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Home My WebLink AboutMiscellaneous - 39 ROSEDALE AVENUE 4/30/2018 (2) W i f "�x FILE r ' � VIM Air Quality Experts, Inc. 3 Brentwood Avenue Salem, N.H. 03073 603-894-6465 OCTOBER 149 19-93 NO. ANDOVER BOARD OF HEALTH 120 MAIN STREET NO. ANDOVER, MA 01845 DEAD' SIR: ENCLOSED PLEASE FIND A COPY OF NOTIFICATION SENT TO THE STATE FOR AN ASBESTOS ABATEMENT PROJECT. THE JOB WILL TAKE PLACE ON OCTOBER 27, 1993. PROJECT: DELDOTTO 39 ROSEDALE ST. NO. ANDOVER, MA 01845 ANY QUESTIONS CONCERNING THIS MATTE' SHOULD BE DIRECTED TO MY ATTENTION. SINCERELY, 4 /5 �� , P CHRISTOPHER THOMPSON PRESIDENT 3�u4y fFP�S - commonwealth of Massachusetts Asbestos Notification form— ANF-001 ,' =x i Asbestos Abatement Description 1. Facility location: a.....A E.L.A.Q TTO............................................... ................::.3.9.....R.O S E D AL E.....AVE......................................... INSTRUCTIONS Mane Address 1.All sections of this .N.O..,......AN. DOVER...............................................Q-V-4-5................................r .g._6.8.6-02i.7-0.................. form must be completed rdWT m qr a eleprmne in order to comply with theDepartment of ............................................................................................................................................................... Environmental �I+�+dVrlyNrm,/,winp,noaroorn Protection notification 2, Is the facility occupied? Q_Yes O No requirements of 310 CMR X 7.15(ten working days prior notification is 3. Asbestos Contractor: ecQ:and the required projAIR QUALITY EXPERTS, INC. 349 SO. BROADWAY #8 proe ................................................................................................. ............ Department of Labor. Name Address and industries notification requirements SALEM, NH 03079 603-894-6465 01453 CMR 6.12 (ten p................................................. ......................................................................... Ciry/lown Ii code Telephone days prior notification is requiredolANY AC 000167 WRITTEN abalemerd project greater IX I l irense/ funlrxi tyle(wrillen/vert a) than three linear or squareleel). 4. On-Site Project Supervisor/Foreman: 2.Submit OriginalForm CHRISTOPHER THOMPSON SF07797 To: Commonwealth of 011 cenil;ul;un/ Massachusetts 5. Project Monitor: Asbestos Program GLOVE BAG ' P.0.6.120087120087 Boston,MA02112• /yarns . .................................................................................................. .................................................................................................................................. 0087 6. Asbestos Analytical Lab: 3.This form may be used for notilying the ................................................. .................................................... ................................................................................................................................... U.S.Environmental Name IXlCeniliral;ull Protection Agency Region Iofasbestos demolition/ 7. Project start d�tt P2t7%3 end d40 L7L3specific work hours(Mon.-Fri.) 12-5 (Sat.Sun.) rendvation operations subject to NESHAPS(40 fi What t I ( ) CFR Subpart M). type of project is this? circle one): demolition repay x6xvilion omer(explaw) For areWuseoxy 9. Describe the asbestos abatement procedures to be used 'fle),.: glovetug enclosure tullconialnmew cleanupencapsulation disposNonly ogler(explain) uora�ooan, fleminODie 10. Is the job being conducted Xindoors ❑outdoors 7 ROM" 3 ,"W ,w 11. Total amount of each type of Asbestos Containing Materials(ACM)to be handled on pipes or ducts(linear ft.) or other con>a e� surfaces(square ft.) tJ� to be removed,enclosed or encapsulated: — fineadsquare feet boiler,breaching,dud,lank surface coatings..._/_� thermal,solid core pipe insulation....... corrugated or layered paper pipe insulation. �/ insulating cement................ .. spray-on fireproofing.....................111—J— bowellspreyencoatings.............. cloths,woven labrks....................._J uarsite board,wall board............. other(please describe).................... 12. Describe the decontamination systems)to be used: GLO.VE.....B.AG............:...:............................................................................................................................................................................... ........................_............................................................._................................. .................... ............... ..... ......._.............. ........ 13. Describe the containerization/disposal methods to comply with 310 CMR 7.15 and 453 CMR 6.14(2)(8): WET....REMOVAL....I.N.T.O....6MIL....P..OLY...ASBESTOS...LABELELI....BAGS.............. .................................. ......................... ...................................._..................................... . .......... 14. For Emergency Asbestos Abatement Operations,the DEP and DLI officials who evaluated the emergency: Maim dDEP OffbalT;IIe ... . _......... ..... ._. .............__........ ......................................................................... ' Da�edAuthorltalia� ................................................................................................................ ft ..................................................................................................... .................................................................................................................................. - Narre ol DU official title ....................... tkredAutlxxtl:V;w1 Wler/ 15. Do prevailing wage rates apply as per M.G.L.c.149,§26,27,or 27A-F to this project? ❑YesNo t Rev.6/92. Facility Description `s 1. Current or prior use of facility: • ..................................................................................................x.9.......V's ...lk �.......................................................................... ... . 2. Is the facility owner-occupied residential with 4 units or less? No 3. Facility Owner: .............:S A1:'IE..................................................... ........................................:...........................................................I......................:....... Nam Address ..................................................................................................... ...................................................... ............................................................................ C10117-1 lip Cale Telel 4. Facility's Owner's On-Site Manager: N/A Name Address ........................ ..................................................... ............................................................................ Clry/Tuwn lip rude Teleptmne 5. General Contractor: .N./A......................................................... .................................................................................................................................. . Nerve Address ..................................................................................................... ..................................................... ............................................................................ Clry/Town lip code Telephone contractor's Workers Comp.insurer PolkyJ Exp.Date 6. What is the size of the facility? 2000(sq ft)2(#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 ................................ ............ ........e........ ...... .... ......... .. ..... .......... ...... ......... ................................. "A.d.dres... .............. .......... .................. ....... ............ . .- ........... . �,nAds SALEM, NEW HAMPSHIRE 03079 603-894-6465 ........................ .. _.. . _..... Ciry/(own lip rade Tewitime 2. Transporter of asbestos-containing waste material from removal/temporary storage site to final disposal site: SAME ..................................................................................................... .................................................................................................................................... Nyne Artiness Nota:Transfer CiryAmvn lip roue Telephone Stations must 3. Refuse transfer station and owner(if applicable): comply with the Solid Waste Divisionreyula- wine....................N/A......................................................... .aairess........................................................................................................................ tions 310 CMR 18.00 ..................................................................................................... ....................................................... ........................................................................... OWTown Zip axle Telephone 4. Final Disposal Site: TURNKEY LANDFILL WASTE MANAGEMENT OF NEW HAMPSHIRE . ..................................................................................................... .................................................................................................................................... loralkxi Name (Wma Name 90 ROCHESTER NECK RD. .......................................................................................................................................................................................................................................... Address ROCHESTER, NEW HAMPSHIRE 03867 603-332-2386 riry/rrnvn lin mile Telephone Ja Certification The undersigned hereby slates,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 7.155,,and that the information contained in this notification is true and correct to the best of his/her knowledge as d beellie 0 1 CHRISTOPHER THOMPSON nncI � ..... .....1�.1...................................... 4._.5.3............. Pdnl Namr Audior¢ed Signature Dale Note:Contractor 603-894-6465 must sign this PRESIDENT AIR QUALITY EXPERTS, INC. ..................................................................................... ........................................................ loan for OLl floslrimVNde Relxesenlniu Telephone notification purposes 349 SO. BROADWAY #8 SALEM, NH 03079 AUdress Ciry/Tuxv Lp axle Fee exempt(City,Town,district,municipal housing authority,owner-occupied residential of four units or less)7yes O no i Sticker!(from front of form):