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Home My WebLink AboutAdvanced Environmental Excavation, Inc. - 12/31/2021()d (Y) 1 A/V !1 j4. s ` town of Mansfield € W[I Qf 1�1r�� i�Cti ]3c� � raj �� 1 � 6 Park Row Mansfield, MA 02048 a^3� Disposal Works, Installer Applicadoflr LICENSE NUMBER: APPLICANT: James Brophy BUSINESS NAME: Advanced Environmental Excavation, Inc. MAIL ADDRESS: 51 Glebe Street CITY/TOVVN: Taunton STATE: MA ZIP CODE: 02780 BUSINESS PHONE: 508-889-4206 BUSINESS CELL: BUSINESS FAX: E-mall: infot?a advanceclenvirnment.com Alt E-mail: FEDERAL ID/SS NUMBER: 04-34503'12 LICENSE FIELD: Town Taunton Year Licensed since 2005 LICENSE FIELD: Town Rehoboth Year Licensed -since 2009 LICENSE HELD: Town Dighton Year Licensed since 2009 Please submit a copy of the licenses held along with a contact name and phone number for each town. References will be checked. I have read 310 CMR 15.00, the State Environmental code, Title 5, Minimum Requirements for the subsurface Disposal of Sanitary Sewage and the Board of Health regulation titled "Minimum Standards for the Subsurface Disposal of Sanitary Sewage". I understand that deviation from them may be cause for revocation of this permit. Permit Expires December 31st yearly. FEE: $ 100,00 SIGNATURE: 9CLD� % J2BeI DATE: 12/30/2020 / Please n7alce appropriate changes, Sign, date, and enclose check for $100.00 payable to Town of Mansfield. Mail to: Board of Health, Town of Mansfield, Six Park Row. Mansfield, MA 02048 /_-_� Ii fJYYi 61VV VI _ LilU V,VIV AC®fd I® naTEtrinrnonw ) CERTIFICATEF LIABILITY INSURANCE �--� 1 /a(zoz'i THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NO'Y CONSTITUTE A CONTRAC"f BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER, IMPORTANT: If the certificate holder is in ADDITIONAL INSURED, the policyhes) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER conrncr Loretta Nrown- FBinsure, L.1_C °N 128 Dean Street Iac, tass _ .8666 --- -- FAX - -01 _d_2Ca) (508}824tAic No)508) 880 Taunton, MA 92780 1n-oi�IL -_...__ t-grown .(rDfbfnsure.aoln ._ INSURED Advanced Environmental Excavation Ino 61 Glebe St Taunton, MA 02780 of SC r'. WERAC.FC DPRTIFiCATF hIHMRER- RFVISIrnN NUKARPP. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISPED B@LOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWII HSI ANDING ANY REQUIREMENT, IERrn oR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS PER TIECATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE .AFFORDED BY Trle `11110 oo"IR.ED HEREIN IS SUBJECT I'O ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHCWhI MAY HAVE BEEN REDUCED BY PAID CLAIMS ITR'. L A 1 X COMMERCIAL GENERAL LIABILn Y :! EACH OCCURRENCE _ ' CLAIMS nnoE I XOCCUR1 S 20A I I14 rW1ACE TO RETMED 8/15/2020 0/95/2021 I f rr uSEs tEI >=„ « )mil l a 5Q0,000 X t 1 I jfED XI (Ally re IAI mS 15,000 _ Ciikt Waiver -_ .PERSONAL 5 1 a6o,QQ0 JJ — 1 r 3,00'6,0001 I�NLACSr'REGATC LIMITAFPLIC`;PER; I, OGRPGTEDS I`r uERAI nrcRtr gTEr,— POLICY L-X JECT ; LOU 'IPRODLICIS COl.IPlOPACG 3 ---0,000 OIHEh. g AUTOMOBILE LIABILITY I UT GOMNIEDSINC LF LIMIT Cen mtlen0 — 1,000,000 ANY AUTO ! i 9096832 1 8/15/2020 8/IW2021 LOD11YINJURY P Ip r o,U -�- OWNED SCHEDULED AUTOS ONLY X AUT09 BODIIYIIIJURYIRraccr nt) - F— HIRED IIOivO NED X - X %{f eOf ERtient)AMhPE , AUTOS AUTOS )FLY ! e —r I —I 1 UMBRELLALIAB f OCCUR I li EACH OCCURRENCE E _.. EXCESS I -An-.'.— (_AGGREGATE - _ —1 __— S — WORK RL COMPENSATION I� PER OTf4� L STAfUiE I ER 1 — ,AND EMPLOYERS' YERS' ANDIFYETEc.UTIVE YrILN �H FAI HACCIDPJI' .ANYPRO RIN _ � N!A I IOFFICERMEM➢ER EXCLUDED. - - 1 itMandatory In Nil) - :� ii E I DISEASE .FA EM I OYLE; III )e . delanw under 1 DF✓ RIPTION Of OPERATIONS time ! _ __ , _ _ EL. DISEASE.- SO 3,_ - - I I I i DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES IACORD U11, addlional Remarks Schedula, mny he ntincM1ed ll mmx sPxce le mgWrnd) Septic systems- installitiouhemoval/repair Contractor. "IOF FlNY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TFIG EXPIRATION DATE THEREOF, NONCE WILL BE DELIVERED IN Town of Mansfield ACCORDANCE WITH THE POLICY PROVISIONS. Town Hall 6 Park Row Mansfield, MA 02048 AUTNOR¢ED REPRESENTANVE ACORD 25 (2016/03) -- (1)1988-2016 ACORD CORPORATION. All right, reserved. The ACORD name and logo are registered rnarks of ACORD NUMBER # 18-20 FEE: $200.00 �fje �Cott�rnouYveoitb of ma o0a rbuoetto Matthew Tanis Permit Number: I20-50 Fee: $100.00 TFie Commonweafth of.Massachusetts Town of Rehoboth Board of Health This is to certify that: James Brophy Doing Business As: Advanced Environmental Excavation, Inc Mailing Address: Same Located at: 51 Glebe St, Taunton, MA 02780 IS HEREBY GRANTED A PERMIT TO PERFORM TITLE V SERVICES WITHIN THE TOWN OF REHOBOTH AS SYSTEM INSTALLER This permit is granted in conformity with the State Environmental Code (Title V) and the Rehoboth Board of Health Rules and Regulations, and expires December 31, 2020 unless sooner suspended or revoked. %) Rachel Smith, Chairman Ton aucher, Vice Ch�airman 7 Theresa Moitozo, Clerk George Kellum IV, Member MaFk HassHassk *"7T n , Member Issued: January 28,2020 (Mg of raunton card of Wilth 11 Zchool,Street �xti�84dt11llfltttfl D2jaD•3212 4 V ' 800 2020 BOARD MLMBEHS DR. BRYAN BAGDASIAN DR. BRUCE E. BONNER DR. CHARLES A. THAYEP, HEATHER L. GALLANT, MPH, RS, CHO EXECUTIVE DIRECTOR ADAM S. VICKSTHOM AssISTANT ExcCUTNE DIRECTOR DISPOSAL SYSTEM INSTALLER'S PERMIT Permit #: 6-2020 Permit Fee: $100.00 This is to certify that: Name: James Brophy, Advanced Environmental Excavation, Inc. Address 51 Glebe Street, Taunton, MA 02780 ...is hereby granted a "Disposal System Installer's Permit" to construct, upgrade, expand and abandon on -site sewage disposal systems in conformity with 310 CMR 15.000, The State Environmental Code, Title 5 Type of permit and any restrictions: Disposal System Installer's Permit Permit expiration date: December 31, 2020 unless sooner suspended or revoked Date issued: January 8, 2020 _ BOARD R HEALTH APPROVED CHARMS A. THAYER, M.D. CHAIRMAN TAUNTON, MA Adam S. Vickstrom Assistant Executive Director Original: Installer cc: Taunton Board of Health Regional Environmental Engineer, DEP Telephone (508) 821-1400 - Fax (508) 821-1403 The Counnenwealttl of Massachusetts 00pariment of industriai Accidents Office of Investigations 1 Congress Street, Suite 100 Boston, MA 02114-201 r" wwvr.rnass.gov/dia Workers' Compensation insurance Affidavit: General Businesses Pleas�Prin. i iy 6V —tea-ss AA+age 5R_SrYJ > CitylStatelzip: J/IAyuff1�t - oar Are you an employer? Check the appropriate box: _ I am a employer with , employees (fish and/ er part-tinl01f 2.1 am a sole proprietor or parinershtp and hove no employees working for me in any capacity. (No workers' comp. Insurance required] ,pr1Ne are a corporation and its officers have exercised that right of exemption per C. 152, §1(4), and we have no employees. INo workers' comp. insurance required]" ,I, We are a non-profit organization, staffed by volunteers, with no employees. [No workers' comp, insurance req.j Business Type (required): 5. Retail G. Restaurantr6arlEaGog Establishment %. Q; 0 crjotor `;aces (Inca. real eslidte, auto, etC.] 8. Non-profit -9, Entertainment 10. Manufacturing 11 Health Care L.Other PC'df1k p I '.lm rxpEan �i it h :9,rs li td::�:i u R ..ou! lon.,nt+u hi orht mput'.uum p,hce mammon. =.T4. z ��-q�+,E'aK �,t(u...e�hu�c usrtstui 8iem iSo >.h:a-.7. upiranni ha. olhrclnpiu.�...ct is eaynircd Mid such an Ahunld Check box A t am an employer that is providing worfsers' compensation Insurance for my employees. Belowis file policy infounatiort. InsuranceCom';artv_N�e: ---- ---------- Policy ii or Self -iris. Lic. # _ EWpAioo Date Attach it Cepy of the vrmkers' comuensation policy_deslaration gue�shmviny the poly numirer antipirallondate), Failure to secure coverage as required under Section 25A of MGL c. '152-can lead to the imposition of criminal penalties of a fine up to $1,600,00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Bo advised that a copy of this statement may be forwarded to the Office of Investigations of the DIAfor insurance coverage verification. I rlo and penalties of is free and correct. Official use only. Do trot write in this area, to he completed by city or town official. City or Town: _ PermitiLicense#__ Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. CityiTown Clerk 4. Licensing Board 5. selectmen's Office 6Other Contact Person: