HomeMy WebLinkAboutMiscellaneous - 196 MIDDLESEX STREET 4/30/2018 (3) MIDDLESEX STREET
210/014.0-0058-0000.0 C`► -
E
c
ABA TEMEII\ll
T c®IVTR®L sE/3111cEs, ®Mc.
ASBESTOS REMOVAL& MAINTENANCE
Jun. 7, 00
NORTH ANDOVER BOARD OF HEALTH
27 Charles Street
North Andover, MA 01845
DEAR SIR/MADAM
ENCLOSED PLEASE FIND A COPY OF NOTIFICATION SENT TO THE STATE
FOR AN ASBESTOS ABATEMENT PROJECT.
THE JOB WILL TAKE PLACE ON JULY 1, 2000
LOCATION: 196 MIDDLESEX ST.,'
ANY QUESTIONS CONCERNIG THIS MATTER SHOULD BE DIRECTED TO MY
ATTENTION.
SINCERLY,
FRANK BALOGH
PRESIDENT
JUN,..;
2 INDUSTRIAL WAY SALEM, NH 03079 NH (603)898-9472 MA(888)870-9292 FAX 603 898-1846
Commonwea/biofillassachusens EXEMPT
AsbeslosNot/l/ca1/onfoim—M-901
13
AsaestosAbatemeniDesciiption -
1. Facility location:
JOHN JELLY 196 MIDDLESEX ST
Name Address
IMSTOUCTIOMS NORTH AN-DOVER 01845 978-681-1926
1.All sections of this OYy?own LP COOL- Te/01—
form must be BASEMENT
cgmpleted In order to
comply with the What&&V mZ/1%e/XJ& ,7Bu0drq name,!,Wing,floor,room
Department of
Environmental 2. Is the facility occupied? "X Yes ❑ No '
Protection
notification ,
requirements of 310
CMR 7.15(AL-»wWOV 3. Asbestos Contracts:
dayspxvnardkaAtw
lsrequlredWany ABATEMENT CONTROL SVC,INC. 2 INDUSTRIAL WAY
"tMWtAVffl .. Addresr
and the Department Nam
oflaborand SALEM, NH 03079 603-898-9472
kwustries
notification 01y/Town zio ade TeMphare
requirements of 453 AC 0 0 0 3 6 2 Written
CMR 6.12(ten days
P/W/v %nyaw is Af./GYrnse t Cantract 7yW(WrWwr or Ve&wV
roprrlredWANY
x0tannoyrea nr AvAct 4. On-Site Project Supervisor/Foreman: .
vnearw�s�uarrreet� NOLBERTO GALICIA AS32348
2.submit Original
Forth To: Nam D[f eerdfkawn a'
Commonvmalth of
Massachusetts S. Project Monitor:
Asbestos Program
P.O.B.120087-0087 NA
3.This Form may be Ay„,a OL/Cerdfkadon#
used for notifying the
U.S.Environmental
Protection Agency 6. Asbestos Analytical Lab:
Region 1 of asbestos
demollUonhenovabon FINAL CLEARANCE ANALYSIS AA000085
operations subject to
NESMAPS(40 CFR OLICe2fka6on X
Subpart M). 7-1-00 7-1-00 7 4
7. Project start date end date specific work hours(Mon.-Fri.) am Dm(Sat.-Sun.)
For Offioal use only ASBESTOS
8. What type of project is this? oWWitlal repair renovation odler(exp/ain REMOVAL
tlotifiration a
9. Describe the asbestos abatement procedures to be used: glove bag endasure !ro
Receve date containment deanup encapsulation o1i;Awl on/y other(ex#ain)
Roceiver
10. Is the job being conducted ®indoors ❑outdoors?
Pant AW*&4DeNm
150
11. Total amount of each type of Asbestos Containing Materials(ACM)to be handled on pipes or ducts(linear ft.) or other
Da+%^date surfaces(square ft.) O to be removed,enclosed or encapsulated:
Urmr Sauare feet thwar Square feet
dol(wGlvdW+�t ata:=raM avfarr avG�ps 77*n7W sa4'dtaepfeha/bW
aynvaevdvr /n'adAW APvasu&nr, hw*44Vm,awt
Saa!'�+'i TioweysFvap'avONgs
Oaft"VM AW TranClyda,i4 wafAuw
Odrn-(A�asL-dsaiGrl odae'(P��'t�)
12. Describe the decontamination system(s)to be used:
FULL CONTAINMENT
13. Describe the containerization/disposal methods to comply with 310 CMR 7.15 and 453 CMR 6.14(2)(g):
Wet removal into 6 ni 1 Poly Asbestos Labeled Bags.
14. For Emergency Asbestos Abatement Operations,the DEP and DLI officials who evaluated the emergency:
NameWVEvaltdal nue
Z"vfAudrrvi 0&W Waver Ar
NWme WDUA AyJ1 TlOe
AMPWAu#AwZwAtr, WDIWO
15. Do prevailing wage rates apply as per M.G.L.c.149,§26,27,or 27A-F to this project? ❑Yes O'No
Rev.6/92
r'
13
fBCl/%IyDBSC/Ip!%Oo
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:
..,JOHN JE_,LEY 196 MIDDLESEX ST
Name Aadiess
N.ANDOVER 0184.5 978-681-1926
Gry/rown
zo code rekl%,aae
4. Facilitys Owner's On-Site Manager: `
NA
N" AOWM
LP code rekpaaue
O!Y/rown
S. General Contractor:
XT ink - A0V1esa
N"
zo code re/*0"
OYy/rawn
5WX-Wd Waters CO*14-W = SKY f FxR Geste
6. what is the size of the facility?1,50(lq ft) 1 (#floors)
Asbeslosl/aospo/ladooeodD/sposa/
1. Transporter of asbestos-containing waste material from site to temporary storage site(if necessary)to final disposal site?
ABATEMENT CONTROL SERVICES,INCA� 2 INDUSTRIAL WAY
MS
SALEM , NH 03079 603-898-9472
ary/rowo LP code re1014—
2. Transporter of asbestos-containing waste materials from removal/temporary storage site to final disposal site:
Name Add/ess
TO code Te/ep/xae
Note:rr"ff 3• Refuse transfer station and owner(if applicable):
StaGcmmrat
c>anA9'with the ,ye,,,a, Aafdiea
-qW Waste
DIKQM lepula. lip code Tem
Oats3100NR 009T-
18.010
4. Final Disposal Site:
.TURNKEY LANDFILL WASTE MGMT OF NH
LOr4007N&W pwnezNdme
90 : NECK RD
Aofdress -�---
}w �r - 603-332-2386
ROCHESTER, NH _
Ory?own Tip code Tekp�aae
6 (,'B/IiIl�C8L00
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,453 CMR 6.00 and 310 CMR 7.15,and that the information contained in
this notification is true and correct to the best of his/her kno ge a lief.
FRANK BALOGH
• Hht/Wme Aathatt Synalwe Lite
PRESIDENT ABATEMENT CONTROL SVC,INC. 60 -898-9472
AWba✓71* Reaeu+'a'� re 079
2 INDUSTRIAL WAY SALEM, NH
Aoki W py/Town lip code
Fee exempt(City,Town,district;municipal housing authority,owner-occupied residential of four units or less)?171Yes ❑No
Stldwr r(from front of form): 71 8 0 7 0