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Home My WebLink AboutSoares Sanitation Pumping 12/31/2018V Commonwealth 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: ROBERT SOARES, SR. Doing business as: SOARES SANITATION PUMPING, INC. 286 THRASHER STREET TAUNTON MA 02780 is hereby granted a SEPTA GE 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 II I section 31A and expires December 31, 2018 unless sooner suspended or revoked. LICENSE NUMBER: 17 TRUCK REGISTRATION NUMBER(S): SM14455, SM65688, SM77545 BOARD OF HEALTH MichaeCblcCCean, Chairman b LICENSE NUMBER: 1T"""---°--- BUSINESS NAME: SOARES SANITATION PUMPING, INC. MAIL ADDRESS: 285 THRASHER STREET TOWN: TAUNTON STATE: MA ZIP CODE: 02780 NAME OF OWNER: ROBERT SOARES, SR. BUSINESS TELEPHONE: (508) 824-8370 CELL: FAX: (508) 824-9429 E-mail: SALES@SOARESPUMPING.COM Alt E-mail: FED ID/SS NO: 04-2947102 NUMBER OF T�R,UUCK(S): 3 REGISTRATION NUMBER(S): SM1`4455, SM6S688, SM7Z,4b FEE PER TRUCK: $75.00 P/aase make appropriate changes. Sign, ate. and enclose check payable to Town of Mansfield. Mail to: Board of Health, To of ansf Id, Si ark Row, Mansfield, MA 02048. SIGNATURE: DATE: 10,a0�11 TRUCKS INSPECTIONS: DATE: 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 Pumps: t Maintained to prevent leaking of sewage I A Acceptable NA Not Acceptable Ins Inspected by: ' p Inspected on: % t 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. Scares,%nitAon Purnpinq Signature of Individual or Corporate Name y: Corporate Officer (Mandatory, i Applicable) 04-091+1102 **Social Security No. (Voluntary) or Federal Ident Ration Number *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 oflndustrialAccidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit: General Businesses. TO BE FILED WITH THE PERIt2TT1'1NG AUTHORITY. Business/Organizatiio�n`gyrName: .es C)aniio-han t�rnP1, 1nC. Address: a00S Thy-014SVIer City/State/Z PM r1'k'Dfl0 M A,0a7 %0 Phone #: 1502 8 a4 Q 031 O Are you an employer? Check the appropriate box: l.)d I am a employer with employees (full and/ or part-time.).* 2. ❑ 1 am a sole proprietor or partnership and have no employees working for me in any capacity. [No workers' comp. insurance required] 3. ❑ We are a corporation and its officers have exercised their right of exemption per c. 152, § 1(4), and we have no employees. [No workers' comp. insurance required] 4. ❑ We are a non-profit organization, staffed by volunteers, with no employees. (No workers' comp, insurance req,j Business Type (required): 5. ❑ Retail 6. oRestauraiit/Bar/EatingEstablishment 7. ❑ Office and/or Sales (incl. real estate, auto, etc.) S. ❑ Non-profit 9. ❑ Entertainment 10,❑ Manufacturing 1111 Health Care a *Any applicant that checks box # 1 must also fill out the section below showing their worker:' compensation policy infomration. **If the corpomte officers have exempted themselves, but the corporation has other employees, a worker;' compensation policy is required and such an organization should check box M. lam an employer that is proi��"rdtng workeTrs,,',,compensadon insurancLfor my employees. Below is the policy information. Insurance Company Name: J� „1.11SUr0jnCe c-ompany Insurer's City/State/Zip: Policy # or Self -ins. Lie, #, We aaa0l99 Expiration Date: 611911 I sk_ 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 maybe forwarded to the Office of Investigations of the DIA for insurance coverjqe verification. I do hereby Phone #' 5o% %&4 03 1 0 ofperjury tly#'the information provided above is true and correct Official. use only. Do not write in this area, to be completed by city or town official City or Town: Permit(License 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 Person vmv.mass.gowdta Phone SOARSAN-02 DCARVALHO CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDNWY) 10/23/2017 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 have ADDITIONAL INSURED If SUBROGATION IS WAIVED, subject to the terms and conditions of this certificate does not confer rights to the certificate holder in lieu of provisions or be endorsed. the policy, certain policies may require an endorsement. A statement on such PRODUCER License # 1780362 endorsements . CAATEACT Diane Carvalho —--- HUB International New England 222 Milliken Boulevard PHONE - AIC, No, Extl: I'a No: Fall River, MA 02721L dlane.carvalhoa@hubinternational.com ESSL___ INSURERIS)APFORDING COVERAGE NAICIf SeleCtive ------ Ce Company if South Carolina 19259 INSURED Star. Insurance Company 16023 Scares Sanitation Pumping, Inc. tINSURER 285 Thrasher Street Taunton, MA 02780 - '-""' '_" "-'•"'•"'�^• KCVIJIUN NUMBER: 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, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN__MAY HAVE BEEN REDUCED BY PAID CLAIMS. _ INSR TYPE OF INSURANCE ADDLSUBR POLICY EFF POLICY EXP D POLICY NUMBER LIMITS A X COMMERCIALGENERALAL LIABILITY EACHOCCURRENCE 1,000,000 CLAIMS -MADE OCCUR S2190987 01/01/2017 011011201$ DAMAGE TO RENTED 100,000 ..- 3REM1�$.(Ee -- MED EXP An one eP rson) $ 5r000 PERSONAL&ADV INJURY 11000,000 GEN'L AGGREGATE LIMIT AP�rP_LIEjjS PER: POLICY D PRO- - u LOC , GENERA_LAGGREGATE $ - -- — - - PRODUCTS.COMP/OP AGO 2,000,000 2,000,000 OTHER: A AUTOMOBILE LIABILITY ANYAUTO AUgT�OS ONLY X AUUTTOSWULEDp AUTOS ONLY X AUTOS ONY A 9100369 0110112017 01/01/2018 COMBINED SINGLE LIMIT (Ea acEdenq-..__—_$_-_ BODILY INJURY Perperson) $ 1,000,000 _0 BODILY INJURY fPer accident X P4OPERTV ppAMAGE („er eccldso -- A X UMBRELLALIAB EXCESS LIAB X OCCUR CLAIMS -MADE S2190987 0110112017 01/01/2018 EACH OCCURRENCE 3,000,000 AGGREGATE 3,000,000 ' -- -- -- LED RETENTION$ B WORKERS COMPENSATION ANDEMPLOYERS'LIABILITY ANY PROPRIETOWPARTNERIEXECUTIVE YIN OFFICER?AUn BER E%CLUDED9 a (Mande o NHI If yea, desaibeunder DESCRIPTION OF OPERATIONS below. N/A WCO220789 06/19/2017 06119/2O1$ PER OTH- __- S TOTE - E.L.EACH ACCIDENT $ 500r000 E.L, DISEASE - EA EMPLOYE $ 500,000 E.L. DISEASE-POLICYLIMIT 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101, Addlflonal Remarks Schedule, racer. �... ,, �.. ..... ...... may be attached if more space is required) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Mansfield, Board of Health THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 6 Park Row ACCORDANCE WITH THE POLICY PROVISIONS. Mansfield, MA 02048 AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) 01988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Town of Foxborough Town of Mansfield Town of Norton 310 CMR 15.505 SEPTAGE MAULERS INSPECTION REPORT PERMIT#: DATE: 11/9/2017 Paid: Y or N First Tri-Town Inspection Day COMPANY NAME: ADDRESS: TELEPHONE#: OPERATOR: TANK CAPACITY: TRUCK LIC. NUMBER: Equipment 70 :JIB X 1.Mobile Tank (securely mounted on truths, watertight, necessary odor controls, leak -proof coven, tight discharge valves) 2. Venting (gas) of Mobile Tank (properly constructed) � 3. Suction or Pressure Hose in good repair A4. Pumps (lealt-proof) This vehicle is in compliance with 310 CMR 15. on Interviewed (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 Pirn Tri-Town inspection Day COMPANY NAME; ADDRESS: TELEPHONE#: OPERATOR: TANK CAPACITY: TRACK LIC, NUMBER: Equipment &W45 OC 1. Mobile Tank (securely mounted on tracks, watertight, necessary odor controls, leak -proof cover, tight discharge valves) Or/2, Venting (gas) of Mobile Tank (properly constructed) X 3. Suction or Pressure Hose in good repair P' 4. Pumps (leak -proof) This vehicle is in compliance with 310 CMR 15 Person Interviewed Town of Foxborough Town of Mansfield Town of Norton PERMIT#: ` a(v' DATE: 11/9/2017 Paid: Y or N 'first Tri•Town Inspection COMPANY ADDRESS: TELEPHON 7 370 OPERATOK TANK CAPACITY: C� TRUCK LIC. NUMBER: Equipment 1. Mobile Tank (securely mounted on trucks, watertiglit, necessary odor controls, leak -proof cover, tight discliarge valves) 2. Venting (gas) of Mobile Tank (properly constructed) vk 3. Suction or Pressure Hose in good repair "i 4. Pumps (leak -proof) � This vehicle is in compliance with 310 CMR 15, P °' 4 Inter ewed (2017) Town of Foxborough -- ---------- ..,.____-- Town of Mansfield Town of Norton q 310 CMR 15.505 SEPTAGE HAULERS INSPECTION REPORT PERMIT#: DATE: 11/9/2017 Paid: Y or N First Tri-Town Inspection Day COMPANY NAME: n �\ CQ-S ADDRESS: Z`6_ /�cl r CzS� TELEPHONE#: OPERATOR: _6L C/ TANK CAPACITY: S Zj O TRUCK LIC. NUMBER: E ment 1. Mobile Tank (securely mounted on trucks, watertight, necessary odor controls, Leak -proof cover, tight discharge valves) 19 2. 'Venting (gas) of Mobile Tank (properly constructed) 443. , Suction or Pressure Hose in good repair q/3.A. Pumps (leak -proof) Whis�ehicle is in compliance with 310 CMR 15.505. In p_p for (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 of N First Tri-Town Inspection Day COMPANY NAME: �CGC�Q ADDRESS: TELEPHONE#: OPERATOR l7 TANK CAPACITY: C;';� uoo TRUCK LIC. NUMBER: DygC\ Equipment 1. Mobile Tank (securely mounted on trucks, watertight, necessary odor controls, leak -proof cover, tight discharge valves) �l 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 CMR 15.505. 1`4dn Interviewed spect (2017) Town of Foxborough Town of Mansfield Town of Norton 310 CMM 15.505 SEPTAGE HAULERS INSPECTION REPORT PERMIT#: DATE: 11/9/2017 Paid: Y or N First Tri-Town Inspection Days COMPANY NAME: ADDRESS: TELEPHONE#: OPERATOR: TANI£ CAPACITY TRUCK LIC. NUMBER: Equipment �1. Mobile Tank (securely mounted on trucks, watertight, necessary odor controls, leak -proof cover, tight discharge valves) N3/2. Venting (gas) of Mobile Tank (properly constrneted) 3. Suction or Pressure Hose in good repair q 4. Pumps peal( -proof) A/This vehicle is in compliance with 310 CMR 15 Person Interviewed (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 Inspecdon Day COMPANY NAME: ADDRESS: TELEPHONE#: OPERATOR: TANK CAPACITY: TRUCK LIC. NUMBER: Equipment 1. Mobile Tank (securely mounted on trucks, watertight, necessary odor controls, leak -proof cover, tight discharge valves) 2. Venting (gas) of Mobile Tank (properly constructed) 1� 3. Suction or Pressure Hose in good repair 4. Pumps (leak -proof) 1104 This vehicle is in compliance with 310 CMR 15.5 Person Interviewed (2017) Jane Doucette From: Sales Soaves <sales@soarespumping.com> Sent: Thursday, November 16, 2017 2:06 PM To: Jane Doucette Subject: re: MANSFIELD PUMPER TRUCK INSPECTION Hello, Yes we will be using truck #SM77545 What day can we come to you and have it inspected? Wednesdays and Fridays work best for us. Thank you Jessica From: 'Jane Doucette" <Jdoucette@mansfieldma.com> Sent: Monday, November 13, 2017 3:06 PM To: "sales@soarespumping.com" <sales@soarespumping.com> Subject: MANSFIELD PUMPER TRUCK INSPECTION Hi Robert, just checking to see if you will be using truck It SM77545 in the town of Mansfield — it was not inspected on November 9". 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