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No.! �( CX S� CJ ' Feesa� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: _j� L Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ZippYication for Miquar *pgtem Construction Vermit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) O Complete System ❑Individual Components Location Address or Lo�t vo. 2 OOS ier's Name Address anj Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Te.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 S No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow - gallons per day. Calculated daily flow 3 S gallons. Plan Date l o`Z D d Number of sheets Revision Date Title Size of Septic Tank X /s T l o Type of S.A.S s o ® ,d 'k 2r Description of Soil Nature of Repairs or Alterations(Answer when a is ble) _S d !> C d itJ O` 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 Certifi- cate of Compliance has been i by this Bo of He�- Signed Date Application Approved by Date / Application Disapproved for the following reasons Permit No. Date Issued 17D �u No Fee A-L P Entered in computer: THE COMMONWEALTH OF MASSACHUSETTS _LZ Yes PUBLIC-HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Application for )Di!5po!5a[ *p.5tem Construction Permit Application Phc,ati n for a Permit to Construct Repair Upgrade Abandon El Complete System El Individual Components Location Address or L Owner's Name Address and Tel.No. Logo..00 ) Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 9 /1 IV L 3e 2 F 1-Y Type of Building: - 3 Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder Other Type of Building S No. of Persons Showers Cafeteria( Other Fixtures Design Flow 73 gallons per day. Calculated daily flow 3 gallons. Number of sheets Plan Date Revision Date Title Size of Septic Tank i s J' -2—Type of S.A.S�.Z� Description of Soil Nature of Repairs or Alterations(Answer when 7-1jibble) lvF /_D 13 --v 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 Certifi- catelo"f Compliance has been issued by this Board-of Health-r Signed, Date 1j/,,`4 Z-gft4�1,1 /4-4— Application Approved by )OLA'AA, 0 1'. Date Application Disapproved for the following reasons Permit No.',, anl( ti Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed Repaired Upgraded Abandoned by T at 5 7/b47 /_X1 Y/ fi� has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.(904) `5 8' dated Installer 4 /2 Designer Z)A 4 'F— C- _V The issuance of this permit shall not be construed as a guarantee that the sys(,eP'jmn W-14.1kfut ic t' as d — "ied.ion s Date Inspector ---------------------------------------- No. A00& Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS lwiqoal *P!9tem Construction Permit A Permission is hereby granted to Construct Repairs V-� d Upgrade an n 47 System located at 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 permit. Date: l a a IOa Approved by. 1 TOWN OF BARNSTABLE � LOCATION 5,�,� �a21 . / / SEWAGE #Za®� VILLAGE ALL-� "� ``r ASSESSOR'S MAP & LOT y 1�d� i INSTALLER'S NAME&PHONE NO. 2 SEPTIC:TANK)CAPACITY C.x I s r o LEACHING FACILITY: (type)Ca.)saU e lg M c5 z S (size JV 1 13� l J_ NO.OF BEDROOMS i BUILDER OR OWNER PERMITDATE: !l 2 COMPLIANCE DATE: 1 -2 oA 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 g. 6D j I � ` '] �30Y � I o No. ! Z Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS " Zippfication for Migpotaf *p!tem Construction Permit (1P Application for a Permit to Construct( )Repair( )Upgrade(V)Abandon( ) elcomplete System El Individual Components Location Address or Lot No. wner's Name,Address and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Drfaxolll_l Ca116111:" / Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder eeo Other Type of Building Gfi No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow /ZZ gallons per day. Calculated daily flow 31?eo gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank /S—®D Type of S.A.S. iY/�i/ i'S Description of Soil Nature of Repairs or Alterations(Answer when applicable) ]~/�P_ .—ZZev 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 Certifi- cate of Compliance has been issued b this Bo of /Z���j Signed —Date Application Approved by Date en Application Disapproved fort folio g reasons Permit No. _ 3 Date Issued No. t- 1 Fee __7`�_© THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE. MASSACHUSETTS ' 01pprication for Zigaar *p.5tem Congtruction Permit 0 Application for a Permit to Construct( )Repair( )Upgrade( V)/Abandon( ) M Complete System ❑Individual Components Location Address or Lot No. b /� �c wner's Name,Address and Tel.No. Assessor's Map/Parcel (� ���/•� ` Installer's Name,Address,and Tel.No. Designer's Name,Address sand Tel.No. ,,✓ Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder(4 - Other Type of Building. No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow /Z gallons per day. Calculated daily flow 3 /) gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. WKr,1,,r Xz ", Description of Soil i Nature of Repairs or Alterations(Answer when applicable) 4L L�'rll,i?�P i Date last inspected: Agreement: The t` 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 Gertifi cate'of Compliance has been issued by this Bo , f He'lt Signed r9 %? Date i Application Approved by' Date �--�— Application Disapproved for thWollom4 reasons V / Y Permit No. Y f�e Date Issued - - ——————— THE COMMONWEALTH OF MASSACHUSETTS G ` BARNSTABLE, MASSACHUSETTS 'ti ti Certificate of (tompriance f THIS IS TO CERTIFY that the On-site Sewage Disposal System Constructed( )Repaired O°Upgraded,( l/� Abandoned( )-by, _ �i' _ _ A''_5 at U L ? ° r' /,-�✓ has been constructed in accordance with the provisions of Title 5 and the for' isposal System Construction Permit No. - L dated Installer f i 4,,& Designer l The issuance of this permit shall not be construed as a guarantee that the system will functi'°n as designed. Date - - Inspector Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Zigooal *pgtem Conztruc .ion Permit Permission is hereby granted to Construct( )Repair( )Upgrade( ✓ Abandon( ) System located at 1 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. i Provided Construction must be completed within three years of the date of this permit. f Date: l/ rC/ 7 Approved by ° ti .a z � t' ''ax r�;, �3r? m ?zap '3Z� sr4 � ux4 e, :_ p» z a MK f `a YS i4 y S.y r NOTICE: This Form=Is To Be Used For the Repair Of Failed Septic Systems Only. { CERTIFICATION OF SKETCH AND APPLICATION FOR DISPOSAL { WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS) 1. hereby certify that the application for disposal works kkl���, construction permit signed by me dated ���jl�� concerning the �� property located at Jam' � rry / / , meets all of T following criteria: i �' h re are no wetlands�,tiit. ' er o hm�00 le... Jt he �r�co_ed Sepnc system �� Ile,., ale n0 DIlV3te%ve1Swahln 1JO �2PI OI Cii� �TODOS:.d SeD_tip SvSi2:T1 T ae OOS:.;ti'ed groundwaier:able :s i- -'CC Or 2—ZIi:'MO+.'v' ' ^ a _. .:1;r_ � he OOl?Cnl 'Jt'..e 'eaC:1.T= `at.. i :1eI 'S -10 ;ncreaSe :Il -ow3nQ'Cr Ca3n? iIl _ : J_..=u �r�n - �I I 7 ' SIGNED : DATE: LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER [Attach asketch plan of the proposed system.Also if the licensed installer posesses a certified plot plan. this plan should be submitted]. 01 M. Nil �z� Z '=;"' _ yy-_.S .>+r`' 'Y.. .•t- .'A ? _ r�•T _ ..a�`:', tc ,x,,. -.,.t'.�_ ,a,. s x��. ;.. _ u x ,:,. '.'�.:.. �'Zz ___�"'`^• �;y "A'�''`' )�:.�i'E fear . s a": c'�d i' Q h28tdif6td ty,a:.ew xr f�^��k ;u r-�' .-�f $,t u, :� ��!..�.r � � -,`4 rk4� ��''`Fsc ���. �rdc,.��,� � a:��`�.� � �ate'..•� �_;�� .�.� - u "�..� ,iz �y, :����•�rR+�r:� '�^�^. '1�,��r . ��� �� '..'�''� N�, '� .F.e e�� �e,. ��`�' .ems�...�.ty,L t�"�i -"��'tF c�'�+^.Y�. �, ► OD c W L Q�guS s�� I II II D W Lt,l,i v-L lmAb Q ' TOWN OF�B/ARN/STnABLLE LOCATION �v �7` �ii2,9 �2// .�J !cd/ SEWAGE VI:I•SAGE ASSESSOR'S MAP & LOT -2 INSTALLER'S NAME&PHONE NO. f SEPTIC TANK CAPACITY e x IS 7- LEACHING FACILITY: (type) (-W,9 -s cS .4,e S (size V 1,3 le NO. OF BEDROOMS " BUILDER OR OWNER PERMITDATE: OMPLIANCE DATE: -.257—o; Separation Distance Between-the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply`.dell and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Ed W wetlands t Edge of etland and Leaching Facility(If any etland exist within 300 feet of leaching facility) Feet Furnished by cam � � � � � ,�� � � ���> � � -----�. c� � � � � �N o� o ��, �.. � b I 3 - a k � (' ! t � � � ', � ,, ,� � a � �� � , ,, ,, TQWN OFBARNS ABLE LOCATION ' 5 �v^�� ear. 11y1i", SEWAGE # VILLAGE ASSESSOR'S MAP & LOT 2 _-Dgd INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 00 tl/b LEACHING FACILITY: (type) �tck- '0 (size) NO.OF BEDROOMS BUILDER OR�WNE L / PERMTTDATE: —g,--q `�7 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist . within 300 feet of leaching facility) Feet Furnished by AI 17 , 8 I 31 x Rc.ar 0-f Az aG 0� HovsE Q A3 - q7' 1.y B3 ` y4 ' �. Ay = Sep ' Sq o y$AS - 7S C3S = G°� LOCATION SIWAGE-:"PERMIT NO. VILLAGE I N S T A LLER'S NAME i ADDRESS B U I L D E R OR OWN ER Lis DATE PERMIT ISSUED �� � DAT E COMPLIANCE ISSUED 4 s ` THE COMMONWEALTH OF MASSACHUSETTS —BOAR® F HEAL l...Q. -------------OF.... _.... - ApplirFation for 11ispoa al Works Tonotru rtion Vanfit Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal System at: -� ....(P. �#.___.f'r. _. ...-h!Iv-----• --------------- ----- ---- --------------..........----...--------------- � dress or Lot No. .......................................... .......-•---............................... ---•^-------•--................................. a F. -.a/A.a6O..fOj 7<.... ........................................... Address...-....................................... Installer Address Type of Buildin Size Lot....................0.......Sq. feet U Dwelling No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria Q' Other fixtures -------------------------------- . w Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter________--_--_. Depth................ 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...................-.................... aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water--_---.____-_-__-_-___-- 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ---------- ---------- 0 Description of Soil..... ....... U -----------------------•---------------....----•----•----------------------•---....------------------•---------------------•--------------------------------------------•---------------•--------------- w . _ UNature of Repairs or Alterations—Answer when applicable_____ �/l� ./,P �/ ______ __ _. _---_.--._-----------. -----------------------------------•-------•----------------------------------------.......--•--------------->`. �� .------. t ....................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TH TJLE 5 of the State Sanitary Code—Pe undersigned further agrees not to place the system in operation until a Certifi>forol iance has be is the�oard o health. Date Application Approved . ...... ..... ...... ...............:. Date Application Disapprove easons--------------------------------------------------------•----------------------------------------------------- .........-•---•......................•--. •--------------•--------- -•---------------............................................................... Date PermitNo......................................................... Issued....................................................... Date - ------------------ -- ---- - - - ------- - ------ No................ --..... . ,, � ` Fps .... ......�� -- ..... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Application for DiopooFal Workii Tonitrur#ion rnmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: __ ••f a#� jt� .1, 'arm�' y=a j- ... ....... sr - rr ..................................... ocation•Address or Lot No. t ress a ..... � .... �` .Y f - Y ..,Luf°!//1, .>_.........•.... ........................................ Ins a ler Address UType of Building Size Lot............................Sq. feet I—. Dwelling o. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) d 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....................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........................................ W Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 0.4 ----------------- D Description of Soil......-�.r_ E----------------- - �'s_ -z ,�;-�'-•----•-•-•---•------•----•---•------------•-•---------•-------...--------...-•------------•--- xk„I r , - , ate:•• -------------- W U Nature of Repairs or Alterations—Answer when applicable �^' f!!' .. , U P PP ''/� - ------------------------------------------------•--•---•--••••--•••••-•---... �' e ''" Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code—'The undersigned further agrees not to place the system in operation.until a Certificate of Compliance has beer issued by the board of health. Signed. ,• ` r -•----- � k' �`' :may «.�- ---:fT `:"�` -f-!- Dat..+�_.fF—a`_ylf Application Approved By-••••------••-•---------•--- -----------------•---•-----.-...- e Date Application Disapproved for the following reasons------------------------•---------•-•-----...--------------------------------•-----------------------...------._ ........----•••••--.......•----••••-----------------•----••••---•-•--••---....-•---....-•--••-•...--••--•------------------•-••-•-----------------••-•-•-----------------•------------ ................. . Date PermitNo...................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH K OF ..r �X ° ...................... .:. ., � ! • Tatifiratr of TompliFanrr THIS IS TO CERTIFY, That the yn Individual Sewage Disposal System constructed ( ) or Repaired by.....'•'V`p~ e? �,''t. '�. �.......�e' ........'ram'-'--- --�A-- ------ ..... jnst ',�' p .E y .. a - has been installed in accordance with the provisions of TITLE # 5of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......................................... dated-.............---------------................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTR E® AS A GUARANTEE THAT THE SYSTEM hall NCTION SATISFACTORY. DATE.....9 71 .....................................................--- Inspector.. . THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH - �`"" N ......................... FEE.../5t..__...... atsposal orko Tomitrurt ion rqmit , Permission is hereby granted.......I=f ""t r A51— ------.... .--•..............•-•---•--- to Construct. ( ) or Repair ( �)„�CnjIndividual Sewa e Di osal yst ! at No...--•--- � ,�"� f g , --- - �� �1 '..e ;��_.-'-; � 6��t ._... ram% d Street as shown on the af(ppliq2tion for Disposal Works Construction Permit- .................... Dated.......................................... �., ��� >-------------------------------------------- Board of Health DATE............................................................................ .- , FORM 1255 A. M. SULKIN, INC., BOSTON �0 ASSESSORS MAP : 2� 1 -_- - - - --- --- - __ _ _ -- -_---- ----_-- - - --_- - --- --- NOTES: ---- �� �Lw T E S T � H 0 L E LOGS------- - - - - - - PARCEL : /�/�,/�/ _l 1) THE INSTALLATION MUST BE IN SUBSTANTIAL COMPLIANCE WITH r vv FLOOD ZONE : L SO I L EVALUA OR :�A��� 1�' �`� � IS PLAN, 1995 MASSACHUSETTS TITLE V & TOWN OF l WITNESS : (u�A S BOARD OF HEALTH REGULATIONS. REFERENCE: �- �� 2� DATE: m 2 THE INSTALLER SHALL VERIFY THE LOCATION OF UTILITIES, �Q�• �� / PERCOLATION RATE: L 'L�crJ f�(�K SEWER INVERTS AND SEPTIC COMPONENTS PRIOR TO �R INSTALLATION. TH- I C-L.Zf TH-2 3) THIS PLAN SHALL BE USED FOR SEPTIC SYSTEM INSTALLATION 1 D ONLY, AND SHALL NOT BE USED FOR PROPERTY LINE I Z, I" 1 L14S,2 0 DETERMINATION. 26 r 4) ALL PIPING TO BE 4" SCHEDULE 40 @ 1/8 "/ FOOT. (UNLESS � A � (0y�31 SPECIFIED OTHERWISE) S�� L q7 37, LOCATION MAP Cr �T�S• L04m S !v � 5) THE DESIGN OF THIS SYSTEM DOES NOT ALLOW FOR THE USE OF A 1b y GARBAGE DISPOSAL. 4$ 6) SEPTIC TANKS AND DISTRIBUTION BOXES (WHEN INSTALLED) Gf M S_��� �pY(Z f� � ,53 MUST BE PLACED ON A MECHANICALLY COMPACTED BASE OR ON ( �� '� t� _ Z 2 p A BASE OF 6"OF CRUSHED STONE. I Dcul VL t i s we 'l� I _ . � c M �o�e C .�ptUM 2 7l 7, GKI L��C�IT 7� �3c up 5'-de UGn w�°�, �4., 7� o -t Lrrj�am., TiTLT- IUa 0/3S, GjG� 4) �r� ND�1Zon�S M���-y��w_�L1'1-I'�1��__.t=ov�ll.___/_ts��..._. SEPTIC SYSTEM DESIGN ) A16 c �cos -'ar FLOW ESTIMATE f of i,�F wFLc..5 w1/n/ l e 6r 3 BEDROOMS AT 110 GAL/DAY/BEDROOM - GAL/DAY 11)�A � � __, _1 SEPTIC TANK __-----' GAL/DAY x 2 DAYS - � GAL USE 00-D GALLON SEPTIC TANK —L-Ct S77 A) IZc.?LkL&- W/ I)Sov q� L-0.tj G SOIL ABSORPTION SYSTEM uN JE7LS?-LETq. R , )u'otn Pke-cAST (14 V �,�r+of �w � ���(G� S �� DARR��sq 4 S-� � Q 1I S 10 s zsA-x 1-' v 2' ��01 ' o M. U SIDE AREA: r2 -��13)Z'� XZ �( 0,7� - f' � Z,�g No. 40 BOTTOM AREA: ZSx 13 x O.7y — Zc�p FG/STE¢ o SAN/TARIPN JJ SEPT I�C SYSTEM SECTION ►-3,2S 1 , li zi �: 7 p ZT— fiUt�=53. 1 � 1 1� ' � ��S�ti � �� �XISTI►� 1° 14. p_g°" �,. �'36 MAx l.2 ` 1 j 47.0r 1s' 2 - /g D���ole r�us�e S >7e �-Bo 4o �v� ✓ I I _ GAL �S, � wQ{�x �- �c1U 1w7TPt'LE4 Cb SEPTIC TANK le�elresS ? r 4320 S7-� 20 ( 21� U0U W/ 1 DrS64Ai��ES See 6 w — SITE AND SEWAGE PLAN LOCATION : 644 S1YL vJ � Ia, kc) OL 15 AAA- PREPARED FOR ce�JEF, 0 SCALE: DARREN M. MEYER, R.S. JJ �Z 43 VINE STREET DATE' — DUXBURY, MA 02332 DATE HEALTH AGENT (781) 585-0293 W Z