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Home My WebLink AboutMiscellaneous - 1160 GREAT POND ROAD 4/30/2018 (50) Health Department 1160 Great Pond Road Brooks School t t All State Abatement professionals, enc. 4 Wilder Drive, Suite 12 866-565-ASAP Plaistow, NH 03865 Fax: 603-378-0610 June 27 2017 RECEIVED JUL 14 2017 Town of North Andover TOWN OF NORTH ANDOVER Health Department FlEALTH DEPARTMENT 1600 Osgood Street Bldg 20; Unit 2035 North Andover, MA 01845 Phone#: (978) 688-9540 Fax #: (978) 688-8476 Re: Asbestos Abatement @ Brooks School, 1160 Great Pond Road To whom it may concern: All State Abatement Professionals, Inc. ASAP is scheduled to perform work for the (ASAP) above referenced e erenced project on the following dates: Start Date: 07/10/2017 End Date: 07/10/2017 All appropriate agencies have been notified for the above referenced project. If you have any questions or need additional information,please do not hesitate to contact me. Sincerely, J. Scott Curley President JSC Jab Enclosures Asbestos e Masonry Cleaning Selective Demolition•Shot/Sand Blasting • Mold Remediation `71 Massachusetts Department of Environmental Protection 100267714 BWP AQ 04 (ANF-001) Asbestos Project# Asbestos Notification Forni i— Project Revision F Project Cancellation B. Facility Description 1.Current or prior use of facility: SCHOOL 2.Is the facility owner-occupied residential with 4 units or less? F a.Yes I✓ b.No BROOKS SCHOOL 1160 GREAT POND ROAD a.Facility Owner Name b.Address NORTH ANDOVER NIA 01845 0000000000 c.City/Town d.State e.Zip Code f.Telephone 4 NORMAN GRENIER 1160 GREAT POND ROAD a.Name of Facility Owner's On-Site Manager b.Address NORTH ANDOVER NIA 01845 9787256284 c.City/rown d.State e.Zip Code f.Telephone _ ALLSTATE ABATEMENT PROFESSIONAL 4 WILDER DRIVE,SUITE 12 �*a.Name of General Contractor b.Address PLAISTOW NH 03865 6033780600 c.City/Town d.State e.Zip Code f.Telephone STATE NATIONAL INSURANCE CO. g.Contractor's Worker's Compensation Insurer NFA086759000 3/22/2018 In.Policy# i.Expiration Date(MM/DD/YYYY) 6.What is the size of this facility? 40000 2 a.Square Feet b.#of Floors C. Asbestos Transportation & Disposal 1.Transporter of asbestos-containing waste material from site of generation: F a.Directly to Landfill or Wo b.To Temporary Storage Location/Transfer Station ALL STATE ABATEMENT PROFESSIONALS,INC. 4 WILDER DRIVE,SUITE 12 c.Name of Transporter d.Address Note:Temporary storage of Asbestos PLAISTOW NH 03865 6033780600 containing waste e.City/Town f.State g.Zip Code In.Telephone material is only allowed at the place of business of a DLS 2.If a temporary storage location/transfer station is used.list name of transporter of asbestos containing licensed Asbestos t l f waste material temporary storage location/transfer station to final disposal site: contractor or a transfer p p station that is permitted by J.O.B ROLLOFF,INC. 69 NORMAN STREET M and operatedcrated in a.Name of Transporter b.Address compliance with Solid EVE RETT NIA 02149 0000000000 Waste Regulations 310 CMR 19.000 c.City/Town d.State e.Zip Code f.Telephone Revised: 11/13/2013 Page 3 of 4 Massachusetts Department of Environmental Protection 100267714 BWP AQ 04 (ANF-0011) Asbestos Project#� Asbestos Notification Form Project Revision F Project Cancellation C.Asbestos Transportation& Disposal: (cont.) 3.Name and address of temporary storage location/transfer station for the asbestos containing waste material: ALL STATE ABATEMENT PROFESSIONAL 4 WILDER DRIVE a.Temporary Storage Location Name b.Address PLAISTOW NH 03865 6033780600 c.City/Town d.State e.Zip Code f.Telephone 4.Name and location of final disposal site(asbestos landfill): TURNKEY LANDFILL WASTE MANAGEMENT OF NH a.Final Disposal Site Name b.Final Disposal Site Owner Name 97 ROCHESTER NECK ROAD c.Address ROCHESTER NH 03839 0000000000 d.City/Town e.State f.Zip Code g.Telephone A Certification JOSEPH CURLEY JOSEPH CURLEY "I certify that I have personally 1.Name 2.Authorized Signature examined the foregoing and am PRESIDENT 6/26/2017 familiar with the information contained in this document and 3.Position/Title 4.Date(MM/DD/YYYY) Note:Contractor must 6033780600 ASAP,INC. sign this form for DLS all attachments and that, based notification purposes on my inquiry of those 5.Telephone 6.Representing individuals immediately 4 WILDER DRIVE,STE 12 PLAISTOW responsible for obtaining the 7.Address 8.CityRown information, I believe that the N1 03865 information is true, accurate,and complete. I am aware that there 9.State 10.Zip Code are significant penalties for submitting false information, including possible fines and imprisonment. The undersigned hereby states that I have read the Commonwealth of Massachusetts regulations governing asbestos abatement (453 CMR 6.00 promulgated by the Department of Labor Standards and 310 CMR 7.15 promulgated by the Department of Environmental Protection), and that I am aware that this permit application or notification shall not be deemed valid unless payment of the applicable fee is made." Revised: 11/13/20133 Page 4 of 4 BWP AQ 04 (ANP-001) best 71ro Assbestos Project# Asbestos Notification Form �� J-- Project Revision r - Project Cancellation II II 14 78 12 A. Asbestos Abatement Description TOWN OF NORTH ANDOVER HEALTH DEPARTMENT 1.Facility Location: SCHOOL 1160 GREAT POND ROAD Instructions 1.All a.Name of Facility b.Street Address sections of this form NORTH ANDOVER must be completed in MA 01845 0000000000 order to comply with c.City/Town d.State e.Zip Code f.Telephone MassDEP notification NORMAN GRENIER DIRECTOR requirements of 310 CMR 7.15 and g.Facility Contact Person Name h.Facility Contact Person Title Department of Labor Worksite Location: GARAGE Standards(DLS) notification i.Building Name,Wing,Floor,Room,etc. requirements of 453 2. Is the facility occupied? r a.Yes rV In.No CMR 6.12 3. Is this a fee exempt notification (city, town, district, municipal housing authority, state facility,or owner-occupied residential property of four units or less)? r a.Yes r b.No MassDEP Use Only 4.Blanket Permit Project Approval,if applicable: Date Received Approval ID# 5.Non-Traditional Asbestos Abatement Work Practice Approval, 2.Submit Original if applicable: Approval ID# Form To: Commonwealth of Massachusetts 6.Asbestos Contractor: P.O.Box 4062 Boston,MA 02211 ALL STATE ABATEMENT PROFESSIONALS 4 WILDER DRIVE STE 12 a.Name b.Address PLAISTOW W 03865 6033780600 c.City/Town d.State e.Zip Code f.Telephone AC000331 h.Contract Type: ry-, 1.Written r 2.Verbal g.DLS License# 7. JEFFREY CURLEY AS034502 a.Name of Contractor's On-Site Supervisor/Foreman b.DLS Certification# 8 AIR TESTING SERVICES INC AA000124 a.Name of Project Monitor b.DLS Certification# 9 AIR TESTING SERVICES INC AA000124 a.Name of Asbestos Analytical Lab b.DLS Certification# 10. 7/10/2017 7/10/2017 a.Project Start Date(MM/DD/YYYY) b.End Date(MM/DD/YYYY) 7:00-3:30 NONE c.Work Hours-Monday Through Friday d.Work Hours-Saturday&Sunday 11. What type of project is this? 1— a.Demolition i b.Renovation I c.Repair 'I—V d.Other-Please Specify: PICKUP Revised: 11/13/2013 Page l of 4 Massachusetts Department of Environmental Protection 100267714 BWP AQ 04 (ANF-001) Asbestos Project# Asbestos Notification Fonn 1— Project Revision r Project Cancellation A.Asbestos Abatement Description: (cont.) 12.Abatement procedures(check all that apply): f— a.Glove Bag 1-` b.Encapsulation F- c.Enclosure W/ d.Disposal Only r e.Cleanup f.Full Containment 1` g.Other-Please Specify: 13.Job is being conducted: to a.Indoors F b.Outdoors 14 a.Total amount of each type of asbestos Containing materials(ACM)to be removed,enclosed.or encapsulated: 0 10 1.Linear Feet(Lin.Ft.) 2.Square Feet(Sq.Ft.) b.Boiler,Breaching,Duct, c.Transite Pipe Tank Surface Coatings 1.Lin.Ft. 2.Sq.Ft. 1.Lin.Ft. 2.Sq.Ft. d.Pipe Insu'.ation e.Transite Shingles 1.Lin.Ft. 2.Sq.Ft. 1.Lin.Ft. 2.Sq.Ft. f. Spray-On Fireproofing g.Transite Panels 1.Lin.Ft. 2.Sq.Ft. 1.Lin.Ft. 2.Sq.Ft. h.Cloths,Woven Fabrics i.Other-Please Specify: 1.Lin.Ft. 2.Sq.Ft. j.Insulating Cement FUME HOOD 10 1.Lin.Ft. 2.Sq.Ft. 1.Lin.Ft. 2.Sq.Ft. 15.Describe the decontamination system(s)to be used: PROVIDE AN ADEQUATE DECONTAMINATION SYSTEM 16.Describe the containerization/disposal methods to comply with 310 CMR 7.15 and 453 CMR 6.14(2) (g) DOUBLE 6 MIL POLY. 17.For Emergency Asbestos Operations,the MassDEP and DLS officials who evaluated the emergency: a.Name of MassDEP Official b.Title of MassDEP Official c.Date of Authorization(MM/DD/YYYY) d.Waiver# e.Name of DLS Official f.Title of DLS Official g. Date of Authorization(MM/DD/YYYY) h.Waiver# 18.Do prevailing wage rates as per M.G.L.c. 149, §26,27 or 27A—F apply to this T a.Yes IV b.No project? Revised: 11/13/2013 Page 2 of 4