HomeMy WebLinkAbout0099 CAMP OPECHEE ROAD - Health 99 CAMP OPECHEE RD., CENTERV.
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Apr 05 07 09:45a ASBESTOS MAN 5082248883 p.2
Commonwealth of Massachusetts
lug Agbest s Notification Form — ANF--001 780446
1 � -A 7
Asbestos Abatement Description
44�(7 DKre- 6ffl �
1. Facility location:
Mnsre �� .SUM 12 ee led ' --
lxsnucnoks Namr Address
1. All sections of tl �,Itiis e
Jotmmuslbewmpleled C10VTa`n ifpaoCe ldeinone
in order to complywah 1 `['X�['J�iLi✓
the Department of �e iG�C L')r -- —
Ernironrtmel Wn7tisft*arJiJVebodwr7atrudingnamr,/, inp,llaor,room
Protect ionnotiticafion 2. Is the facility occupied? )Yes ❑ No
regvitacerts o1310 CZAR -
pri oJiricten aionis 3. Asbestos Contractor:
prior nolifiplhon is
pro%ect):and reo d the coanyabalenenr Asbestos Man Removal Co. , Inc. 929 State Road
•-
Department of labor Name 'ddrass
and Industriesect Plymouth, MA 02360 508-224-5500
noGlical�n reQuBements y •
cl t53 CMR 6.12 (ion C!y/rwn zip aods rdey�aie
days prior notirAwlion is
require/of ANY AC 0 0 0 3 4 2 �� =
abaremerlt Mafed greater DU Lkinse I C-1w rype(wrlhanrler"i
Man three linear or
squvelea). 4, 0n•She Project Supervisor/Foreman:
2. SubmitOriginWtform Jose Vilalta AS61 1 56 To: Name OLl Canifka6wr/
Commonwealth of
Masaachuselts 5, Project Monitor.
asbestos Program
P.0.0.120087 N/A " _-
Poston,MA02112- Name DUC.rlraeWkw41
00e7
6. Asbestos Analytical Lab:
3. This farm maybe N/A
used tot notifying the --
U.S.EnvironmMial /vans DL1Ceracalbnof
Pr otection Agency Region �y
Iof asbestos demolileorJ Projeetstart-dale ttVti2t�Pacific work hours(Mon.-Fri.) (Sat.Sun.)
ienotiation operalions
subject to NESWS(40
CfR Subpart K. a. What type Of, project is this? (circle nne): oNraauDnn repair trmgton odWt`erplaia)
lororoyu�omy 9. Describe the asbestos abatementproceduresto be used.(circle . aaoreoag w�casam - twitwerainmrrr uuanur
aneaµsurad- dafflazdanty oG9ft(Lvala) ..
rrardotloo/ .
Aa°v.aOW 10. Is the job being conducted 0Indoorsxoutdoors 7
,. m 11.- Total amount of each type of Asbestos Containing Materials(ACM)to be handled on pipes or ducts(linear t1.) or other
ie surfaces(square ft.) PSZ0 to be-removed.-enclosed or encapsulated:
11near/square feet
boiler,breaching,duct fink surface coafinos..._J thermal,solid core pipe hrasutWon...... �
cormgaled or layered paper pipe InudafPon.... ........... ..
spray-fireproofing,.................... coatings..............
cloths,!wren hbirs... �: _/ tra n&board,wall board ........_.
adw(please describe).. � �,(/f1q.A s—J
12. Describe the decontamination systems)to be used:
Remove asbestos usln loveba s seal off critic—al _
arriers using six millimeter po y > m.
13. Describe the costalnerization/dfsposat methods to compywith 310 CUR 7.15 and 453 CMR 6.14(2)(p):
Wet asbe-stos and double ba usin six
mar a an a e po y bags
14. For Emergency Asbestos Abatement Operations,the D.EP and DU officials who evaluated the emergency:
Mane NDfaflnkJa!
Dab ofMhodzalbn IVyxrf —
Narne of lxl aadat mete
Dxe of Aulbortrallm fvJror/
15. Do prevailing wage rates apply as per W131.e.149.§26.27.or 27A-F to this project? 0 Ye-A No
Rev.er?z
Apr 05 07 09:45a ASBESTOS MAN 5082248883 p.3
0 Facllity Descriptlon
I. 'Current or prior use of facility:
q yl tl_ei l
2. 4s the facility owner-occupied residential with 4 units or less? k
es Q No
3. !Facility Owner.
wag Address
urrirown 27P mare
Te�hor�ie
4. Facility's Owner's On-She Manager.
N/A
N/A
-COMM? Zlp code
rdrepxr,e
5. 'General Contractor.
N/A
;Name Address .
N/A
caryiro wn Z/p code
Te/ephona
Contractor}WorXars Comp.Insurer PoNry/ EyAoate
6. What is the size of the facility? (sq ft);L(I of floors)
Asbestos Transportation and Disposal
1. Transporter of asbestos-containing waste material from site to temporary storage site(if necessary)to final disposal site:
Asbestos Man Removal Co- , Inc. 929 State Road
Afxm Address
Plymouth, MA 02360 508-224-5500
crri/rdwn zip Code retepw-P
2. Transporter of asbestos-containing waste material from removalftemporary storage site to final disposal site:
John Norton DBA Norton. Truckirsar 65 Marrvmourit Road
Nan Address
:Quincy, MA 02169 617-786-8556
Note.Transfer MOOT—
Stations np mdb r�epr�ne
must 3. Refuse transfer statron and owner if applicable):
campfy.with the ( .
Solid Waste
Division regula- Nacre Address
flons 310 CMA
18.00
Zli code re/cpno�r
4. Pinar Disposal Site.,
WMNH—TREE
Lcurao AWW Amos Name
90 Rochester Neck Road P.O. Box 7065
Address
Rochester, NH 03839 603-330-0217
i:lly/T— .Zip Wd& reledaane
� Certlticatlort
The undersigned hereby states,underthe penalties of perjury,that he/she d the Commonwealth of Massachusetts Regulations
foride Removal.Containment or Encapsulation of Asbestos,453 CM 946i 310 CMA 7.15.and that the information contained in
this notification is true and correct to the best of his/her knowled d f'eli
Raul Ilac ua
PnW Nana AuC,arltedS�ira/ure _ We
FF
Note:Contractor
must sign this President AMR Co. 508-224-5500
form for DU A=WmMee IrQy,,,,AV rerepnor�e
notificariori
purposes 9:29 State Road Plymouth, MA 02360
Address cy/ro»n try mare
as exempt(City,Town,district,municipal housing authority,owner-occupied residential of four units or less)?Byes O no
Sticker! (from front of form): j `
1
0 } ASl3l:8TOS MAN 111.7jMO SAL C.O. INC.
~ Y ;" 929 State Road, Plymouth, MA 02360
Pbon:e 508-224-5500
Fax 508-224-8883
License No.AC00342
Mr. Thomas McKean
Barnstable Health Department
200 Main Street
Hyannis, MA 02601
Dear Mr. McKean:
We are notifying you about an asbestos removal job to be done
at Q ►/ r f The startup
p
date is and the end date is '�lq J(n
Enclosed please find a copy of the Asbestos Notification Form (ANF-001)
for.your files.
I`e3 L
If you have any questions, please contact us at (508) 224-5500. M' r
Sincerely,
Paul Ilacqua rn
Enc: ANF-001 form
Commonwealth of Massachusetts s
Asbestos Notification Form-- ANF-001VA
Ilk
g80446
°._
Asbestos Abatement Descrlptlon " �
-_
1. Facility location:
innucT10Ns Name Address —
ein2 rr�l d'A( L CV1 1. All sections of this � t
form must be completed Civown lip code Telephone
in order to comply with x kri f
the Department of
E rry i r o nm enl a l Wbaf is fhe rwrlalte location?bullding name,IIft floor,room
Protection notification 2. Is the facility occupied? Yes O No
requiremens of 310 CMR N
7.15 (ten working days
prior notification is 3. Asbestos Contractor:
required of d
projecQ:andnd the nyabarame Asbestos Man Removal. Co. , Iric. .929 State Road
Department of Labor Name Address
and Industries Plymouth,notification requirements Y e MA 0 2 3 6 0 5 0 8—2 2 4—5 5 0 0
of 453 CMR 6.12 (ten city/row" Zip code Telephone
days prior notification is
req0edo1ANr AC000342 � :J abatement project greater IXllkense/Man three linear or cmlrad rype(wrltklowbalf
square lea). 4, On-Site Project Supervisor/Foreman:
2. Submit Original Form Jose. Vilalta AS61 1 56
To: Name 011 Wilka6m/ -- -
Commonwealth of
Massachusetts 5. Project Monitor:
Asbestos Program
P.O.B,120087 N/A
Boston,MA02112. Nalm DUCerollcallon/
0087
6. Asbestos Analytical Lab:
3. This form maybe N/A
used for notifying the
U.S.Environmental ON DtICertlgcaim1. --
I of as lion s deco Region q_�� � (� r-�
IofasbeslosdemofitioN 7. Project start.date enddate �f pecrficworkhours(Mon.-Frf.) l"'_5 (Sat.Sun.)
renovation operations
subject to NESHAPS(40
CFR Subpart MY 8. What type of project is this? (circle one): &wiiuon repair renorab'on other(explain)
For Official Lisa Only 9. Describe the asbestos abatement procedures to be used..(circle,...gbvedag rrxiosure luucontaimmlx cleanup
Nddo6on r enrapsulatlm disposal Only OWfe)Valn)
R�"edDT 10. Is the job being conducted O indoors ]outdoors 7
- A,
ear raw eo 11. Total amount of each type of Asbestos Containing Materials(ACM)to be handled on pipes or ducts(linear ft.) or other
surfaces(square ft.) 1'SVO to be removed, enclosed or encapsulated:
1nearlsquare feel
boiler,breaching,duct lank surface coatings..._/ Thermal,solid cote pipe insulation......
corrugated or layered paper pipe insulation...._ 4 insulating cwwnl....:........... ..
spray-on fireproofing....................._� kowel/sprayer coatings.. ...,.......
cloths,woven bbrics. �: _/ transile board,wall board:...... .
o#w(please describe)..rJ�
12.. Describe the decontamination systems)to be used:
Remove asbestos using loveba s seal off critical
barriers using six millimeter poly film.
13. Describe the containerization/disposal.methods to comply with 310 CMR 7.15 and 453 CMR 6.14(2)(g):
Wet asbestos and double bacr using ix millimeter
marked and labled ;po. v bags.
14. For Emergency.-,sbestos•,batem2niCOperations,the D:EP and DLI-of-ficiats who evaluated-the,emergency:
Name r0 Dfi naidal rn!e
Date olklhorinlioa Walser/ --
Name alX1 andat ruk
Dare olkthorintlm Walrer/
15, Do prevailing wage rates.apply as per M.G.L.c.149,§26,27,or 27A-F to this project? O Yes No
Rev.6/92
I
Facility Description
1. Current or prior use of facility:
2. GIs the facility owner-occupied residential with 4 units or less? Yes 0 No
3. .Facility Owner.
:Name -
Address
�Ciry/fown Dp cads Tel hone
4. Facility's Owner's On-Site Manager.
N/A
Name Address
N/A
C1ty/T0wn Tip ode
Telephone
5. General Contractor.
N/A
wane
Address .
N/A
010Town ZIP Code
Telephone
Contractor's Workers Comp.Insurer Policy/
frp.Date
6. What Is the size of the facility? (s4 ft) (#of floors)
Asbestos Transportation and Disposal
1: Transporter of asbestos-containing waste material from site to temporary,storage site('rf necessary)to final disposal site:
Asbestos Man Removal Co. , Inc. 929 State Road
Nang
Address
Plymouth, MA 02360 508-224-5560
Clry/Town ZIP
p
Telephone
2. Transporter of asbestos-containino:waste material from removal/temporary storage site to final disposal site:
John Norton DBA Norton Trucking 65 Merrymount Road
Name Address
Quincy, MA 02169 617-786-8556
Note:Transfer Ciry/Town np
Stations must Telephone
comply.with the 3. Refuse transfer station and owner(if applicable):
Solid Waste
Division regula-
tions 310 CMR None Address
18.00
C/ry/Town NO Cade
Telephone
4. final Disposal Site:
WMNH—TREE
Iocadcn Nana OKr�ea Nano
9,.0 Rochester Neck Road P.O. Box 7065
Address
Rochester, NH 03839 603-330-0217
MY/To" Zip cede telephone
Certification
The undersigned hereby states,under the penalties of perjury,that he/she read the Commonwealth of Massachusetts Regulations
for the Removal,Containment or Encapsulation of Asbestos,453 CM 0°and 310 CMR 7.15,and that the information contained in
this notification is true and correct to the best of his/her knowled and deli .
Paul Ilac ua C
Vdnl Name Au&&edS1gnafure
Hole:Contractor - - Qale
must sign this President AMR Co.form for DU 508-224-5500
notification Po�IbrVnCe AVmsenllrq
Telephone.
purposes
929 State Road Plymouth, MA 02360
vlddress Clry/Town
Tip cede �Fee exempt(City,Town,district,municipal housing authority,owner-occupied residential of four units or less)?,eyes O no
Sticker#(from front of form):
),4rW-216 �. 2 o(5 / � w
No. Fee 5 0
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ✓
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
01pprication for 30igw6al *pttem Con6truction Permit
Application for a Permit to Construct( )Repair( x)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. 99 Camp Op e ch e e Rd Owner's Name,Address and Tel.No. 7 81 —8 21 —41 8 6
Assessor'sMap/Parcel Centerville Catherine Gallagher 1 Briar Rd
Canton, MA 02021
Installer's Name,Address,and Tel.No. 7 7 5—8 7 7 6 Designer's Name,Address and Tel.No.
W E Robinson Septic Sry
PO Box 1089 , Centerville
Type of Building:
Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder(no)
Other Type of Building No. of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil sand
Nature of Repairs or Alterations(Answer when applicable) Title 5 Septic system consisting
of 1500g tank, D-Box and three 500-gallon precast leaching chambers.
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 by thi BoVd of Health. �J Q
Signed Date
Application Approved by Date
Application Disapproved for a foflowing reasons
Permit No. Date Issued
)� • .._ ` a ♦ .++ t w r.'0•w.n c•.w+Ywwl' .P'W--v+ g..n•,..sm.- - r :......T.-m't...+r..v..xrrgr4ww..V•s 'F W+.ro...-Yw.. +�..w.a..--_ - -... /.+.+a.n
$5 0.0 0
No. � V Fee J
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer. V/
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
01pprication for Migogar *pgtem Construction Vermit
Application for a Permit to Construct( )Repair( x)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. 9 9 Camp Opechee Rd Owner's Name,Address and Tel.No. 7 81 —8 21 —41 88
Assessor'sMap/Parcel Centerville Catherine Gallagher 1 Briar Rd
Canton; MA 01021
Installer's Name,Address,and Tel.No. 7 7 5—8 7 7 6 Designer's Name,Address and Tel No.
W -E Robinson Septic Sry
PO Box 1089, Centerville
Type of Building:
Dwelling No.of Bedrooms 3 Lot Size sq. ft. Garbage Grinder(nq
Other Type of Building N ofPrso Showers( ) Cafeteria( )
Other Fixtures
Design Flow %gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title,
Size of Septic Tank Type of S.A.S.
Description of Soil sand
Nature of Repairs or Alterations(Answer when applicable) Title 5 Septic system consisting
of 1500g tank, D-Box and three 500-gall,on precast eac ng chambers.
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 by thi B7d of Health.
Signed �i Date
Application Approved by 0 Date
Application Disapproved for e fol owing reasons
,3
Permit No. `Date Issued
THE COMMONWEALTH OF MASSACHUSETTS J
BPtS� T, BLEASSACHUSETTS
Gallagher
Certificate of Compliance
THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired ( X )Upgraded( )
Abandoned( )by
at 99 Camp Opechee Rd, Centerville `has been cons tdd%l aUordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. qg VI-131 dated
Installer_ W E Robinson Septic SrV Designer
The issuance of this perimgshal?obe ht�strued as a guarantee that the system%,futn as designed.
Date // ,,jj Inspector
No. ' L' ---------------_------Fee 50.00
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETT6L
Dallaghere =igotal *pgtem Congtruction Vermit
Permission is hereby granted to Construct( )Repair(X)Upgrade( )Abandon( )
System located at 99 CamaO Opechee Rd
Centerville
Installer: W E Robinson Septic Service
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: 7 - 7 / Approved by
9/ 0 - a (SLI
NOTICE: This Form Is To Be Used For the Repair Of Failed
Septic Systems Only.
CERTIFICATION OF SKETCH AND APPLICATION FOR A
DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT
ENGINEERED PLANS)
I, William E. Robinson, Sr. ,hereby certify that the application for disposal works
construction permit signed by me dated concerning the
property located at 99 Camp Opechee Road. Centerville, meets all of the
following criteria:
* There are no wetlands within 100 feet of the proposed leaching facility.
* There are no private wells within 150 feet of the proposed septic system.
* There is no increase in flow and/or change in use proposed.
* There are no variances requested or needed.
* If the proposed leaching facility will be located with 250 feet of any wetlands,the bottom of the
proposed leaching facility will not be located less than fourteen(14)feet above the maximum adjusted
groundwater table elevation.
Please complete the following:
A)Top of Ground Elevation(according to the Engineering Division G.I.S. map) —�
B)Observed Groundwater Table Evaluation(according to Health Division well map)
SIGNED: DATE 1— O
LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER 20-1998
(Attach a sketch plan of the proposed system. Also if the licensed installer posesses a certified plot plan,
this plan should be submitted).
�.
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TOWN OF BARNSTABLE f,
LOCATION ' .A s.. n_ ��'Ic Lc ' � SEWAGE # - `- d3
VILLAGE CC Alr ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE NO. RAA�Z 9,6 4 7 7
SEPTIC TANK CAPACITY
LEACHING FACELITY: (type) 3" (size)
NO.OF BEDROOMS S
BUILDER OR OWNER 64 tr l2
PERMTTDATE: 'l`'7 — 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 exist
within 300 feet of leaching facility) Feet
Furnished by
GI.,,
W
r
i -
TOWN OF BARNSTABLE
LOCATION k QaI SEWAGE # /7'
VILLAGE CC 1 ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE NO. RA j
SEPTIC TANK CAPACITY <3
LEACHING FACILITY: (type) 3 (size)
NO.OF BEDROOMS -
BUILDER OR OWNERS
PERMTTDATE: ~ 7 COMPLIANCE DATE: 7
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
c14
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