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HomeMy WebLinkAboutMiscellaneous - 41 CHESTNUT STREET 4/30/2018 (2)d I OCT-29-2003 14:57 E.C.S. I. 603 642 9223 P.01 ` 111 Route 125— Kingston,NH 03848 P.O.Box 1147- Atkinson,NH 03811Environmental Compliance Tel: 603-6429200 Specialists,• ftx To: No.Andover Board of Heafth-Susan Ford From: Mary Rourke/ECSI-NH Ext.204 Fax: .978-688-9542 Pages: 4 (Includes over sheet) III Dab: 10129!03 Re: Mass Notification CC: D Urgent X For Review O Please Comment X Please Reply ©Please Recycle We will be doing Asbestos abatement work in No. Andover, MA E.C.S.1. is notifying as required. Please review attached sheet(s)for additional information. If you have questions, Please call. Thank You Where Compliance Builds Confidence OCT-29-2003 1457 E.C.S. I. 603 642 9223 P.02 ti ' Commonwealth of Massachusetts 100001A94 Asbestos Notification Form ANF-001 OecalNumber ,. ....._. -----.......---------.. Affix Asbestos Notification Decal Here �.._.._..._......._._.................... `When filling out P whhen rA. Asbestos Abatement Description dorms 0i1.U 1. a.is this facility fee exempt city_,town,district,municipal housing authority,owner-oocu led oorrtputer,use tY p � � P 9 Y. p only the teb key residence of four units or less? ✓ Yes {�No to move your cursor-do not b.Provide blanket decal number if applicable- use Number use the return ley. 2. Facility Location: 41 CHESTNUT STREET 41 CHESTNUT STREET a.Wa traetAddn:s NORTH ANDOVER MA `��� �� �o1a4s � It97e�7zs-36so r~Cdy/rown d.Stats a.Zlp Code f.Telephone Number INSTRUCTION8 3• worksite Location: 1.All sections of this BASEMENT � � form must be s.Building Name/Budding Location b,Building 11 C.Wing d.Floor e.Room completed in order to Comply With 4, Is the facility occupied? Pl Yes D No DEP notification requirements of 310 CMR 7.15 5. Asbestos Contractor: mis Of00DbW11 CA1 ENVIRONMENTAL COMPLIANCE spECIALIs 54 OLD JACOBS ROAD safety(Dos) a.Name _ b.Addressmotifi=bm GEORGETOWN �� 01833 6036429200 rWirarr amts of 458 CMR 6.12 C.C• � d.Zip Code e.Telephone Number 000407 g.Contract Type: 121 Written n Verbal OS Ucanse Number INNY PORCELLA 160PERATIONS MANAGER h.Fs&K ERrta-ctn- 1.ContaCt on's Tille_ ti• FRANCISCO J.FERNANDEZ AS033467 a.Name of On-Site Supervisor/Foreman b.SuDervisoriForeman DOS Ceriftation Nurnkgr 7 FLI ENVIRONMENTAL 000144 a.Nam of Pro Monitor b.Pripjact Monitor DOS Certification Number pRO SCIENCE �� AA000156 $ a.Name of Asbestos Analytical Lab b.Asbestos Analytical eb DOS Certification Ngmber 9. iiM2/3003 �? 11114/2003 a.Pr eCt Start Date mmldd b.End Date(mm/dgboaW -� 0 7:CA-3;30P c�xnurs mon-Fri. d.tNork hours Sat-Sun. M=10�- I0 10. a.What type of project is this? =O []Demolition Renovation iCLEANUP �.. p Repair +!]Other,please specify: Is.Describe 11. a, Check abatement procedures: ° >D Glove bag Encapsulation [{Enclosure Disposal only �✓ Cleanup T3 Other,specify: S [✓�Fuh containment b.Describe �Z a 12. is the job being conducted: w Indoors? 0 Outdoors? anf001ap doc 10/02 Asbestos Notification Form•Page 1 of 3 OCT-29-2003 14:57 E.C.S. I. 603 642 9223 P.03 s •' Commonwealth of Massachusetts ■ Asbestos Notification Form ANF-001 Decal Number A. Asbestos Abatement Description (cont.) 13, Total amount of each type of asbestos Containing Materials(ACM)to be removed,enclosed,or nca sulated: a.Tolm pipes or ducts(linear ft) DTotalOmer suffaoe6 square 111) c.Boiler,breaching,duct,tank = = d,Insulating cement surface coatings Lin.It. 'R. Lin. 5q,ft. e.Corrugated or layered papa 160 = pipe insulation Lin.fl. ft. Lin.Trowel/Sprayer COating6 Lin.R. Sq.fL g.Spray-on fireproofing h.Transite board,wad board3 fl. L i.Cldhs.woven fabricsu—h— J.Other.please specify. L M;D k.Thermal,solid core pipe insulation Lin.IL Sq. I.Specify 14. Describe the decontamination system(s)to be used: 3 CHAMBER DECON/GLOVESAG 15. Describe the containerization/disposal methods to comply with 310 CMR 7.15 and 453 CMR 6.14(2) ): _ DBL 6 MIL POLY I3GS OR LND ORMS,PRPLY LBLD,AND DISPSD OF IN APPRVD LANDFILL 16. For Emergency Asbestos Operations,the DEP and DOS officials who evaluated the emergency: a.Nam of DEP W;Q b.Taus -- c.Date(mnttdctt of Authorization d.DEP Waiver# e.Name of DOS Official I.DOS Oniciale g.Date(mmiddtyyyy)of Authaftalfa h.DOS Waiver# N ° 17. Do prevailing wage rates as per M.G.L.c. 149,§26,27 or 27A-F apply to this project? Yes Q No ° B. Facility Description ��.N o 1. Current or prior use of facility: PRIVATE RESIDENCE �o 2. Is the facility owner-occupied residential with 4 units or less? 0 Yes ❑No r DAVE MERMELSTEIN 41 CHESTNUT STREET 3' a.Fadktv owner Mame b.Address ° INOANDOVER,MA 01845 978-725-3630 o c.C own d.Zip Code s.Tele-phone Number Lares code and extension a 4 DAVE MERMELSTEIN 1 CHESTNUT STREET a.Name of Facility Owner's On-Site Manager b.On-Site Manager Address Z NO.ANDOVER,MA 01845 (978-725.3630 ZZES510mQ C.Cityrrown d.Zip Code e.Telephone r3l umber(area code and extension) ■ antl)01ap.doc•10/02 Asbestos Notificatlon Form•P 2of 3 �■ OCT-29-2003 14:5? E.C.S. I. 603 642 9223 P.04 Commonwealth of Massachusetts 100001494 Asbestos Notification Form ANF-001 Deced Number S. Facility Description (cont.) 5 a S. a.Name of General ConIMcIQr b.Address c.CkvfTown d.Zip Code a.Tete hone Number area code andextension) AMERICAN ASSURANCE 1 11027637 03120/Z004 f, ontraetor's Worker's Comp.Insurer g.Polk Ny„mbar h.E&o. Date(mmldd/M 6. What is the s¢e of this facility? ae.Squ 3.Square Feet b-Number of floors C. Asbestos 'Transportation and Disposal 1. Transporter of asbestos-containing material from site to temporary storage site(if necessary)* Note:Transfer a.Name of Trens oder ^, b.Addrass stations mutat ^-� I L— comply wkh the e.City/Town d.zip Coda e.Telephone Number Solid Waste Division 2. Transporter of asbestos-containing waste material from removal/temporary site to final disposal site: Regulations 310 CMR 19.000 SERVICE TRANSPORT GROUP PO BOX 2132 a.Name of Trans oder b.Address BRISTOL,PA �� E19007 j 877999-9559 o.City/Town d.&Coda e.Telephone Number a.Refuse Transfer Station and Owner b.Address c.C IT M d.Z' Coe.T to hone Number 4. A/;AMP; L SALVAGE INC. � de I a.Final Disoosal Site Location Name b.Final Disposal She Location Owner's Name 11225 STATE ROUTE 45 LISBON _ -I a.Fetal Dts f SiLe Addmn d.Ci /Town OH 44432 e.State f.Zip Code g.Telephone Number D. Certification At The undersigned hereby states,under the [MARY ROURKE =� penalties of pefjury,that he/she has read the a.Nameb.Authorized Signature o Commonwealth of Massachusetts regulations IADMINISTRATOR j 110/29/2003 for the Removal,Containment or Encposkion/Title _ is 310 CMR 7.1n of Asbestos, information CMR 6.00 and (603)642-9200 310 CMR 7.15,and that the information contained in this notification is true and correct a.Telephone Number f.Rapresentin to the gest of Mather knowledge and belief. ,,99111i ROUTE 125 IKANGSTON,NH 03848_ h.City/Town 1.Zip Coda Z �a rf anf001ap.doc•10102 Asbestos Notification Form•Page 3 of 3 TOTAL P.04 NOV-12-2003 08:37 E.C.S. I. 603 642 9223 P.01 111 Route 125- Kingston,NH 03848 P.O.Box 1147- Atkinson,NH 03811 Environmental Compliance Tel: 603.642-9200 Fax:W3-642-9223 Specialists, ftx To: No Andover Board of Health From: Mary RourkelEC51-NH Ext.204 Pax: 978.688-9542 Pages: 4 (Includes cover sheet) Phones Data 11/12/03 Re: Mass Notification CC: O Urgent X For Review D Please Comment X Please Reply ❑Please Recycle We WM be doing Asbestos abatement weak In No. Andover, NIA EC.S.1. las notHying as required. Please review attached sheet(s)for additional Wonnation. N you have quesdoru, Please can, Ceu Project veschedWed out t:120MM % Where Compliance Builds Confidence NOV-12-2003 0837 E.C.S. I. 603 642 9223 P.02 j Commonwealth of Massachusetts 100001494 Asbestos Notification Form ANF-001 ••°°�'-"• ' `--- --'--- -' - -"-` Affix Asbestos Notification Decal Here ImporWWhen Mit A. Asbestos Abatement Description When iJllirpg out p • comps on the computer,use 1, a.Is this facility fee exempt-city,town,district,municipal housing authority,owner-occupied (,_j only ate tab key residence of four units or less) ✓ Yes El No to move your cursor-do not b.Provide blanket decal number if applicable: Blanket Decal Number use the return k"' 2. Facility Location: 41 CHESTNUT STREET 141 CHESTNUT STREET a.Name of F2CI5V b NORTMANDOVER MA X01845 (978)726.3630_ +� c.City/Town d.State e.Zip Code I.Telephone Number WSTRUCT"s 3. Worksite Location: 1.All sections or shit BASEMENT form must be a.Building Name/Building Location bb,Building 0 c. d.Floor e.Room completed in order to comply with 4. Is the facility occupied? `✓1 Yes [I No � �/� DEP nodficatlon requirements of 310 CMR SAS 5. Asbestos Contractor: and are Division of occupational ENVIRONMENTAL COMPLIANCE SPECfALIS 154 OLD JAcoBs ROAD Safety(00s) a3 Nam b noUficetaon GEORGETOWN 01833 6036428200 // /Z/0-3 roquirements of 453 CMR 6.12 a Cit Rown d.Z0 Code .Telephone Number COD040T 1.093 uN m"—>�` Q. ct Type: Q Written (]Verbal VINNY PORCELLA OPERATIO GER F Pecifiv Contact Person i.Contact Person%Title 6 1FRANCISCO J,FERNANDEZ (AS033467 a.Name eor/Forem n DOS Certification Number FLI ENVIRONMENTAL (AA000144 7' a.Name of NOW Mondor b-PMiW ti&&for DOS CarGrication Number PRO SCIENCE 000156 8' a.Name of Asbestos An*IAAI LAb estosica 0 tion Number 11/1212003 11/1412003 e 9' a.Prolect Start Date mm/ddl . d Date mm/dd! —0 7:OA-3:30P j a c.Work nours Mor Fri. d.Work hours Sat-Sun. �v 10. a.What type of project is this? �c 0 Demolition Q Renovation iCLEANUP r Repair -01 Other,please specify: b-Describe 11. a. Check abatement procedures: �o ✓ Glove bag ❑Encapsulation mmsla�o Enclosure: 0 Nsposal only , "W Q Cleanup 0 Other,specify: i �z Q Full containment b.Describe �Q 12. Is the job being conducted: [y], Indoors? L-1 Outdoors? M ornDlap doc•10/02 Asbestos Notification Foran•Page 1 of 3 NOV-12-2003 08:3? E.C.S. I. 603 642 9223 P.03 Commonwealth of Massachusetts 100001494 .r, Asbestos Notification Form ANF-001 Decal A. Asbestos Abatement Description (cont.) 13. Total amount of each type of Asbestos Containing Materials(ACM)to be removed,enclosed,or encapsulated: a.Total pipes or ductsnear owl other surfaces square c.Boiler,breaching,duct,tank surtaes Coatings ��L t. d.Insulating cement Lin.h. K. a.Corrugated or layered paper 169 f.TrowellSpmyer coatings pipe insulation Lin.ft. 9l q.ft., Lin.ft. Sq.R g.Spray-on fireproofing5 i h.Transite board,wall board Lin. --j I.Cloths,woven fabrics in. jOther,pi ewe specify: Li—'nom k.Thermal,soM core pipe insulation LaL tt $4.ff. I.specify 14. Describe the decontamination system(s)to be used: 3 CHAMBER DECONI GLOVEBAG 15. Describs the containerization/disposal methods to comply with 310 CMR 7.15 and 453 CMR 6.14(2) DBL 6 MIL POLY BGS OR LND DRMS, PRPLY LOW,AND DISPSD OF IN APPRVD LANDFILL 16. For Emergency Asbestos Operations,the DEP and DOS officials who evaluated the emergency: a.Name of DEP Official rbb. it c.Dale m Wddl of AutrwraabW d.DEP Waiver 0 o.Name of DOS Official 1.DOS Official Title g.Date(mmiddlyyyy)of Authorization h,D S Waiver# N ®0 17. Do prevailing wage rates as per M.G.L.c. 149,§26,27 or 27A—F apply to this project?[i Yes[v1 No B. f=acility Description �N ' o 1. Current or prior use of facility: PRIVATE RESIDENCE o 2. Is the facility owner-occupied residential with 4 units or less? L—,/J Yes [I No 3. DAVE MERMELSTEIN 4i CHESTNUT s'PREET A.Facility Owner Name b.Address ° NO.ANDOVER,MA 09845 976-725-3630 ° c.Cil/Town d.Zie Code e,Tele hone Number area code and extension DAVE MERMELSTEIN 1 141 CHESTNUT STREET 4. a.Name of Fae Owners On-Site Mmoper b.On-site Ma er Address z NO.ANDOVER,MA -J 01845 78-725.3630 Q c.Cay/Town d.Zip Cod& a.Telephone Number(area code and extension) anf001ap.doe-10102 Asbestos Notification Form•P NOV-12-2003 08:3? E.C.S. I. 603 642 9223 P.04 Commonwealth of Massachusetts _ 100001494 Asbestos Notification Form ANF-001 Decal Number B. Facility Description (cont.) N/A 5' a.t4ame of General Gorttractor b.Address c.CftfTown d.Zip Cods e.Telephone Number area code and extension AMERICAN ASSURANCE 1027637 1 JUN2012004 f.Contractors Workers Comp.Insurer a,Poky Numbs h.Exp.DatemMt� 6. What is the size of this facility? 3 800 3 a.Square Feet b.Number of floors C. Asbestos Transportation and Disposal 1. Transporter of asbestos-containing material from site to temporary storage site(if necessary): Note:Transfer a.Name of Transiporter b.Address stations must I I I _ I comply whh the C.City/Town d.Zip Code e.Telephone Number solid W461e Division 2. Transporter of asbestos-containing waste material from removal/temporary site to final disposal site: Regubtlons 310 CMR 19.000 ,SERVICE TRANSPORT GROUP jPO BO 132 a.Name of Trans orter b.Address BRISTOL,PA19007 (877)999.OWO 0. own d.T&Code I e.T tWne Number a.Retuse Transfer Station and Owner b. c. Citi/TownCitiLfrown d.Zip Code a.Te! hone Number 4. /;AMP;L SALVAGE INC. a.Final Dismal Site Location Name b.Final Dismal Site Location Owner's Name 11225 STATE RouTE 45 IUSBON c,Final D_igjt 1 i e Address d.CIIIV/ToWn off aaa 2 e.State f.Zip Code g.TakI tone Number �..•moo 0 ° D. Certification The undersigned hereby states,under theMARY ROURKE o penalties of perjury,that he/she has read the 0.Name b.Authorized Si nature a Commonwealth of Massachusetts regulations _ADMINISTRATOR 110/29/2003 for the Removal,Containment or d ate mrn/dd/=d Encapsulation of Asbestos,453 CMR 6.00 and r 310 CMR 7.15,and that the information c.PosltionRbl(603)842-9200 IE.C.S.I. Contained in this notification Is true and correct e,T leahone Number .r.r F.Rearesentina ° to the best of his/her knowledge and belief. 1111 ROUTE 125 �b KING3TON,NH 03848 Z h.City/Town i.Yip Code Q anf001ap doe-10/02 Asbestos Notification Form•Page 3 of 3 TOTAL P.04