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09/08/2015 09:36AM 5442 DAVE WALSH PAGE 02/06
AQ 04-Asbestos Removal Notificadon Form ANF--001-Transaction... https:,'/Pdep.dep.mass.gov!WebForms/Asbe.stos,BWI?ANFOOI.aspx
NOW-
• Commonwealth of Massachusetts ,100225212R2
` Asbestos Notification Form ANF-001 Asbestos P%Number
aj ProjectRevslon
Project Revision Notification
Project Cancellation
A. Asbestos Abatement Description
1,Facility Location:
iAMY ARCHER I ;37ri0 NiAiN$T..1
Name or Factliy - --_- StreetA01ress
BhRN5T,48LE >f1 I 02630 �• i848�5T�25�5
Ctty/Tbwn state ,Zip Code Telephone
SAME ;SAtie-----
t118VUCtion3 1.All Facility Contact Person Name: - Facility Contact Person Tlde ^ry - •-----_-.--� -
sections(if tht5 form must Worksite Location: 1BASEMENT&1 S7 fLg4R
be competed h order to Building Name,Wrig,Floor,Room,etc.
corn piy w1m WhssDEP
notifira6cnreguilrements 2.Blanket Permit Project Approval,ifappiicable:
I
of 31 D UR 7,15 and Approval I D 9
Deaartrwtor teoar 3-Nan-Traditional Asbestas Abatement Work Practice Approval,if applicable:
- SteMerds tDLS) _-------•------....,....-^,• _ _ AOracouaLtD..#--- _--
rrotmcetion regrtirements �fl�_ -912015 ___ � tys/10/2015 _ _ _
or463 CUR a32 Project Start Daft(MWOD/YYYY) --- End Date(MMIDDIYYYY
me I
Work Hours-Monday Through Friday Work Hours-Saturday a Sunday
MesaDEP Use Only
fete Received-�1 B. Other Project Revisions:
2.Submit Original
Form To: } ..
:
Commonwealth of _..
Maseaehusetts p 0.
Box 2d0ston,A1A 02211 D. Certification
022tt
"I certify that I have personally examined DFUJ _ _ _ ---------- ---
the foregoing and am tamillar with the i Name Authofizetl Signature
Information Contained in this docurnen[ - r--""'"..--•---------••-•--•-.--•-----
Note:Temporary �•-----__._----__.:..,-�--------� ,
storage of Asbestos and all attachments and that,based on i'—ionrl' ----
my inquiry of thaw individuals
PositionrrUe Dots(MMlDDJYYYI�
oontainingwea� 9 rY
immediately responsible for obtanin 781.76z-3380 iAtR SAFE,INC
f
material is only allowed immediately 1�.,....-----_---------w.w^, ,. ,_..._..------•--___-_:_..-^-------'
at the place of the information,I believe that the Telephone Representing
business aT a OLS information Is true,accurate,and IgµjbtE _1. SAME
licensed Asbestos complete.I am aware that there are Address cityrrown.
s nificant penalties for submitting false
contractor of a transfer 9 P 9 IM � 102062--_.__.__...-_....:..._.....__._i_._
station Olaf s permitted information,including possible ranee and ----------------_..---__.. ..--- -----_ ..�_.__._--------_
by Mass0EP and .ImprtsovmerrL The undersigned hereby State Zip Cade
operated in compliance states that I have read the
with solid Waste Commonwealth of Massachusetts
Ragulallons s10 CMR regulations goveming asbestos
19_000 abatement(453 CMR 6.00 promulgated r
by the Depatlmentot Labor Standards
and 310 CMR 7.16 promulgated by the
Note:Contractor must Department of Environmental ,
Sign this form for DLS Protection),and that I am aware that,
11 of 2 8/23/20]5 11:15 AM
09/08/2015 09:36AM 5442 DAVE WALSH PAGE 03/06
(�04-,Asbestos Kemoval Nontication Form Alvh-UUI-•transaction... nups:ireaep.aep.mass,90v'weoronosrrsoustow Wrtuvrwtpx
re
Commonwealth of Massachusetts 11002252112
�. Asbems Project Number
Asbestos Notification Form ANF-001
J• �-- Project Revision
!!n Project Cancellation
r f..
A. Asbestos Abatement Description
1.Fatality Location:
r378D MAIN ST
- 'AI ARCHER _,i m--- - ----- ---_.�_. ..----...- -----
Name of Facility StrealAddress
(L_.__..,.- --•----i 1849.457-2575 ,
02630 _....._� �_._..._:.:..--------=-�----------..--..:..•._.
ChylTown State Zip Code Telephone_-�--- —---
:SAME —
..--•-- ZA
FaGlhy Cprtt2ot Person TitleFacility Contact Person Name --- �,----.— 1
ln�rmectloss 9.AM Worksite Location: BASEMENT&9STFLOOf�
- Building Name,Wing,Floor,Room,etc.
sections of this form must
be competed in order to
coplywkh MM13EP 2.Is the facility occupied? J i Yet � �
m .0
not rr�tlsn requnsrRenre
3_Is this a fee exempt notification(city,town,district,municipal housing authority,state facility,or owner-
oratacnsz 7.19ana .
Department of labor occupied residential property of four units or less)? Yes i!No
nottttcattan nequuemamte 4.Blanket Permit Project Approval;if applicable: ---�•• —f
of 453 Cm e.t2 r, Approval is 9
[cable:
5,Non-Traditional Asbestos Abatement Work Practice Approval,if applicable;
Approval ID 0
Mawl)EP QSe Only
�—i s.Asbestos Contractor.
C---..�.,�----J ___ _ _..--__....-•-------.�_—j 161EwDic4TTSTRI±E'T___-.....----------•---T-
Data Received {R SAFE INC --- L—_— ---._:...----•— — ----_
Name Address
NORWOOD --
2 Submtl Original CitylTown State ZipcodeTelephone---
----- --
FOnn To: IAC000464 _ .-_•--- _-._-� Contrast Type:`_'�_W,'. t Verb
Commonwealth el ❑LS License# _—_....
Mas=husette,P.O.am ----------- --— -- -----._....�.
4062 Boston,MA 7. --
02211 Name of COntr ODft Oct-Site Supervisor/Foreman US Certl0cation#
8. {SAMUEL N COHEN
..----_-.ti.�,•..,-_-----•---• ----•----•-_,__-.__,.- --- tifiC2lHOff#S Cer
Name or Project Monitor DL ..,..-------" -t
NVIROTEST LABORATORY INC -. ..._•----.-•---°'-•= --•--.---I
�_
Name of Asbestos Anaiytical Lab DLS CerocsTimm Jf' -
10.08f04J20t5 _ ; LD8J04'2915
ProjW Start Data(MM/DDNYYY) � T - End Date(MhVI)0IYYYY) -_--
r----�-------nv-------- ---- —..� trap` ...•,---_—.,:--..--�
UVorK Hours-Saturday s.Sunday
Work Hours•Monday Through Friday ,.
11.What type of project is this?
1 Damolition •_i '- Re it i, outer-Please Specify:=j Renovation pa
12,Abatement procedures(check all that apply):
I -s Glove Bag ":Encapsulation. ti._ Enclosure Disposal ONy F701eanup ; Full containment
Other-Please Specify. r �..r„<,.�� ..�...,.�..,,,.-`, .,�,-..«>��._.,. � •-�-�••-•--_...-..�.
.7/2212015 4:40 AN
l nfa
09/08/2015 09:36AM 5442 DAVE WALSH PAGE 04/06
►t�04-Asbestos Kemoval Notilication corm AN F-UU1- imrisaotion•.. nttpsvieaep.aep.mass,goy/weorunn5r.tksoesLus1Dw rniNruu►.aslrx
B. Facility Description
1,Current or prior use of facility: REstDEtJTlAL
•
Z. Is the facirity owner-occupied residential with 4 units or less? i.._r Yes No
3. r^ Y ARCN R �1760 MAIN STY-•------�,N-,. —--^'w------.:�i
Facility Owner Name Address
[2 ARNSTA6t E VILLAGE l :MAl ;0rfi30 ; ,648 457-2S76
Cityrrown state Zip Code Telephone---_—�-_r -__ --
Name of Facility Owner's on-Site Manager Address
SAME ------- !
__.., ?MA__..f 1Q2f30 666-457-2575 - -�
Cityr town State Zip Cods Twophone
1SAME5 ,
Name of General Contraaw Address
iSAMf MA t 102630 '0461r57-2575
Oityrrown Stale Zip Code Telephone
NA __
Contractor's womees Compensation Insurer
Policy# Expiration Date(MM/DDNYYY)
6.What is the size of this facility? ----..----= -- ---_,.,-.—._..--.-.--�,.._..•--•— "
Square Feet as of Floors
C. Asbestos Transportation & Disposal
1,Transporter of asbestos-containing waste material from site of generation: r
�r,, Directly to Landrlll or To Temporary Storage LoCation[Transw Station
L221M1 OW ST-- _ �——--- — — _
,
Name of Transporter--— —— ,. -----— Address ----
CHELSEA MA• l0275r i I781--762.339D
Gityffown - - 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:
,1,iSERVV TRANS GR'JUP _ i 58 PYLES R° i
Name of Transporter Address
;NEwCASTLE LOE _ ' j18720 i l877-999.9559
Citylrown State Zip Code) Telephone.
3.Name and address of temporary storage iocationitransfer station for the asbestos containing waste
material: ;
SAIR SAFE ;SAME e '•
Temporary Storage Locstior.Name, Address
i$ArVtE I i.i237.7$2-3390
CitylTown State Zip Code Telephone
4.Name and location of final disposal site(asbestos landfill):..
PRINERVA __.'MINERVA I I..—_.._..._..._.__,_.., -- .._....- -- ..., ...._....--
Final Disposal Site Name Final Disposal Site Owner Name
:0000 MIN ERVA R° I
Address
2 of 4 7/22I2015 9:40 AN
09/08/2015 09:36AM 5442 DAVE WALSH PAGE 05/06
Ail U4-ASDe5t*$KeMoval NotInCation kOt'rn ANF-11fU I-'Iransactbon.., llttps;/;cciep.cep.mass.gov/WeDVoffns/AsbestosJB W FAN FOU Law,
of AftsW CMMM9 MAYNESBURG I 'O 46688 — lilt-tti-1t11
wasterratertaileonly Cityflown Slate Zip Coda Telephone
allm Place 13,Job is being conducted: ;ix :Indoors outdoors
business or a DLS '
8cernsadAislastos 14.Total amourit of each type of asbestos Containing materials(ACM)to be removed,enclosed,or
contreclororaharWer encapsulated:
station that is pffmMd by 300 i --------
ueseOEPand oDsraded in Lfnear Feel(Lin.Ft.) — Square Feet(Sq.Ft.) -
compliance w M Seild
Waste Reoumtlons3l0 Boles'Breschino,Duct tank (-_--- _14M.r—_- Transits Pipe
Surface Coatings Lin.Ft.. Sq.Ft. Lin.Ft y Sq.Ft
Pipe fnsulaWn ,340 -� ' Transite Stitngles ;
Lin.FL Sq.Ft. Lin,Ft w Sq.Ft
Spray-On Fireproofing I� ._.___? Transita Panels
Lin.Ft Sq.Ft Lin,51, Sq.Ft.
--••r-----••_
Cloths,Woven Fabrics --- I I Orer-please specify:
Lin.Ft Sq.Ft
Insulating Cement 1 - I. -
.,_..:..J�--�-ems.. -..�
Lin.Ft. ,Sq.Ft Lin.Ft- Sq.Ft
15.Describe the decontamination system(s)to be used:
13 CHAMBER DECON
i
I
16. Describe the containerizationldlsposal methods to comply with 310 CUR 7.15 and 453 CMR
6-14(2)(g) _..:..._.:_...__
rfi MIL POLY BAGS
I 4.
,
Note:ConbaCtormusi •
s(gn Ras Corm for OL6
notltbcatim pu*ses 17. For Emergency Asbestos Operations,,the MasrDO and DLS officials who.evaluated the
emergency;
Name df MassDEP OfrrClal Tale of MsasDEP Official
Date of Authorization{MMMDNYY(} WAivei#
Name of DLS Qtbdal. Title of DLS Oftal
Date ofAuthorizetion(MMIDD/YYYY) Waiver#
18. Do prevailing wage rates as per M.G.L.c, 149.§26,27 or 27A—F apply to this I ii?No
D. Certification ,
"1 certify that I have personally examined iDPNI -� ----� IDFW-- --- _the foregoing and am familiar with the Name Authorized S(gnatme
information Contained in this document -' -j 1071221201 5 ---
and all aHachrnents and that,based on - --- - -------
my:nquiry of time Individuals PosiflonlTlNe t7ate(MW0DNYYY)
ff781-782-339d NR$_AFE,iWC
immediately responsible for obtaining I—_--_-_-^--._-_-•__-..__. .�.,. -------..—•---.--,.,.,.J
the information,I believe that the Telephohe ,Representing
Information h� true,ancuroat,and w WiE
complete.i am aware that there are Address - -- cityrlbwn
signifarant penalties lot submitting false ---�W ---�'`I 02062 -�---- -----
information.including possible fines and - --- `-- ,.,'•r---
imprisonment.The undersigned hereby SPate Zip Code
3of
7t22/2015 9:40 AIV.
09/08/2015 09:36AM 5442 DAVE WALSH PAGE 06/06
4Q 04-ASMIM KernQvai NoiutcaXIOn rOCRt kNr-uui= iransacttott... ttuPs:/rCUCP.UCP.Umds,guvrwauruwtzwK5vt.*Lus,nwrni,4rvvi,aavx
states that I have read the
f
Commonwealth Of Massachusetts
regulations governing asbestos
abatement(4W CMR 6,Do promulgated
by the Department of labor Standards
and 3110 CMR 7.15 promulgated by thEt
Department of Environmental
Protaction),and that I am aware that
this pwmlt application or notification
Shalt 11IN be deenW varid unless
payment of the applicable fee is made."
{
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e
4 of 4 7/22/2015 9:40 A1v•
i . 07/27/2015 08:45AM 5442 DAVE WALSH PAGE 02/06
AQ 04-Asbestos Removal Notification Form ANF-001-'transaction.., https:/,'edcp.dep.mm.gov/fWebFoms./AsbestosiBWPANFOOI.aspx
Commonwealth of Massachusetts i400225212R1
L7. 71
Asbestos Notification Form ANF-OO1 AabeetoaProjectNumbery -.1 1 project Revision
Project Revision Notification
- HProjectC,anceilation
A. Asbestos Abatement Description
1.Facility Location:
A�MYARCHER Pszetl MAIN STa` -
Name of Facility --- - ---- - Stree[Addre6e
`BARNS'rABhEl—,- -- -----•--� fMA �02830------� ;8_46-d57-2575'-------------- -�
GdylTwdn state Z:p Code J Telephone
;`SAME--------- --•-----_--__----- SAR9E ._._—.,.__-_�,..„__.:....,...w..w..,,,._,-.-...,..�.
trratrucdona 1.NI Facllay Contact Person Name --- - - Facility Contact Pereon Title - ----
sectlons of"form muet WOrtCBlteLocation: 1-AS_EMENT_&1ST FLOOR - -- �
be completed In order to Budding Name rMng,Floor.Room,ems. --- --- _
comply withlv%e WEP
eamatron requlremerds 2. Blanket Permit Project Approval°ff applicable:
of310CNR7.15and Approval ID `
Deparflnentorl.abor 3.Nan-Traditional Asbestos Abatement work Practice Approval,i#applicable:
Standards(,DLB)
notucatronregnsremem '0/02/2015s '------------------------------------� �----------------._..__�._:..-•------ ---
of 453 CWR 6.12 Project Start Date(MIWIDDrYYYY) End Date(MM/DDIYYYY)
j7AM-6PM-
Work Hours•Monday Through Friday Work Hours-Saturday&Sunday
N%ssDEP Use Only
Date Received - B. Other Project Revisions:
I
2.Submit Original
Form To: - x
commonwealth of - -- __-- _.....'._.. .... .._ :.... .. __ ._...__..._._... : . .....i
Massachusetts PO.
Box 4062 Bastnn,MA ri
OZ211 C. Certification
N certify that I have personally examined
the foregoing and am familiar with the Name Authorized Signature
Note:Temporary information contained in iris document - t_;._._.........:....-•-•-----.____-___.___..
Po rY V 10712712018- --
storage ofAsbestas and all altachments and that basedon L_______..---•--.__.�---•-•----_- ----•--•------.-.--_---_--
PosibonlTltle 'Date(MM/DD1'YYY)
containing waste myinquiry.ofthoseindividuals
matertal Is city albwed N F g t761-?62-339D -_- iR SAFE.INC
vrtrtl640te res 4nsible for obtaining - —_
at the place of the information,Ibelieve that the Telephone- Representing
business of a DLS information Is true,accurate,and
licensed Asbestos Complete.Iam aware that there are' Address CitylTawn
contrWororatransfer signlfIcantpenaltles for submittirigfalse. i .•.:-------------------------i 02062"-- - „v. ----- - --
station that is permitted bnfoRnation,including possible fin6s and --- --- -------- --- I- - --- -- ---
by MaMDEP and impatonmem.The underslgneo hereby Slate Zip Code
operated in compliance states-hat I have read the
with Solid Waste Gommonweallh cf Mieriachusefts z.
Regulati ons sit)CMR regulations governing asbestos
1a.400 abatement(453 CMR6.00 promulgated
by the Department of Labor Standards
and 310 CMR 7.15 promulgated by the r
Note;ConlraCtor.must Department of Environmental
sign this form for DLS Protection),and that 1 am aware that
- t
t of 7/27/2015 9:32 AM
r
07/27/2015 08:45AM 5442 DAVE WALSH PAGE 03/06
A 04-AsbestosKernovalNOtiticauonYotmANP-vuf,'iranSactton... napsweoep.aep.mass.govr 0 WrML,4rvv 4-mljA
Commonweafth of Massachusetts ioo22521z -----_- -__.
abeslDs PrOJect Numher
Asbestos Notification Form ANF-001 A
_i I Project Revision
$ � - Project Cancellation
- i
A. Asbestos Abatement Description b
1.Facility Location:
'AMYARCWER -�--^--------�.�.. -.--; �3i6G MAIN ST .W„�------,..v.-•- ----.^,.-'
'-------- ----._ - ------ �I -------. - --.- _ -.
Name of Facility -- - -- Streat Address M
I 164&457�2e75 .
city/Town State Zip Code, K Telephone
Facirrty Contact Person Name -- Fadlity Contact Person Title
rrnrn,cuunsl.M Vdorksite Location: `9ASEMEydT&iSTPL00R� N-�---__ rt -I .
smume of thsfonn must Budding Name.Wing.Floor,Rana,etc.
be completed in orb to - _
=npymr w Ma l3EP 2.Is the facility occupied? f-FZ Yes No
notlAcation reauirements
0310 CM2 7.16 and
3.Is this a fee exempt notification(city,town,district,municipal housing authority, state facility,or owner-
-
Departex�t of Labor occupied residential property of four units or less)?I R?' Yea no
Ste, (DLS)
notlncation ra�remente 4.Blanket Permit Project Approval,$applicable:
ot453CMR 6.12 Approval ID#
5_Non-Traditional Asbestos Abatement VVork Practice Approval,if applicable:
Approval ID#T
MauDEP Use onty
- — --- _, B.Asbestos Contractor:
DiaoReceived �, AiRSAFEINC ---- _M„_TJ 161ENDICOTTSTREfi ---- 1 '
Name Address
,' IMA-- 102002---- .rl i781-762-3300^-
2.Submit Original Cftyrfown - - State Zip Code Telephone m
Form To: --�
Commonwealth of --- - -- - - Comfort Type:' tJ Wrttter �`�V®roof
—�..
Ma"achteietts P.O. DLS License#
BOX 4062 Boston,MA 7. �AlAAB EAMAYA _ _ - ; jAS080847 _.._..._.._,.------•-•---_...._____-. ___f
02211 Name of Contractoes On-Site SupervisodForeman - - ., DLS Certiftcation#
8. �SAAALEL N COHEN_^ ----- -I. ra tl60787
------ -
Name of Prolert Monitor- - DLS Certlocation ----.-
9. ,Er NVIROTE5T LABORATORY INC -- -- -----4 AAOGOt28 ~--_- Y------- _..--------- ----a
NOW of Asbestos Analytical Lab DLS Certification#
10.L 8'Odl2G15
Project Stan Date(MMIDD"Y). End Date(MMIDDIYYYY) , — ---
INA
y4rk Hours-Monday Through Friday - Work Hours-Saturday&SundaY M
11,What type of project Is this?
;'1�bemoli6on j Renovation l Repair , r:Other Please 5pecity: " (�'� M1•, M
12,Abatement procedures(check all that apply);
y Glove Beg I Encapsulation i Enclosure OisPeael Only Cleanup Lei Full Containment
.. r �.ww.%H•.rKaYPww-n...—.+.-wvwr .....7
Other PftseSpecify:
of 4
7/22/201 S 9A0 AN
07/27/2015 08:45AM 5442 DAVE WALSH PAGE 04/06
'kQ 04-Asbestos Removal Notitleation Form ANr'-001- tranSactlon- nttps:fredep.dep.mass.gov1 Wool-orMS/Asbestos;BWeA.vruut.aspa
B. Facility Description
1.Current or prior use of,facility: RESIDENTIAL
2.Is the facility owner-occupied residential with 4 units or less? i. iYe- �No
3. iAMY ARCHER �.:_.... .:........ _. _ i �3760 MAIN ST- ----—---__------- ----
Facility Owner Name Address -- ------
It3ARN5TAHLE VILLAGE
Cltyrtown — --- State Zip Code Talaphon9 M—---- --
4.
Name of Fatality Ownefs On-Site M2nagar Address
1646-457_2575 .-••-- --•---..—.�
Cltyl n— State Zip Code Telephone
5. ;SAME--—--�� w.. _ _--•_ _.� -• ---— -- ---- -
Name of General Contractor Address ---
SAME rfUlA - {02830
CitylTown State Zip Code Telephone
Contractor's Worker's Compensation Insurer -- -- —-
Policy# — -- - - -- - - ExpirBkicn Data(RAMIDDIYYYY}
8.What is the size of this facility? fz
Square Feet V of Floors
C. Asbestos Transportation & Disposal
1.Transporter of asbestos-containing waste material.from site of generation:
? ,Directly to Landfill or r2 !TO Temporary Storage LoCatlon/Transfer$taticn
r
1A1R5AFE' ------•-_--------------------I 12a1NILlOWST...,r,.-..,...,.r. --,� -;-- -- '" -
Name of Transporter Address
!CHELSEA -----.� __ •_ _,.i L�A_�, t02:50_ i 81 762-3390-- -_- --'
Cltyfroxn 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 loco tionAran sfer station to final disposal site:
SERVICE TRANS GROUP 1158 PYI,Es RQ,--_ �- ... .•
Name of TtanWorter Address
;NEW CASTLE
C�tylTbwn--- ---- -- - -- --- 3tata Zip Code Telephone
3.Name and address of temporary,.storage location/transfer station for the asbestos containing waste
material;
• iAIRSAFE--- --- ---y - •-- ---- �i iSP,ME �_'------•-------_--•— ----••----••-•-•--�-�
Temporary Storage Locatlon Name• Address
MIA i rr02'Sa ------ ' ;7$1-7G23390. w.., --- ----
�
CitylTown.... - -- ---- -- --- State ZIp Code Telephone
4.Name and location of final disposal site(asbestos Iandtiii):
IMINERVA I IMIN�RVA
Finat Drsposal Site Name Final Disposal Site Owner.Narita
;8000 MINERVA RD
Address ---- - -- --
2 of 4 7)221'201.5 9:40 AN
07/27/2015 08:45AM 5442 DAVE WALSH PAGE 05/06
Aq U4-Asbestos Kemoval Notiticatton rorrn ANIr-VUI- transaction:_- https:IlMep.aep.mass.gov/Webtornxs/Asbe$tOVBWFANYU0l.asp;
l
ofAsbestas contalning IUVAYNES8t1RG ! 10_H _.. _.._......r
`--------__.._ _-_• h408S8
waste mated Is ordy Cityrrown -- Stale r Zip Code Telephone
allowed at the pltee of
buetrrass of a US13.Job Is being conducted: Indoors l-Outdoors
IicensedAsb%tos 14.Total amount of each type of asbestos Containing materials(ACM)to be removed,enclosed,or
contractor Ora transw encapsulated:
04"thatispermtlfertby
MMOEP and operated In Linear Feet(Lin.Ft) Square Feet(Sq.Ft)'T
oomplia nce with Solld
Bonet.Breaching,Duct,Tank �_ Ransite Pipe
Waste R�uleUane 310 r--------' ----!
Surface CoatIngs Lin.FL. Sq.Fl Un,Rt, Sa.FL
CNA�19.OD0 __
Pipe Insulation t3oo ---�;—� Transne Shingles
Lin,Ft. Sq:Ft Lin.Ft— Sq.FI.
Spray-on FiraprWfing 3r-- - Translte Panels -- -
Gn.Ft. Sq.Ft, J Lin.Ft Sq.Ft.
Moths,Woven Fabrics Other-Please Specify:
Un FL',.- Sq.Ft
Insulating Cement
Un.Ft. $q.Ft Lin.Ft Sq.Ft
15, Describe the decontamination system(s)to be used:
I3 CHAMBER DECON - r-•--'-----------•--=---�..:_..u,..,.,._,,._.".,..-..�_.,..'
_-.__...___ _.a----•
- Y
16, Describe the containerization/disposal methods to comply with 310 CMR 7.15 and 453 CHAR
;6 MIL POLY BAGS ---- --`
i
trots;C 08dar must
elfin this form for DLS -----•.�,.,...,_.,._., "..--------------------------. . :_� - --•----------------- ----.._.
17.For emergency Asbestos Operations,the MassDF-P and OILS officials who evaluated the
emergency:
Name of'MassDEP Official --- 7itie of MassDEP.Olficial - -- i
Date otAuthorizatitin(MM.IDDIYYYY) Waiver#
Name of DLS Official -- -- Title of DLS Offndal -- -- —
Date pfAuthorizatlon(MMICDlYYYY) Warver# -----
18. Do prevailing wage rates as per M.G.L.c.149,§26,27 or 27A—F apply to this !`n!v®s No
D. Certification
"I caRfAl d+at I have personally ex
am
tha foregoing and am familiar with the Name Authonzea 84nat►re ---
Information contained in this document r -- --_..--- __ -_ �.,, :..•,.--------_-•
tvP I t)7122120f 5
and all attachments and that,based on
my intlultY of Chase indriridusls' Positlonrntle Date(MM/DD/YYYY)
Immediate nssponSibls RN obtaining, ULT fO2-3330
the Inrormation,I believe that the Telephone Representing
informative is true,acxxrra;p,and AME - _..,,...� E----•--.._._ ---
complete.I am aware that.there are Addima Cblrown
significant penalties for submitting false --• --- -. —_ .� ,�.----__---_
Informadon,including possible fines and —__ Iczoe2
imprisonment Tile undersigned hereby State zip code
3 of 4 7J22/2015 9:40 AN.
07/27/2015 08:45AM 5442 DAVE WALSH PAGE 06/06
U4-ASIMtos Kemoval Nottilcatton kOTM ANt-UU I- I ransactton... ttttp5-f/egep.aep.tMass.gov/Webr0t7fi.S/ASbeSlOslt7wrax4t vu I.aspx
n . a
states that I have read the
C Mhl0nWeallh of MassarhusEttp
MgUlalions governing asbestos
alhatement(453 CUR0.00 promulgated
by the❑epartment of tabor Standards
and 310 CMR 7.15 pMrrt*ated by the
Department of Environmental
Protection).and that I am aware that
MIs permit applleallon or notitiCation
span not W deefred valid unless
payrnft of the applicable fee is made."
V •
4 .7/22/2015 9:40 AM
08/20/2015 10:36AM 5442 DAVE WALSH PAGE 02/02
c A.Q 04 Asbestos Removal Notification Form ANF-001-Transaction.:, I!- : https:,'/edeP.dep-mass-gov//Webt:orms/Asbestos/BW.PANFOOI.aspx
Commonwealth of Massachusetts r—_—-- - --------
•r 106225Z12R7
" Asbestos Notification F0. ANF-001 Asbestos Protect Number
"4 Project Revision Notification L ProJer#Revision
Hq`PraieCt Cancellation
r_
,
IL
is Now
A. Asbestos Abatement Description .
i_Fadllty Location:
AI19Y ARCf3ER
Name of Facility Street Address
BARNSTABLE •---- - --- --
t--------------•
GnWrown
S to Zip Code — Tetephone
Irfstrucfians 1.p5 Feel%Contact Person Name --J Facility Corrtact Person Idle ----.,..'...-��.-V, •—� .
r----'------ --'--�
sections or sus form must Worksite Location: 16A56AAtiNT&1 ST FLO_OR ---- - -_--- _-
be compleeed P1 order to 8utiding Name,Wing,door,Room,etc.
comprywith MsDrP
nolmcation neWirements 2.Blanket Permit Project Approval,if a licab6,
of;,S10 CMR 7.15 and Approval ID#
Department of Labor 3.Non-'traditional Asbestos AbaterrfentUVak Practice
slate(OLSt I Approval,if applicable: C—_—
eotirrcation rsaulraments �9l0212C15 — --_--- -_-------��--� �Oe1D3/2016 --------_---------•---------••,-.-'
or 453 CMR 5.12 Project Start Date(MM/DD/YYYY) J End Date CWDDNYYY)
7AM r3PM �
Work Hours-Monday Through Friday Wtwk Hours-Saturday&Sunday
Mas9DEP Use Only °l
Date Received B. Other Project Revisions:'
2.Submit Original
Form To:
commommealth of _.._...._ .............
Massac huseHs P_O.
Box 4002 Boston,MA
02211 C. Certification
'I certify that!have oereonally examined ,DFW the foregoing and am familiar with the Name Authorized Signature
Note:Temporary information contained in this document p----=- -------- --- -- - ----------------
__1 I0T/27/2015
stooge of asbestos and all attachments and that,Dried on ositonfrrtle--------' I Date MMIPD/Y J
containing waste my inquiry of those individuals _. -- - {
material is only allowed Immediately responsible for obtainin li791-762-'3337IR_SAFE:tNC_ _ —_
at the place of the information,I believe that the Telephone Representing _
business of a DLS Information is true,accurate,and (SAME :' i 1•SAME•___.__._.______..._.._-----_.---;
licensed Asbestos complete.I am aware that there are -- -------- -- ----- - '---------- --- --''-�
Address: Cttyrroum
contractor or a transfer signifeant penalties for submitting false
slalion trtat Is permitted information,including possible fines and t._ ------------------- ---------------------.-.-----____--
by MassDEP and Imprlsonment The undersigned hereby State zip Code
operated in compliance states that t have read the
with Solid(Made Commonwealth of Massachuseft
Regulawns 310 CMR regulations governing aebeabs
19.ot70 abatement(453 CMR 6.00 promulgated
by the Department of Labor Standards
and 31 D CMR 7.15 promulgated by the k
Note:Contrador must De"entor Environmental
sign Ws form for DLS Protection),and that I am aware that
I of 2 7127/2015 9:32 AM
08/20/2015 10:36AM 5442 DAVE WALSH PAGE 01/02
Arr Safe, Inc.
61 EhdicottStreet,Bldg.32-1
Norwood,MA 02062 781-762-3340
Experts in Asbestos arnd,tllold Removarl
FAX TRANSMISSION
DATE: - r
TOTAL NUMBER OF PAGES INCLUDING::;COVER: ft.
TO: BARNSTABLE BOARD OF I ALTH
FAX RECEIVING: 508-790-630 PHONE 508- 862-4644
FAX SENDING: 781-762-2815
, p
IL
TOWN OF BARNSTABLE 6
LOCA'1""ION -3D (00 iZl. 6n A- SEWAGE#
VILLAGE C0 w.w.A M-y\h, ASSESSOR'S MAP & LO A
INSTALLER'S NAME&PHONE NO. on oa*_
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) t-CAP i NLt�T (size) t`tcr, t-a t �GJ�,
NO.OF BEDROOMS
BUILDER O OWNER 1J ITT
PERMrT.DATE: COMPLIANCE DATE: Jr
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
dzTE. (flA
k
OF HOUSE
ASSESSORS MAP NO- Fee 6—b
THE COMMONWEAPLAI%�r�ivn=t93i�•irtQ'. 'rT'��'�'
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
01p pfication for Miopozal *p5tem Construction Permit
Application is hereby made for a Permit to Construct( )or RepairA *)an On-site Sewage Disposal System at:
Location Address or Lot No. Owner's Name,Address and .No.
Y/
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
�- -
Type of Building: 2
Dwelling No.of Bedrooms U Garbage Grinder(ZW
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
Description of Soil
Nature of Repq&s or Alterations(Answer when applicable) 'C'e'
Date last inspected:
Agreement:
The undersigned agrees to ensure the cons cti
' ' on and maintenance of afore described on-site sewage disposal system
in accordance with the provons of Title 5 e Environmental Code a of to pla the system in operation un '1 a Certifi-
cate of Compliance has been t Board of Health.
Signed Date
Application Approved by
Application Disapproved for the following reasons
Permit No. r �� Date Issued �1 d
ilia . --— — -•-— —�e,�.,�_..� �� --- - ---
.,,•,.....,y.,r -,...:.�.�++:_._.tom, .�ra:.��-vr..a-� s.+�.: .:.--R-.
No. '� VIFee
THE COMMONWEALTH OF MASSACHUSETTS `
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
2pplicat ors for Migozar *pgtem -Contr-uctiort Permit
i
Application is hereby made for a Permit to Construct( )or Repair )an On-site Sewage Disposal System at:
Location Address or Lot No. Owner's Name,Address and Tom,.No.
37 6 A R
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
tr..:(�(.i �w - �.9— --•4_
2 .L
Type of Building: -
Dwelling No.of Bedrooms rJ Garbage Grinder(J4-'0
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow ` - ` gallons per day. Calculated daily flow LT`�C� gallons.
'Plan Date 5� / - `T-� Number of sheets _Revision Date y
Title
Description of�oil — _. GA i f
Nature of Repays or Alterations(Answer when applicable) e �1'1/
Date last inspected:
Agreement:
The undersigned agrees to enK. ar
tion and maintenance of afore described on-site sewage disposal system
in accordance with the prov' ons oEnvironmental Code a of to plat the system in operation until a Certifi-
cate of Compliance has been tof Health.
j Signed Date �^E%
Application Approved by -
Application Disapproved for the following reasons
{
Permit No. 'F:� � Date Issued ��" 4/p
THE COMMONWEALTH OF MASSACHUSETTS
e PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS
Certiftcate of (Compliance
THIS IS TO CERTIFY, that the On-site Sewage Disposal System installed( )or repaired/replaced( AT on
by ��L! 5 '�J' : for ° a '`�`"�.��- A,
as C5 ! 5F 4 has been constructed in acc rdance
with t�he rovisions of Title 5 and the for Disposal System Construction Permit No. F, � �fdated���- �✓
Use o'f this system is conditioned on co�npl'ance with the provisions set forth below: )
No. •7 .� Fee
THE COMMONWEAL T H OF MASSACHUSETTS
P BLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS
nigaal *pgte�m (Con5tructionN eer-mit�
Permission is hereby granted tof
to construct( )repair( /1 an On-site Sewage 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.
All construction must be completed within two years of the date below. �f
Date: Approved b � ..lril
PP y —
m SENDER:
o ■Complete hems 1 and/or 2 for additional services. 1 also wish to receive the
�► ■Complete items 3,4a,and 4b. following services(for an
I ■Print your name and address on.the reverse of this form so that we can return this extra fee):
N card to you.
■Attach this form to the front of the mailpiece,or on the back if space does not 1. ❑ Addressee's Address
permit. d
y ■Write'Retum Receipt Requested'on the mailpiece below the article number. 2. ❑ Restricted Delivery rn
t ■The Return Receipt will show to whom the article was delivered and the date a
C delivered. Consult postmaster for fee.
0
3.Article Addressed to: 4a.Article Number d
a � E.
E E 4b.Service Type
u ❑ Registered Ertertified ¢
rn �
� ❑ Express Mail ❑ Insured 0
❑ Return Receipt for Merchandise ❑ COD
o 74
7.Date of very
0%9cc 1. 13 is '-I
0 5.Received By:(Print Name) 8.Addressee's Address(Only if requested -19
w
I Q and fee is paid) t
urejXA.ddressee ent) ~
T ;�' ! + Iq > tf iff If,' if 1, It lift
rm 3811, D cember 1994 102595-97-B-0179 Domestic Return Receipt
First-ClassMail
UNITED STATES POSTAL SERV4CE 1, CPostage&Fees Paid
USPS
.k' 20
,.1 Permit No.G-1U
• Print yow-fiam ,address, and ZIP Cod r6V#Vb"ox 0 e"
N
I
I'
I
Board of Health
M Town of Barnstable
P.O.Box 534
Hyannis,Massachusetts 02601 '
� Ii.I � Ii�lIII��►„�llli � �ld11 �1,+1, 11��1„I� {��1
�Z 2r3 498 783 .
US Postal Service
Receipt for Certified Mail
No Insurance Coverage Provided.
Do not use for International Mail See reverse
Sentto
Street&Numbifif
Post Office,State,&ZIP Code 7
07-
Postage $
Certified Fee
Special Delivery Fee
Restricted Delivery Fee
Return Receipt Showing to
Whom&Date Delivered
a Retim Receipt Showing to Whom,
Q Date,&Addressee's Address
0 TOTAL Postage&Fees $ a�•'7 7
th Postmark or Date
I
Stick postage stamps to article to cover'First-Class postage,certified mall fee,and
f charges for any selected optional services(See front).
1. If you want this receipt postmarked,stick the gummed stub to the right of the return
address leaving the receipt attached, and present the article at a post office service
window or hand it to our rural carrier no extra charge). In
Y ( �
2. If you do not want this receipt postmarked,stick the gummed stub to the right of the Q
return address of the article,date,detach,and retain the receipt,and mail the article.
uO
Id 3. If you want a return receipt,write the certified mail number and our name and address °)
Y P Y rn
on a return receipt card,Form 3811,and attach it to the front of the article by means of the
gummed ends if space permits. Otherwise,affix to back of article. Endorse front of article a
i
RETURN RECEIPT REQUESTED adjacent to the number. Q
4. If you want delivery restricted to the addressee, or to an authorized agent of the 0
h addressee,endorse RESTRICTED DELIVERY on the front of the article. r M
5..Enter fees for the services requested in the appropriate spaces on the front of this E
i receipt. If return receipt is requested,check the applicable blocks in item 1 of Form 3811. t6
6.'Save this receipt and present it if you make an inquiry. 102595-97-B-0145 a
I
I
I
;;i
Town of Barnstable
Department of Health,Safety, and Environmental Services
Public Health Division
1639.A'�3+14 P.O. Box 534,Hyannis MA 02601
Office: 508-790-6265 Thomas A.McKean,RS,CHO
FAX: 508-790-6304 Director of Public Health
i C April 14, 1998
Betty Fitterer j
282 Partridge Run; {
Mountainside,N.J. 07092-1310 !
NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.00. STATE SANITARY
CODE II MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION
AND THE TOWN OF BARNSTABLE RENTAL ORDINANCE,ARTICLE 51
The property owned by you located at 3760 Main Street, Barnstable, was inspected on
April 13, 1998 by Jerry Dunning, Health Inspector for the Town of Barnstable, because
of a complaint. The following violations of 105 CMR 410.00, State Sanitary Code II,
Minimum Standards of Fitness for Human Habitation were observed:
310 CMR11.00-17.00: Cesspool cover is missing and the cesspool is overflowing
causing a health problem.
You are directed to correct the violation of 310 CMR 11.00-11.00 within twenty-four
(24) hours of receipt of this notice.
You are also directed to correct the remaining above listed violations within seven (7)
days of receipt of this notice.
You may request a hearing if written petition requesting same is received by the Board of
Health within seven (7) days after the date order is received. However, these violations
must be corrected regardless of any request for a hearing.
Please be advised that failure to comply with an order could result in a fine of not more
than $500. Each separate day's failure to comply with an order shall constitute a separate
violation.
PER ORDER OF THE BOARD OF HEALTH
Phomas A. McKean
Director of Public Health
cc: Rosemary Dooley
}
x
j
I
�vfr:/Ivlrs.
1h �,�- 0-76 g'a- l r0
NU'CICE 'I'U AUA'I'E VIUL"�rmNs OF 10S CMlt 410.0� �1A lA�N��X
___—
1111N1t\1UA1 STA1VUAftU5 UC rl'CNES��1NANCOIR E AK11CLl',S1
AND TIIE 'l U1YN Uf, HARN57AljLE ItEN IAL U ��
ew++ b f
The roperty owned by you located at 3 7/-o s b use non
V 1998 by
p Ilealth Agent for the Town of gArnst bl
Ma.� �
comt�llint. Ilse fOIlowing violations of the 'I'tJW r��rn Ishl��nhl
Co licic 51 and llic Sanitnry (:odc 11 were observed:
ktJo i
ago v►��
C• �D
P.O. 7 93
M
U
iolation of 3'n`'" within 24 hours of tecelpt of th"
v
You are directed to correct file
notice by
You
are also directed Iv corrtcI the remaining above listed violations WNhlA keen
(7)days or receipt of this notice..
' the�oerd of
You may request a hearing if written petition requesting same Is receivved b se violations
I tcaltl, �villiin seven (7) (Inys a(lcr tltc csl for aer is hearing.tveJ.
must be corrected regardless of any request
Please be Advised
vised flint failure to comply with an order could result in A one of tlol arate
than �5t)0. t:ach Se tale
(11y'S failure to comply with an order shell constitute a s p
violation.
re also suh'ect to non criminal citations of S40.00 for the otM vlolellon cne'csed�
You a 1
ti,r each Additional violation. 'rickets will be issue) Jelly until the violationsde to violations
Lnclosed are citation numbers
observed on
PER ORDER OF THE HOARD or HEALTH
Thomas A. McKean
Director of public Ileallit
Town of Barnstable
Health Complaints
10-Apr-98
Time: 3:00:00 PM Date: 4/10/98 Complaint Number: 1278
Referred To: JEROME DUNNING Taken By: K.S.
Complaint Type: TITLE V SEWAGE
Article X Detail: UNSANITARY CONDITIONS
Business Name:
Number: 3760 Street: Main Street
Village: CUMMAQUID Assessors Map_Parcel:
Complaint Description: This women is renting the house. She fills that
the septic system fails because of bed sewage
smell.
Actions Taken/Results:
Investigation Date: Investigation Time:
1
l.L O
LOCATION
TOWN OF BARNSTABLE
� �
VILLAGE C ^ SEWAGE # -T'6 — (p
A v��
INSTALLER'S NAAM&PHONE NO. '`ASSESSOR'S MAp g LOT2
.�t
SEPTIC TANK CAPACTTY 3 Qo Co S.
LEACHING FACILITY: (type)
NO.OF BEDROOMS ' AC
N LL 2A (size)
tnq
BUILDER O O R
i
PERMITDATE: C `� ^ I l Te., C
Separation Distance Betw COIvIpLCE DATE: �Z�
een the:
Mum Adjusted Groundwater Table and Bottom of
Private Water Supply Well and Leaching Facility
on site or within 200 feet of leaching
cog Paciy) (If any Fells exist Feet
Edge of Wetland and Leachin facility)
Within 300 feet of leachingg Facility(If wetlands exist Feet
Furnished by facility)
Feet
WF W5
ZONING & RESOURCE PROTECTION NOTES
1
1. PARCEL ID:317/028/001
y�
2. OWNER OF RECORD:LEHMAN,MATTHEW&FORT,ELIZABETH c
.4
JF E 3. ADDRESS: 3760 MAIN STREET,BARNSTABLE,MA 02630
GATE _
7U1
4. A PORTION OF THE SITE,BEYOND THE LIMIT OF WORK,IS IN LOCATED WITHIN F.I.R.M ZONE AE AS SHOWN ON COMMUNITY PANEL NO.25001C0558J,
r' 1 W
R RtVERFRp
DATED JULY 16,2014 NE a
\ WASTEWATER NOTES 0 m
\\o 0
C H i t 1. ELEVATION, PROPERTY LINE AND EXISTING CONDITIONS ON THIS PLAN ARE BASED ON THE PLAN ENTITLED,"EXISTING CONDITIONS,"BY THE HORSLEY (n o
O N1F E WITTEN GROUP,STAMPED BY DANIEL W.MACKENZIE, PLS,ON SEPTEMBER 6,2019. '>
2. UNLESS OTHERWISE NOTED,ALL SYSTEM COMPONENTS AND CONSTRUCTION METHODS SHALL BE IN ACCORDANCE WITH THE STATE Q a Q <� Q a
ENVIRONMENTAL CODE AND THE RULES AND REGULATIONS OF THE BARNSTABLE BOARD OF HEALTH.
3. THIS PLAN IS INTENDED TO ADEQUATELY PROVIDE THE INFORMATION NECESSARY TO LAYOUT AND CONSTRUCT THE PROPOSED SEWAGE DISPOSAL
-- i SYSTEM REPRESENTED ON IT AND SHOULD NOT BE USED FOR ANY OTHER PURPOSES. -0 w
(D W
WOODEN �! �' 4. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE ENGINEER AND/OR THE LOCAL BOARD OF HEALTH(BOH)STAFF. s
DECK O
5. PRIOR TO CONSTRUCTION,THE CONTRACTOR SHALL COORDINATE WITH THE PROPERTY OWNER AND ENGINEER ON THE CONSTRUCTION SITE
b ACCESS AND MATERIAL STOCK PILE AREAS.
V �
I. 6. TRENCH SAFETY SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR INCLUDING ANY LOCAL AND/OR STATE PERMITS REQUIRED FOR THE O 3
It'd I TRENCHWORK. _ ..
7. THE CONTRACTOR SHALL REPORT ANY DISCREPANCIES FOUND IN SITE CONDITIONS FROM THOSE SHOWN ON THE PLAN TO THE DESIGN ENGINEER. (O
i 8. FAILING TO PROPERLY INSPECT OR PUMP THE SEPTIC TANKS AND TREATMENT SYSTEM OR CHANGES TO EFFLUENT FLOW,GRADING,OR w m J
_ LANDSCAPING, EITHER ON-SITE OR ADJACENT TO THE SITE,MAY RESULT IN IMPROPER FUNCTIONING OF THE SEPTIC AND LEACHING SYSTEM(S). U
1 O 2)
,^ v 9. THIS ON-SITE WASTEWATER TREATMENT SYSTEM IS
• ° NOT DESIGNED FOR USE WITH A GARBAGE GRINDER. o
FREL,
I 10. THE OWNER SHALL INSPECT AND PUMP THE SEPTIC TANK ONCE EVERY 2 YEARS. o •0
O 11. PROVIDE WATERTIGHT SEALS BY USE OF NON-SHRINK GROUT AT ALL POINTS WHERE PIPES ENTER OR LEAVE ANY CONCRETE STRUCTURES. d Q O o
` / .. .� tp r•• C14o
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cr 12. USE SCHEDULE 40 PVC PIPING WITH WATERTIGHT JOINTS UNLESS OTHERWISE NOTED ON PLAN. ALL PIPE SHALL BE PLACED ON A COMPACTED FIRM v M r> >
BASE. i w O a Cl)00 Go z
I,
* 13. INSTALL MAGNETIC WARNING TAPE ABOVE ALL INSTALLED SEPTIC COMPONENTS. _ y o
O Ch-f' •. .- .. -- ..
14 ALL SEPTIC TANKS SHALL BE TREATED 2 COATS OF DAMP PROOFING OR BITUMINOUS MATE
' ------ --� - to r Y. 0 p15. MATERIAL.
a I
THE CONTRACTOR SHALL RESTORE ALL SURFACES EQUAL TO THEIR ORIGINAL CONDITION AFTER CONSTRUCTION IS COMPLETE THE CONTRACTOR
Y. - ' SHALL TAKE CARE TO PREVENT DAMAGE TO SHRUBS,TREES,OTHER LANDSCAPING AND/OR NATURAL FEATURES. WHEREAS THE PLANS DO NOT
SHOW ALL LANDSCAPE FEATURES, EXISTING CONDITIONS MUST BE VERIFIED BY THE CONTRACTOR IN ADVANCE OF THE WORK.
3760 MAIN STREET 16. ALL UNPAVED AREAS DISTURBED BY THE WORK SHALL HAVE A MINIMUM OF 4-INCHES OF LOAM INSTALLED AND BE SEEDED WITH GRASS SEED AS
2 U)
4" INV - �'hr _ I SHOWN ON THE PLAN AND/OR AS DIRECTED BY THE ENGINEER.
l I
4" INV OUT:21.75
150C�r 2 `L`L 1
SE 0-
FFE:26.32 T �/ _D
_ CLEANOUT 4 PVC 4 INV OUT:21.85
I _ L=38' S=1.03% 22 W W
[��
- 23.50 V
INSTALL 4"SCHEDULE 40 Cot- S O 1a-s~ � C � J
L r,r ILL
--- - , •
WYE IN-LINE WITH EXISTINGS s I G
DS DISTRIBUTION BOX INLET LLI
k. 4 INV IN:21.75 U) > U)
f 1,500 GAL PRECAST z Q Q 0
LAWN LAWN ,Y LEACHING 2 CONCRETE TANK
HAMBERs WITH BAFFLE Q z
4"INV IN:21.10' / 1
4 INV OUT:21.50 � � i � �
m 24 20"DIAMETER COVER(2)
- ------ 24
_--- --- \ PLAN VIEW-------- --- ----- --- - ------ OUT -
ER RtVERt bf E LiMiN006 Sii)EvLALK
ROPE T gREA \ _ M<M
_. .-- -- ----------------- \ - - - DRIVEWAY AF W
81 U Vi ,,
v r.• ,
-------------r --- - ----- o. r; i 20"DIAMETER PROVIDE 24"DIAMETER
COVERS WITHIN 6"OF WATER TIGHT RISER AND
-- - - - -
- - --- FINISHED GRADE COVER TO GRADE
1"TAPER c
_._ H-20 6"TOP �I 1° f0
ROUTE 6A - MAIN STREET 4"DIAMETER
a a
4"OUTLET INLET RUBBER
GRAPHIC SCALE ANITH DCBOOTLAAMP - BOOT WITH CLAMP
SCH 40 PVC TEE
10 0 5 10 20 40 } } WITH BAFFLE 10"
19" 10"
E U) o
Q M
5'-10" Q o
(in feet) 4'-q" BAFFLE WALL SEE NOTE 5 a 4'-7" O
1 INCH = 10 FEET O z co
Q 4" 3" a 11 Q F_ I
X� W O Z I
w X
.: - - •. .. ti Q = f0
SECTION VIEW
N
-� 1. CONCRETE:4,000 PSI MINIMUM AFTER 28 DAYS.
2. TANK CONFORMS WITH 310 CMR 15.00.
3. ALL REINFORCEMENT CONFORMS WITH ASTM C1227.
W 4. TEE AND GAS BAFFLE NOT PROVIDED.
5. TONGUE AND GROOVE JOINT TO BE SEALED WITH BUTYL RESIN.
i
6
(n
U
1500 GALLON TANK DETAIL �.
0 NOT TO SCALE
i
(♦ 0
m _+ " ACD co co O
� Q � �r�j J
ED W
2 _C 0 Q
d. 2 o 0 Q
w O lr -0O C N
C\I J) = rn cn I �i o
CURB BOX MOUNTED 4"PVC
N
FLUSH TO GRADE THREADED CAP Registration:
-%H OF
N 12" ` moo? .�SEPH F_ �yc
C SEE SITE PLAN FOR + L q" HERE
L_ SURFACE MATERIAL t�
CL
45°BEND
O ��SS
N
WYE FITTING
It
N I1' -ZO
r-
Project Number: Sheet:
XMATT 1 of 1
O Sheet Number:
E CLEANOUT DETAIL ^
M V
NOT TO SCALE 1 1
1
GENERAL L NO TES ACCESS COVERS MUST BE WITHIN 9' MINIMUM. I
THIS PLAN /S FOR THE DESIGN AND CONSTRUCTION � l VI V ER T EL E ��� T I ONS U F� S I (3i%' CR I TL k .,
6' OF FINISH GRADE-' 3 ' MAXIMUM COVER
� � FIRST 2 ' TO INVERT AT BUILDING: 21. 75
DESIGN FLOW:
1. � INVERT /N SEPTIC TANK: 21.55 3 BEDROOMS AT ! lo G.P.D. PER
OF THE SEWAGE DISPOSAL SYSTEM ONLY. BE LEVEL, MIN 2' OF PEASTONE - --
- - INVERT OUT SEPTIC TANK: 21_3_ BEDROOM EQUALS 330 G.P.D.
' DIAN PIPE
2. VERTICAL DATUM IS NGVD. FOR BENCH MARKS -- o - -- - __-�- 1 INVERT /N DlST. BOX: _21.88
__E--_ =r3/4' - l l/2' D/A. NO GARBAGE GRINDER
SET. SEE SITE PLAN. f�75 I 2l.3 \20.B8 T/O' �. WASHED STONEINVERT OUT DIST. 80X: 20.88 a ; I_ do .___ �_._ __ 0 INVERT /N LEACH CHAMBER: 20.8
SS ( BAFFLE— 21. •B — —
—L____—dpd_ ' 4 HIGH CAPACITY INFILTRATOR BOTTOM OF LEACH CHAMBER: 20. 0 SEPTIC TANK REQUIRED:
J. ALL CONSTRUCTION METHODS AND MATERIALS AND 13 OUTLET ---- --- 330 G.P.D. X 200% - 660 GAL.
MAINTENANCE OF THE SEPTIC SYSTEM SHALL0-BOX CHAMBERS W/3. 5 ' STONE AROUND ADJUSTED GROUND WATER: 15. 0
ISoo GAL 2- 10 '. x l9 'I X lo'd SEPTIC TANK PROVIDED: 1500 GAL . MIN.
CONFORM TO MASS. D.E.P. TITLE 5 AND LOCAL OBSERVED GROUND WATER: 14.9 _
BOARD OF HEALTH REGULATIONS. SEPTIC TANKV6'
' CRUSHED STONE BASE
BOTTOM OF TEST HOLE •l: l4. I SOIL ABSORPTION SYSTEM REQUIRF_C:
INDEX WELL AIW 247. ZONE R DESIGN PERC RATE ( 5 MIN/INCH
4. ALL SEPTIC SYSTEM COMPONENTS LOCATED UNDER GRUr ; NOT TO SCALE 98 READING-20.8'. ADJ-0. I ' SOIL TEXTURAL CLASS - I
AREAS SUBJECT TO VEHICULAR TRAFFIC OR GREATER EFFLUENT LOADING RATE - 0. 74 GPD/SF
THAN 3 ' IN DEPTH SHALL BE CAPABLE OF WITH- 330 GPD / 0. 74 GPD/SF - 446 S.F. REQUIRED
STANDING H-20 WHEEL LOADS.
' PROVIDED: 4 HIGH CAPACITY INFILTRATOR
S. ALL SEWER PIPE SHALL BE SCHEDULE 40 OR ---- \, � \�\, i CHAMBERS w/3.5 '3 STONE AROUND. A-460 S.F.
APPROVED EQUAL. ; 1
\ j \ AA REQUIRED - 33010. 75 - 446 S.F.
6. SEPTIC TANK AND D-BOX SHALL BE REINFORCED \\ AA PROVIDED - (10+1) (19•I)x2 - 446 S.F.
PRECAST CONCRETE AND WATERTIGHT. Ew
7. BEFORE CONSTRUCTION CALL 'DIG-SAFE-. \ _ `S;i r' L 7 L j` 7 �I T n� ,' ,y
I-888-DIG-SAFE AND THE LOCAL WATER DEPT. Ew 12_1 \\ I EW 6
FOR LOCATION OF UNDERGROUND UTILITIES. r of ME1�g►±G = - ``_\6/�,.- \\\ \\ , , - PERCCAT ES o PI C TES
Ew /3 w.�• _- \ \ \ TEST = GROUND,WA TER
8. EXISTING METAL TANK TO BE PUMPED DRY AND
BA CKF I L L ED. \\\ / P 9140
� i I
9. ALL UNSUITABLE MATERIAL (A 6 B HORIZONS) _ I i' j Ear 5 0, HOR I ZON TEXTURE COLOR
ENCOUNTERED BELOW THE INVERT OF THE LEACHING \ I HARDEN 1 �— LOAMY /OYR
1
FACILITY TO BE REM Q REMOVED FOR A DISTANCE OF 5 ' \\ % Il SAND 3/2
AROUND AND REPLACED WITH SAND IN ACCORDANCE \ I 1 /O'
W/TH TITLE 5. ,\\ \\\ ' j p LOAMY I OYR
20 L. SAND 4/6
............ .... _
,y o C COARSE I OYR -
SAND 6/3
LAWN / 92'1-�-'_- 14.9
tw 102� - NO WATER 14. 1
°��►FE.e m / -_ 1 1 ��\�_ DATE: APRIL 28. !998
TEST BY: 5TEPHEN HAAS
A.
WITNESSED BY: JERRY DUNNING
M9TAL TANK\\
C4VIil,:�.( PERc, RATE: ( 2 of1N.IINCH 'I
G J500 SAL �� LAplf
SEP T/C TA� / y \ p \ \ E
'PO. / Se� S, / -----__--
lK
AVE GOD SAY / T \\ ORAVEL DR/VE �) \ '-__--- \A0
5 37o5 RUU7 PARCH-!_ 28 - 1
36- MAPLE /t' PA RE D
LOCv R T
\ GR lAIof 282 PAR TR / DOE RUN . M0U/V TA / /VS / DE . /V_J 07"092
A� ��
SCAL E : / - 20 MA Y / 8 . / 998
EA\ GI_ E SUFR \ /' EYI f`- 10 I r
AM. /CN
1 £L-24.�? NOVD __ 923 Route 6 A Ya rmo u t h p o r t , MA . 02675
C
F I L- 508 362-8132
R� RL_
I
TOWN OF BARNS TABL E HEALTH REGULATIONS SECTION I. /3: �� \ ( 5 0 8 ) 4 3 2---5 3 3 3
I 100' IS REQUIRED BETWEEN THE SAS AND THE WETLAND. \�
60 ' IS PROPOSED. A 40' VARIANCE l S REQUESTED. - _�._ __._..__._ ____._____ ___._.________ _
LOCUS NIa P �, 1° 20 �0 JOB No: 9e-035 FIELD:CFWIEEK CALL: SAH,ICFW 1 CHECK: CFW r ,A!i
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