HomeMy WebLinkAboutMiscellaneous - 116 HIGH STREET 4/30/2018 116 HIGH STREET
210/053.0-0022-0000.0
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E. Water St.
Critical Infrastructure Risk:
Merrimac River
Lake Cochikewick
Lawrence Airport
Greater Lawrence Sanitary District
Water Treatment Plant
Police Station
Fire Stations
Rte. 495
Rte. 125
Rte. 133
Springfield Terminal RR
2003 Data Collection Packet
JUN-17-2005 08 : 13 AM DUDLEY 781 643 1255 P. 02
1
is
Commonwealth of Massachusetts 100018786
DeW Number
Asbestos Notification Form ANF-001
Imports„tl A. Asbestos Abatement Description
When Ono out
forma on the 1. a.Is this facility fee exempt.ally,.-,town,district,municipal housing authority,owner�p
COR1p�'use residence of Four units or less?�t Yes E]No — ---- _
only the tab key ..,
to move Your lrcable:
cursor-do not b.Provide blanket decal number if app i Blanket Decal Nisttb9r
use the return
key, 2. Facility Location:
” - Fib HIGH STREET
LEONARD WINDLE rr!!;'
F 01Add
S" WT
8)882.6121
ndover L�A_ -
C.CivTown
d.Skate a.7JP Code
INSTRUCTIONS 3. Workslte Location:
BASEMENT L.. �1 m'
1.All Sections of tNB d.Floor a.Room
form nat be a.Bulkling Na Build Location b.Building
Completed In order led? Yes [,�No
to compiy with 4. Is the facility occupied?
DEP noWleatlon
f°n`A'"MV t'of$10
CMR 7.15 5. Asbestos Contractor --�- —
ar---� ---" 43 DUDLEY STREET PO BOX 132
and the oivislon DUDLEY SERVICES INC _
of Occupational � �.n �"� b, dreW
safety(Dos) a.Names. .---- 02976 781843328
notmcaeon ARLINGTON .�� �--T-
requirements of 453 c.G ITOwn d.Zl Code e.Telep Number
CMR 6.12 Written Verbal
._�-.--^ g.Contract Type:
.. -. BNU f . ..-.�
-iConiac 9frsori
AS032602
ti SAMUi~L J NItaRO III I L 8-WEd p�®rtlf Nu
rN
me oo ��"''an �-� A�M060297
VIRO$AF ENt3RING ..! bio- fmatron Naber --
7 a.Name
E�Vii�O'AF'ENGINEERING Rbgpl
009—Le .
._ - ..__- na�yll Dd! ati n Nurll +r
8
a,,-
, 7Asbestoc An�"'�' r9l Leb ..- -. ����--��--�� 0611712005
081712005 ......�i b� d
V8A
�^-rrr1�,Ns
0 1d. a.What type of project Is this?
0 Q Demolition R1 Renovation b.1 �
[�]Repair [J Other,please speclfy
a-Check abatement procedureii,
Glove bag Encapsulation — _ �-
o Enclosure Disposal only
Cleanup ( Other,specify:
a Dewribs
Full containment b.
z
a 12. Is the Job being conducted: �]✓ Indoors? 0 Outdoors?
Asbestos Notificatkm Forth-Page 1 of 3
anfoolap.doc+10102
JUN-17-2005 08 : 14 AM DUDLEY 781 643 1255 P. 03
r
Commonwealth of Massachusetts
100018788 _,�
Asbestos Notification Form AIF-001 De
W Number
A. Asbestos Abatement Description (wont,)
13. Total amount of each typo of Asbestos Containing Materials(ACM)to be removed,enclosed,or
4 RE
e -
apipes o ear 0. 1001 otner simmez7g5iffft)
c,Boller,breaching,duct,lank E= ] 4 d,Insulating cement
surFSCe coatings Lln�� Un.ft
laye ,
a.Cornigated or red paper f.TrowelISproyer coatings
Me insulation Lin,It. �, � it
g.Spray-on fireproofing laL h.TranaRe board,WAIT Word
I.Cloths,woven fabrics - J.Other,please speak.
k.Thermal,sold cora pipe
insulation n.
14. Describe the decontamination system(s)to be used,
CONtAINMENT BARRIER WITH CLEAN ROOM USING NEGATIVE AIR SYSTEM!AND HEP
15, Describe the cotitainerizatlonldisposal methods to comply with 310 CMR 7.15 and 453 CMR
8,14 ' —.-------��
(WET ASBESTOS PACKED IN DOUBLE 6 MIL POLY BAGS LABELED"ASBESTOS".
16. For Emergency Asbestos Operations,the DER and DOS officials who evaluated the emergency:
_JIM JORDAN J INSPECTOR
A_ A�ari`t�EP`aAicfal b.Title
��..�.....,, ....,...
8/1 MOB
c.0
o.Data( d._Waiv es f-
mr�Authoriaetlon _
JOYCE RHODES INSPECTOR
s, ams _ raa a
f iiia 5I'2005 FHV 0ls16T.
a g,pate hL DOS Waiver
0 17. Do prevailing wage rates as per M-G.L.c. 149,§26,27 or 27A-F apply to this project?0 Yes No
�a B. Facility Description
�N RESIDENT-IAL DWELLING
0 1. Current or prior use of facility: - ----w�-
2. Is the facility owner-occupied residential with 4 units or less? ✓]Yes LJ No
LEONARD WINDLE �� 118 HIGH STREET
3' a.Faall�ltOwner NAme b.Address
° NO,ANDOVER,MA 0181 97'8.682.8121
o c.G' OWn d,Zi Mode e,T )ne Num area code and extension
U- 4, ra a Facility darner s Oe ante --n- to ena2er
�QT.CitylTown 6.Telephone elf um r(area anaextension) .. .,
an=lap.doc•IIN02 Asbestos Notification Fora+
JUN-17-2005 08 : 15 AM DUDLEY 781 643 1255 P. 04
Commonwealth of Massachusetts
0018798
Asbestos Notification Form ANF-001 OeoidNumbar
B. Facility Description (cont.)
$ a.Name of Osnerel Conte Dor 4.Address
1, ... ®... . � -� e
d.Z C� e.:Tela one Number area Rode and extension
a.IL�Policy Number h.. Date rrn►!dd
f.Co"traClArs Workers COmp•trrsurer
2000 2
.6. What Is the size of this faclllty4 a.square Feet b.Number of floors
C. Asbestos Transportation and Disposal
1. Transporter of asbestos-containing material from site to temporary storage site(if necessary):
Note:TranaTer a.Name of 7renaprter � � - ""� b." - - -- Y
Stations must � J �..�J E..
comply with the c.City/Town d.Zip Code e.Telephone Number
Solid Waste
Division 2. Transporter of asbestos-containing waste material from removalitemporary site to final disPOeai site:
Regulations 910 —,_ ----......-.. —�
CMR 18.004 J.O,B.ROLLOFF PO BpX 6037
a.Name of Tranejq!_Wr
CHELSEA,MA 02150 81. 7)387.1495
—..
C.CI (town d.Bo Code e.Telephone Number
_...
a.Refuse Transfer Station end Owner " b• raos
L_....� � d.Zipde I e.Tel one Number
c_Clty/Town �.-- _o..e �_... ��.
4, WANE SYSTEMS INCORPORATED = C._, ... _
a.Final® l)�isp sa!Site Location Name _ -. b.Final�al Site Location Ownet 8 Name-..---._
90ROCHESTER NECK ROCHES I'ER
c.Final 4WI.2@Address .....-.- ... d•G °^n —..
f.Zip Code g.Telephone Number
D. Certification _
N
The undersigned hereby states,under the ;SAMUEL J.NIGRO III /y
�o penalties of perjury,that he/she has read the a.Na �b,.Autthww ed S "a roCommonwealth of Massachusetts regulations PRESIDENT !151200'5
for the Removal,Containment or � � �'
Encapsulation of Asbestos,453 CMR 6.00 and c'Posrtaon/rljl�
310 CMR 7.15,and that the information 781 $43"'4828 DUDLEY SERVICES INC.
r contained in this notification is true an6 correct e.TetegL.n }vumber f.Retxeaenunr)_ __
to the best of his/her knowledge and belief. 43 DUDLEY STREET
�� ddroaa
�� ARLINGTON,MA� 02478 _
h.Cltyrrawn i.Zip Code
anf001 ap.doo•10102 Asbestos Notification Forth-Page 3 of 3
JUN-17-2005 08 : 13 AM DUDLEY 781 643 1255 P. 01
DUDLEY ASBESTOS REM
T.0.Sox 132
A$ington,MA 02474
(A,divisioa of Dudley Services,Inc.)
Tel:781.643.4328
Fax.781.643.1155
wwwAudteyasbeows.com
MA Lic. AC 000111
Date;
To:IV, Aj e�Board of Health
Enclosed,please fled copies of the Division of Occupational SR ety and the Dept,of
EmlitonnuentalProtectionformANP-001 foran;ksbestDs abatement project
to be performed in Your ciWtnwll. Please feel free to call if you have atty questions.
Sincerely,
Samuel J,Nigro IIT
, r
AM CVMMER4
AS_�.CSTUS ABAT�M,�ZYT .,
a
116 high Street
North Andover, Mass. 01845
September 25, 1984
Board of Health
Main Street
North Andover, Mass. 01845
Gentlemen:
During this summer, the piazza areas on both
sides of my house have become coated with a black
powder like substance.
The accumulation is very dense on the inside
suppIrt columns and the eaves areas.
r would like to have some person from the
Board of Health come to the premises and take a
sampling of the black substance for the purpose
of having a chemical analysis made.
May I have your favorable response?
Very truly yours,
Leonard Windle
so
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