HomeMy WebLinkAboutMiscellaneous - 31 INGLEWOOD STREET 4/30/2018 31 INGLEWOOD STREET
2101011_0_0008_0000_i
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Air Quality Experts,Ex erts Inc.
3 Brentwood Avenue
Salem, N.H. 03075
603-994-6465 `^
OCTOBER05 1993
i
NO. ANDOVER BOARD OF HEALTH
120 MAIN STREET
NO. ANDOVER, MA 01845
DEAF: SIR:
ENCLOSED PLEASE FIND A COPY OF NOTIFICATION SENT TO THE STATE
FOR AN ASBESTOS ABATEMENT PROJECT.
THE JOB WILL TAk:E PLACE ON OCTOBER 26, 19'33.
PROJECT: KALEMBA
31 INGALWOOD ST.
NO. ANDOVER, MA
ANY QUESTIONS CONCERNING THIS MATTER SHOULD BE DIRECTED TO MY
ATTENTION.
SINCERELY,
CHRISTOPHER THOMPSON
PRESIDENT
i
Commonwealth of Massachusetts '
Asbestos Notification Form— ANF-001
^, 11 Ilk, 0
n•
Yy � Asbestos Abatement.Description
1. Facility location:
.DAVID.....KALEMBA..................................... ..................3.1.....IN.GAL.WO.O.D......S.T..........................................
INSTRUCTIONS Narne Address
1.All sections of this ANDOVER...............................................O'rl�$.e 4.5................................. ............
form must be completed Durr relephorre
in order to comply with
the Department of
Environmental bugdirry,erre,/,wing,fluor,room
Protection notification
requirements of 310 CMR 2. Is the facility occupied? Q_Yes O No
7.15(ten working days X
prior notification is 3. Asbestos Contractor:
requbedondthe Cement AIR QUALITY EXPERTS, INC. 349 SO. BROADWAY #8
pro%eery:and Ore ..................................................................................................... .........................................................................................
..........................................
Department of Labor.
Name Address
and Industries
SALEM, NH 03079 603-894-6465
notification requirements � �'
..................................:.................................................................. ....................................:..:.............. .........................................................................
of 453 CMR 6.12 (ten Ciry/fown lip rade 1Nephone
days prior notification is
niquiredolANY AC 000167 WRITTEN
abatement project greater
than NreelirearDtiLkense/ Coalra-1Type(wrnteaNeroal)
square/e0• 4. On-Site Project Supervisor/Foreman:
2.Submit Original Form CHRISTOPHER THOMPSON SE'07797
..................................................................................................... ..................................................................................................................................
To: Name ULI Cenilireliwr/
Commonwealth of
Massachusetts 5. Project Monitor:
A:bast12Program FINAL CLEARANCE ANALYSIS AA00085
P.O.B.120087
Boston,MA 02112• ...................................... ...............'hvri.....................................:i.
.....................................................................
Name 011 CenipuriwN
0087
6. Asbestos Analytical Lab:
3.This form may be FINAL CLEARANCE ANALYSIS AA00085
usedfor notifying the ..................................................................................................... ...................................................................................................................................
U.S.Environmental Name W Cerllliraliun/
Protection Agency Region
lofasbestos demolition/ 7. Project start Alp enddA_091§1935pecificwork hours(Mon.-Fri.) 7-5 (Sat.Sun.)
rendvation operations
subject to NESHAPS(40 What type CFR Subpart M). 8. yP of project is this? (circle one): demolition repair Marion ooer(explaw)
For aius,ony 9• Describe the asbestos abatement procedures to be used (circle): glovelap enclosure conranrrenr cleanup
ennVisulation disposal only o7,er(explainJ
N*Kgon I
1490wo Dare 10. is the job being conducted Indoors O outdoors?
R
40
„n1eoo ea 11. Total amount of each type�Q,sbestos Containing Materials(ACM)to be handled on pipes or ducts(linear ft.) or other
surfaces(square ft.) J uu to be removed,enclosed or encapsulated:
sm�ro—6ir
linear/square feet
boiler,breaching,dud,lank surface coatings..._/fig thermal,solid core pipe insulation......_/
corrugated or layered paper pipe insulation.... insulating cement................ ..
spray-ongreprdoring..................... y V/_ uowellsprays,coatings..............
cloths,woven Iebrks....................._/ uarsite board,wall board.............
otlrer(please describe)....................._J
12. Describe the decontamination system(s)to be used:
1....•RECON""CHAMBER...................................................................................................................................................
........_......
.............. ..........................................................
...._........._ ... ........... .... .......
13. Describe the containerization/disposal methods to comply with 310 CMR 7.15 and 453 CMR 6.14(2)(8):
WET:...REMOV.AL....I.N.T.O....5MIL....ROL.Y....ASBES.T.OS....LABELED....BAGS...........'...................................
... ......... ... ....... ......... ... .,......
..
14. For Emergency Asbestos Abatement Operations,the DEP and DLI officials who evaluated the emergency:
Name dDEI Uditial Tide
t}............................................................................................... .......ver/ .
.............................. ............................................................................................
. WkdAullwdralia, Wai
..................................................................................................... ..................................................................................................................................
Named DLI rllllolal Tine
....................................................................................:............... ................................................................................
..................................................
WreWAullwdrelwur Waiver/
15. Do prevailing wage rates apply as per M.G.L.c.149,§26,27,or 27A-F to this project? res o
Rev.6192.
Facility Description
1 Current or prior use of facility:
.................................................... ........................... ........................................./.1 .........................................................................................
� r.
2. Is the facility owner-occupied residential with 4 units or less? ELY-ts 0 No
3. Facility Owner:
....................... ..............................................
nam Address.......................:......:.....:..........:..::..: ......................................
. ...................................................... ..................................... ...................................................... ............................................................................
citylTolmn zip C&k Telephone
4. Facility's Owner's On-Site Manager:
.................... ..........
Marne Address
.............................................................................................................. ...........................................................................
Zip rale Telephone
5. General Contractor:
......................NIA........................................................ ....:......................I......................................................................................................
Name Address
............... '' *'-o"de,*' ............ "eT*1apho'na* .......... .........................................
lip c
Contractor's Workers Comp.Insurer Policy/ Exio.Dzte
6. What is the size of the facility?2000(sq ft) 2 (1 of floors)
Asbestos Transportation and Disposal
1 Transporter of asbestos-containing waste material from site to temporary storage site(if necessary)to final disposal site:
AIR QUALITY EXPERTS, INC. 349 SO. BROADWAY #8
...................................................................................................
...........
Marne Address
")SALEM NEW HAMPSHIRE : 03079 '603-894-6465
2. Transporter of asbestos-containing waste material from removal/temporary storage site to final disposal site:
SAME
.(................................................... ...........
Note:Transfer cifyfTowrr zip axle leleldrwre
Stations must
3. Refuse transfer station and owner(if applicable):
comply with the
Solid Waste
...........................N/A......................................................... ....................................................................................................................................
Division rejl61- Marne Address
tions 310 CMR
18.00 ...........I..........................
citylTowrl Zip axle Telellholle
4. Final Disposal Site:
TURNKEY LANDFILL WASTE MANAGEMENT OF NEW HAMPSHIRE
...................................... ....................................................................................................................................
awlers Marne
90 ROCHESTER NECK RD.
..........................................................It.................................................................;.........................................................................................
Address
ROCHESTER, NEW HAMPSHIRE :03867' 1 1/, ,, -603-332-2386
....... .... .. __..........-..................................... .........
zill code Telenhone
Certification
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 T H 0 M P S 0 N
....................................... ........................................... .... ................/.......................
Print Name AuffioaledSipature pate
Note:Contractor
must sign this PRESIDENT AIR QUALITY EXPERTS, INC.603-894-6465
.........................................................................................................................................................
form for DU Represenlinp Telephone
notification
purposes 349 SO. BROADWAY #8 SALEM, NH 03079
...................................................................................... ......................................................................... ........................................................
City/Town 11p axle
Fee exempt(City,Town,district,municipal housing authority,owner-occupied residential of four units or less)?Er/ye, 0 no
Sticker#(from front of form): q