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Home My WebLink About0932 MAIN STREET (COTUIT) - Health 02, Main Street 035_093 Cotuit i P i. TOWN OF F3f NSTA��L� xocp. .torr S SacR' M.q l',Si LO. �, INST'tA.L1 ETVS NAiR t Nf No._ �lrlic Tarty -- L (typ f N�'CD � RRO0 BUILDEROR OW iiTI31�' :._.:A.r... W�CD1bI)"[..w CE IDMTE:, S�a�satadow lei stitCBr �c tv� eta tIAC: -T ' e3Idjuct Gepuncw Otto On luil tC e 010 Prlvt�: Sis�c�;uplly Wcll`a;etl l� a�. in�1?ucility t� ►3' vs;ifs exist u au sate a WRW 200 fe t of Ic'm-i11s t�;ciW), I?ci �:cif W.cdaurl mead Loac6ttu Ficillry(If any wetlauds exist` S fee �(=�19.laica: f6e f le��:9isa�laelliry} �..,. lrui��islrcd by. i � -r.a � C job F G ' o , a c a • O -mil TOWN OF BARNSTABLE 10CATION 07 _ %�S /_rt a n �J� SEWAGE ViLAGE (!,—O**'C)712. �' ASSESSOR'S MAP&LOT - INS''ALL.ER'S NANF4&PHONE NO. :3 SEP11C TANK CAPACITY LFACI i3NO FACILITY': type _,_ ._._ (size) ,k III � NO.OF EEOROCJP1dS ®�.,_,,...,. 1 BUILIDER OR OWNER, FERMITOATk?:.—.-..---;.- COivIPLIANCI DATE: 1". Separation Di since Between the: Maximum A.djustul Groundwater fable to the Bottom of Luching Pacility e ' Private Water Supply Well and Leaching Facility (lf any wells exist on site or within 200 feet of leaching facility) ...�- beef Edge of Wedand and Leaching Facility(If an we an exist within=feet lcaebing fa ility) < Feel Furnished by =L -O Az -- O c• � p O ?1 R., n a TOWN OF BARNSTABLE LOCATION:'—603" 9a5 1440, 4 5 t SEWAGE # VILLAGE w'f� ASSESSOR'S MAP&LOT033=c 4—,04 INS&LER'S NAME&PHONE NO. SEPTIC TANK CAPACITY '-1 606 (c I LEACHING FACILITY: (type) L ecir4 t7 LJ�5 (size) X 3 NO.OF BEDROOMS ay BUILDER OR OWNER t—U Tit t T, M C ULt 0 $ PERMITDATE: 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 4 leaching facility) Feet Furnished by F o cq, _ za V �V ` • TOWN OF BARNST/ABL,EE ON C � � t S�l.� SEWAGE # i.LQt..ATI 0 VILLAGE �.6�u ASSESSOR'S MAP®& LOT- INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO. OF BEDROOMS —� BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 O ' 1 O 1. O Q o o O 4, TOWN OF BARNSTABLE SEWAGE # i�,LLAGE CC5-U-1A- ASSESSOR'S MAP& LOT 7 INSTALLER'S NAME&PHONE NO. �C�bi `a ' r-�C.I SEPTIC TANK;CAPACITY LEACHING FACILITY: (type) Cam$ 66� � (size) des NO.OF BEDROOMS G r BUILDER OR OWNER �lc`A�i1®rP PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Welland Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) A Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by " " n t ' i j Commonwealth of Massachusetts 100218227 x` Asbestos Notification Form ANF-001 Asbestos Project# r, 1-1 Project Revision r Project Cancellation all A. Asbestos Abatement Description 1.Facility Location: rwa3 MARISA KELLEY 932 MAIN ST. Name of Facility Street Address sg 4;a.a Instructions 1.All BARNSTABLE MA 02635 5082612068 sections of this form City/rown State Zip Code Telephone must be completed in SAME OANER order to comply with MassDEP notification Faality Contact Person Name Facility Contact Person Title requirements of 310 Worksite Location: RESIDENCE CMR 7.15 and Department of Labor Building Name,Wing,Floor,Room,etc. Standards(DLS) 2. Is the facility occupied? F Yes No notification requirements of 453 CMR6.12 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)? I✓3 Yes r 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 6.Asbestos Contractor` Massachusetts ASBESTOS MAN REMOVAL 929 STATE ROAD Asbestos Program P.O.Box 120087 Name . Address Boston,MA 02112- PLYMOUTH MA 02360 5082245500 0087 City/Town State Zip Code Telephone AC000342 Contract Type:YP F Written 177 Verbal DLS License# 7, JOAN BERTON AS002057 Name of Contractor's On-Site Supervisor/Foreman DLS Certification# $, EDWN G.MORGAN JR. AM051114 Name of Project Monitor DLS Certification# 9, GUERTIN&ELKERTON AA000173 Name of Asbestos Analytical Lab DLS Certification# 10. 4/25/2015 4/25/2015 Project Start Date(MM/DD/YYYY) End Date(MM/DD/YYYY) { 7AM-2PM 7AM-2PM Work Hours-Monday Through Friday Work Hours-Saturday&Sunday 11. What type of project is this? r` Demolition I- Renovation Repair r-i Other-Please Specify: Revised: 11/1.3/2013 Page 1 of4 Commonwealth of Massachusetts 100218227 Asbestos Notification Form ANF-001 _._...__----__.______ .. Asbestos Project# X � ❑ Project Revision ❑ Project Cancellation A.Asbestos Abatement Description: (cont.) 12.Abatement procedures(check all that apply): Glove Bag Encapsulation Enclosure Disposal Only Cleanup Full Containment r g r p r r p Y r P r r Other-Please Specify: 13.Job is being conducted: r Indoors r Outdoors 14.Total amount of each type of asbestos Containing materials(ACM)to be removed,enclosed,or encapsulated: 35 Linear Feet(Lin.Ft.) Square Feet(Sq.Ft.) Boiler,Breaching,Duct, 35 Transite Pipe Tank Surface Coatings Lin.Ft. Sq.Ft. Lin.Ft Sq.Ft Pipe Insulation Transite Shingles Lin.Ft. Sq.Ft. Lin.Ft Sq.Ft. Spray-On Fireproofing Transite Panels Lin.Ft. Sq.Ft. Lin,Ft. Sq.Ft Cloths,Woven Fabrics Other-Please Specify: Lin.Ft Sq.Ft Insulating Cement Lin.Ft. Sq.Ft. Lin.Ft. Sq.Ft. 15.Describe the decontamination system(s)to be used: REMOVE ASBESTOS IN FULL CONTAINMENT UNDER NEGATIVE AIR PRESSURE 16.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 BAGS 17.For Emergency Asbestos Operations,the MassDEP and DLS officials who evaluated the emergency: Name of MassDEP Official Title of MassDEP Official Date of Authorization(MM/DD/YYYY) Waiver# Name of DLS Official Tide of DLS Official Date of Authorization(MM/DD/YYYY) Waiver# 18.Do prevailing wage rates as per M.G.L.c. 149, §26,27 or 27A—F apply to this r yes I✓ No project? Revised: 11/13/2013 Page 2 of Commonwealth of Massachusetts 1.100218227 _______..______..._____..______.._-----.--_ Asbestos Notification Form ANF-001 Asbestos Project# ❑ Project Revision 3 ❑ 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? r Yes l ? No 3,SAME AS ABOVE SAME Facility Owner Name Address SAME MA 02635 5082612068 Cityrrown State Zip Code Telephone 4.NONE N/A Name of Facility Owner's On-Site Manager Address N/A MA 02635 5082612068 City/Town State Zip Code Telephone 5.NONE N/A Name of General Contractor Address N/A MA 02635 5082612068 City/Town State Zip Code Telephone Note:Temporary N/A storage of Asbestos containing waste Contractor's Worker's Compensation Insurer material is only 99999999999999999999999999999999 9/9/9999 allowed at the place Policy# Expiration Date(MM/DD/YYYY) of business of a DLS licensed Asbestos 6. What is the size of this facility? 2000 2 contractor or a transfer station that is permitted by Square Feet #of Floors M and operatedcrated in C. Asbestos Transportation & Disposal compliance with Solid Waste Regulations 1.Transporter of asbestos-containing waste material from site of generation: 310 CMR 19.000 r Directly to Landfill or I✓ To Temporary Storage Location/Transfer Station ASBESTOS MAN REMOVAL CO 929 STATE RD Name of Transporter Address PLYMOUTH MA 02360 5082245500 Cityrrown State Zip Code Telephone 2. If a temporary storage location/transfer station is used, list name of transporter of asbestos containing waste material from temporary storage location/transfer station to final disposal site: JOB ROLLOFF POB 6037 Name of Transporter Address CHELSEA MA 02150 6173871495 Cityrrown State Zip Code Telephone Revised: 11/13/2013 Page 3 of 4 f f Commonwealth of Massachusetts [10002218�227 .. ...... Asbestos Notification Form ANF-001 Asbestos Project# t ❑ Project Revision ❑ Project Cancellation none:contractor must C.Asbestos Transportation & Disposal: (cont.) sign this form for DLS notification purposes 3.Name and address of temporary storage location/transfer station for the asbestos containing waste material: ASBESTOS MAN REMOVAL CO 25 ADAMS ST. Temporary Storage Location Name Address BRAINTREE MA 02184 5082245500 City/Town State Zip Code Telephone 4.Name and location of final disposal site(asbestos landfill): TURNKEY LANDFILL WASTE MGT. WASTE MGT. Final Disposal Site Name Final Disposal Site Owner Name 90 ROCHESTER NECK RD Address ROCHESTER MA 03839 6033390039 Cityrrown State Zip Code Telephone D. Certification "I certify that 1 have personally examined the foregoing and am PAUL ILACQUA PAUL ILACQUA familiar with the information Name Authorized Signature contained in this document and PRESIDENT 4/9/2015 all attachments and that,based Position/Title Date(MM/DD/YYYY) on my inquiry of those 5082245500 AMR CO individuals immediately responsible for obtaining the Telephone Representing information,I believe that the 929 STATE RD PLYMOUTH information is true,accurate,and Address Cityrrown complete. I am aware that there MA 02360 are significant penalties for submitting false information, State Zip Code 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 II AsBuilt Page 1 of 1. i TOWN OF BARNSTABLE LGCAT10NMMOAN . -A--'Wi SEWAGE# 03 ILLAGE. (--,!!, AA' ` ASSESSOR'S MAP&LOT 93 LL INSTAER'S NAME&PHONE.NO.�d h,1 C'r r G.C.1 576,y C 23/? SEPTIC TANK CAPACITY LEACHING FACILITY:(type) Cis. iPrsC1 (size) NO.OF BEDROOMS_ BUILDEROROWNER 1pkOf PERMITDATE: 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 blJ - OecJ� q tOVe� bx� C,�rq�e i http://issgl2/intranet/propdata/prebuilt.aspx?mappar=035093&seq=1 4/23/2015 I _