HomeMy WebLinkAbout0028 NORRIS STREET - Health 28 NorrA .
Hyann s, i
A= 306 041
c,
No. �� 6 -C)-- Fee
' THE COMMONWE H OF MASSACHUSETTS Entered in computer:
es
i PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
a
01ppYication for Mioonl *p5tem Cow5truction Perron
Application for a Permit to Construct_( )Repair( )Upgrade( )Abandon M Complete System ❑Individual Components
Location Address or Lot No. Owner's Narpe,Address and jel.No.
ell
As�essor's Ma /Parcel � js
Installer's Name,Addree§�s,and Tel.No. Designer's Name,Address and Tel.No.
!e3M
Type of Building:
Dwelling . No.of Bedrooms 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 gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil,
Nature of Repairs or Alter tion)(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 by�th* oar H .
Signed Date /J`✓D
Application Approved by Date
Application Disapproved for the following reasons
Permit No. 52 ar-)3 Date Issued
No. Fee c�l>
u t Entered in computer:
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-TOWN OF BARNSTABLE., MASSACHUSETTS es
f i
Z.ppricatiott:for Migogat *pgtem Cow5truction i3ermit
Application for a Permit to Construct( )Repair( :)Upgrade( )Abandon(V) ER Complete System ❑Individual Components
Location Address or Lot No.Z //O '"Owner's Narpe,Address and Tel.Noliel
As
V ssor's Ma /Pazce ��l � 4
-e Li/
Installer's ame,Addres�s,and Tel.No. Designer's Name,Address,and Tel.No.
Wr t�/o�/� C4flS
>/
Type_of Building:
Dwelling No.of Bedrooms 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 gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil
Nature of Repairs or Alter tions(Answer when applicable) � � �� L�X�S /�,� ee-a
r
ti
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 th'.s/• oar, of Heal�f.
Signed ' Date D/�S/d 5
Application Approved by Date o�1/S1 S
Application Disapproved for the.following reasons
Permit No. ��W 5 O 3 Date Issued S
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS 9-TO CERT jFY,that the n-sitefSewag Disposal System Constructed( ) Repaired ( )Upgraded( )
Abandoned )by P� � e f � L � L/
at Z _16-t /r//.S ✓r" /Y__1 __5has been constructed in a cordance
p
with the rovision (Tide 5 and th f r Disposal System Construction Pen-nit No. �5-97�iated �o I
Installer � � p y Designer
The issuance of this permit sh l�not l�c nstrued as a guarantee that(he sy to ilk ctio as designed.
Date ( l Inspecto
No. � � ----------.--------——,--.—Fee
"
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS
1i6pogal *pgtem Cow5tructiou permit
Permission is hereby granted to ConstEuf t( )Repair( )UP, rade( ) andon( �r
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 mdst be completed within three years of the date of thi p rfniP
Date: ) Approved'by
' '. '.....'a L:..'::':'l.l tYloIiOYMn'1uo.e ® /! �i" " ' .. ! 49 ....W...r..a:..n,y...•v 1. _ a.
Garage #2 4
#28
F.F. 6" S #22
F. F 6" S 2 D
Service 5
0 . 5 2 5' -
5.5' .Deep
��4 > F. F.
Q No !,� 25 . 52
0 PO E _ -P ING
1 1, 41 _ I � � —e..
#12-36Z2 Sl36/3 , .�� ; NO
-FRO s
3+00 SMH- 1
1 T D
GAS` -� -�, C S GAS -_ -GAAs GAs ----� O 0
H - 1
SIG
/ N
LL6 Se
� 40, '\, z 5' Dee
\ i Q 26, 44 -�t
p "
33.5' 15 Service
J \ 1
6" Se►vic 5' Deep �
5.5' Deep :--�.—s
ice X F F F F _
p
F. F. 24. 12 23. 6 LD /(
F.
23. 92 26-
14 #ZJ
1#29
r
i
F
6ov c
Y '
,.vl 0
i
i
� I
'ode ,
-AS'H S!0S MAN i�l�ytt)V�1Ta t�.Q. IN(�.
929 State, Road, Plymouth, MA 02360
Phone 508.224-5500 Fax 508-224-8883
License NO,AC00W
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 `� �/� t r Sl" . The start up
date is /
and the end d y ate is
Enclosed please-find a copy of the Asbestos Notification Form(ANF-001)
for your files.
If you have any questions, please contact us at (508) 224-5500.
Sincerely,
Paul Ilacqua
Enc: ANF-001 form
t _ _
Commonwealth of Massachusetts ■
1 001 95748-- __. ..
Asbestos Notification Form ANF-001 Decal Number,
Important:When filling out p A Asbestos Abatement Description
-
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? ❑Yes ❑✓ NO
to move your
cursor.-..do_not b. Provide blanket decal number if applicable:
use the return Blanket Decal.Number
key. 2. Facility Location:
ji l EVELYN HIDENFELTER 28 NORRIS ST.
a. Name of Facility b.Street Address
YYANNIS 'Mt_A J 02601 5 884288608
c.City/Town d.State e.Zip Code f.Telephone Number
INSTRUCTIONS 3. Worksite Location:
1.All sections of this RESIDENCE BASEMENT
form must be a.Building Name/Building Location b.Building# c.Wing d. Floor e.Room
completed in order
to comply with 4. Is the facility occupied? ❑Yes ❑✓ No
DEP notification
requirements of 310
CMR 7.15 5. Asbestos Contractor:
and the Division
of occupational JASIBESTOS MAN REMOVAL 1929 STATE ROAD
Safety(DOS) a.Name _ b.Address
notification requirements of 453 JPLYMOUTH 02360 1 15082245500
CMR 6.12 c.City/Town d.Zip Code e.Telephone Number
AC000342
f.DOS License Number g. Contract Type: ❑Written ❑✓ Verbal
h.Facility Contact Person i.Contact Person's Title
PAUL A ILACQUA AS050350
6' a.Name of On-Site Supervisor/Foreman b.Supervisor/Foreman DOS Certification Number
N/A
7' a.Name of Project Monitor b.Project Monitor DOS Certification Number
(N/A - I
$' a.Name of Asbestos Analytical Lab b.Asbestos Analytical Lab DOS Certification Number
9 4/7/2014 4/7/2014
�o a.Project Start Date mmldd/ b.End Date(mm/dd/
�0 7AM-1PM
c.Work hours Mon-Fri. d.Work hours Sat-Sun.
�N
=o 10. a. What type of project is this?
10 ❑ Demolition ❑✓ Renovation
❑ Repair ❑ Other, please specify: b. Describe
11. a. Check abatement procedures:
_o ❑✓ Glove bag ❑ Encapsulation
-o ❑ Enclosure ❑ Disposal only
emu- ❑ Cleanup ❑ Other, specify:
❑ Full containment b. Describe
-z
=Q 12. Is the job being conducted: ❑✓ Indoors? ❑Outdoors?
■ anf001 ap.doc•10/02 Asbestos Notification Form•Page 1 of 3
Commonwealth of Massachusetts _ ■
100195748
Asbestos Notification Form. ANF-001 Decal Number
A. Asbestos Abatement Description (cont.)
13. Total amount of each_type of Asbestos Containing Materials (ACM) to be removed, enclosed, or
encapsulated: _
a oota pipes or TTucts(linear ft) 0.Total other su aces squa`re�
c.Boiler,.breaching,.duct,tank -
surface coatings Lin.ft. Sq. d:Insulating cement. Lin.ft. Sq.ft.
e.Corrugated or layered paper 100 C� f.Trowel/Sprayer coatings C�
pipe insulation Lin.ft. Sq.ft. (Lin.ft. Sq.ft.
g.Spray-on fireproofing Lint J Sq� h.Transite board,wall board Linl---- Sq.
I.Cloths,woven fabrics j.Other,please specify:
Lin S Lin.ft. S .ft.
k.Thermal,solid core pipe
insulation Lin.ft. Sq.ft. I.Specify
14. Describe the decontamination system(s) to be used:
REMOVE ASBESTOS USING THE GLOVEBAG METHOD
15. Describe the containerization/disposal methods to comply with 310 CMR 7.15 and 453 CMR
6.14(2) (g):
WET DOWN ASBESTOS AND DOUBLE BAG USING 6 MIL MARKED AND LABELED BAGS
16. For Emergency Asbestos Operations, the DEP and DOS officials who evaluated the emergency:
a.Name of DEP Official b.Title
c. Date(mm/dd/yy )of Authorization d.DEP Waiver#
e.Name of DOS Official f. DOS Official Title
i
g.Date(mm/dd/yyyy)of Authorization h.DOS Waiver#
N
_0 17. Do prevailing wage rates as per M.G.L. c. 149, § 26, 27 or 27A—F apply to this project? ❑Yes ✓Q No
B. Facility Description
N
=o 1. Current or prior use of facility: RESDIENCE
_0 2. Is the facility owner-occupied residential with 4 units or less? ❑Yes 21 No
EVELYN HIDENFELTER 1 306 CAPT. LIJAHS RD.
3' a. Facility Owner Name b.Address
�0 CENTERVILLE 026321 15088642046
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 b.On-Site Manager Address
�Q c.City/Town d.Zip Code e.Telephone Number(area code and extension)
■ anf001ap.doc•10/02 Asbestos Notification Form•Page 2 of 3 ■
Commonwealth of Massachusetts
��"`� 100195748
Decal Number
% Asbestos Notification Form ANF-001
B. Facility Description (cont.)
5' a.Name of General Contractor b.Address
c.City/Town d.Zip Code e.Telephone.Number area code and extension)
f.Contractor's Worker's Comp. Insurer q. Policy Number h.Ez .Date mm/dd/
6. What is the size of this facility?
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):
ASBESTOS MAN REMOVAL CO 929 STATE RD
Note:Transfer a.Name of Transporter b.Address
Stations must IPLYMOUTH 023601 15082245500
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 disposal site:
Regulations 310
CMR 19.000 JOB ROLLOFF JPOB 6037
a.Name of Transporter b.Address
CHELSEA 021501 16173871495
c.City/Town d.Zip Code e.Telephone Number
3.
(a.RRefus�e Transfer Station and Owner b.Address
I
c.City/Town d.Zip Code e.Tele hone Number
4. IWASTE MANAGEMENT OF MAINE
a.Final Disposal Site Location Name b.Final Disposal Site Location Owner's Name
AIRPORT ROAD I INORRIDGEWOCK
c.Final Disposal Site Address � ®� d.City/Town
e.State f.Zip Code g.Telephone Number
�o
D. Certification
N
The undersigned hereby states, under the PAUL ILACGIUA CPAUL ILACQUA
�0 penalties of perjury,that he/she has read the a.Name b.Authorized Signature
�o Commonwealth of Massachusetts regulations PRESIDENT 1 13/25/2014
for the Removal, Containment or c.Position/Title d.Date(mm/dd/yyyy
Encapsulation of Asbestos,453 CMR 6.00 and 5082245500 AMR CO
310 CMR 7.15, and that the information
contained in this notification is true and correct e.Telephone Number f.Re resentin
O to the best of his/her knowledge and belief. 929 STATE RD
O q.Address
�U_ I PLYMOUTH 102360
h.Cityrrown i.Zip Code
Z
anf001 ap.doc•10/02 Asbestos Notification Form•Page 3 of 3