HomeMy WebLinkAboutMiscellaneous - 217 HIGH STREET 4/30/2018 (2) / 217 HIGH STREET i
290/066.0-0040-0000.0
I
i
Commonwealth of Massachusetts
Asbestos Notification Form— ANF-001
WO# 1046
Asbestos Abatement Description
1. Facility location:
Brian Bergendahl 217 High Street
astnucnots "'n' AMM Z;
No. Andover, MA 978-685-0883
1.A0 sections d M ah/roan 10 W* rdep W
•fammatbecompleted Basement
in oda to campywih
the Department of Wad NYewaavkrds1=907OuCQ4tpANKA.*ft AWmom
Ensironmenlal
Protection nodficdion 2. Is the facility occupied?)Wes O No
requiemerts of 310 CMR
7.1S(an nvrkhg drys
Prior norradwb 3. Asbestos Contractor.
muieddarryaliala^ent Advanced Building Systems, Inc. 97 Shannon Rd.
pro iectl:and 0» —Department of Labor AWN Adfnu
and
cailonoqu Salem N.H. 03079 603_-893-0380
rrouFicatian faquienais e
of 4S30416.12 (trn clor t IN co* 7dlpanr
days prior norf dice s
MuraddANY AC000319 Written
abaternentpfv)dgreafa DE11t6n„/ umnarral 1
Man twee linear or
sgtwered). 4. On-Site Project Supervisor/Foreman:
2.Submit Original Form Ray Curridr AS30971
To: Nsamr ear rrtirridan/
Commonwealth of
Massachusetts 5. Project Monitor.
Asbestos Program Enviro Safe AA000131
P-0-3.120087
lesion,MA 02112- Wm alGrdaak+n/
0087
6. Asbestos Analytical lab:
3.This lam may be Enviro Safe AA0001 31
used lot notilying Tie
U.S.Enviranmaail Naim a/Greaabrt/
Protection Agency Region
Iofasbestos demotitiory 7. Project start date—M /9 ind date3/6/9work hours(Mon.-Fri.) (Sat.Sun.) 7-4
temomion operations
subied to NEStWS(40
CFR Subpart M). 8. What type of project is this? (circle one): denrYlaon rtpau tsro nam oomr(e¢tunJ
I,orerur.ay 9. Describe the asbestos abatement procedures lu be used (citc:e): pa rttrlp cern n:rr:aar. deny
ncaasudlan dh;=d only oerr(r¢+tin)
wrown I
moo'". 10. Is the job being conducted (Xindoors O outdoors 7
11. Total amount of each type of l�¢estos Containing Materials(ACM)to be handled on pipes or ducts(linear ft.) 6 0 or other
s� surfaces(square ft.) 4 p to be removed,enclosed or encapsulated:
linearlsQuare feet
((��
Doiev,brGrCAing,duct Wk saYyaoe Coatings..._fe�A�y rwmaf,aaV car pipe inuiaticr,..,..60_J
corrugated or 6ywed papa pipe imulation...._J isolating catty r.................. J
spray-on hreproobrp....................._J roweVsprayercoatings.............. _/
dolls,woven 6brim......................_/ raraile board,wafl board.............___J
oCa(please describe)....................
12. Describe the decontamination system(s)to be used:
Three chamber decontamination chamber with shower-
13.
hower13. Describe the containerization/disposal methods to comply with 310 CMR 7.15 and 453 CMR 6.14(2)(8):
All material will be wetted thoroughly,
double-
ar ged and labeled
14. For Emergency Asbestos Abatement Operations,the DEP and DLI officials who evaluated the emergency:
N/A
Nam of DEP 06cid lif4
Oak orAutnortrarlon -
TOWN OF NORTH ANFer;Vt
BOARD OF HEALTH Mow daIcrscw ��tr
p Wd err/
17 1999 R+rdAunonrbn
15. Do prraailing wave lois a;chj as per M.G L.e.133.§26.27,or 27A-F to this pr;iecf? O Yes Ex No
Facility Description
1. Current or prior use of facility. -
Residential
2. Is the facility owner-occupied residential with 4 units or less? Of Yes 0 No
3. Facility Owner
same
tan Ad&m
ClOr—
ra W* rr�pnae
4. Facility's Owner's On-Sfle Manager.
same
AU= Addria
i
Crb/roen 1(D cxe rraplan
5. General Contractor.
N/A _
Borne Address
py/loen lip cwr�---•-- T�4pmone
Reliance Insurance Co. NWA179501900 1 /18/ 00
conUmton worbmr Camp.Msunr Poky/ Gp Wu
5 000
6. What is the size of the fallity? (sa fl) 2 y of floors) 60 years
i
Asbestos Transportation and Disposal
1. Transporter of asbestos-containing waste material from site to temporary storage site(if necessary)to final disposal site:
Advanced Building Systems 97 Shannon Road
AWW Aarnts— —--- –------ —
Salem, —
a em, N.H. 03079 603-893 0380
C11y/ror0 —
pkw
2. Transporter of asbestos-containing waste material from removaU temporary storage site to final disposal site:
Logano Trucking 209 Pickering Street
Name AXr=——
Portland, CT 0648.0800-272-3867
Note:Transler Ciry/rovm I.o raoa rerrenxr
Stations must
comply with the 3. Refuse transfer station and owner(if applicable):
Solid Waste N/A
Division regula-
tions 310 CMR Nm 'files '
18.00
Clygowe -
4. Final Disposal Site: PRIMARY: SECONDARY:
Valley L andfill _ So. Allegany Disposal
(aadm Wme
RD#2 PD BOX _$IA_
Pleasant Valley Road 843 Miller Pickering Rd.
Ad*w ........--- •-- ------- — ----
Irwin, PA 15642 Davidsville, PA 15928
Uy/rorrr -
724-744-7446 814-479-2537
Certlfkatton
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 knowledge
and/belief.
William Shea -c/�G...-
AvCwUedSyrwwe --
Nofe:Contractor Prhrwmr President lbtr
musform forD1.gn / ARS Inc_ 603-893-0380
form JorOCI Pwbvrbd
?��IFAtA ��no Treyar
roWIV OFOW6' HANDOVER/
BOARDOFHEALTH 97 Shannon Road Salem, N.H. 03079
OF TH
Aeklrw Clq?an to mG
Fee exempt(City.Town,district,municipal housing authority,owner•cc:upied residential of four units or less)? yes O no
FEB 17
729563
i `� St.cker/(!rem fr:-:e•'!cr.;