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Home My WebLink AboutJ. Hockman, Inc. 12/31/2018Commonwealth of Massachusetts Town of Mansfield Town of Mansfield 6 Park Row Mansfield, MA 02048 Board of Health Septage Pumping and Transporting Permit This is to certify that: JASON HOCKMAN Doing business as: J. HOCKMAN, INC. 11 SHERWOOD DRIVE NORFOLK MA 02056 is hereby granted a SEPTAGE PUMPING AND TRANSPORTING PERMIT to engage in the pumping or transporting of the contents of privies, cesspools, septic tanks and other offensive substances. This permit is granted in conformity with the STATE ENVIRONMENTAL CODE: 310 CMR 15.02(2) and MGL chapter III section 31A and expires December 31, 2018 unless sooner suspended or revoked. LICENSE NUMBER: 10 TRUCK REGISTRATION NUMBER(S): J-800 PUMP BOARD OF HEALTH MchaeCMcCCean, Chairman t Septage Pumpers Application DATE: 2017 LICENSE NUMBER: 10 BUSINESS NAME: J. HOCKMAN, INC. MAIL ADDRESS: 11 SHERWOOD DRIVE TOWN: NORFOLK STATE: NAME OF OWNER: JASON HOCKMAN BUSINESS TELEPHONE: (508) 384-1400 E-mail: JASONH@PUMPERGUYS.COM MA ZIP CODE: 02056 CELL: (508) 326-8416 FAX: (508) 384-8850 Alt E-mail: FED ID/SS NO: 04-3496500 NUMBER OF TRUCK(S): 3 REGISTRATION NUMBER(S): J-800jZ7929 PUMP "FE PER TRUCK: $75.00 � — Please make appropriate changes. Sign, date. and enclose check payable to Town of Mansfield. Mail to: Board of Health, Town of Mansfield, Six Park Row, Mansfield, MA 02048. SIGNATURE: G `� - DATE:/ ............................... ......qju ......... ....... ......... ......... ........ ......--TRUCKS INSPECTIONS: D: THURSDAY NOVEMBER 9, 2017 TIME: 7:30 AM - 10:30 AM PLACE: FOXBOROUGH DPW PARKING LOT, 70 ELM STREET, FOXBORO PLEASE BE THERE, OR CALL THE FOLLOWING NUMBER (508) 261- 7366, IF YOU CAN NOT MAKE THIS DATE FOR HEALTH AGENT'S USE ONLY 310 CMR: State Environmental Code, Title 5; Minimum Requirements for the Subsurface Disposal of Sanitary Sewage. 15.502 Transportation and Disposal of Privy, Cesspool, and Septic Tank Contents. 15.505 Equipment: No person shall use equipment to remove or transport the contents of prives, cesspool, or septic tanks or other offensive substances unless such equipment has first been inspected and approved by the Board of Health. A. Mobile Tank: B. Venting of Mobile Tanks: Securely mounted on truck _ Vent permits escape of gas, but not liquid Watertight C. Hose: Leak -proof cover Suction or pressure hose in good repair Tight discharge tanks D. Pumps: Maintained to prevent leaking of sewage A, Acceptable Inspected by: NA = Not Acceptable Inspected on: TAX CERTIFICATION FORM I certify under the penalties of perjury that I, to my best knowledge and belief, have filed all state tax returns and paid all state taxes required under law. "/VvCICO�&) G Signature of Individual or Corporate Name **Social Security No. (Voluntary) or Federal Identification Number �. By: Corporate Officer (Mandatory, if Applicable) *This license will not be issued unless this certification clause is signed by the applicant. ** Your social security number will be furnished to the Massachusetts Department of Revenue to determine whether you have met tax filing or tax payment obligations. Licensees who fail to correct their non -filing or delinquency will be subject to license suspension or revocation. This request is made under the authority of Massachusetts General Law Chapter 62C, section 49A. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: General Businesses Applicant Information Please Print Leeibly Business/Organization Name: J HOCKMAN INC Address: 11 SHERWOOD DRIVE City/State/Zip: NORFOLK , MA 02056 Phone #: 508-384-1400 Are you an employer? Check the appropriate box: Business Type (required): 1.0 I am a employer with 14 employees (full and/ 5. [—]Retail or part-time).* 6. ❑ Restaurant/Bar/Eating Establishment 2. ❑ I am a sole proprietor or partnership and have no 7, ❑ Office and/or Sales (incl. real estate, auto, etc.) employees working for me in any capacity. 8. ❑ Non-profit [No workers' comp. insurance required] 3. ❑ We are a corporation and its officers have exercised 9. ❑ Entertainment their right of exemption per c. 152, § 1(4), and we have 10. ❑ Manufacturing 4. ❑ no employees. [No workers' comp. insurance required]**11.❑Health We are a non-profit organization, staffed by volunteers, Care with no employees. [No workers' comp. insurance req.] 12RXX Other EXCAVATING AND SEPTIC COMPANY *Any applicant that checks box # 1 must also fill out the section below showing their workers' compensation policy information. **If the corporate officers have exempted themselves, but the corporation has other employees, a workers' compensation policy is required and such an organization should check box # 1. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy information. Insurance Company Name: HOLLIS INSURANCE AGENCY Insurer's Address: 140 MARION ROAD City/State/Zip: WAREHAM MA 02571 Policy # or Self -ins. Lie. # 4219101 Expiration Date: 06/20/2018 Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). 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 $1,500.00 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. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify, under the ofperjury that the Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License # above is true and correct. 11/1/2017 Issuing Authority (circle one): 1. Board of Health 2, Building Department 3. City/Town Clerk 4. Licensing Board 5. Selectmen's Office 6.Other Contact Phone www.mass.gov/dia Y l'�/l If Yam® CERTIFICATE OF LIABILITY INSURANCE D DU/YYYY) 6/13/13/2017 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 NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must 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 endorsemengs). PRODUCER ACT Cheryl L. Hollis C.L. HOLLIS INSURANCE fA, (508)295-9500 FAX .(508)295-9898 [EbMAL 140 Marion Rd .cheryllee@insurehollis.00m INSURERS AFFORDING COVERAGE NAICN Wareham MA 02571 INSURER.IT*,* a -Re ublic Franklin Ins. 12475 INSURED INSURERB;Gra hi.c Arts Mutual Ins CO 25984 J. Hockman, Inc. INSURERC.Utica Mutual Ins Co. 5976 11 Sherwood Or INSURERDHartford Insurance INSURER E: Norfolk MA 02056 INSUREiRF: KGYIDIUK IVYmCCK: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONSAND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, ILTR NURE TYPE OF INSURANCE POLICYNUMB P DCY EFF M 0 P LI EX DD UMRS A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR XCU COVERAGE INCLUDED PP 4135351 /22/2017 6/22/2018 EACH OCCURRENCE $ 1,000,000 X T D RE S a Occurrence) 1 E 300, 000 E 5,000 MEDEXP(An one arson) X PERSONALS ADV INJURY E 1,000,000 X CONTRACTUAL GENERAL AGGREGATE E 2,000,000 GENL AGGREGATE 17 POLICY LIMITAPPLIES PER: X PRO- LOC PRODUCTS-COMP/OP AGG E 2,000,000 E A B D A AUTOMOBILE LIABILITY ANY AUTO ALLOWNED M SCHEDULED AUTOS AUTOS HIRED AUTOS NON -OWNED AUTOS UMBRELLA DAB X OCCUR EXCESS UAB CLAIMS -MADE NIA C 4135352 LP4349777 219101 0814SZS4727 DCP4477214 6/22/2017 6/22/2017 6/26/2017 /24/2017 6/22/2017 6/22/2018 6/22/2018 6/26/2018. 6/24/2018 /22/2018 COMBI SING E MT Ea aedtlent BODILY INJURY (Per person) 1 •GOO 000 E BODILY INJURY (Paraccl4ent) E X PR_0_PElRtleM AMAGE MetllcalE en68 EACH OCCURRENCE E X E E AGGREGATE E D X R TENTU1 10,00 WORKERS COMPENSATION EMPLOYERS' LIABILITY Y/N PROPRIETOR(PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? N❑ ItItoaiInNHer SCRIPTION OF OPERATIONS below CONTRACTORS EQUIPMENT OWNER PUBLIC PROTECTIVE STATU• OTH•AND XANY EC lo E.L EACH ACCIDENT EIr9 E.L. DISEASE -EA EMPLOYE E E.L. DISEASE -POLICY LIMIT E LEASEOIRENTEDMAX 200,000 LIABILITY ... 000RENCE 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101, AldlUonal Ramuke Schedule, U more space to requlretl) AviaT,CrA�T! uA, ,nww TOWN OF MANSFIELD BOARD OF HEALTH 6 PARK ROW MANSFIELD, MA 02048 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITHTHE POLICY PROVISIONS. Hollis/CHERYL • oa .•• a .m •name ann mnn ve rmreaeron marve n1 Anr1RD reserved. Town off Town o Town oxborou orton 310 CMR 15.505 SEPTAGE HAULERS INSPECTION REPORT PERMIT#: DATE: 11/9/2017 Paid: Y or N n� �� t1 First Tri-Town Inspection Day COMPANY NAME: 3 , t koc/k 1" � ADDRESS: A✓f\!\'t�y /�90� l l -' ) TELEPHONE#: OPERATOR: TANK CAPACITY: TRUCK LIC. NUMBER: U D lJ I Eq/u/,ipment p' 1. Mobile Tank (securely mounted on trucks, watertight, necessary odor controls, leak -proof cover, tight discharge valves) W/2. 'Venting (gas) of Mobile Tank (properly constructed) /3. Suction or Pressure Hose in good repair 9/4. Pumps (leak -proof) I�h Thi`s vehicle is�i ompliance with 310 CMR 15.505. Person Interviewed ns ector (2017) Town of Foxborough Town of Mansfield Town of Norton 310 CMR 15.505 SEPTAGE HAULERS INSPECTION REPORT PERMIT#: DATE: 11/9/2017 Paid: Y or N First Tri•Town Inspection Day COMPANY NAME: �C,G�rxl ADDRESS: TELEPHONE#: OPERATOR:r) TANK CAPACITY: -W TRUCK LIC. NUMBER: ?o yo Equipment 1. Mobile Tank (securely mounted on Ducks, watertight, necessary odor controls, leak -proof cover, tight discharge valves) 2. Venting (gas) of Mobile Tank (properly constructed) 3. Suction or Pressure Hose In good repair 4. Pumps (leak -proof) This vehicle is In compliance with 310 C.MR 15.50.` erson Interviewed (2017) Jane Doucette From: Chris M <chrism@ pumperguys.com > Sent: Wednesday, December 13, 2017 7:02 AM To: Jane Doucette; Amy Donovan -Palmer Cc: Tina Hockman; Jason Heckman Subject: RE: Mansfield Pumper Inspection Attachments: PUMP Inspection Mansfield.pdf Hi Jane, I apologize for any confusion with the septage haulers permit but we sold the truck with the registration #77929. The two trucks we should be permitting in Mansfield have registration #PUMP & #1800. The truck with registration #PUMP was inspected at the tri-town inspection day and I have included a copy of the inspection report on this email. Please let me know if there are any other questions or concerns. Thank you, Chris Marchand J. Hockman, Inc. 11 Sherwood Drive Norfolk, Ma 02056 508-384-1400 chrism @pum oerguvs.Com Cell 774-721-6077 From: Jason Hockman Sent: Wednesday, December 13, 2017 5:57 AM To: Tina Hockman <tinah@pumperguvs.com>; Chris M <chrism@pumperguvs.com> Subject: FW: Mansfield Pumper Inspection From: Jane Doucette[mailto:Jdoucette@mansfieldma.comj Sent: Monday, December 11, 2017 9:12 AM To: Jason Hockman <iasonh@pumperguys.com> Cc: Amy Donovan -Palmer <adpalmer@mansfieldma.com> Subject: Mansfield Pumper Inspection Hi Jason, one of the trucks listed on your application did not get inspected at the group inspection. Please contacts us regarding truck registration #77929. The information contained in this communication from the Town of Mansfield is confidential. It Is intended solely for use by the recipient and others authorized to receive It. If you are nor the recipient, you are hereby notified that any disclosure, copying, distribution or taking action in relation of the contents of this Information is strictly prohibited and may be unlawful. This email has been scanned for viruses and malware, and may have been automatically archived by Mimeeast Ltd, an innovator in Jane Doucette From: Chris M <chrism@pumperguys.com> Sent: Wednesday, December 13, 2017 7:02 AM To: Jane Doucette; Amy Donovan -Palmer Cc: Tina Hockman; Jason Heckman Subject: RE: Mansfield Pumper Inspection Attachments: PUMP Inspection Mansfield.pdf Hi Jane, I apologize for any confusion with the septage haulers permit but we sold the truck with the registration #77929. The two trucks we should be permitting in Mansfield have registration #PUMP & #J800. The truck with registration #PUMP was inspected at the tri-town inspection day and I have included a copy of the inspection report on this email. Please let me know if there are any other questions or concerns. Thank you, Chris Marchand J. Hockman, Inc. 11 Sherwood Drive Norfolk, Ma 02056 508-384-1400 chrism Dumper¢uvs,com Cell 774-721-6077 From: Jason Hockman Sent: Wednesday, December 13, 2017 5:57 AM To: Tina Hockman <tinah@pumperguys.com>; Chris M <chrism@pumpereuys.com> Subject: FW: Mansfield Pumper Inspection From: Jane Doucette[mailto:Jdoucette@mansfieldma.com] Sent: Monday, December 11, 2017 9:12 AM To: Jason Hockman <iasonh@pumperauys.com> Cc: Amy Donovan -Palmer <adpalmer@mansfieldma.com> Subject: Mansfield Pumper Inspection Hi Jason, one of the trucks listed on your application did not get inspected at the group inspection. Please contacts us regarding truck registration #77929. Disclaimer The information contained in this communication from the Town of Mansfield is confidential. It is Intended solely for use by the recipient and others authorized to receive It, if you are not the recipient, you are hereby notified that any disclosure, copying, distribution or taking action in relation of the contents of this Information is strictly prohibited and may be unlawful, This email has beeri scanned for viruses and malwaie, and may have been automatically archived by Mimecast Ltd, an innovator in