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Home My WebLink AboutMiscellaneous - 411 MAIN STREET 4/30/2018 411 MAIN STREET 210/056.0-0032-0000.0 I i I I VI/ zj � f Air Quality Experts, 4C. C (603)894-6465 Asbestos Removal (800) 621-1189 23 Hall Farm Road Residential-Commercial-Industrial (603) 894-7044 FAX Atkinson, NH 03811 AirQualityExperts@AQENH.com ED ' July 30, 2014 , 014 p,UG 0 5 NpRTN pNDO ' TQWN 4 �EPpRTMEN F 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 August 23, 2014 to August 25, 2014. Project: Lois Manning 411 Main Street Any questions concerning this matter should be directed to my attention. Sincerely, Christopher Thompson President Asbestos IN otitication norm AIN Y-UN A c� � � �.` Asbestos Project # — Project Revision (— Project Cancellation A. Asbestos Abatement Description 1.Facility Location: LOIS MANNING 411 MAIN STREET Name of Facility Street Address Instructions 1.All NORTHANDOVER MA 01845 9786852355 sections of this form City/Town State Zip Code Telephone must be completed in LOIS MANNING OWNER order to comply with MassDEP notification Facility Contact Person Name Facility Contact Person Title requirements of 310 Worksite Location: BASEMENT CMR 7.15 and Department of Labor Building Name,Wing,Floor,Room,etc. Standards(DLS) 2. Is the facility occupied? P`Yes F No notification requirements of 453 CMR 6.12 3. Is this a fee exempt notification (city, town, district, municipal housing authority, state facility, or owner-occupied residential property of four units or less)? r Yes r No MassDEP Use Only 4.Blanket Permit Project Approval, if applicable: Date Received Approval ID# 5. Non-Traditional Asbestos Abatement Work Practice Approval, 2.Submit Original if applicable: Approval ID# Form To: Commonwealth of 6. Asbestos Contractor: Massachusetts AIR QUALITY EXPERTS INC 23 HALL FARM ROAD Asbestos Program P.O.Box 120087 Name Address Boston,MA 02112- ATKINSON NH 03811 6038946465 0087 City/Town State Zip Code Telephone AC000167 Contract Type: F Written F Verbal DLS License# 7, JOSUE NAZARIO AS001124 Name of Contractor's On-Site Supervisor/Foreman DLS Certification# 8. N/A Name of Project Monitor DLS Certification# 9. N/A Name of Asbestos Analytical Lab DLS Certification# 10. 8/23/2014 8/25/2014 Project Start Date(MM/DD/YYYY) End Date(MM/DD/YYYY) 7AM-5PM 7AM-5PM Work Hours-Monday Through Friday Work Hours-Saturday&Sunday 11. What type of project is this? F- Demolition F RenovationRepair " Other-Please Specify: Revised: 11/13/2013 Page 1 of l UIIlIIlUI1WCAlli1 Ul 1Vld55dlIlUSCLLJ 1100204487 j - Asbestos Notification Form ANF-001 Asbestos Project# Project Revision Project Cancellation A. Asbestos Abatement Description: (cont.) 12. Abatement procedures (check all that apply): F Glove Bag r— Encapsulation f— Enclosure r Disposal Only f— Cleanup F Full Containment Other-Please Specify: 13. Job is being conducted: F Indoors r— Outdoors 14. Total amount of each type of asbestos Containing materials (ACM)to be removed, enclosed, or encapsulated: 200 20 Linear Feet(Lin.Ft.) Square Feet(Sq.Ft.) Boiler,Breaching, Duct, 20 Transite Pipe Tank Surface Coatings Lin.Ft. Sq.Ft. Lin.Ft. Sq.Ft. Pipe.Insulation 200 Transite Shingles Lin.Ft. Sq.Ft. Lin.Ft. Sq.Ft. Spray-On Fireproofing Transite Panels Lin.Ft. Sq.Ft. Lin.Ft. Sq.Ft. Cloths,Woven Fabrics Other-Please Specify: Lin.Ft. Sq.Ft. Insulating Cement Lin.Ft. Sq.Ft. Lin.Ft. Sq.Ft. 15. Describe the decontamination system(s)to be used: 3 CHAMBER DECON 16. Describe the containerization/disposal methods to comply with 310 CMR 7.15 and 453 CMR 6.14(2)(g): WET 2 PLY POLY 17. For Emergency Asbestos Operations,the MassDEP and DLS officials who evaluated the emergency: Name of MassDEP Official Title of MassDEP Official Date of Authorization(MM/DD/YYYY) Waiver# Name of DLS Official Title of DLS Official Date of Authorization(MM/DDNYYY) Waiver# 18. Do prevailing wage rates as per M.G.L. c. 149, § 26, 27 or 27A—F apply to this Yes No project? Revised: 11/13/2013 Page 2 of 4 11 I.tJIIIIIII)I1WCdIlt1 Ul LV1AS5dCIlUSCLLJ L Asbestos Notification Form ANF-001 100204487 Asbestos Project # Project Revision a} Project Cancellation B. Facility Description 1. Current or prior use of facility: RESIDENCE 2. Is the facility owner-occupied residential with 4 units or less? (7 Yes F No 3.LOIS MANNING 411 MAIN STREET Facility Owner Name Address NORTH ANDOVER MA 01845 9786852355 City/Town State Zip Code Telephone 4.LOIS MANNING SAME Name of Facility Owner's On-Site Manager Address NORTH ANDOVER MA 01844 9786852355 City/Town State Zip Code Telephone 5.AIR QUALITY EXPERTS,INC. 23 HALL FARM ROAD Name of General Contractor Address ATKINSON Ni 03811 6038946465 City/Town State Zip Code Telephone Note:Temporary N/A storage of Asbestos containing waste Contractor's Worker's Compensation Insurer material is only N/A 1/1/2015 allowed at the place Policy# Expiration Date(MM/DD/YYYY) of business of a DLS licensed Asbestos 6. What is the size of this facility? 1800 2 contractor or a transfer station that is permitted by Square Feet #of Floors MassDEP and C. Asbestos Transportation & Disposal operated in compliance with Solid Waste Regulations 1. Transporter of asbestos-containing waste material from site of generation: 310 CMR 19.000 r Directly to Landfill or 17- To Temporary Storage Location/Transfer Station SERVICE TRANSPORT GROUP,INC. P.O.BOX 2132 Name of Transporter Address BRISTOL PA 19007 8779999559 City/Town State Zip Code Telephone 2. If a temporary storage location/transfer station is used, list name of transporter of asbestos containing waste material from temporary storage location/transfer station to final disposal site: SERVICE TRANSPORT GROUP,INC. P.O.BOX 2132 Name of Transporter Address BRISTOL PA 19007 8779999559 City/Town State Zip Code Telephone r Revised: 11/13/2013 Page 3 of 4 MOW— W111111011WCdltll01lviassaCIMSCLLS 100204487 yyg *( Asbestos Notification Form ANF-001 Asbestos Project # Project Revision Project Cancellation Note:contractor must C. Asbestos Transportation & Disposal: (cont.) sign this form for DLS notification purposes 3.Name and address of temporary storage location/transfer station for the asbestos containing waste material: SERVICE TRANSPORT GROUP,INC. 23 PRIVILEGE STREET Temporary Storage Location Name Address WOONSOCKET Po 02895 4017661824 City/Town State Zip Code Telephone 4.Name and location of final disposal site(asbestos landfill): MINERVA LANDFILL MINERVA LANDFILL Final Disposal Site Name Final Disposal Site Owner Name 9000 MINERVA ROAD Address WAYNESBURG CH 44688 3308663435 City/Town State Zip Code Telephone D. Certification 1 certify that I have personally examined the foregoing and am CHRISTOPHERTHOMPSON CHRISTOPHER THOMPSON familiar with the information Name Authorized Signature contained in this document and PRESIDENT 7/30/2014 all attachments and that, based Position/ritle Date(MM/DD/YYYY) individuals immediately my inquiry those 6038946465 AIR QUALITY EXPERTS,INC. n responsible for obtaining the Telephone Representing information, I believe that the 23 HALL FARM ROAD ATKINSON information is true, accurate, and Address City/Town complete. I am aware that there Ni 03811 are significant penalties for submitting false information, State Zip Code including possible fines and imprisonment. The undersigned hereby states, under the penalties of perjury,that I have read the Commonwealth of Massachusetts regulations governing asbestos abatement (453 CMR 6.00 promulgated by the Department of Labor Standards and 310 CMR 7.15 promulgated by the Department of Environmental Protection), and that I am aware that this permit application or notification shall not be deemed valid unless payment of the applicable fee is made." Revised: 1 IM/2013 Page 4 of 4