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Home My WebLink About0076 BENT TREE DRIVE - Health 76 BENT TREE DRIVE Centerville A= 168-023 S M EAD® KEEPING YOU ORGANIZED No. 1M 2-I&WR co vasrca�su�rt® GETORGA MATMEARM J i a 3 I 1 j 7 Massachusetts Department of Environmental Protection 100281288 BWP AQ 04 (ANF-001) ----- {� Asbestos Project# Asbestos Notification Form' r-i Project Revision r' Project Cancellation A. Asbestos Abatement Description 1.Facility Location: BELLISARIO 76 BENT TREE DRIVE Instructions 1.All a.Name of Facility b.Street Address sections of this form BARNSTABLE must be completed in MA 02632 0000000000 order to comply with c.City/Town d.State e.Zip Code f.Telephone MassDEP notification x x requirements of 310 CMR 7.15 and g.Facility Contact Person Name h.Facility Contact Person Title Department of Labor Worksite Location: WCHEN Standards(DLS) notification i.Building Name,Wing,Floor,Room,etc. requirements of 453 2. Is the,facility occupied? W a.Yes r b.No CMR 6.12 3. Is this a fee exempt notification (city, town, district, municipal housing authority, state facility, or owner-occupied residential property of four units or less)? rv_ a.Yes r b.No MassDEP Use Only 4.Blanket Permit Project Approval,if applicable: Date Received Approval ID# 5.Non-Traditional Asbestos Abatement Work Practice Approval, 2.Submit Original if applicable: Approval ID# Form To. Commonwealth of Massachusetts 6.Asbestos Contractor: P.O.Box 4062 Boston,MA 02211 NEW ENGLAND SURFACE MAINTENANCE LLP 850 WASHINGTON ST a.Name b.Address WEYMOUTH MA 02189 7813372117 c.City/Town d.State e.Zip Code f.Telephone A0000196 h.Contract Type:r 1.Written r 2.Verbal g.DLS License# 7. JOHN P.VAWQUETTE AS060773 a.Name of Contractor's On-Site Supervisor/Foreman b.DLS Certification# 8 RICHARD K BOWEN AM061044 a.Name of Project Monitor b.DLS Certification# 9 FLI ENVIRONMENTAL INC AA000144 a.Name of Asbestos Analytical Lab b.DLS Certification# 10. 3/6/2018 3/6/2018 a.Project Start Date(MM/DD/YYYY) b.End Date(MM/DD/YYYY) 7-4 N/A c.Work Hours-Monday Through Friday d.Work Hours-Saturday&Sunday 11.What type of project is this? r a.Demolition V b.Renovation r— c.Repair r d.Other-Please Specify: Revised: 11/13/2013 Page 1 of 4 Massachusetts Department of Environmental Protection 100281288 BWP AQ 04 (ANF-001) Asbestos Project# L7t Asbestos Notification Form r Project Revision r Project Cancellation A.Asbestos Abatement Description: (cont.) 12.Abatement procedures(check all that apply): r a.Glove Bag r b.Encapsulation r; c.Enclosure r d.Disposal Only r e.Cleanup r f.Full Containment ' g.Other-Please Specify: 13.Job is being conducted: r a. Indoors ' b.Outdoors 14 a.Total amount of each type of asbestos Containing materials(ACM)to be removed,enclosed,or encapsulated: 120 1.Linear Feet(Lin.Ft.) 2.Square Feet(Sq.Ft.) b.Boiler,Breaching,Duct, c.Transite Pipe Tank Surface Coatings 1.Lin.Ft. 2.Sq.Ft 1.Lin.Ft. 2.Sq.Ft. d.Pipe Insulation e.Transite Shingles 1.Lin.Ft. 2.Sq.Ft. 1.Lin.Ft. 2.Sq.Ft. f. Spray-On Fireproofing g.Transite Panels 1.Lin.Ft. 2.Sq.Ft. 1.Lin.Ft. 2.Sq.Ft. h.Cloths,Woven Fabrics i.Other-Please Specify: 1.Lin.Ft. 2.Sq.Ft. j.Insulating Cement TILE 120 1.Lin.Ft. 2.Sq.Ft. 1.Lin.Ft. 2.Sq.Ft. 15.Describe the decontamination system(s)to be used: AS REQUIRED 16.Describe the containerization/disposal methods to comply with 310 CMR 7.15 and 453 CMR 6.14(2) (g): AS REQUIRED 17.For Emergency Asbestos Operations,the MassDEP and DLS officials who evaluated the emergency: a.Name of MassDEP Official b.Title of MassDEP Official c.Date of Authorization(MM/DD/YYYY) d.Waiver# e.Name of DLS Official f.Title of DLS Official g.Date of Authorization(MM/DD/YYYY) h.Waiver# 18.Do prevailing wage rates as per M.G.L.c. 149,§26,27 or 27A—F apply to this r a.Yes r b.No project? Revised: 11/13/2013 Page 2 of 4 i 1 7ylBWMassachusetts Department of Environmental Protection 100281288 AQ 04 (ANF-001) P Asbestos Project# Asbestos Notification Form r Project Revision r Project Cancellation B. Facility Description 1.Current or prior use of facility: RESIDENCE 2.Is the facility owner-occupied residential with 4 units or less? 5F a.Yes r b.No 3 BELUSARIO 76 BENT TREE DRIVE a.Facility Owner Name b.Address CENTERVILLE MA 02632 0000000000 c.City/Town d.State e.Zip Code f.Telephone 4.X X a.Name of Facility Owner's On-Site Manager b.Address X MA 00000 0000000000 c.City/Town d.State e.Zip Code f.Telephone 5.X X a.Name of General Contractor b.Address X MA 00000 000000000 c.City/Town d.State e.Zip Code f.Telephone X g.Contractor's Worker's Compensation Insurer X 1/1/2019 h.Policy# i.Expiration Date(MM/DD/YYYY) 6.What is the size of this facility? 1400 2 a.Square Feet b.#of Floors C. Asbestos Transportation & Disposal 1.Transporter of asbestos-containing waste material from site of generation: r a.Directly to Landfill or r b.To Temporary Storage Location/Transfer Station NEW ENGLAND SURFACE MAINTENANCE;LLP 850 WASHINGTON STREET c.Name of Transporter d.Address Note:Temporary storage of Asbestos WEYMOUTH MA 02189 7813372117 containing waste e.City/Town f.State g.Zip Code h.Telephone material is only allowed at the place of business of a DLS 2.If a temporary storage location/transfer station is used,list name of transporter of asbestos containing licensed Asbestos waste material from temporary storage location/transfer station to final disposal site: contractor or a transfer p rY g p station that is permitted by RED TECHNOLOGIES 10 NORTHWOOD DRIVE MassDEP and a.Name of Transporter b.Address operated in compliance with Solid BLOOMFIELD CT 06002 8602182428 Waste Regulations 310 CMR 19.000 c.City/Town d.State e.Zip Code f.Telephone Revised: 11/13/2013 Page 3 of 4 `71 Massachusetts Department of Environmental Protection 100281288 BWP AQ 04 (ANF-001) Asbestos Project# Asbestos Notification Form Project Revision r- Project Cancellation C.Asbestos Transportation& Disposal: (cont.) 3.Name and address of temporary storage location/transfer station for the asbestos containing waste material: RED TECHOLOGIES 203 PICKERING STREET a.Temporary Storage Location Name b.Address PORTLAND CT 06480 8603421022 c.City/Town d.State e.Zip Code f.Telephone 4.Name and location of final disposal site(asbestos landfill): MINERVA ENTERPRISES MINERVA a.Final Disposal Site Name b.Final Disposal Site Owner Name 9000 MINERVA ROAD c.Address WAYNESBURG OH 44688 3308663435 d.City/Town e.State f.Zip Code g.Telephone D. Certification JIM DOYLE JIM DOYLE "I certify that I have personally 1.Name 2.Authorized Signature examined the foregoing and am PARTNER 2/15/2018 familiar with the information contained in this document and 3.Position/Title 4.Date(MM/DD/YYYY) Note:Contractor must 7813372117 NESM,LIP sign this form for DLS all attachments and that,based notification purposes on my inquiry of those 5.Telephone 6.Representing individuals immediately 850 WASHINGTON STREET, WEYMOUTH responsible for obtaining the 7.Address 8.City/Town information, I believe that the MA 02189 information is true,accurate,and complete. I am aware that there 9•State 10.Zip Code are significant penalties for submitting false information, including possible fines and imprisonment.The undersigned hereby states that I have read the Commonwealth of Massachusetts regulations governing asbestos abatement (453 CMR 6.00 promulgated by the Department of Labor Standards and 310 CMR 7.15 promulgated by the Department of Environmental Protection), and that I am aware that this permit application or notification shall not be deemed valid unless payment of the applicable fee is made." Revised: 11/13/2013 Page 4 of 4 C, TOWN OF BARNSTABLE - LOCATION/ y1,/ �f SEWAGE # "' VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME PHONE NO. 30 SEPTIC TANK CAPACITY �� LEACHING FACILITY:(type)��,, ` � � �`��(size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE . COMPLIANCE ISSUED: VARIANCE GRANTED: Yes ' No r A_ - � io c� ,� � 0 .� ,,� 9 t I -- - � � F$$ �-...._ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH oF'.4.A RAJV. .b.�'2. -------------•••--...... Appliratinn for Disposal Works (gnnu=ividual irrntit Application is hereby made for a Permit to Construct ( ) or Repair Sewage Disposal System at: 7�e�.......... ." ........... ................................. ................ ..•---....-----.......------...----•------- .......................-....._.......... ion- ress t No.o ..... i4 ..._._._. ............... ..... ....................................._.... Owner Address M 04 Installer Address Type of Building Size Lot............................Sq. feet V Dwelling—No. of Bedrooms___________ ____________________ Expansion Attic ( ) Garbage Grinder ( ) ►-+ -•-- Other—T e of Building ..._._. o. of persons............................ Showers — Cafeteria Other fixtures ------•---••-•--•--•..............•-----•--. Q ............... -......--•--• ..................•------- W Design Flow................................... .......gallons per erson per day. Total daily flow---......_....... .... ..._._....._.____._..__gallons. WSeptic Tank—Liquid capacity........ ,all ength...............: Width................ Diameter_.__._.......... Depth................ x Disposal Trench—No......... .......... Wid.. ....... ............ Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No.................... Diameter..._ ............. . Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( osing to ( ) ►" Percolation Test Results Perfor d by---••-...... ............................................................. Date........................................ aTest Pit No. 1................minutes er inch Dep ► of Test Pit.................... Depth to ground water........................ (i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ A+' -•-••-------------------------------••-•-.............--•---•--•--.....-••................•---............................................................... 0 Description of Soil.................................................................................................=...................................................................... W M -------------------•---.-----.--------••-------...---.---------•--------------------...---.-----------.-----•--------------•-------•--------•----_-•---------.--.---••--------------------•----•-------- W -•••-•-•-•---------•-••••-------- -----•-----•-•--•----••-----•-------•-••--••--------•..............---•---- ............ U Nature of Repairs or Alterati n Answer hef� 1'cable� _�__� ... `................./-............. Ze�� ------------------------------------------------------•-••••----•-•---•.....-•- ....! " ---------------......=-' ----....-•-------............------------...........---- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TAI HE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued he b d of Health. moo— . Signed_.j� _. _ Date Application Approved By-----------�__ --� .......................................... ......... ?.) ...... Date Application Disapproved for the following reasons-------------------------•----.....---•--------•--------••-------------------•----...............--•--•......--- ...---•..........................•--•-•--------------•--••----••-•---•-••-••••---------............-••-..._...........-••---............................................................................ Date Permit No....._/.._2:. ..-- --•--••------ - ---------------------- Issued----------...._... --.._.... - Date ^................ -" _`�� w .� � �, � ., . . . . a —� f, ,� .�� ti �. 3 re, ;� � .. 4 1._•.. i . ' . � C �. " 3 , THE COMMONWEALTH OF MASSAC HUSETTS BOARD OF HEALTH S .......................................... F (ZAJ. ..4,.A.. �Vr ......... ....4.kf ............................................. Appliration for, Disposal Works Tonshvdiott Errant Application is hereby made for a Permit to Construct or Repair (� Individual Sewage Disposal System at: ew'r Tieee D. Z i ..........Z!�---V........................................... ................... ....................................................................... O'sti •j;ess 'on A................ ........ Owner Address ...........C .......C. . ............................................... ... ................................................................... ....... .... .... Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms--_-_---- -----------------------Expansion Attic Garbage Grinder Other—Type of Building ............. ............. o. of persons._.......................... Showers Cafeteria Other fixtures ........................................ ......................................................................... ---------------- -------------gallons Design, Flow------------------------------------/--.ga nis per erson per day. Total daily flow...........................................gallons. Septic Tank—Liquid capacityZ.......gall�d,�� gth_.............. Width................ Diameter..._............ Depth......_......._. ii en dt r....... ............ .. Total Length.................... Total,leaching area....................sq. ft. Disposal Trench—No. ------- i ------- ------------ Seepage PitDiameter........._........ Depth below inlet.................... Total leaching area..................sq. ft. Other Distribution box osing tank Percolation Test Results Perfo I r mi/d by__-----:-_ ............................................................. Date....................------------- ... Test Pit No. I................minutes per inch Depth of Test Pit.._................. Depth to ground water.._..............`..... fi Test Pit No. 2................41inutes per inch Depth of Test Pit..._..........._.... Depth to ground water................L ----------------------------------------- ------------*-------------------------------------------- ........*"'*------------- 0 Description of Soil........................................................................................................................................................................ W - .....................**------------**............ ------------*------------------------*-----------*---------*"**-------------*------------------ -------*-------------- .................................................................................................................................. �z'�... ....... ................................ �44 0;�1.- * U Nature of Repairs or Alter%* ��,-Answer when ficable__/,,,� 7,'4_4(�......................X7.:: ze,iocl0i �_�z_`o. ... .... ............................. .......................................... ......... . . ................. ... ..................................I...................... Agreement- '�",\ 'I . I I The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of T 1 T 1E 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issuedpby-jh I e hpa d of health. Signed..4...........� ....... ................................................ -----__---- --- ...... Date Application Approved By •....... ........ ....)�. .......... ......................................... .......... Date Application DisapproVed for the following reasons:.............................................................................................................. .....................................................................................:�................................................................................................................... Date PermitNo..... I...................... Issued_....-----------------------........A................. Date THE COMMONWEALTH OF MASSACHUSE17S BOARD OF HEALTH ..........................................OF ...................................... THIS IS TO CERTIFY, Trrfifiratr of Tomplianu It J-hat)the Individual �ewage Disposal System constructed or Repaired C ...... ................................................................................................... by....--- _Installer ............ 1111fg...... .A .................................................................... has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No..__.._. .-..k ........ dated................................................ y THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................... '................................ Inspector......SL.:� ---------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEAL ...........................................0 F.. ............................ FEE. ................ Disposal Works TvT�rlldiott Prrutit Permission is hereby granted......- /7 &Z�1� .........I----------*....."............ ........................ ....... ....... .......... to Construct or Repair n i,dividual Sewage Disposal Sy,I at No.:_.....7-6----- ............. stpn ................................................... Street as shown on the application for Disposal Works Construction Permit NofA.4V..?.. Dated............................................ V ...................................................... DATE............ Board of Health .................._---------------- . s=� � 'y � '�"'� - �.. J� � � �