Loading...
HomeMy WebLinkAboutCorrespondence - 190 MILL ROAD 1/26/2004 50 CONCORD SrREL T, NORTH READING, MASSAt',HOSE'rTS 01864 �'7r-�70-2860 O �r FALIH .......w,�,�. T FAX 0783 470-'1017 2 7 ?[I HI a January 26, 2004 J Health Department Town of North Andover 27 Charles Street North Andover, _MA 01845 RE:' Asbestos Abate, ent 190 Mill Road i Dear Sir or Madam: Please be advised that Dec-Tarn Corporation will be performing an asbestos abatement project at the above referenced location. This work has been scheduled for February 9, 2004. All applicable local, state and federal agencies have been notified of this work. Please let me know if you have any questions. Sincerest regards, Brenton D. Irgenstern Sales Estimator BDM/jmp Enclosure A`?BEsr'C, SABA1`EMENT MOLD RFMEDIA'1"ION LEAD ABATEME:N"r www.Gier,tarri.COM E-E ad: s;rY atfci G4rrl wr;t orz.r,cavr Commonwealth ®t Massachusetts E770782 Please Enter Decal# Asbestos Notification r -° 770702 A. Asbestos Abatement Description Important: When filling out 1. Facility Location: forms on the computer, use Ms Catherine Lowery 190 Mill Road only the tab key Name of Facility Street Address to move your North Andover Ma 01845 978-682-8165 cursor-do not City/Town State Zip Code Telephone use the return key. Worksite Location: Q11b Basement Building name,#,wing,floor,room. Q 8 2. is the facility occupied? ® Yes ❑ No 3. Asbestos Contractor: Dec-Tam Corporation 50 Concord St Name Address INSTRUCTIONS N. Reading. MA 01864 978-470-2860 1.All sections of City/Town Zip Code Telephone this form must be AC000035 completed in order DOS License# Contract Type: ED Written ❑ Verbal to comply with Brenton D. Morgenstern Sales Estimator DEP notification Facility Contact Person Contact person's title requirements of 310 CMR 7.15 4 Charles Brewer ASB30534 and the Division Name of On-Site Supervisor/Foreman DOS Certification# of Occupational S afety(DOS) 5 FLI Environmental AA000144 S notification Name of Project Monitor DOS Certification# requirements of FLI Environmental AA000144 453 CMR 6.12 6. Name of Asbestos Analytical Lab DOS Certification# 2.Submit Original Form to: Commonwealth of 2/9/04 2/9/04 Massachusetts 7• Asbestos Program project Start Date End Date PO Box 120087 Boston MA 02112-0087 7am-4pm NA Work hours Mon-Fri. Work hours Sat-Sun. 8. What type of project is this? ❑ Demolition ❑ Renovation ❑ Repair ❑ Other, please specify: 9. Check abatement procedures: ❑ Glove bag ❑ Encapsulation ❑ Enclosure ❑ Disposal only ❑ Cleanup ® Other, specify: CriticalBarrier/Neg Air/Poly Walls/Decon/ ❑ Full containment Remove floor tile/2xbag 6-mil poly 10. Is the job being conducted: ❑ Indoors? ❑ Outdoors? 04010046 Lowe ryNoAndoverMa•9/02 Asbestos Notification Form•Page 1 of 4 Commonwealth of Massachusetts E770782 Please Enter Decal# Asbestos Notification r 1 A. Asbestos Abatement Description (font.) 11. Total amount of each type of Asbestos Containing Materials (ACM) to be removed, enclosed, or encapsulated: 525 pipes or ducts(linear ft) other surfaces(square ft) Boiler,breaching,duct,tank surface / / Insulating coatings lin.ft sq.ft lating cement lin.ft sq.ft Corrugated or layered paper pipe insulation fin.ft sq.ft Trowel/Sprayer coatings fin.ft sq.ft Spray-on fireproofing lin.ft sq.ft Transite board,wall board lin.ft sq.ft Cloths,woven fabrics lin.ft sq.ft Other,please specify: Thermal,solid core pipe insulation lin.fit /sq.ft Floor Tile Only lin.ft /sq.5t 12. Describe the decontamination system(s) to be used: Three Stage 13. Describe the containerization/disposal methods to comply with 310 CMR 7.15 and 453 CMR 6.14(2) (g): Material will be wetted and placed in double bags and labeled for transporatation 14. For Emergency Asbestos Operations, the DEP and DOS officials who evaluated the emergency: Name of DEP official Title Date of Authorization Waiver# Name of DOS official Title Date of Authorization Waiver# 15. Do prevailing wage rates as per M.G.L. c. 149, §26, 27 oi*27A—F apply to this project? ❑ Yes® No B. Facility Description 1. Current or prior use of facility: residence 2. Is the facility owner-occupied residential with 4 units or less? © Yes ❑ No Ms. Catherine Lowery 190 Mill Road 3' Facility Owner Name Address North Andover 01845 978-682-8165 City/Town Zip Code Telephone 4 Ms, Catherine Lowery Same as Above Name of Facility Owner's On-Site Manager Address City/Town Zip Code Telephone 04010046 LoweryNoAndoverMa•9102 Asbestos Notification Form•Page 2 of 4 Commonwealth of Massachusetts E770782 Please Enter Decal# Asbestos Notification r B. Facility Description (cunt.) n/a 5' Name of General Contractor Address City/Town Zip Code Telephone Commerce & Industry WC9694329 12/28/04 Contractor's Worker's Comp.Insurer Policy# Exp. Date 6. What is the size of this facility? 2700 2 Square Feet #of floors C. Asbestos Transportation and Disposal 1. Transporter of asbestos-containing material from site to temporary storage site (if necessary)to final disposal site: Service Transportation Group 58 Pyles Lane Note:Transfer Name of transporter Address Stations must New Castle, DE 19720 302-778-5930 comply with the City/Town Zip Code Telephone Solid Waste Division 2. Transporter of asbestos-containing waste material from removal/temporary site to final disposal site: Regulations 310 CMR 19.000 As Above Name of transporter Address City/Town Zip Code Telephone 3. Refuse transfer station and owner Address City/Town Zip Code Telephone 4. Minerva Landfill n/a Final Disposal Site location name Owner's Name 9000 Minerva Road Waynesburg Address City/Town OH 44688 330-886-3435 State Zip Code Telephone D. Certification The undersigned hereby states, under the Brenton Morgenstern ,' penalties of perjury,that heishe has read Name Authorized 5ighature and Date the Commonwealth of Massachusetts Sales Estimator Dec-Tam Note:Contractor regulations for the Removal, Containment must sign this form or Encapsulation of Asbestos, 453 CMR Position/Title Representing for Dos notification 6.00 and 310 CMR 7.15, and that the 978-470-2860 50 Concord St purposes hone Address information contained in this notification is Telephone true and correct to the best of his/her N. Reading,MA 01864 knowledge and belief. CityTrown Zip Code Fee exempt(city,Town,district, municipal housing authority,owner-occupied residential of four units or less?) ®Yes ❑ No 04010046 Lowe ryN oAndoverMa•9/02 Asbestos Notification Form• Page 3 of 4