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HomeMy WebLinkAbout0030 IRVING STREET - Health 30 IRVING STREE 226-119 CENTERVELLE Psi 7 6 7 FEB 2 0 .0 0 THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH T o wn......................O F............B a r n-s t o b.l e ------------------------------------------------- ApplirFation for Disposal Works Toaaotrurtion Prrmi# Application is hereby made for a Permit to Construct ( ) or Repair kCXX an Individual Sewage Disposal System at: ..........3.0._Sruin ...Stxaet:...ldas.t...ttg i.s" rt-------------------------------------------------------------------------------------•-------.. Location-Address or Lot No. .........M.�E�d.GYM-1�...Yc�,Ft�p�].��31�-....--•--------------------•-•------- --...........--------------------•-----.....----.....--•----•---...--•---------------•---••------- Owner Address a ..........1._P—Ma-c:ombar-...................................................... ------•---------------................----.....---------------------------------------------- Installer Address Type of Building Size Lot............................Sq. feet U Dwelling No. of Bedrooms..................3.........._......._.....Ex Expansion Attic�-+ g— p ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures ----------------------------------------------------------------------------------------------------------------------------------------------------- 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........................................ Test 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........................ Ix ---------------•--......---------------------------•----•---------...----•------••-••-•-----•-•----......................................................... 0 Description of Soil........................................................................................................................................................................ W ------------------..........................................San-d--- ----Gravel----------------------------------------------------------- ---•----------------------------- x ----------------------- -----_------- --------•---------.._......-----------------------------------------------------------------------------------------------------------------------------•------. U Nature of Repairs or Alterations—Answer when applicable--______-___d—}.©{30---ta-nk---------------------------------------------------- -------------------------------------------------------------------------------------------------------------------1 l f3©-0 z t------------------------------------------------------- Agreement: The undersigned agrees to install the afor edescribed Individual Sewage Disposal System in accordance with f'1T r•1••-• IS the provisions of is 5 of the State Sanitary Code— The u dersigned further agrees not to place the system in operation until a Certificate of Compliance has be 11 issue b th bo of health. d -• .......-- -------- 1.0,-L4,l88 s Date 9297429te'—Application Approved By---- ° ... ------1 / Date Application Disapproved for the following reds ns:---•------------------•----...----•-------------------------------------------•----------------•-----•.......... --------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- Date PermitNo.--- ------ .......... Issued------------------------------------------------------- L tt No......Q-0 _ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........Town......................OF.............ti3c1Cr.S :. '�.7 0_... .......------------.................-•- r? A-liptiration for Uhgp sal Wnrkg Taymuurtion Vrrufit Application is hereby trade for a Permit to Construct ( ) or Repair 6CXk an Individual Sewage Disposal System at: Location-Address or Lot No. ---------- •--•••-----------•---------------------------••-•----------.._.._--•------------------------------ Owner Address W TT 1R �n .mh^g^ a uil Installer Address Q Type of Bding Size Lot............................Sq. feet Dwelling-'—No. of Bedrooms___..•_...........3.......................Expansion Attic ( ) Garbage Grinder ( ) aOther f 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 ( ) Percolati t- -Test Results Performed by........................................................................... Date........................................ Te t Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water•..-_-_-------_-___-_--- f4 T t Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 9 ---------------------------------------------- ---•.................. .-•--------- .----------- •....... ......................................................... Descriy ion of Soil....................................................................................................................................................................... ---..-- -. .................................................................................................................. V Nature of Repairs or Alterations Answer when applicable.------------'.__ _o _ .__.�_uiYf,____-___--.--.-.-.-_-.-.--..-__-....._._•_..-______- i-1 aQf3 on•t"r--------------------------------------------•-----•--- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'? IE 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 by the board of health. Signed.:. ..._ a�.....E: Jt......1 4C.:_�.......... � D 0/1!",l0+fi Application Approved BY f/'=/� t Q Date Application Disapproved for the following real ns:----•----------•--••---••---------------•----------------------•-------------••----------•------..........----- ------------------ - Date Permit No...( r D,`-__.. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..............Town................OF...............Bar.n.s.t.rib.1.1, ...................................... (9rdif irFatr of Toutpliattrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired kx) by-----J.P:vlacom'oer - Installer at. 3......_r_,r..n ...Str' _.._ti_1e..t---Hyannis:por'c-----•------•-----------•-------•------•----. has been installed in accordance with the provisions of i "-- 5 of h to Sanitary Code as described in the application for Disposal Works Construction Permit �To. _��' "��` dated.......................____-___-------_-------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE....................... } f° ... ....................... Inspector...----........ ED................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH T��wm Barnstable .......................:..................OF..................................................................................... NO.. . FEE.t�... '_c:o 0 �-o Disposal Marko T-Lonstrttrtuatt prrutit Pet ission is hereby granted............................J 2-.?na r- inrimlaar................................................................................ to Construct (P, ) or Repair -(X, an Individual Sewage Disposal System at No30.1I.tr_Ving Street 'Nes l_ Nya_nni sport ------- ----•-•. --------• ..... .. Sueet as shown on the application for Disposal Works Construction Permi Da d. � .pC/ ...Q_�?...._._-- 6 / 1t _ - �' Boa�&-- th DATE----�� . Q.-•�� ----•--- FORM 1255 ZBBS & WARREN, INC., PUBLISHERS r v to �w rid c")y CA% !` JWN OF BARM. TABLE Lo CA-r ON 40 / S SEWAGE N VILLAGE_ L"' e,All9 eR L1LLC- ASSESZ'30R'S MAP & LOr ;akbl- � r �o INSTALLER'S NAME & PHONE NO. 77,E 3�3f SEPTIC TANK CAPACITY-- �� -LEACHING FACILITY:(type) /, h NO. OF BEDROOMS WELL OR PUBLIC WATER—_ BUILDER OR OWNER DATE PERMIT ISSUED: -- DATE COMPLIANCE ISSUED__ VARIANCE GRANTED: Yes - i 5kr%, o , Commonwealth of Massachusetts ■ 1100156011 Asbestos Notification Form ANF-00 A 1 Decal Number Important: A. Asbestos Abatement Description When filling out p forms on the computer,use 1. a. Is this facility fee exempt-city, town, district, municipal housing authority, owner-occupied only the tab key residence of four units or less?R1 Yes El No to move your cursor-do not b. Provide blanket decal number if applicable: t----®-�-- - - - - - use the return Blanket Decal Number key. 2. Facility Location: a �� YAMPOL$4CY ��- [0 IRVING ST a.Name of Facility _ _ b._Street Address _ _w_�r.___ __on C i �.r---`- ; RNn-rn ni r MA 02632 { �_.R._..__....... .._..�.__._.._...`._....,�_._._' mvm's � - yy� .......__... �....._..__..__.......� ... ...�..- -.-.� c.City/Town _ d.State e.>Zip Code f Telephone Number INSTRUCTIONS 3. Worksite Location: EXTERIOR _ I� �_ .,__�•_�_ � i F -- 1.All sections of this forth must be a.Building.Name/Building Location :,b.Building#. c.Wing d.Floor e.Room . completed in order to comply'wMtn 4. Is the facility occupied? ✓ Yes ._J No DEP notification requirements of 310 CMR�:1'6 5. Asbestos.Contractor. and the Division of occupational N#cW ENGLAND SURFACE MAINTENANCE I 850 WASHINGTON STREET Safety(DOS) a.Name, b.Address notification ti WEYMOUTH 02189 i 78 'requirements of 453 —J 433721171 CIVIR 6:12 c.:City/Towns, _ d.Zip Code 6-Telephone Number 1AC000196 6 f.DOS License Number � 9` Contract Type: 'Written Verbal h FacilitV.Contact Person w i.Contact Persons Title _ k IJOHN P VALLIQUETTE AS060773 6' a.Name of:On-Site Supervisor/Foreman >., i b..Supervisor/Foreman DOS Certification Number N/A N/A 7' a.Name of Project Monitor b.Pro'ecf Monitor DOS Certification Number N/A N/A 8. a.Name of Asbestos Analytical LabLa b.Asbestos Anal ical Lab DOS Certification Number 09104/2012 �� 09/04/2012 _ �0 9' a.Pro'ect start Dato(mm/dd/y .yy) b.End Date(mfrUdd/ �0 18-4 . yvr�! �N c.Work hours Mon-Fri. d.Work hours Sat-Sun. =o 10. a. What type of project is this? =0 E] Demolition Renovation ___ ' ✓® Repair Other,please specify: b.Describe. -- ---- — — -- t _ 11. a. Check abatement procedures: o ❑ Glove bag E Encapsulation —o [ :Enclosure, [] Disposal only - - —. �u- i El Cleanup _ 17 Other, specify: SHINGLES �Z [�_Fult containment �4 ;_ b.Describe . Q 12.'-Is the job being conducted: [�] Indoors? j✓ Outdoors? , ■ anf001ap.doc•10/02 Asbestos Notification Form•Page 1 of 3■ i Ll Commonwealth of Massachiusetts ■ 100156011 • Decal Number Asbestos Notification Form ANF-001 A. Asbestos Abatement Description (cont.) 13. Total amount of each type of Asbestos Containing Materials(ACM)to be removed, enclosed, or 9 encapsulated: 250 a.Total pipes or ducts(linear ft) 'Total o herher suifaces((square Mt ' c.Boiler,breaching,duct,tank surface coatings Lin.ft. Sq.ft. d.Insulating cement Lin.ft. " Sq.ft._ e.Corrugated or layered paper w...._j f.Trowel/Sprayer coatings �--.____.:___,j �__._....1 pipe insulation Lin.ft. Sq.ft. Lin.ft. Sq.ft. g.Spray-on fireproofing 1------� --- h.Transite board,wall board I - Lin.ft Sq.ft. Lin.ft. Sq.ft. i 1 is Cloths,woven fabrics �) —W-' j.Other,please specify: E250 Lin."ft. So.ft Lin ft gft.�m k.Thermal,solid core pipew ( . I IIItICxLES insulation Lin;ft: Sq:ft: I.Specify +_ 14. Describe the decontamination system(s)to be used: AS REQUIRED 15. Describe the containerization/disposal methods to comply with 310'CMR 7.15 and 453 CMR 6.14(2)(g):, AS REQUIRED 16. For Emergency Asbestos'Operations, h6 DEP and DOS officials who`evaluated the emergency; a.'Name of.DEP Official:, b.Title c:Date(mm/dd/yyyy)ofAuthon2ation ' d::DEP Waiver# e.Name of DOS Official f..DOS Official Title �N g.Date(mm/ddlyyyy)of Authorization. h.DOS Waiver o 17. Do prevailing wage rates/as per M.G.L. c. 149, §26,.27 or 27A=F apply to this project? Yes Z No "o B. Facility Description �N RESIDENCE - �o 1. Current or prior use of facility: - --- �o 2. Is the facility owner-occupied residential with 4 units,or less? �✓.Yes. No SAME t 3' a.FacilityOwner Name b.Address o --�- o c.City/Town d.Zip Code e.Telephone Number(area code and extension) LL 4 �.� a:Name of,Facility Owner's On-Site Manager rb.On-Site Manager Address �Q c.City/Town d.Zip Code e.Telephone Number(area code and extension) ■ anf001 ap.doc•10/02 Asbestos Notification Form•Pa e 2 of 3■ E , Commonwealth of Massachusetts ■ �100156011 Asbestos Notification Form ANF-001 Decal Number B. Facility Description (cont.) 5. a.Name of General Contractor E b.Address _ c.CiN/Town _-���d.ZipC ode e.Telephone Number(area code and extension) f.Contractor's Workers Comp.Insurer g.Policy Number h�Exp.Date(mm/dd/y ) 6. What is the size of this facility? i ---�-----� a.Square Feet b.Number of floors C. Asbestos Transportation and Disposal 1. Transporter of asbestos-containing material from site to temporary storage site (if necessary): a.Name of Transporter b.Address Note:Transfer y�- 1 Stations must comply With the, c:.City/Town _.._.. d.Zip Code e.Telephone Number Solid Waste Division 2. Transporter Of asbestos-containing waste material from removal/temporary site tO final dispOSat site: Regulations 310 _ __ CMR 19:000- ECHNOLOG RED T a Name of Transporter � W M_ _ b.Address C.City/Town Ld.Zip Code:`: e.Telephone Number 3. R nfr i r a.Refuse Tra s e Stat on and Ovine ib.Address c.Ci /,Town d.Zip.Code a Telephone Number 4 MtNERVA ENTERPRISES INC a:.Final Disposal Site,Location Name b:Final Dis osal;Site Location4Owner's Name r 9000 MINERVA ROAD " . , WAYNESBURG.. c.'Finaf Disposal Site Address d.Ci frown OHI 44688 e.State J.Zip'Code. g.Telephone Number M O _ �O _ D. Certification aN The undersigned hereby states, under the IKEN FURTNEY -� �0 penalties of perjury,that he/she has read the a.Name b.Authorizegnature �O Commonwealth of Massa d si Massachusetts regulations for the.Removal;Containment or 8/15/2012 C.Position/Title d.Date(mm/dd/)nry_) Encapsulation of Asbestos,453 CMR.6.00 and ' 310 CMR 7.15,and that the information 1 L contained in this nobf elation is true and correct e:Telephone Number f.Representinq o to the best of his/her knowledge and belief. O q.Address emu. t l � h.City/Town L Zip:Code Z �Q anf001 ap.doc•10/02 Asbestos Notification Form•Page 3 of 3■