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HomeMy WebLinkAbout0222 WEST MAIN STREET - Health .Vest Main Street �Iyannis �. A= 290.- 061 — ° " E I " f t t hl e ° R { 6 e a t ° " J Massachusetts Department of Environmental Protection 100263335 BWP AQ 04 (ANF-001) Asbestos Project# Asbestos Notification Form r Project Revision lFoject Cancellation P+w A. Asbestos Abatement Description •Ta 1.Facility Location: TOWN OF HYANNIS 220411 W.MAIN STREET Instructions 1.All a.Name of Facility b.Street Address sections of this form HYANNIS must be completed in MA 02601 0000000000 order to comply with c.City/Town d.State e.Zip Code f.Telephone MassDEP notification BRUCE BRITTON VICE PRESIDENT requirements of 310 CMR 7.15 and g.Facility Contact Person Name h.Facility Contact Person Tide Department of Labor Worksite Location: EXTERIOR Standards(DLS) notification i.Building Name,Wing,Floor,Room,etc. requirements of453 2. Is-the facility occupied? r7a.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)? r 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 NON LICENSED REMOVAL NON LICENSED REMOVAL a.Name b.Address NON LICENSED REMOVAL MA 02108 6172925500 c.City/Town d.State e.Zip Code f.Telephone A0000000 h.Contract Type:r 1.Written r 2.Verbal g.DLS License# 7. NON LICENSED REMOVAL NON LICENSED REMOVAL AS000000 a.Name of Contractor's On-Site Supervisor/Foreman b:DLS Certification# 8. N/A a.Name of Project Monitor b.DLS Certification# 9 N/A a.Name of Asbestos Analytical Lab b.DLS Certification# 10. 5/5/2017 5/19/2017 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 r b.Renovation c.Repair ri d.Other-Please Specify: DISPOSAL ONLY Revised: 11/13/2013 Page 1 of 4 Massachusetts Department of Environmental Protection BWP AQ 04 (ANF-001) Ass- bestos Project# Asbestos Notification Form Project Revision 100263335 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 r g.Other-Please Specify: EXTERIOR 13.Job is being conducted: r a.Indoors r' b.Outdoors 14 a.Total amount of each type of asbestos Containing materials(ACM)to be removed,enclosed,or encapsulated: 100 0 1.Linear Feet(Lin.Ft.) 2.Square Feet(Sq.Ft.) b.Boiler,Breaching,Duct, c.Transite Pipe 100 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 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 1✓ a.Yes r b.No proj ect? Revised: 11/13/2013 Page 2 of 4 i f Massachusetts Department of Environmental Protection 100263335 BWP AQ 04 (ANF-001) _ _ Asbestos Project# Asbestos Notification Form 1- Project Revision L r Project Cancellation B. Facility Description 1 1.Current or prior use of facility: STREET 2.Is the facility owner-occupied residential with 4 units or less? r7 a.Yes V' b.No 3 TOWN OF HYANNIS X a.Facility Owner Name b.Address X MA 00000 0000000000 c.Citylrown 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 0000000000 c.City/Town d.State e.Zip Code f.Telephone X. g.Contractor's Worker's Compensation Insurer X 1/1/2018 h.Policy# i.Expiration Date(MM/DD/YYYY) 6.What is the size of this facility? 1000 0 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 SERVICE TRANSPORT GROUP,INC 58 PYLES LANE c.Name of Transporter d.Address Note:Temporary storage of Asbestos NEW CASTLE CE 19720 0000000000 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 ora storage l f waste material temporary a location/transfer station to final disposal site: contractor or a transfer P n' g P station that is permitted by MassDEP and a.Name of Transporter b.Address operated in compliance with Solid Waste Regulations c.City/Town d.State e.Zip Code f.Telephone 310 CMR 19.000 Revised: 11/13/2013 Page 3 of 4 I Massachusetts Department of Environmental Protection 100263335 BWP AQ 04 (ANF-001) -- - -- Asbestos Notification Form Asbestos Project# Project Revision r! Project Cancellation C.Asbestos Transportation&Disposal:(coot.) 3.Name and address of temporary storage location/transfer station for the asbestos containing waste material: a.Temporary Storage Location Name b.Address 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 CH 44688 3308663435 d.City/Town e.State f.Zip Code g.Telephone A Certification BRUCE BRITTON BRUCE BRITT'ON "I certify that I have personally 1.Name 2.Authorized Signature examined the foregoing and am VICE PRESIDENT 4/21/2017 familiar with the information contained in this document and 3.Position/Title 4.Date(MM/DD/YYYY) Note:Contractor must 0000000000 W.WALSH COMPANY sign this form for DLS all attachments and that, based -- notification purposes on my inquiry of those 5.Telephone 6.Representing individuals immediately 32 WALTON STREET ATTLEBORO responsible for obtaining the 7.Address 8.City/Town information, I believe that the MA 02703 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 No. -- --------------- Fee----� -- - -- BOARD OF HEALTH TOWN OF BARNSTABLE Application-*r Well Congtruction_30er_tnit Application is hereby made for a permit to Construct (' Alter ), or Repair an individua Well at: NCO---�iY' MAIM- ©�-' --- ------- Location — Address Astessors Ma e Owner Address ---------------------------------------------------------------------------------- Installer — Driller Address Type of Building Dwelling------------------------------------------------------------ Other - Type of Building No. of Persons--------------------------____—______—______ Typeof Well----s----------------------- --------- - Capacity--------�------------------------- Purpose of Well- � �--' j= d=- Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of H Private Well Protection Regulation — The undersigned further agrees not to place the well in operatio n ' a ertificate .of Cqqnpliance has been issued by the Board of Health. Signed -- �-- -- -- - ------- — - - � - ------- ate Application Approved By---------- -- -- ---- —--—— ---- -- — date Application Disapproved for the following reasons:---------------------------____________________________--________-_________—__________ -------------------------— - ------- - — ---— — - - --- ----------------- - ------- -- - Issued — - ------ ----- ---------- ------date-------------- Permit No. — 0-0- — date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate Of Compliance THIS TO_CERTIFY, That the Individual 1 Constructed (Altered ( ), or Repaired ( ) bY------- 1►'1O_ ' - 't-� -C_t—D-- 4X9 -------------------------------—- - — —- -—- Installer at- - -t.� ------- -- - ° ------------------------------------- has been installed in accordance with the provisions of the Town of Barnstable Board of th Well Protection Regulation as described in the application for Well Construction Permit No. - -- ed------------------------ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE------------------— — —---------—------------ — — -- Inspector---------------------------------------------------------------------------- ------- , NJ- ---------------- Fee----�----------- BOARD OF HEALTH > ,TOWN OF BARNSTABLE zipplicat ion,forWell ConstructionPermit Application is hereby made fora permit to Construct ( Altev( ), or Repair ( )an individual Well at: - ------- ------ ---------------- Location — Address Owner Address -------------- Installer — Driller Address Type of Building Dwelling--------------------------------------------------------------- Other - Type of Building--Gam'"-"—�"t 2_u rf�- No. of Persons------------------------- Type of Well---- — --- - Capacity---------- N F Purpose of Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Hflj4 Private Well Protection Regulation - The undersigned further,agrees not to place the well in operati un 1 a ertificate .of pliance has been issued by the Board of Health. g< ate Application A ro edrB PP PP Y—--,—------;-- -- -- -- -— ----- - - date, Application Disapproved for the fol owing reasons':------------------ ------------------------------------------- —— —— — — ------------------------ ------------------ - ------------------------------------------------------ -- -- ---------- ------------------------ date --���Permit No - - - Issued-- -- - - — --- date BOARD OF HEALTH TOWN OF BARNSTABLE C ertif icate ®f Compliance - ` THIS LS TO CERTIFY, That the Individual Well Constructed fll, Altered ( ), or Repaired ( ) ------------------------- ----------------------------- -------- Installer at -- '� ------------Y-Y oy '-------------------------------------- hasgbeen installed in accordance with the provisions of the Town of Barnstable Board of •IS)Zed Well Protection Regulation as de P )Vscribed in the a lication for Well Construction Permit No ------ -------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE----------------------------- - - -- Inspector-------------------------------------------------------------------------- ----------- 7------------------------------------------------------------------------------------------� BOARD OF HEALTH TOWN OF BARNSTABLE Vell Cootruct ion Permit N o _ _ -- ---75 Fee - Permission is hereby granted- � �--- �_- - 1 � �-------------------- to Constructs , Alter ( ) or Repair ) an Individual Well at: No. - --- - _!`- "� -- = - - -/`r0--�------------------------- Street as shown on t epp icatio for a W I s onstruction Permit ~ s No. - --- - ------ --------------------------------------------- - - ; -- - - Dated - - T- Bo�r�of ealth DATE-- - - e_ ----------- — -- 4dC r Massachusetts Department of Conservation and Recreation jw--h—etfa Office of Water Resources Aft 1qQWWell Completion Report 11-JUL-07 11:19:44 WELL LOCATION 250333 GPS North: 410 38.908' GPS West: 700 18.301' Address: 220, West Main Street Property Owner/Client: DePaola Begg & Assoc Subdivision Name:Hyannis Mailing Address: 220 West Main Street City/Town:Barnstable City/Town, State:Hyannis MA Assessors Map: 290 Assessors Lot #: 061 Permit Number:W2007-018 Board of Health permit obtained: Y Date Issued: 07/02/2007 Work Performed Proposed use Drilling Method Overburden Drilling Method Bedrock New Well Irrigation Auger CASING From (ft) To (ft) Type Thickness Diameter 11.00 -47.00 PVC Schedule 40 4.00 SCREEN From (ft) To (ft) Type Slot Size Diameter -47.00 -51.00 Stainless Steel Well .012 4.00 Point WELL SEAL / FILTER PACK / ABANDONMENT MATERIAL From (ft) To (ft) Material Description Purpose „ w .. . WELL TEST DATA (ALL SECTIONS MANDATORY FOR PRODUCTION WELLS) Date Method Yield Time Pumped Pumping Level Time to Recover Recovery (GPM) (bra & min) (Ft. SGS) (Era & Min) (Ft. BGS) 07/05/2007 Constant Rate Pump. 20.0000 01:00 22.0000 00:01 21 STATIC WATER LEVEL (ALL WELLS) PERMANENT PUMP (IF AVAILABLE) Date Depth Below Ground Pump Description:Goulds 33GSIS Measured Surface (ft) Type: 2 Wire Constant Speed Submersible Intake Depth: 48.0000 07/05/2007 21 Nominal Pump Capacit y: 33.0000 Horsepower: 1.5000 ADDITIONAL WELL INFORMATION WELL DRILLER'S STATEMENT Driller: Patrick Desmond Developed: Yes Fracture Enhancement:No Supervisor: Patrick Desmond Rig #: 36 Disinfected:Yes Well Seal Type:None Firm: Desmond Well Drilling Inc. Total Well Depth: 4b.000 Depth to Bedrock: Registration #: 877 Date Complete:07/06/2007 Comments: Well is set at bottom of 11 deep well pit. Top of pipe measurements are 401/10' (well/static). . OVERBURDEN From To 'Description Color, Comment Water` Loss/Add Drill Drill (ft) (ft) Zone of Fluid Stem Drop Rate 00 40.00 Fine to Coarse Sand Brown Yes N/A BEDROCK ` From To Code Comment Water Drill Extra Drill Rust Loss/ # of (ft) (ft) Zone Stem Large Rate Stain Add of Frac nron per ft 1/1 1 nt. ENVIROTECHLABORATORIES, INC AM CERT. NO.:M-MA 063 ' 8 Jan Sebastian Drive Unit 12 Sanditich,MA 02563 (508)888-6460 1400-339-6460 FAX(508)888-6446 Client Name Desmond well Drilling Location 222 West Maw SUW Address Po Box 2783 Hyannis MA Orleans MA 02653 Sample Date o7mw Collected By Desmond Well Sample Time 1&00 Sample Type New Well/Irrigation Date Received o7/06/07 Lab Order Number DW-mw Well Specs r SCH 40 PVC 49110' y �s�ocatuia�Source g���'� Date C©Ilected TimeColected�} ,'��� _ ` �� � t,amrrYe/rtsk �'` r Analysis Regrtested Units Recommended Limits Analysis Result Method Date Analyze Analyzed By Total Coliform /100m1 0 0 9M B 7/62007 IRS pH pH units 6.5.8.5 5.83 4500-H-B 7/62007 LL Specific Conductance umhos/cm 5M 204 120.1 7/6r"7 LL Nitritee-N mgiL 1.00 <0.004 300.0 MOM LL Nitrate-N mg/L 10.0 10.7 300.0 7/62007 LL Sodium mg/L 20.0 31.7 200.7 7/122007 MC Total Iron mg/l. 0.3 0.01 200.7 7/122007 MC Manganese mg/L 0.05 02(34 200.7 7/122007 MC Comments: Low pH indicates high corrosive charaderistics. Nitrate level exceeds nmdmtun contaminant level. Saloon level is not a health hazard. Manganese is not a health hazard,but may cause staining and/or give water an odor or taste. Stagged retest. Water is not Suitable for drinking purposes for parameters tested. Date o J.Saari Laboratory Dire or BRL=Below ReportabkLimits Page 1 of 1 sSeeAuached