HomeMy WebLinkAboutMiscellaneous - 26 SECOND STREET 4/30/2018 (2)N
r Vol
Air Quality Experts, Inc.
Asbestos Removal
Christopher Thompson 40 Lowell Road, Unit 1 Residential -Commercial -Industrial
(603) 894-6465 Salem, NH 03079 1-800-621-1189
p (oeC+ of ct.l_-, 4-n r i3�1�y
November 16, 1999
North Andover Health Department
146 Main Street
North Andover, MA 01845
Dear Sir:
Enclosed please find a copy of notification sent to the state for an Asbestos
Abatement Project.
The job will take place on November 29,l 999.
Project: 26 Second Street
Any questions concerning this matter should be directed to my attention.
Sincerely,
Christopher Thompson
President
CO//I/IIO/7WBa/IhO�MBSSaC//USefIS
ASAMOSAr0MCAM0/I AN__4AV-0611
1. Facility location:
Campbell Stras 26 Second Street
Name Address
iNsreeeneNS North Andover MA 01845 (978) k86-0820
1. All sections of this cly/Town Ep rode re/ephone
form must be
completed In order to basement
comply with the What /s the MWASIte locamon?Bu//d/ng name, 0 Wng, 900, nwm
Department of
Environmental 2. Is the facility occupied? ® Yes ❑ No
Protection
notification
requirements of 310
CMR 7.15 (ten work/ng 3. Asbestos Contractor:
da)spdornotlfcatlon
/sregdred efany Air Quality Experts, Inc. 40 Lowell Road Unit 1
abatement project). Name Address
and the Department
of Labor and Salem, NH 03079 (603) 894-6465
Industries p/y/Town Z/p code re%phone
notification
requirements of 4S3 AC 000167 Written
CMR 6.12 (ten day3 Contract 7)M (WrAAw or Verba/J
pdornob77catlon/s OL/L/cense,#
requtied ofAIN1
abatementproject 4. On -Site Project Supervisor/Foreman:
greater than three
//near ora7uare feet).
Joseph Sharpe AS 30725
2. Submit Original Name D"CertlBcatlon P
Form To:
Commonwealth of
Massachusetts 5. Project Monitor:
Asbestos Program
P.O.B. 120087-0087
N/A
3. This Form may be Name DLI Celocatlon 0
used for notifying the
U.S. Environmental
Protection Agency 6. Asbestos Analytical Lab:
Region 1 of asbestos
demollUon/renovation
operations subject to OLlCertlllcatlon.t
NESHAPS (40 CFR Name
Subpart M).
7. Project start date 11 g0999 end date 11� 1 specific work hours (Mon. -Fri.) 7am3 m (Sat. -Sun.)
For omdal Use only
8. What type of project Is this? demo/ihrenotab'on
bn rep, oASer(egP/afn)
NotlRptlon R
9. Describe the asbestos abatement procedures to be used: /Ow bag endosu/e fid containment
Receive date cleanup eneapsu/adore &Wosa/ only other ( rn
Receiver
10. Is the job being conducted ® Indoors ❑ outdoors?
Permit Awme/Denied
t>edeion �� 11. Total amount of each type of Asbestos Containing Materials (ACM) to be handled on pipes or ducts (linear ft.) 120 or other
surfaces (square ft.) to be removed, enclosed or encapsulated:
linear Sauare feet linear Sauare feet
&da;dteaaSAg, dcct bntsunSce avtlngs 7hermat, M&am,*eAun/atfa
a_wtda-A,mrd,dFer#Pehnrdadtn 120 rnsvkCrq �t
Sprdym /AgvonArg 7h7"ne(/RraYs'ccdCnl7s
Cam "wren fabk 7tarlore Gerd, Ra9dvrd
oek.(pt+vedem2r) oaa'(pr�ede"otbeJ
12. Describe the decontamination systems) to be used:
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 DU officials who evaluated the emergency:
Name ofOEP O/17da/ 77be
Date ofAuthodrdtlon WaArr AV
Name ofOirOftfa/ 77bb
Date ofAuthotfzv&a WNW of
Rev. 6/92 15. Do prevailing wage rates apply as per M.G.L. c. 149, § 26, 27, or 27A -F to this project? ❑ Yes ® No
Note: Transfer
Stations must
comply W i the
So//d Waste
Division regula-
tions 310 CMR
IB.00
13 fAawffes hyffen
1. Current or prior use of facility:
Residential
2. Is the facility owner -occupied residential with 4 units or less? ® Yes ❑ No
3. Facility Owner:
Campbell Stras 26 Second Street
Name Address
North Andover MA
ary/Town
4. Facility's Owner's On -Site Manager:
01845 (978)686-0820
27P code Telephone
Name Address
Oty/Town Z!p code Te%phone
S. General Contractor:
Address
CY1y/rown np code Te%phone
Contractor's Wolters Comp. Insurer Pocy BV.. Dwe
6. what is the size of the facility? 2 000 (sq it) 2 (# floors)
Asdesmslta�spe�tsde�dd0/sposel
Christopher Thompson
I. Transporter of asbestos -containing waste material from site to temporary storage site (if necessary) to final disposal site?
Air Quality Experts Inc.
40 Lowell Road Unit 1
Name
Address
Salem NH
03079 (603) 894-6465
cy/Town
Z/p rode WWI -
phone2.
2. Transporter of asbestos -containing waste materials from removal/temporary storage site to final disposal site:
J.O.B. Rolloff
P. O. Box 6037
Name _
Addl
Chelsea MA
02150 (617) 387-1495
�?o—
27P �e Telephone
3. Refuse transfer station and owner (if applicable):
Address
C WTown
4. Final Disposal Site:
Valley Landfill
Iocat/on Name
np rode Telephone
O"ers Name
Pleasant Valley Road
Address
Irwin PA 15642 (724) 744-7446
C7ry/Town Dp rode - Telephone
V CeAffceden
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.
Christopher Thompson
11/15/1999
print Name
Authodzed S/gnature
Date
Note: Conbador
President
Air Quality Experts, Inc.
(603) 894-6465
must sign M/s
quiffonlMle
Repmsent/nq
Telephone
AM for DLI
notification
40 Lowell Road, Unit 1
Salem, NH
03079
purposes
Address
aly/Town
Z/p code
Fee exempt (Qty, Town, district, municipal housing authority, owner -occupied residential of four units or less)? ® Yes ❑ No
Sticker # (from front of form): 744168
Air Quality Experts, Inc.
Asbestos Removal
Christopher Thompson 40 Lowell Road, Unit 1 Residential -Commercial -Industrial
(603) 894-6465 Salem, NH 03079 1-800-621-1189
November 16, 1999
North Andover Health Department
146 Main Street
North Andover, MA 01845
Dear Sir:
Enclosed please find a copy of notification sent to the state for an Asbestos
Abatement Project.
The job will take place on November 29, 1999.
Project: 26 Second Street
Any questions concerning this matter should be directed to my attention.
Sincerely,
Christopher Thompson
President
INSTRUTIONS
1. All sections of this
form must be
completed In order to
comply with the
Department of
Environmental
Protection
notification
requirements of 310
CMR 7.15 (ten work/ng
days pr/or notification
Is requ/red of any
abatementprojew..
and the Department
of Labor and
Industries
notification
requirements of 453
CMR 6.12 (ten day's
pnb)-notifrcation IS
required ofANY
abatementproject
greater than three
Anew- or square feet)
2. Submit Original
Form To:
Commonwealth of
Massachusetts
Asbestos Program
P.O.B. 120087-0087
3. This Form may be
used for notifying the
U.S. Environmental
Protection Agency
Region 1 of asbestos
demolitlon/renovation
operations subject to
NESHAPS (40 CFR
Subpart M).
Approve/Denied
Decision date I
vponaomnwea/IbofNaqssac/iasells
Asbesl SINVIlifcalfonfoON-ANfool
1. Facility location:
Campbell Stras 26 Second Street
Name Address
North Andover, MA 01845 (978) 686-0820
C/ty/Town Z/p code Telephone
basement
Wbat/s the works/te /ocat/on?Sul/ding name, #, w/ng, Abo, room
2. Is the facility occupied? ® Yes ❑ No
3. Asbestos Contractor:
Air Quality Experts, Inc. 40 Lowell Road Unit 1
Name Address
Salem, NH 03079 (603) 894-6465
Clk Town Z/p code Telephone
AC 000167
DLIL/cense ,#
4. On -Site Project Supervisor/Foreman:
Joseph Sharpe
Name
5. Project Monitor:
N/A
Name
6. Asbestos Analytical Lab:
Name
Written
Contract Type (Written or Verba/)
AS 30725
DLI Certification If
DLICet&Acation #
DLI CeI ACation ,#
7. Project start date 11/29/1999 end date 11/29/1999 specific work hours (Mon. -Fri.) 7am313m (Sat. -Sun.)
8. What type of project is this? demo/ition repa �Vatlon
other(erp/ain)
9. Describe the asbestos abatement procedures to be used:love bag enclosure fd/contain/nent
Cleanup encapsu/anon disposal 0171Y other (exp
10. Is the job being conducted ® indoors ❑ outdoors?
11. Total amount of each type of Asbestos Containing Materials (ACM) to be handled on pipes or ducts (linear ft.) 120 or other
. surfaces (square ft.) to be removed, enclosed or encapsulated:
linear Square feet
Bo/%%bleachIng, duct tank sulfa--lings
cbnvgatedor/aye*rdpaperplpeinsu/abon 120
Spey -on /irnpiaoring
Cob5s, woven fabric
Other (p/ --qct d—,ibe)
12. Describe the decontamination system(s) to be used:
Thermal, so/!d mie pipe Insulation
Insulatlng rement
r-wWsprayer —tings
Trans/te board, wall bWlZf
Other (please d—be)
Linear Square feet
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:
Name ofDEP OMC/,?/ Tice
Date ofAutborization
Name ofDLIO>fc/a/
Date ofAutbodzation
Wa/ver 10
!va/ver,#
Rev. 6/92 15. Do prevailing wage rates apply as per M.G.L. c. 149, § 26, 27, or 27A -F to this project? ElYes ® No
A011WIMsC-011,911
1. Current or prior use of facility:
Residential
2. Is the facility owner -occupied residential with 4 units or less? ® Yes ❑ No
3. Facility Owner:
Campbell Stras '
Name
North Andover, MA
Cio/Town
4. Facility's Owner's On -Site Manager:
Name
CIOy Town
5. General Contractor:
Name
COO Town
26 Second Street
01845 (978) 686-0820
Z/p code Telephone
Address
Z/p Code
Address
Z/p code
Telephone
Te%phone
Conb-aCWIIS Workers Comp. Insurer Po//cy # Exp. Date
6. What is the size of the facility? 2.000 (sq ft) 2 (# floors)
AsbeslesTiaIIspeitetienaodDispesa/
1. Transporter of asbestos -containing waste material from site to temporary storage site (if necessary) to final disposal site?
Air Quality Experts, Inc. 40 Lowell Road, Unit 1
Name Address
Salem, NH 03079 (603) 894-6465
Cio/Town Z/p code Telephone
2. Transporter of asbestos -containing waste materials from removal/temporary storage site to final disposal site:
Note; Contractor
must sign th/s
form for DU
no[ificat/on
purposes
Christopher Thompson
PdntName
President
Pos/t/onTt/e
40 Lowell Road, Unit 1
Address
C-T11fir-
Author/Zed S/gnatwe
Air Quality Experts, Inc.
Representing
Salem. NH
- Clty/Town
11/15/1999
Date
(603)894-6465
Te%phone
03079
Z/p code — -
Fee exempt (City, Town, district, municipal housing authority, owner -occupied residential of four units or less)? ® Yes ❑ No
Sticker # (from front of form): 744168
J.O.B. Rolloff P. O. Box 6037
Name Address
Chelsea, MA 02150 (617) 387-1495
collrown Z/p code Telephone
Note: Transfer
3. Refuse transfer station and owner (if applicable):
Stations must
comoiy wlffi the
Name Address
Solid waste
Division regu/a-
Eons 310 CMR
C/ty/Town Z/p code Telephone
18.00
4. Final Disposal Site:
Valley Landfill
Location Name Owners Name
Pleasant Valley Road
Address
Irwin, PA 15642 (724) 744-7446
COO Town Z/p code Telephone
� Ce�catie�
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.
Note; Contractor
must sign th/s
form for DU
no[ificat/on
purposes
Christopher Thompson
PdntName
President
Pos/t/onTt/e
40 Lowell Road, Unit 1
Address
C-T11fir-
Author/Zed S/gnatwe
Air Quality Experts, Inc.
Representing
Salem. NH
- Clty/Town
11/15/1999
Date
(603)894-6465
Te%phone
03079
Z/p code — -
Fee exempt (City, Town, district, municipal housing authority, owner -occupied residential of four units or less)? ® Yes ❑ No
Sticker # (from front of form): 744168