HomeMy WebLinkAboutMiscellaneous - 110 MARBLEHEAD STREET 4/30/2018 (2) f ,�, � Coma�oowee/lhofillassacbusel�s f �
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I. Facilitylocation:
MICHAEL BOEN:ITZ 110 MARRLEHEAD_---STREET
Name Address
IMSBUCTIOMS NO. ANDOVER, MA 01845 978, 689-3742
I.NI sections of this CJ1y/Town 75P code Te%phone
form must be BASEMENT /
completed In order to i
comply with the What.ts Ole Nwhs/te/arapon7Bui/ding name,x wing,/lw
o ,loom
Department of (w—
Protection
A r
EnvProttectionntal 2. Is the fadlity occupied? 99 Yes
noti0ration
requirements of 310
CMR 7.15(ten worn/ng 3• Asbestos Contractor:
dal'spnornotekaoiwi i ' • ^ .
&IWWWofany `' ABATEMENT CONTROL SVC,INC. 2 INDUSTRIAL WAY K
adatementprojeer).
and the Department Name Address
of tabor and SALEM, NH 03079
Industries 603:-8'9"$-9472
notification CRy/Town _ Zip cw/e �, Telephone -
requirements of 453
CMR 6.12(tvA" AC000362 Written
P70rP:v/hcadawe
B OLf4jm
requ/mOorANY Contract 4pe(WnKen or verbal)
,1W&WAa7t/vo,�-a 4. On-Site Project Supervisor/Foreman:
greater plan&I'M� ..
/b,ear orsquare feet)
2.
JOSE ALICEA AS032747
To:Original Name
Form To: DLI eeitihcatyon 1
Commonwealth of
Massachusetts 5. Project Monitor:
Asbestos Program
P.0.8.120087-0087
SAME SAME
3.This Form maybe Name
used for notifying the ovCertiBcalon
U.S.Environmental `
Protection Agency 6. Asbestos Analytical Lab:
Region 1 of asbestos
demolition/renovation ENVIRONMENTAL REMEDIATION SERVICES, 'INC. AA000122
operations subject to
NESHAPS(40 CFR Name ai ceroricadon w
Subpart M). ,
7. Project start dat''10/1 0 0 n Oa� p
F«orraal use oo d 1 0 SQIc Oo3k hours(Mon. -Fri.) 7 am 4 om(Sat.-Sun.)
8. What type of project is this? demo/ilion repair renOKM471 Vain
rabronon: ASBESTOS REMOVAL
Receive 9.dateDescribe the asbestos abatement procedures to be used: glove bag endasure
xrttainmen cleanup encapsu/adon dl'
sposa/only Omer(exp/�Nzk—
Rerriwx
10. Is the job being conducted f]indoors ❑outdoors?
Permit APPmve/outieo r. ,?':•-.:
oeusm date 11. Total amount of each type of Asbestos Containing Materials(ACM)to be handled on pipes or ducts(linear ft.) 0 or other
surfaces(square ft.)�„Q_to be removed,enclosed or encapsulated:
Linear §9wre fretLinear Square fret
L+n4e',A(xbt{hq dLaY�tttnlacr mrbgs 77xrma/,SdMrwe PRO rrw�HLm
r2nepaada+LDn'edGAi�'PixbJ1daLY1'r lnsu30M remen!
�� � TioweysAa}r.+'Cnrtiys
Cit rdd'k Adfwte AV,# ad&"
r7atn-(p{9;tp oelvdrJ Odxr(ptnrse aresa�erJ
1 12. Describe the decontamination system(s)to be used:
FULLCONTAINMENT
13. Describe the containerization/disposal methods to comply with 310 CMR 7.15 and 453 CMR 6.14(2)(g):
Wet removal into 6 mil Poly Asbestos Labeled Bags.
14.,For Emergency Asbestos Abatement Operations,the DEP and DLI officials who evaluated the emergency:
v AHme a✓DEP 7hSdd/ Tide
Late wrAuthorlratYa, r Waiver>
•. .. Name a✓OLIO/tlaa/ Tide
Date a Auolwitadon Waiver a'
Rev.6/92 T 15y. Do prevailing wage rates apply as per M.G.L.c.149,§26,27,or 27A-F to this project? ❑Yes}QX No
.si..ti�•. raw .. 4.... ..,
faC EW-9esCA-01 00
1. Current or prior use of facility:RESIDENCE
2. Is the facility owner-occupied residential with 4 units or less? ®Yes ❑No /
3. Facility Owner:
MICHAEL BOENITZ 110 MARBLEHEAD 9 RP.PT --
Nam Address
NO, ANDOVER, MA. 01845 978-689-3742
Oty?own zip code Telephone
4. Facility's Owners On-Site Manager:
Name Address
Oty?own Lp rode Telephone
S. General Contractor:
Name Address• 4 ... .. .. _
ory/Town zip code Teowne --
CaotradwY Wakens Ccmp.Insurer policy O Eop.Date
6. What is the size of the facility?10 0 0(sQ ft) 2 (#Floors)
Asbes/osTiaosOedadaoand0/soosa/ '
1. Transporter of a assbestos-containing waste material from site to temporary storage site(if necessary)to final disposal site?
ABATEMENT CONTROL SERVICES,INC. 2 INDUSTRIAL WAY
Name Address ,
SALEM, NH .03079 603-898-9472 T
City/Town zip rode Telephone
2. Transporter of asbestos-containing waste materials from removal/temporary storage site to final disposal site:
SERVICE TRANSPORT GROUP, INC. 58 PYLES LANE
Name Address
~ NEW CASTLE, DE, 19720 1-877-999-9559
Ory/Town zip rode Telephone
Nola:Transfer 3. Refuse transfer station and owner(if applicable):
r sbb'atsmust
WMAly W%Cl the Nam, Address
staid Waste
OtWSW tegu/a-
tions 310 ONR City/Town zip nide Telephone
18.00
4. Final Disposal Site:
BFI..IMPERIAL LANDFILL B.F.I.
[oradon Name Owners Name
11 BO.GGS. ROAD
.IMPERIAL, PA-. 15126 724-695-0900
cly/Town Dp rode re/em—
Ce�////cad0o •
The undersigned hereby states,under the penalties of perjury,that he/she has read the Commonwealth of Massachusetts Regulations
for the Removal,Containment or Encapsulation of Asbestos 53 CMR 6.00 and 310 CMR 7.15,and that the' oration contained in
this notification is true and correct to the best of his/her Pfwledge and belief.
FRANK BALOGH SEPTEMBER 23, 2003
flint Ndme Authonzcd nature Date
PRESIDENT ABATEMENT CONTROL SVC,INC. 603-898-9472
prw'owntle Represenonq Telephone
2 INDUSTRIAL WAY SALEM, NH 03079
Address C/ty/Town zip code
Fee exempt(City,Town,district,municipal housing authority,owner-occupied residential of four units or less)?16Yes ❑No
Sticker#(from front of form): l X3`1
y _
ABATEMENT CONTROL SMUCES, /NC.
M ENVIRONMENTAUDEMOLITION CONTRACTORS
D
s
SEPTEMBER 23,2003
NORTH ANDOVER BOARD OF HEALTHOF sk_
27 Charles Street -- i 1
North Andover, MA. 01845 r� 2003
978-688-9540
DEAR SIR/MADAM k
ENCLOSED PLEASE FIND A COPY OF NOTIFICATION SENT TO THE STATE FOR AN
ASBESTOS ABATEMENT PROJECT.
THE JOB WILL TAKE PLACE ON: FRIDAY, 10-10-03
LOCATION: 110 MARBLEHEAD ST. NORTH ANDOVER, MA.
ANY QUESTIONS CONCERNIG THIS MATTER SHOULD BE DIRECTED TO MY
ATTENTION.
SINCERLY,
FRANK BALOGH
PRESIDENT
i
2 INDUSTRIAL WAY • SALEM, NH 03079 NH (603) 898-9472 MA(888) 870-9292 FAX (603) 898-1846