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Home My WebLink About0258 TOWER HILL ROAD - Health 258 TOWER HILL cs D �O..STERVILLE = 142—043 1 � FU ,� - •i yjAA&sfos.Hutiflcation Form — ANF-001 Asbestos Abatement Description 1. Facility location: r DIVAUCT101111 + Addrw �ster. f.�.. _ .m.. .... . . Q' ................ ...... .VV_..V.........`�.T.._.o... v_" - _..._ ......... ................ 1.u semoro of his [iyAoMn pp and rrep!rorw form mash be tomple(ed c ,-�(; p haderloamCty*ih _.... .. (1. �._......�?. �.'....!-.t.�.� ?. »_._............_._ ............_.._. h Der erlment of Wa h er eab/e WlM7 erreo4g dam./.sop,lbo�Fried I;m4eM+eniel ►ralacllon nobrrallon 2. Is the facility occupied? Yes 0 No rs•TAemerts of 110 Cm 1.Is(trrwaiey(b)s piu ndACA M e 3. Asbestos Contractor. rprddrryabate„ai1evJ Erx�iunct_SvrF�1.(�C'._. .tn�! . ..tk.P......._.. (1ree+ pre*01:and h wme Address De►artmerd of Labor endlndarlrles '��$Q `] ndliatanraavienets V�/ ..A.L..2._»»_.._.-._..........!..L!..a......._ ....................1.(..............»,.1......._ .rr f...l...............7..�.._._.__.........._ 014SJCW612 (fen CrryrToan �DeO� Cars Pfor m6rolian is �7 rr,c isd d AN r P1C....QG0 1.'l.b........... ....................................................................................._ ......... .................... ... .. eiLyr if P'e�Rya' tx r i 1`* ./ ....... car Ind rTy+(e arrvt.rwrl rAai Wee Wx d s"r ko- 4. On-SAe project Supervisor/Foreman: . .................. 2 CrUrl�ron/FU io( .. alar ee�ee>,edti el Yassaciaselta 5. .Project Monitor. Wortas Ilepns ►a,.12D037 ....... ........................................ ..................._......................................................................... ......_.------- ►eslea,IAAo2112- aher CoCereedlmI poll 6. Asbestos Analytical lab: 1. TTolammgbe racdfor rddyiq lie -... _......_._..1 '....I..A...-......................................- ....»...................._......__..........................»........................_._._—--- US.Erniorymial Nana RTGrekaraar/ 00 do heaciJonAgMR -7Iofrbeslosdemolition/ 7. Project start dale enddate specific work hours Mon.-Fri. (Sat.Sun.) noxyz6cn"dbns of jdfo RE9WS 140 A yyhat type of project Is this? (circle one): dwoarca nruk Mnow eurfeuw1n) CFR Subprl 1611. ra ouoa ur c.h , 9. Describe the asbestos abatement procedures to be used (circle): paw nap rxt'a" ro+ur/a used de»'a' Nr.{r+d/bo drpaaavr `oorr'�( S t�1(,f►'C S 1D.-I1 the job being conducted 0 Indoors Aoutdoois 7 ate— 11. Total amount of each type of Asbestos Containing Materials(ACM)to be handled on pipes or ducts(linear fl.) or other to be removed,enclosed or encapsulated: surfaces(square it.) 11`�I linear/square feet Darb,derhA'q.&c(W Whcecoalinps..._/ tlmna(sow cote pbelrw/aUon...... _� eanpafed or h)ered paps pipe ksulalial...._/ hsuW inp own".................. sMr-wLwvoofinp..................... tc%eVsp8)WCoa"nps.............. rkes,Wow WC1................... _J ►ansne board,wan baud............. orw(phuse describe)....................-_JJNL 12. Describe the decontamination system(&)to be used: ...------..................................-.._............_................................................................................................................ 13. Describe the contain eilzalionldisposal methods to comply with 310 CMR 7.15 and 453 CMF16.14(2)(g): .Q..........>..(al- c:.........._6...m�. ....._.....I.ca ._........................................................................................................................................................ 14. for Emergency Asbestos Abatement Operations,ilia DEP and DLI officials who evaluated Ilia emergency: .............................. ... . �...�. } .............................._._.........._».._...._.. ....._.._.._..._.._........ .... .. . War d0ffewd ...................._.. . ......._..._...._......�_...-_.. ........._-........_._.........._._. ... ... . .................................� ......._--_......_..._._._...._..... _ Meer dW(efdel . ' ..........................................................................................._._.. ... DN dAreeore/ke Wirw/ 15: Do prevaf4ng wage rates apply as per M.G.L.e.149.126,27.to 27A-F to this project? []Yes Alo �t;ae / facility Description 1. Current or prior use of facility: C� ..—........__...._._....-....---......._............._.................._.._.._._ ..,.____.........._._.— 2. Is the facility owner-occupied residential with 4 units or less? XYes ❑ No / 3. Facility Owner. ------C- �.l::s............:................................................................................_........__ _ r Ad ............................................_ _._...__...._._.........:.................._....._...__. 4. Facility's Owner's On-She Manager.gee .....N...I....?....................................... ...........................................................__.. MAW Cry/To+n lhmde %NpriaM 5. General Contractor. ........................................................._.........................:....._.:...:..........._....................-_._._.__ Nxm � AdOnst —.---._�_......w._....___._......................... cock TsNphons Can&WWr1 Worun Camp.lnsunr Aoery/ EAP•Oere 6. What Is the size of the facility? (sq 11) (1 of Iloors) 13 Asbestos Transportation and Disposal 1. Transporter of asbestos-containing waste material from she to temporary storage she(1 necessary)to final disposal site: _....N.lc_sr. ..,........_� P................................... . i. .5 .......VJ.Gksh�. ................... .trGe AURN w_e, fYla: ................. ........ . Q' �f`..................... .� (7..'.� ..7...'a.�.1.7._.......__ 2.- Trans_orter of asbestos-containing waste material from removal/temporary storage site to final disposal site: _ ..... y..._...._ ..............CT......................... ........ C.11W............... Note:Twsfer RAM1{oma fNtpOarr StaBons must =1 Refuse transfer station and owner-(#applicable): cm,pry;Rh 11iI solid Waste — Dmsbnregufa• ryur A&W Bons 310 CMR- td.00 _ _..__.._....._..._,..::................. ...................._..._..._......_.r ......_......_...�___: __ _ ah%fwo ,- 4. Final Disposal Site: pitT?Un L ar)(A- 16l. oMnlRAlsnr ROVke - _5 - - ;dho -. _ ►_�_ Q!.b h.t.._.....F'.! .........:. 607n......._........... .............:........................__......._:......_...._.._ crry/To.o n0,cd, rNeplarer .. Cerlilicadon The undersigned hereby states,under the penafties of perjury,that he/she has read the Comrnonweahh of Massachusetts Regulations for the Removal,Containment or Encapsulation of Asbestos,453 CMR 6.00 and 310 CMR 7.15.and Ihat the Information contained In this notification is true and correct to the best of his/her knowledge and belief. f�— FW AWN AuAare rerun tbAr Note:Connector must sign this �(-�V� N r U-P (�17-337-a117 form for DCI __.... ... ....._.__...._._.._.._ ._. _.. PorporVnq ling fNpAwb , nolrTicslion L p purpous • � hl .5_.__.....:! _..... AMW py/raMn 4M W* Fee exempt(City.Town,district,municipal housing authority,owner-occupied residential of four units or less)? yes ❑no Sticker/(from I(onl of form): -7 139 I ,` TOWN OF BARNSTABLE LOCATIO� s VILLAGFt�Sy�l/CJ%/� ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO.,�,� SEPTIC TANK CAPACITY G� / D LEACHING FACILITY:(type)/:::%� (size) NO. OF BEDROOMS. PRIVATE WELL OR PUBLIC WATER BUILDER 1 OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No / At�` o -- No...�91--�y---. .. . Fi THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE Appliratiou for DiBpwial Works Tatifitrurtiuu Famit Application is hereby made for a Permit to Construct ( ) or Repair (L,Yan Individual Sewage Disposal System at: /Nh `.f e �ocation-:\ddress I I or Lot No. e� ------------------------------------------ -----�+---•-----•-••-----------. ------•-----•--......---......---------••-------••--..... caner Address Y...... ... Installer Address UType of Building 2 Size Lot............................Sq. feet Dwelling—No. of Bedrooms---------------------------------------- ---Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ...................... No. of persons---------------------------- Showers ( ) — Cafeteria ( ) a' Other fixtures ------------------------------- - - w Design Flow-------------------------------------------- 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........................................ a a Test Pit No. I----------------minutes per inch Depth of Test Pit--_-.----_--_.--_-- Depth to ground water..................... (i Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ 1:4 .........................................................•------•---------------------..._---------......................................................... 0 Description of Soil--------- ----------------------------------•-------..............-•------------------------------------------------------------------------------------................ x U ........................ .................... -------------------------•---------•-----•--•---•------•----------.......----------•--------------------•-------•------•-----------•-•------------------- w UNature of Repa/i'r�s or Alterations—�GAnswer when applicabe.._.____ C ///�� . f��C}�_.Q.. ....T_ f_2_._�.1.."`.......'2� ......�.-0.0.....r�'�.-_'_f..... ...C..! ...................../�.. .____.. --/../� w:_a..` _ ...-�J'_'.'... ..� Agreemeent. `/� / ../ ( iLJ The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b,Fpri issued by the board of health. Signed ........)A -------- ................................ .. ........ ------- Application, Dace qq Application.Approved By ..................._ -. - - -- ,. '..- -L..�S Application Disapproved for the fo owing reasons- ----------------------------------_:...-------------------------------------__--------------------------------------.. ---- ----------------------------------------------------------------------------------------------------- ---- ----------------------------------------------------------------------------- --------------------------------------- m Permit No. ��]+ �V �-�'�'----------------- Issued ----------------.....- . e_�.. .........�''�.... f � Fic No.. � - � $...-��...� .... THE COMMONWEALTH ,OF MASSAC,HUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Apphratilatt for Di-tipnial Work,6 Cllanntrnrtinn Permit Application is hereby made for a Permit to Construct ( ) or Repair ( �, -an Individual Sewage Disposal System at: _ ...s.............................................. ... 0 S_f e l l Location-Address I t t I or Lot No. Fet....�h �' �' ---•--•-------------------------------------- .................................... �rmcr - W �� I-+�' 1---�-�'1 `-�` 5 ...._ ...vS�E'/c/!..........................Address.................'1028•--------------------'o ... Installer Address d 1 Type of Building Size Lot............................Sq. feet U _Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of persons_---------------.-..--.---- Showers ( ) — Cafeteria ( ) dOther fixtures .----------_-- •------------------------------------------------------------------ ---...........-----------"--------.......------. W Design Flow............................................gallons per person per day. Total daily flow-------------------_........................gallons. WSeptic Tank—Liquid capacitv------------gallons Length---------------- Width.-..-..--------. Diameter....----..--_-- Depth.......... x Disposal Trench—No- -------------------- Width-------------------- Total Length..................... Total-leaching area....................sq. ft. Seepage Pit No..................... Diameter------------- ------ Depth below inlet.................... Totallleaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) �-' Percolation Test Results Performed bY............................................................ -------------- Date........................................ ..a Test Pit No. I----------------minutes per inch Depth of Test Pit....---------------- Depth to ground water........................ Gi, Test Pit No. 2...............minutes per inch Depth of Test Pit.................... Depth to ground water........................ 9 ---------------------------------------------------------•-----------------•---------------••-------......................................................... 0 Description of Soil--------------------------------------------------------"•------------------------------------------.......--------------------------------------------................ x w UNature of Repairs or Alterations—Answer when applicable----.._Lf l;.f_r+ Q.._ Agreement: N; The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental 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 (nf /D'.. << ---------------------------------- 9'--=� r vim`...---Dace F c - Application Approved BY —r �C�... - - - - -" " `- ---- -------------- -- ---------- !�� .. s � Dace Application Disapproved for the following rearons ---.'---------- -=-------- . .:c-:..:._' ------------------------------------------------------------------------------------_-.....----- ---- ---------------- ..--...._................._..._..._............... ....:................................. cD �are Permit No. ..... _ '._-....t '., z ------------------- Issued .-------------------- '�e- --- -1 IC _ _ ti->_--__-_----_®®v_.,,>.�._,_ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE C_ertifira e of C�umpliance l THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( t.ir by--- ---------------------------------.-----.--------- ---------------------------------------- _ hs�auer at .....02-�- -------------------.v----r'-...f....-----.J------._ f--------0 S--- -- ---`-r' ------�- ------------------- ------------- ------------------------------ has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. .._._ ..-...8..�j.�c.. dated THE ISSUANCE OF THIS CERTIFICATE SHALL' NOT BE CONSTRU D AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE..--.../v�cr� -.- "...��r -- Inspe tor_ - .... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE ;� — n.,�j� FEE..3O..D.... Ropo al Workii Tnnstrurti.nn rrntit Permission is hereby granted.........tA—) _I P_l•--�-E'` _.__5----------------------------------• to Construct ( ) or Repair (L-an Individual Sewage Disposal System atNo.... . - ............. .. e---------------------------------------------------------------- Street a 7 C C as shown on the application for Disposal Works Construction Permit No.............. 'Dated.-.- ........ .................•-•-------... -��-------------- ............................................ -.. Board of Health DATE. �••. .�....... J----- --------- FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS