HomeMy WebLinkAboutMiscellaneous - 108 MAIN STREET 3/14/2016 03/14/2')016 03:14PM 978"531097 ECONOMIC ENVIRA TFf: PArc 01 /mc
D 'oN Wd01 :6 9[06 'Sl 'JPA au.iil paniaOa�
Economic EnvlroTechs, Inc.
313 Inte1'valo Road
Fitchburg, MA 01420
p.978.348.1118
f.978.3e3_1097
www.acoenvlro ech.net
TRANSMITTAL DOCI MENT
zo: PROM:
Rhonda
COMPANY: DATE:
Andover:Boatd of Health 03/14/16
F_A.X: TOVI NO.OF BAGS JNCWDjNG CovER:
(978)6238320 6
is
PHONE Nl.�ssYR: sENDER'E���NCE NU�[aeR;
RE:
YOUR REMENCE`UMBRX:
108 z1T9k':Street
To V71 0m It May Concern,
Following please find a Copy of the DEP/DOS notification forte for the asbestos
abatement at 108 Main Stteet. The project is scheduled for Match 28,through ApW 4,2016.
The Oxw naL notificatioa and permit fee w!go out in the mail tomorrow.Please conta.c°t
Henty Moscs (978) 423-3999 or myself if Toll have any quesdons.
Thaws so much,
Rhonda:
i
133!1412016 03:,14PM 9783331097 ECONnMTr pN`/Tpn TPr r-PA/r- ftA the
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Commoriwealth of Massachusetts 1 23901
Asbestos Notification Form ANF-001
Asbestos Project#�
;. .;'j 1'rojact Revision
r Project Cancellation
A.Asbestos Abatement Description
1.p'aoility Location.
1D8 MAIN STREET 108 MAIN&TREET
Name of Facility Sbset Address
In9tructions 1.All NORTH ANDOVER MA 01845 6036678699
sectlons of this fo{m City/Town State Zip Code Telephone
must be completed In JO8FYH KARPIAK OVMIBR I'U'RES5MA71VE
order to comply With
NA59DEP nolificat n Facility Contact Person NamO Facility Contact Person Title
requirements of 31e Worksite Location: THPLLMOUr
CMR 7,15 and
Dapartment of tabor euiklng Name,Wing,Floor,Room,eb�
Standards(01.8) 2.Is the facility occupied? (✓;yes ❑No
rptific�,tlon
regylrements of 453
CNIR e''2 3. Is this a fee exempt notification(oi(y,town, district, municipal housing authority,state facility,or
owner-occupied residential property of flour units or lesap ❑ Yc6 r No
MasspEP ura Only 4 Blanket Permit Project Appro-val,if applicable:
Date Reca've ", Approval ID#
3.Non•'X'raditional Asbcsfos Abatement Work Practice Approvab
if applicable: A royal ID#
2.Submit App
royal
Ta
Commonwealth;of 6.A8bestos ,ontraefor.
MaeAeehueotts MONOMQEWROTMK!5 38INTIEWALI PDAD ;
P.O.oax4062 —
Boston,MA 02211 NMTA Address
FITCHBURG MA 01420 9784233999
Cityrrcwn Stata Zt)Coda Telephone
AC000458 Contrsot Type: 0-Wrluefl O verbal
DLS License if
7, HENRY MOSES A2031082
Name of ConmacWs On-Slre supamsor/Foreman DLS Certfcstion#
8. SMESH MAN SINGH AM031998
Name cf Prciact Monitor DLS Certificaton to
9,ATCGROUPSERRViCFS[NO AA000007
Name of Asbesto9 Analytical Lab DLS Certification#
10. 3/28/2ot6 4/412010
projed Start Date PwAtIDAWY) End Date(MWQD/YYYY)
7A-SP 7A��
Work Hours-Monday Tf,rouoh Friday Work Hours•Satur W&Sunday
11.What type of project is fhis?
1- Demolition F- Renovation 0 Repair Other-PIease Specify:
l m,bed:11/13/2013
Page 1 of4
03/14/2016 03q 1.4PM 9723831097 EComnMTO P-NUTDn Ten
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ComtnonWealtll of Massachusetts 100239D18
Asbestos NotWiicationt Form ANF-001 asbestos Project#
� G Projectltovision
(� Project Cancellation
A.Asbestos Abatement Description., (coot.)
12.Abatcmont grocedures(check all that apply);
1" Glove$ng Encapsulation [v] Enclosure [, Disposal Only Clounup (" Full Containment
F, Other-P1ew Specb�!
13.Job is being conducted: r Indoors fl Outdoor4
14,Total amount of each type of asbestos Containing materials(ACM)to be minoved,enclosed,or
encapsulated:
Linear Feet(Lin.Ft) Square Feet(Sq.Ft)
Boiler,Breaching,Ducts Transite Pipe
Tank Stirface Coatings un.Ft. Sq Lin.Ft. Sq.FL
Pipe ltlsulation Traftsite Shingles
Lin.Ft SQ,FL Lint.Ft Sq.Ft
Spray-On Fireproofing Transit*Panels
Litt.Ft 3q.FL Lin.Ft, Sq.Ft
Clouts=Woven Fabrics Outer.Please Specify:
Lin,Ft. Sq.Ft
Insulating Cement VAT,MA$TiC �g�p
Lin.Pt Sq.F=t Lyn.Ft. N,Ft
15.Describe the deoontamittatlon systern(.5)to be usod:
3 Ct1fl1NeER
16.Describe the conWrierization/disposat m,etltods to comply With 310 CMR 7.15 and 453 CMR 6.14(2)(8):
(2)6-MIL BAG5 WETTED
17,For Emergency Asbestos Operations,the MwsDEP and DLS officials who evaluated the emergency:
Name of MassDEP O(gcfal Tile of MataDEP Official '
Date of Authorisation(MM/DDIYYYY) Waiver#
Name of DL8 Official Tide of DL8 Official
Date of Authorization(MM1001YYYY) Waiver 0
16.Ao prevailing wage rates a3 per%,I.Ci.):.._c. 149,§26,27 or 27A—F apply to this vo
project?
Revised; 11!13/2013 Pago 2 of
03'/14/2016 03:14PIA 9793031097 ECQNnMTf PN ITPn T� nn r ran in
ti�91 9 �VdZI 6 9 0 'Sl 'aeW aUI J p;A1a3a�
OW Cotr>ruo-nwealth ofMassachusetts 1ooz�so18
Asbestos N'otWicatxon Form ANA'-001 A "
•A.be9toS1 Project#
Project Revision
('; Project Cancellation
B.k'adifty Description
1.Current or prior use of facility: BANK
2.Is-the facility ovTter-000upled x'esidential with 4 units or less? r Yes ! No
3,TD BANK 70 G7RAY ROAD,MAILSTOP MI!
Facility Owner Name Address
FALtv1p(JTt•I M' 04105 2034WI34
Cltyrrown State Zip Coda Tde*m
4.JOE ttARaIAK SAME AS ABOVE
Name of ParJIIW Owner's an-Site Manager Address
SAME AS ABOvE NE 041 Ds 603857t%59
Cipr/rown Steto Zip Coda Telephone
5.ECONOW ENMRO'IECHS,INC. 381NTERVALE ROAD
Name of General Conhactor Address
FITCHBURG MA 01420 8783491118
Notar Temporary
slorogt OfAsbe9lUa cltyrfowa We lap Code Telapmw
containingweete BERKS-IIREHATHAWAYGUARD
malarial is only
allowed ai the glace ContfaGtcre Worker's Compensation Insurer
of bu*4se of a DL;S RZVC,654861• 12/212016
110ansed Asbestos Polo y t prradon Sate(MM/DOJYYYY)
oomractor or a trartVar
station that la 6.What Is the size of this facility? 400D 1
permitted by
MassDEP and
oparntad in 8gtmre Feet 0 ofFloors
vVestoiRes with$1611d C.Asbestos Transportation &Disposal
VYest�Regulauonn'
310 CMR 16,000
1.Tvansporttr of asbestos-coutaiWnS waste material fwm Site ofgenoratlon:
E7 Directly to Landfill or G To Temporary Storage Location/Transfer StAtion
ECONOMIC ETMROTECHS,INC. 38 INTERVALE ROAD
Name of Transporter Address
FrTCHBURG MA 01420 9763491118
Cilyrrown State 7Jp Coda Telephone
2,If a temporary Storage loeet{onftmnsfer station I$used,list netwe of transporter of asbestos containing
waste material from temporary storage location/transfer station to final disposal site:
SEA.VICETRAN5MRT GROUP 58 PYLES LANE
Name of Transporter Addre9g
NEW cAS rLE ca 19720 3027781394
C•Itylyown That- Zip Cade Telephone
Note:Contractor must
Stan this form for Di.s Revised:11113/2013 Page 3 Of 4
0/14/2016 03;14PM 97821821097 ECOWnMTr F111TOn Tcr,
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COMMOl twealth of Massacbusetts to023aQ18
r`�'' Asbestos Notification FOXin ANF-001 Asbestos Project 1r
>
Fi 1'rojcctRevigion
C Projeot Cancellation
C.Asbestos')i rauriportation&Disposal:(cont.)
3.Name and address of temporary storage)ocation/transfelr station for the asbestos containing 1rasto
material: '
FIORETRUClaNG RECYCtI5&DISPOML 160 OWSON STRea:T
Tornporary 8rorage LOW00h Name Addrobs
FITCN@URG MA 01420 97835x3182
Cibfrcwn State 7.1p Code Te!ephone
4.Name and location of final disposal Site(asbestos)agdfiill):
MNEWAMERPRISES INC. .W415RvAE3lTMm6LS INr-
Final pisposal Site Name Final Diepotml Site Owner Name
eeM MINERVA ROM
Address
wAYNESSURG CH 44688 3308663435
oityfrcrun State lip Cate Telephone
D.Certification
"I certffy that I have personally
examined the foregoing and am HENRYMOSES
familiar with the Information NaTO Authoriz6d Signature
contained In this document and ,
all attachments and that,based PosRioNrtle D9t9 MM10D
on my Inquiry Of those 9784233999 M"C LNG aTECHS,INC
Ihdlviduals immediately
responsible for obtaining the Telephone Repre3onfins
Information,I believe that the 38INTERVALE ROAD F7iCyeURG
information Is truo,accurate,and Address City/Town
complete.I am aware that th0e 01420
are significant penalties for
submitting false information, 8tefe 2Jp Code
including posslble fines and
imprisonment.The undersigned
hereby sfetee that I have read the
Commonwealth of
Massachusetts regulations
governing acbastos abatement
(453 CMR 6.00 promulgated by
the Department of Labor
Standards and 310 CMR 7.16
promulgated by the Department
of Environmental Protection),
and that I am avlare that this
permit application or notification
shall not be deemed valid
unless payment of the
applicable fee Is made."
Revised,1 1/13/2013 Page 4 of '