTIC: SYSTEM SECTION i P " Z� T° go �9 �y G l,' / 18 22! wAn 1511NC�� f3FE Z51►� Q Do�u 6 oWaS S{4e 1� setZo M 13�0� j b �SOO GAL 2$',�l Gtl2�r�As� 2 y� � 2�, �b C� I� �7 � t� ���, ° '(oP OF rd� 3b•6g liter F�, EPT I C TANK 3 nv� / `z ovt3t. . l���w � � r � 5r �----- ZS X13 -1�077vA-t off- l�S i NO(�° ' .�..w�..�-/? Z'' cw W(ZXAA N SITE AND SEWAGE PLAN 3 E - LOCATION : 1140 1?� ' ✓�� � OPPS�S ' PREPARED FOR : GILC. LC.! DARREN M. MEYER, R.S. SCALE 0 a s lJ�vY : 43 VIN E STREET DATE: tl 02- aim r-i eo Pw-t I bs In- DUXBURY, MA 02332 T� Eti�����tNle. �( p.G(.,�; �ENf� �TI� R� 1Q-12.�1 } PI,S OG7 DATE HEALTH AGENT (781) 585-0293 S f. J Sv