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HomeMy WebLinkAbout0100 WATERFIELD ROAD - Health 4-05' WATERFIELD ROAD, OSTERVILLE A-119-023 11 �r fl i o i o o 0 o TOWN OF BARNSTABLE ✓ LOCATION AlUl 4id?7 .......1`..... o'r. SEWAGE # Zed ,?4Z VILLAGE (I5 'rU1/l� ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. �Brt ld / llrs 7 7/ SEPTIC TANK CAPACITY LEACHING FACILITY: (type) '���l a.� ��/� (size) /D Ye$a,Y."o NO. OF BEDROOMS 3 BUILDER OR 6,w55 PERMITDATE: s/ O® COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility s 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 a/ within 300 feet of leaching facility) �(6 Feet Furnished by 6 C�' ,dive tar (l/ .r; . s�„ '�M. - a+a y3 ' ,., y9 b �s� Y� .. t . �'✓��1� . ;0� r� �o 1 .� No. 1�7 Fee'._23_ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: es PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS - ZIppYication for Mie;pozat *p5tem Congtructton Vermit Application for'a Permit to Construct( )Repair( ✓)Upgrade( )Abandon( ) O Complete System MIndividual Components Location Address or Lot No. Owner's Name,Address and Tel.No. Assessor's Map/Parcel 03le 101le j' Installer's Name,Address,and Tel.No. /�y� Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder(A-6le Other Type of Building w/ .le_oe�e No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow 3<✓�� gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank 1eea F Type of S.A.S. 'l0 If/ i��`1t7jli/ Description of Soil X 3,0irZ/ 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 Certifi- cate of Compliance has been issued this ard f Health. / Signed 4 Date Application Approved by —Date "l Application Disapproved or the following reasons Permit No. Date Issued `" 2�� I - TOWN OF BARNSTABLE LOCATION 1 � lfi>!?1� �``lr'��jp� SEWAGE # D zGY�IJ � VILLAGE dS�`c'y't/i��� ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. — S TIC.TANK CAPACITY /ODD S iR EP i LEACHING FACILITY: (type) ��[. �i►�_��� (size) /D 2 3d' Y-2 , NO. OF BEDROOMS 3 BUILDER OR� W�N GrOS 5 + i PERMIT DATE: s —/q O® COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the$ottom of Leaching Facility S� Feet - I Private Water Supply Well and Leaching Facility (If any wells exist ilpf on,site or within 200 feet of leaching facility) Feet I Edge of-Wetland and Leaching Facility (If any wetlands exist Within 300 feet of leaching facility) /V Feet ;.Furnished by � - - z: 000, i ass 9 Sh I I • T %oil . `�r G��err� �i/�9' No. r �Q — Fee �.. THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: es PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE S MASSACHUSETTS. 0(pprication for Migpomf *pztem Cottgtruction Permit Application for a Permit to Construct( )Repair( ✓)Upgrade( )Abandon( ) El Complete System [M Individual Components Location Address or Lot No. r01 Owner's Name,Address and Tel.No. Assessor's Map/Parcel lee 03 L,ol Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. N;��t f�Go i Of Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( � Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow �//� gallons per day. Calculated daily flow 3 3W gallons. Plan Date Number of sheets Revision'Date Title Size of Septic Tank /���'W/ , )_:111A l Type of S.A.S. V` ", h�l !I �/lC���`Yo `►!c 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 ;t 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 �4thBqar�drfealth. Signed Date Application Approved by `. Date O � d Application Disapproved or the following reasons Permit No. .0;W1 .- d 9a Date Issued •-,7 ------------------------- r THE COMMONWEALTH OF MASSACHUSETTS //Q— Z 3 BARNSTABLE, MASSACHUSETTS.. f Certificate of ContPrfance THIS IS TO CER , that the On-site Sewage Disposal System Constructed( )Repaired ( )Upgraded( ) Abandoned )by at lee �4 r l� IQ f�$ !�%,�' has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit Nt700y" dated ^ Installer Designer The issuance of this �rmit shall not be construed as a guarantee that the syst11 fur_ction as designed Date_ -� Inspector . s � THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Zigpoar Opotem Com6truction Permit Permission is hereby gr d to Construct( )Rep pgrade( )Abandon,( ) 'Y System located °31.{4 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. :z r. Provided:Construction must be completed within three years of the date of this it. Date: - Z ��-�� Approved b � � i '✓���t 11�6199 ' NOTICE: This Form Is To Be-Used For the Repair Of.Failed Se_."tic Systems Only. - CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PULNffr(WITHOUT DESIGNED PLANS) Aherehy certify that the application for disposal works construction permit signed by me dated r7/1 ®� concer=2 the property located at l®6" ��L � /�21� 05>ef,//A&ees ail of the following criteria: - l i� I he wile:.' sysem is:toner a :o a resdentiai dweiling oniv. i ue:a are ao c;=e:cai,or'ousness rises assecated with the dwelling. Lae soli is ciassife as C A.;S I and he ce=oiaccn-ate s less than or quaff e : mutes xr Wci i net e are no wetlands within '00 'err-off-:e,rotxsed s=vc system here are no prvate we:L within :-40 'ee:of he promse .eruc vszem here is no incense in flow andier .nan,P'in lse prepcser ' ?here are no var =rcauesed or her red . The bottom of the proposed leaching hciiity will not be located less than five feet above the ma..dmum adjusted;mmdwater=ie--Ie raticm ,A =the roundware.abie a=g the?::mptcr method when applicable) 6 Y the S.A.S. will be located with 210 fed;of 3nv vegetated wetlands, the oottotn of the rcposec 5 p . leaching facility will not be located less than fourteen(14)feet above the maximurn adjusted groundwater table elevation, Please complete the following: A) Top of Ground Surffaa IIrration(using GIS information). _ !' B) G.W.Elevation y the MAX Aigh G.W.Adjustment. DIFFERENCE BETWEEN A and B SIGNED: DATE: U� 7lp (Skctd ympand plan of e2em(m bad]- lop O p . leQ �%.t�li1 ' 0 a ALBEIT J. SCHULZ ATTORNEY AT LAW WILLIAM CHARLES PLACE 7 PARKER ROAD OSTERVILLE, MASSACHUSETTS 02655-2034 TELEPHONE(508)428-0650 FACSIMILE(508)420-1536 July 20, 1999 Thomas A. McKean, Director of Public Health Town of Barnstable 367 Main Street Hyannis, MA 02601 Re: Rotstein and Aronson vs. Birch and Chase 100 Waterfield Road, Osterville,MA Dear Tom: Confirming our telephone conversation-of yesterday concerning the above matter, I enclose herewith a copy of an Agreement for Judgment executed by my clients Koby A. Rotstein and Tina Aronson and their tenants' Mark Birch and Jacqueline Chase in connection with the above captioned case. Please note the provisions of Paragraph 8 relating to your letter to my client dated-July. 11, 1.999. I understand that since the parties have agreed to the resolution of the matters set forth in your letter of July 13, 11999, your office does not object to completion after the tenants vacate on September 22, 1999. If have not accurately recounted our conversation please contact me. Thank you for your attention and cooperation in connection with this matter. Sincerel , C Albert.L Sch z. AJS/mm :_ Encl s cc: .KobyA.,Rotstein,and Tina Aronson Z 203 499 020 US Postal Service Receipt for Certified Mail No Insurance Coverage Provided. Do not use fQr International Mail(See reverse) to Sygptts&oNu r P Otfice fate,&'.aw 9dde Postage $ Certified Fee Special Delivery Fee Restricted Delivery Fee L Return Receipt Showing to Whom&Date Delivered .Q Return Receipt Showing to Whom, Q Date,&Addressee's Address 0 TOTAL Postage&Fees $ CO Postmark or Date u_ a r Stick postage stamps to article to cover First-Class postage,certified mail fee,and charges for any selected optional services(See front). 1. If you want this receipt postmarked,stick the gummed stub to the right of the return address leavingthe receipt attached and resent the article at a post office service P P P m window or hand it to your rural carrier(no extra charge). 2. If you do not want this receipt postmarked,stick the gummed stub to the right of the m return address of the article,date,detach,and retain the receipt,and mail the article. cc io 3. If you want a return receipt,write the certified mail number and your name and address M on a return receipt card,Form 3811,and attach it to the front of the article by means of the gummed ends if space permits. Otherwise,affix to back of article)Endorse front of article a RETURN RECEIPT REQUESTED adjacent to the number. Q 4. If you want delivery restricted to the addressee, or to an authorized agent of the C addressee,endorse RESTRICTED DELIVERY on the front of the article. M 5. Enter fees for the services requested in the appropriate spaces on the front of this receipt. If return receipt is requested,check the applicable blocks in item 1 of Form 3811. ti 6. Save this receipt and present it if you make an inquiry. 1 o25s5-s7-B-o145 a r I I aFT"E'er• Town of Barnstable Department of Health, Safety, and Environmental Services * 3AMSTABLE. 1639. ,0� Public Health. Division A'ED'AArA P.O. Box 534, Hyannis MA 02601 Office: 508-862-4644 Thomas A.McKean,RS,CHO FAX: 508-790-6304 Director of Public Health July 13, 1999 Koby Rotstein & Tina Aronson 45 Fenwick Road Waban, MA 02168 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.00, STATE SANITARY CODE II, MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE RENTAL ORDINANCE,ARTICLE 51 The property owned by you located at 100 Waterfield Road, Osterville, was inspected on July 8, 1999 by Glen Harrington, R.S. Health Inspector for the Town of Barnstable, because of a complaint. The following violations of 105 CMR 410.00, State Sanitary Code II, Minimum Standards of Fitness for Human Habitation were observed: 410.100: Hole in bottom of kitchen cabinet was observed. Suspected entry point for pests (open to crawl space below.) 410.351: Dishwasher(provided by owner) not operable. 410.351: Master bathtub faucet was observed to be leaking. 410.351: Flu to fireplace is not present. Bricks on hearth are broken and loose. 410.452: Water meter pit located in walkway has broken frame. Cover is unsafe as. it is starting to fall in. 410.452: Wooden steps to master bedroom are rotted and poorly supported. 410.482: Smoke detector'In basement is not operating. 410.500: Wall and frame around sliding glass door are rotted. Threshhold under sliding glass door is rotted as to not allow door to slide properly. 410.508: Water damage to wall above tub enclosure was observed. rotstein/wp/q/Is 410.551: Window screens are not tight fitting in master bedroom and living room. You are directed to correct these violations of 410.351 (dishwasher) and 410.452 (steps) within twenty-four(24) hours of receipt of this notice. You are also directed to correct the remaining above listed violations within five (5) days of receipt of this notice. You may request a hearing if written petition requesting same is received by the Board of Health within seven (7) days after the date order is received. However, these violations must be corrected regardless of any request for a hearing. Please be advised that failure to comply with an order could result in a fine of not more than $500. Each separate day's failure to comply with an order shall constitute a separate violation. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean Director of Public Health rotstein/wp/q/Is tM�roe The Town of Barnstable • -_ Health Department 367 Main Street, Hyannis, MA 02601 riva AY�' Office 508-790-6265 Thomas A.McKean FAX 50b.j7pe344 J v 99 Director of Public Health 94 Wa.(�� /tom 0 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.00, STATE SANITARY CODE II, MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION The property owned by you located at I 41e(d RaP US�'was vo t•�c��f-er inspected. on I,-tY F, 1591 RAW by,a (I �Favv��g r,, 2• S, Health Inspector for the Town of Barnstable, because of a complaint. The following violations of 105 CMR 410.00, State Sanitary Code II, Minimum Standards of Fitness for Human Habitation were observed: �d 57 2 ` to.10o; No(e. kk,, al V�'Fvl. C r�.a rt G-r-) 0 4,P q tE� o C o .�( S cud (ae.eirw�. 3-Sl ls �wa.skx�- Cr-w-- .byoz.v,,-1 k.o1- 66- i-1 l y a 3 l AA a3 k,, CL 6 d UaMA,LOGSQ v l((U, 1S'I CdA Gk.vCSkR An.& Sierl)aY)Wf q� You are directed to correct ftkam violations within twenty- U n� V four (24) hours of receipt of this notice. t You are also directed to correct IA--A- within i"v (�q—y / s of receipt of this notice. You may request a hearing if written petition requesting same is received by the Board of Health within seven (7) days after the date order is received. However, these violations must be corrected regardless of any request for a hearing. Please be advised that failure to comply with an order could result in a fine of not more than $500. Each separate day's failure to comply with an order shall constitute a separate violation. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean Director of Public Health Cj-� l C) o t4 S`Z `T l o , C�l Gam- o�iv�' pad f o(n C) r � t L R4 , '` �— ,M THE COMMONWEALTH OF MASSACHUSETTS FORM 30 `H&W HOBBS 8 WARREN n BOARD OF HEALTH CITY/TOWN Pee,-w` DEPARTMENT ise �3y; 3G az" s d- km it s,* ADDRESS F6 Z—w qL GiM Svey`ew '7 TELEPHONE Address f 610'G�eae d'tlt.C.&f�l�r/�i C(� io IFZ Occupant—j-o_at,`,e U&5`4�_ 4(Z 0-,303;� Floor Apartment No. No.of Occupants No.of Habitable Rooms No.Sleeping Rooms-- No. g g _� No.Stories t No. dwelling or rooming units � Name and address of owner a b 1�o-FS-e a� -� T1h a r O 0-SC,L, yS ����a^' Remarks Reg. Vio. YARD Out Bld s.: Fences: Q.10_4A-L v.-g fe4- i+ low4ed `,,, G..ajUW Garbage and Rubbish (AVLg Jo%,-ditt,,,, j4-Sk 4 LevtCG Containers: Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: Dual Egress:and Obst'n.: ❑ B ❑ F ❑ M Doors,Windows: S 'cl., t4o-.c o e, (o wal, i5 Roof '1(A (c( i Yv ikd-S c,- 100-C4._ is �11Z Gutters, Drains: ,.V ej(244 [(j( Walls: M" 9t&vw,, S S " ro t cc�- S 49-2. PC, Foundation: Aak Chimney: BASEMENT Gen.Sanitation: Dampness: Stairs: Li htin : STRUCTURE INT. Hall,Stairway: w4 - Sc,✓teA, j fwo Obst'n.: A4 o g 2 fi L p Hall, Floor,Wall,Ceiling: Hall Lighting: Hall Windows: HEATING GA5 Chimneys: Central ❑ Y ❑ N E ui . Repair TYPE: h( / Stacks, Flues,Vents: is kp Z5eK 6;, 1S,icks 1644 `3s- PLUMBING: Supply Line: -<- �,,, a�-Nn ❑ MS ❑ ST ❑ P Waste Line: H.W.Tanks Safety and Vent(s) ELECTRICAL Panels, Meters,Cir.: ❑ 110 ❑ 220 Fusing,Grnd.: AMP: Gen.Cond. Distrib. Box: Gen. Basement Wiring: DWELLING UNIT rin alke Ventil. Lqtnq.. Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen 13144r Bathroom `t©' ' Pantryf�lo►dt[` Den Living Room Bedroom 1 Bedroom 2 Bedroom 3 Bedroom 4 Hot Water Facil. Sup.Ten. G , Oil, Elect.: j3( 01, Stacks, Flues,Vents,Safeties: Kitchen Facilities Sink c te- (p le t' Stove ko-f o a4A Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: 7Z.,16 (0AkI r rT Je 1oc.,lb-, -Lv&A4 s-/ Wash Basin, Shower or Tub: LVA // Gt bw-1- !o-e_C_[6J"%e 0T Infestation Rats, Mice, Roaches or Other: M iG8- d i I o6 -eevc-cP i.. K%4tA+P� Egress Dual and Obst'n: Ca-Z., + General Building Posted Locks on Doors: ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSPECTOR.(See Over) "THIS INSPECTION REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIE OF PERJURY." INSPECT TITLE ��,� 441L} t ro DATE //� TIME A.M. THE NEXT SCHEDULED REINSPECTION P.M. � :�;..,«... •n•n taw-w;� .n'.:'cs+•••m ti.�-f;,r'n^'_:; i:Y?. ,�;syt.�� :.. � 'T„,�47''1t�7». •�" ,�t. t4. x 4� 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions, when found,to exist in residential premises, shall be deemed conditions which may endanger or impair the heaith, or safety and well-being of a person or persons occupying the premises. This listing is composed of those items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter ll, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to include affect the legal obligation of the person to whom the order is issued to comply with such order. (A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. -(B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B) and 410.202. (C) Shutoff and/or failure to restore electricity or gas. (D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com- mon area required by 105 CMR 410.254. (E) Failure to provide a safe supply of water. (F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR 410.150(A)(1)and 410.300. (G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object, including garbage or trash,which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452. (H). Failure to comply with the security requirements of 105 CMR 410.480(D). (I) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar- bage, rubbish,filth or other causes of sickness which may.provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. (J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.) (K) Roof, foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or other dangers or impairment to health or safety. (L) Failure to install electrical; plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating, gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352, so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety. (M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105 CMR 410.353. (N)" Failure to provide a smoke detector required by 105 CMR 410.482. (0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or knowledge of the owner of said condition or conditions: (1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven or any defect that renders either inoperable. (2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2)and 410.150(A)(3)or any defect which renders them inoperable. (3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard. (4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as required by 105 CMR 410.503(A)and 410.503(B). (5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550. (P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0)shall be deemed to be a con- dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner to remedy said condition within the time so ordered.by the Board of Health. k S Health Complaints 08-Jul-99 Time: 9:00:00 AM Date: 7/8/99 Complaint Number: 1948 Referred To: GLEN HARRINGTON Taken By: GLEN HARRINGTON Type:Complaint T e: CHAPTER II HOUSING p Article X Detail: Business Name: { Number: 100 Street: WATERFIELD RD Village: OSTERVILLE Assessors Map_Parcel: Complaint Description: getting evicted and papers said to call if there were items that were to be fixed by the owner and weren't. stated that heating system was inadequate to heat house properly. Windows and screens did not work like the slider. Handle to slider broke off due to lack of ease of operation. Actions Taken/Results: GH - Housing inspection performed. See file. Investigation Date: 7/8/99 Investigation Time: 10:00:00 AM 1 + i ..... ... ................ .. .. ......... 'alfi:'' '?li? 919 2 .........:.:.........:.. 0006128•::•>::•:::::;:. :: 0000000 .'•..'•.lst°''<`Efkiit3Oid.«::30AC t:;{{t:;}ii>.i>.•'.i�:4i:?�:iiiiiii:v:����.yyy�:?yyyyiii.$'.»iM14Ctyiiiiiii+:;i{iiii3 y;, .83 exx 12 tt,..��/ 101 yyyySy� ?: 1:�. 't'.JR''. ROTSTEIN KOBY&::• :................ ........... ,,...........,.. ARONSON TINA `«> M1 ..... 45 FENWICK RD €00 ......:..... WABAN MA< 02168 0 0 0 000-000 0301 4 'y #.'.' 8 2:>:: ROTSTEIN KOBY& ? 0384>'?'fir# e11+31111VkYY:. 4041/292 iEkl€ Ll : 00 691 . 79000 EXt41-V...........S:>:•:0000000000 . s >» ;'t::>: :::.1.0 .;•:: ELD'R'.�AD TERFI 0 :`:`:`:fd #Muir it:: . 1.789: ....................::::::... : 0100 yy�� i CO 9'•:•i ::iH. fiY.':. Unassi ne Road Name ...................:::::::.......................... :..•::.:::. d d SENDER: V ■Complete items 1 and/or 2 for additional services. I also wish to receive the u► ■Complete items 3,4a,and 4b. following services(for an ■Print your name and address on the reverse of this form so that we can return this extra fee): card to you. 8 ■Attach this form to the front of the mailpiece,or on the back if space does not 1. ❑ Addressee's Address Z permit. d ■Wnte'Retum Receipt Requested'on the mailpiece below the article number. 2. ❑ Restricted Delivery N ■The Return Receipt will show to whom the article was delivered and the date c o. delivered. Consult postmaster for fee. 0 �.Argcle Ad essed to: 4a.Article umber� 9 � c 4b.Service Type �. c°� ❑ Registered 11 Certified o, �� � � ❑ Express Mail ❑—Insured � ❑ Return Receipt for Merchandise ❑ COD c 0 7.Date of Delivery •- z 5. ceived By:(Prin me) 8.Addressee's Address(Only if requested W and fee is paid) r � 6.SigMtu (Address`a rAgent)i PS Form 3811,'Decembei 1994 t}t {t t 102595-97-B-0179 Domestic Return Receipt First-Class Mail UNITED STATES POSTAL SERVICE- .- Postage&Fees Paid LISPS Permit No.G-10 o Print your name,address, and ZIP Code-in this box o I P011c Health Division Town of Bamstable PO Box 534 Hyannis,Massachusetts Cal i Fax(508)775-3344 I, Phone(508)790-6265 I �I i