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HomeMy WebLinkAbout0550 PARKER ROAD - Health 550 Parker Road A= 114-043 Osterville '-fir i I d r APR-1,r20W4 13:03 FROM: TO:1508790&M4 P.2 Massachusetts Department of Environmental Protection 1100195208 Bureau of Waste Prevention —Air Quality Decal Number �,. Project Revision Notification For Asbestos Notification ANF-001 and AQ 06 Important)When filling plat A Facility Location bans the computer, r,use JOHN MCDONNELL e only the tao key 1.Name of Facility to move your el, PARKER RD cursor-do not 2.$trout PARKER < use the return key. 184848TABLE MA '�� J. i 4.MAtO S.Zip Code rd - 6,Telephorm Number INSTRUCTION$ B. Project Cancelled I- This rorm is only available for Check here if this project is/was cancelled. online filing of proloct date rovislons. 2. Enter al number. C. Project Dates decal number. 3. Validate that 03J28J2014 03J2 the project 8=4 location ir corroot 1.06131ftl Start pate mr"/dd/ I t for the entered decal. 3.Latest Reviced Start Date mmld( d/yyyy) 4.Latest Rgvised End t],yte(mmlddlyyyy) 4. Enter your now project dates. 5, Certify your notification, D. Revised Project Dates Submit date mangos 04J02J2014 04J20J2014 1.Revised Start Dato(m dd/yyyy) 2,Reviscd End hate gate(mrn/dd/yyyy). E. Other Project Revisions CLERICAL ERROR CORRECTION: OWNER'S NAME MICHAEL RUBERTO&HOUSE NUMBER IS 550 a a F. Revision History e 06p.drn.doc rev.2/5/04 APR-1-2014 13:03 FROM: TO:15OB7906304 P.3 Commonwealth of Maachusetts t 100195208 l_— Asbestos Notification Form ANF-001 Decal Number Important: A. Asbestos Abatement Description When filling out p forma on the o.Is this facility fee exempt C town, district, municipal housing authority, owner-occupied computer,tine tY P - ®No I� 9 p only the tab key residence of four units or less?I�✓ Yes to move your cursor-do not b,Provide blanket decal number if applicable: Blanket Decal Number use the return key. 2, Facility Location: JOHN McDONNELL $6 PARKER RD a Name iiffacilify bJt%J1Ad. r BARNSTABLB I IMA ---- 102655 c•City/rown d.State e.Zip Code f,Telephone Number INSTRUCTIONS 3. Worksite Location: 1 All sections of this SAME form must be a.Building Name/Building location b.Building# c.Wing d.Floor e.Room completed in order to comply with 4. Is the facility occupied? Yes [�No iDEP notification requirements of 310 CMR 7.16 S. Asbestos Contractor: and the 01VI31on of 0=1patlonal AIR SiF-E INC lili I~NDICOTT STREET Safety(008) a,Name b.Address notification NDRWdOC 02062 7f3'I7623390 requirements of 453 CMR 6.12 C.cityfrown d.Zip Code e.Telephone Number ACOOOA6A f.DOSLicense Number g- Contract Type: Written ❑Verbal h. An ntad esraon I,-Contact Person's Title 6. JAIME E AMAYA AS060847 a.Name of Mn Site Su rvisor/Foreman b.Supervisor/Foreman DOS Certification Number SAM COMENro' AM060787 7' a.Name of PMonitor. b.Pro ect Monitor DOS Ce41oetion Number 8 ENVIROTEST LABS AA000128 a.Name of A5be5toa Ana ical 96 n N m r _ rurranrno4_aI Inninn mni e N c.Work hours Mon- r. 0-Wont hours at-Sun. 0 10. a.What type of project is this? �o ® Demolition © Renovation []✓ Repair Other, please specify: b, Describe 11, a. Check abatement procedures: o Glove bag Encapsulation o Enclosure Disposal only Cleanup ❑✓ Other, specify: AT z C] Full containment b.Describe 12. Ig the job being cvnduated: R✓ Indpvrs? [3 Outdoors? t 80001 8p.doC 102 Asbestos Nofification Form•Page 1 of 3 APR-1-2014 13:03 FROM: TO:15087906304 PA . �.:..-...,ems Commonwealth of Massachuseft 100195208 i' Decal Number Asbestos Notification Farm ANF-001 A. Asbestos Abatement Description (cont.) 13. Total amount of each type of Asbestos Containing Materials(ACM)to be removed, enclosed,or enca rulat 0 300 a.Total pipes or au=(linear r1i 5. 1 ofal W ar su cas square c.Boiler, breaching,duot,tank surface coatings , Sft d.Insulating Cement Lin,it. Sq. e.Corrugated or layered paper pipe insulation. Lin - S .ft. F.Trowr®IlSpreyer Coatings 4in�— ft g.$prey-on fireproofing L�fl�.._J k,,I h.Treaalte board,wall board din. i.Cloths,woven fabric$ ink— ---J gl-- —_�t j,Other.olasse soedfy; 300 K.Thermal,solid core pipe VAT insulation I.in. Sq.tt- I,specify 14. Describe the decontamination systern(s)to be used; 3 CHAMBER DECON 15. Describe the.containerization/disposal methods to comply with 310 CIVIA 7,15 and 453 CMR S.1a(2) ; 6 MIL POLY SAGS 16. For Emergency AsbsStos Opersltions,the DE and DOS officials who evaluated the emergency: a.Name of DER tWdalo r;.Date mrn/dd/ of Authorization d.DER Waiver# e.Name of DOS Offldal , N g.Date(mrnldd/yyyy)of Authorlration h.DOS Waiver# a 17, Do prevailing wage rates as per M.G.L c. 149, §26,27 or 27A—F apply to this project? Yes FZ]Nb ° B. Facility Description N o 1. Current or prior use of facility: RESIDENTIAL Q sAJ 2. Is the facility owner-occupied residential with 4 units or less? �]J Yes No r 3 SAME . Q.FaCillty Owner Name � o.apdresa 0 Q c.cityirown d.Zip Code e.Telephone Number area code and extension tr. 4 a.Name of Facility Ownses On-Site Manager b.On-Sits Manager Address Q C.Cityrrown d-Zip e.Telephone Number(area code and eztgrision) .:.�.. dnf001ap.doo•10102 Asbestos Notification Form 9 Page-_._of 3 APR-1-2014 13:04 FROM: TO:15087906304 P.5 �- Commonwealth of Massachusetts 100'.95208 { Asbestos Notification Form ANF-001 I?ecalNumber B. Facility Description (cant.) 5' a.Name of General Contractor b.Address o.C /Town d.Zip Code e.Telephone Number area code and extension f.Contneotors worker's Comp.Insurer gi.Polit j Number h.Ex .Date mmldd 6, What is the size of this facility? rereFeet b_Number of ttoars C. Asbestos Transportation and Disposal 1. Transporter of asbestos-containing material from site to temporary storage site(if necessary): AIR SAFE StatIns must a.Na. of T aria crier 1 b.Address Stations must comply with the a CgfTown d,Zlp Code e,Telephone Number scud watttd WSW 2. Transporter of asbestos-containing waste material from removal/temporary site to final disposal site: Regulations= CMR 19.000 9.iVBm®Of Transporter � b.Address a C' !Town d.Zi Code e.Telephone Number 3. a.Refuse Transfer Station and Owner b.Address c.CWrown d.Zip Code s.Ted hone Number, 4, IMINERVA ENTERPRISES INC a.Final DisDml Site L=tion Name) b.Final Di o3al Site Location Owners Name 9000 MINERVA ROAD WAVNESBURG d Cf OH.,,.....,..,..........,..^, 0 e.State f zip Code g Telephone Number M O D. Certification The undersigned hereby states,under the DF WAUH penaltios of perjury,that he/she has road the a.Name b.Authorized Signeture c Commonwealth of Massachusetts regulations Ivp I""""'"""-""" 1 for the Removal,Containment or r Encapsulation of Asbestos,463 CMR S.00 and r. 310 CMR 7.15,and that the information (79f)762.3390 AS r contained in this notification is true and correct e.Telephone Number f.Re resentln ° to the Crest of his/her knowledge and belief, 151 ENDICOTT p A.Address NORWOOD OZOfiF h.City/Town 1,Zip Code Z d anro0lap.doc•10/D2 Asbestos Notrfioation Forth•Page 3 of 3 TOWN OF BARNSTABLE LOCATION S5'Q /10A1dor SEWAGE# . wILLMGE 4S(���/� ASSESSOR'S MAP&PARCEL ill /Jq-4 INSTALLER'S NAME&PHONE NO. 0.NG'.callil_ '- sod_W•Sr;p SEPTIC TANK CAPACITY / 6171• LEACHING FACILITY: (type)lnwef P 7 �Excsi���� (size) _/,dor Gel NO.OF BEDROOMS / OWNER PERMIT DATE: COMPLIANCE DATE: Z� 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 4 34 v 3 �=N-ao No. )-V 6l — '7 7 Fee (� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2ppliLation for Mispo8al 6pstrm Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. SSd /9 e -m- Owned'_s Name,Address,and Tel.No. OS r"�III 1� tI Cf �t.�p�{/l O / Assessor's Map/Parcel [/— a y,3 $�O YA hc- Dd% <!G Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. CtaCCIt.s r 6-9- 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(min.required) gpd Design flow provided /.7(fsT,�� ew d �,�/ /�sc g0p Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) 2t: Ce G" //J40 6,9,1 h - �� , cl I e ,nc. -ao e 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 Certificate of Compliance has been issued by this Board of Health. S' ed Date J tit !�020// Application Approved by At2n Date Application Disapproved by Date for the following reasons Permit No. Date Issued ----------------------------- No. a U I IJ 17 7 Fee 0 �- THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: lies PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 'ftplitation for ]Disposal 6pstem Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. SSU Ji�K �R. �� Owner's Name,Address,and Tel.No. Assessor's Map/Parcel Installe 's Name,,4ddress,and Tel.No. Designer's Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms LI Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures .+ Design Flow(min.required) _ gpd Design flow provided /-tIt S/, r 16-4r /� / pd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. "-"- Description of Soil 1 Nature of Repairs or Alterations(Answer when applicable) C o(0 5 r/j tt �c \ , ��h, Ct e t�Jl `tC H F K t 51���� (�(-3 0 a 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 Certificate of Compliance has been issued by this Board of Health. S ed � �C`'G� Date �1 N e •F 02 Application Approved by Date v Application Disapproved by Date for the following reasons Permit No. 7 ( Date Issued i I G`G Ct J J /a ' THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired Upgraded( ) Abandoned O by St(crr e A,,k r w - at O 1��e+c��t 1 �( G S has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. r— I-7 7dated /o I Installer a v� c e Designer ip #bedrooms Approved design floy j, l( !< gpd The issuance of this p/e it shall ,of be construed as a guarantee that the system ill funs •o s ned. Date � v�I Inspector ---- ------ - - 1( - -- -- Fee --------- ----- - -No. - ------------------------ ------- -- --- - ----------- -- - /vU— -- --- -." THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal p stets Construction Permit Permission is hereby granted to Construct( ) Repair Upgrade( II) Abandon( ) System located at J G � and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Co1(0 trucf n must be completed within three years of the date of this permit. ate D Approved by a L-0 CAT ION SEWAGE PERMIT NO. VILLAGE s� �� I N S T A LLER'S NAME & ADDRESS Y-nci LI v zIr-- B U I L D E R OR OWNER E""M�-1 DATE PERMIT ISSUED , /D �� e�� DATE COMPLIANCE ISSUED ����. o A� THE COMMONWEALTH OF MASSACHUSETTS 1�l BOAR® OF HEALTH r .........OF......./ /................. a.. .._._....... Appliration for Disposal Works Tomitrnrtinn rnmi# Application is hereby made for a Permit to Construct ( ) or Repair. ( an Individual Sewage Disposal System at: _ .........3�d. . ..-�`!'! .1. AVt ...... qz&-f��� -------------------------------•----•- -----------........-----..............--- Lo t• n-Address or Lot No. �1� ' ------------------------------- y� wne; Address W �..., % u. •-----......--•- --•------•- -------------------------------------------- Type Installer Address d of Building' Size Lot............................Sq. feet Dwelling�No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures ------------------------------------------------•--------•--••••----------•-•-••-••--------•........................................................ 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........................................ �4 - 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........................ ODescription of Soil......- ... ...... .' ............................................................................................................. x U --•-----•-•---•--•--------•------•-•----...----•---------•-----•--•------••••......••••••••---•------•...---------•-•---•-...-•---•---••---------••--................................................. VW ------•-•--------------------•------------•-•----•--•-•-•--•-•.....-•---•--------••--•--•-•---•-•----•-----•--- ------ -•-----•-•--•------------- Nature of Repairs or Alterations—Answer when applicable__._._.. _ ---------------- ..-•----------••---•---------••••---•-----•-•••--••----•••••••-•-•••-------••-•----•••--•-•------------------•----------•--•-----•--•-••--•----------------------•••••-•-----•••------.............----- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b n issued bj the Ward',;;fhealXth. Date Application Approved BY ;,�...- � - :.._... f Date Application Disapproved for the following reasons----------------•---------------------------------------------------------------•---•----•-••--•------•......•-- .........---•---•-•-•-•..........-•-•••--------------•------•--.............--•-••---.................._..---•--•-----••---••---------------•-------------------•-•-•------••••--•--------•---•-••------- Date PermitNo......................................................... Issued....................................................... Date No....... ........................... THE COMMONWEALTH OF MASSACHUSETTS - BOARD OF HEALT _OF......... . ........................................ Appliraffou for Disposal Works Tomitrurtion "amit V Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at: . .............................. ............................................................................................. Location-Address or Lot No. ............................. ................=........... ........................................... 'O7ner 'Address...-----­-------------- ---------- Y., Installer Address Type of Building,. Size Lot............................Sq. feet Dwelling�P?No. of Bedrooms............................................Expansion Attic Garbage Grinder Other—Type of Building ............................ No. of persons.......... .................. Showers Cafeteria A4Other fixtures ..................................................................................................................................................... Design Flow-,..........................................gallons per person per day. Total daily flow....... W ............... ...............gallons. 04 Septic Tank—Liquid*capacity............gallons Length................ Width.._............. Diameter..._......_..__. Depth................ 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 b ............................................. Date........................................ y----------------------------- Test Pit No. I................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.___....._.._._......... .............. ........................................................................................................ 0 Description of Soil....... .. ........... . ..............................I..................I................ U ............................................ ......................................I................................................................................................................................................................. . .................... .................................................................................................................. ------------------- �V. �_ -v --- --------*----------------- U Nature of Repairs or Alterations—Answer when applicable .......................ev, ................................................................................................................................................................... ................................... Agreement: The undersigned agrees to install the aforedes'cribed Individual Sewage Disposal System in accordance with the provisions of T I TIE 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 .......................................................... ................. ................. Application Approved By.......... ........................... ---4-4<...........*------------- .. ....0 Date Application Disapproved for the following' rea'sons:...........................................I................................................................... ........................................................................................................................................ ...........................................................I------ Date Permit No------------------------------------------------------- Issued------.....----- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF 6......................... .............. ... ..........I I...... ...... Tr Tompliatta T,H That thel!! IS,'!S,,TO CERTIFY, idual Sewage Disposal System constructed or Repair W v by..... 2. ......................................................................................................................................................... Installer at.-------L' .......................------*------------------------------------------------------------------------*----------------.................................... has been installed in accordance with the provisions of TITLE 5 of TU State-Sanitary Code as described in the application for Disposal Works Construction Permit No------0_41....... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................. ........ Inspector.--------- ........................................................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........OF........ ................... I............................ FEE....................... Permission is hereby granted.. ....... ..... . ...... .......................... ....... ................................... to Construc o!/ i (k-,� an ndividlu ��e Djposal System 1 ............. ............ C M e /1'1�1 ?� - . Z,,- ........................................ at No.....3� -4) ZZ .............f� ... Street as shown on the application for Disposal Works Construction Permit NP....................... Dated.......................................... ...................... .................................................................... TE�.................... Board of Health ........................ �------------------------ FORM 1255 A. M. SULKIN. INC.. BOSTON