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HomeMy WebLinkAboutMiscellaneous - 420 GREAT POND ROAD 4/30/2018 (3) ��. a� (1- 6" — ----- t 1 DEC-TAM CORPORATION 978.470.2860 Specialty Contractors fax 978.470.1017 RECEIVED SEP i 3 2013 TOWN OF NORTH ANDOVER HFALTH DEPARTMENT September 9, 2013 North Andover Board of Health 1600 Osgood Street Building 20, Suite 2-36 North Andover, MA 01845 RE: North Andover Waste Water Treatme , 420 GDRoad, Andover, MA 01845 Dear Sir or Madam: Please be advised that Dec-Tam Corporation will be performing an asbestos abatement projects at the above referenced locations. This work has been scheduled for September 12, 2013 thru September 12, 2013. All applicable local, state and federal agencies have been notified of this work. Please let me know if you have any questions. Sincerest regards, Brenton Morgenstern Sales Estimator BM/cam Enclosure Environmental Remediation Services • Surface Preparation • .Facilities Services 50 Concord Street • North Reading, MA 01864 • www.dectam.com • solutions@dectam.com F or Commonwealth of Massachusetts 00184 EIVBG_ Asbestos Notification Form ANF-001 Iecal Number Ll r SEP 13 2013 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT Important: When filling out A. Asbestos Abatement Description forms on the computer,use 1. a. Is this facility fee exempt-city, town, district, municipal housing authority, owner-occupied only the tab key residence of four units or less? ❑✓ Yes ❑No to move your cursor-do not b. Provide blanket decal number if applicable: use the return Blanket Decal Number key. 2. Facility Location: NORTH ANDOVER WASTERWA' 1420 GREAT POND ROAD a.Name of Facility b.Street Address NORTH ANDOVER MA � 101845 _� 9787941503_T c.City/Town d.State e.Zip Code f.Telephone Number INSTRUCTIONS 3. Worksite Location: 1.All sections of this ROOF-FLASHING F C �� form must be a.Building Name/Building Location b.Building# c.Wing d.Floor e.Room completed in order to comply with 4. Is the facility occupied? ❑✓ Yes ❑No DEP notification requirements of 310 CMR 7.15 5. Asbestos Contractor: and the Division of occupational DEC-TAM CORPORATION 150 CONCORD STREET Safety(DOS) a.Name b.Address notrequirements NORTH READING �y � 01864 9784702860 requirements of 453 CMR 6.12 c.Ci /Town d.Zip Code e.Telephone Number AC000035 f.DOS License Number g. Contract Type: Q Written ❑Verbal BRENT MORGENSTERN I ISALES h.Facility Contact Person i.Contact Person's Title GEORGE A. PAGE AS071933 6' a.Name of On-Site Supervisor/Foreman b.Supervisor/Foreman DOS Certification Number RPF ,� (AA000118 �' a.Name of Project Monitor b.Project Monitor DOS Certification Number_ �PF AA000118 8' a.Name of Asbestos Anal ical Lab b.Asbestos Analytical Lab DOS Certification Number 9/12/2013 9/12/2013 ����—� 9' a.Pro'ect Start Date mm/dd/yyyyL_ b.End Date mm/dd/ _o 7A-4P �N c.Work hours Mon-Fri. d.Work hours Sat-Sun. =o 10. a. What type of project is this? —o ❑ Demolition Q Renovation ❑ Repair ❑ Other, please specify: b.Describe 11. a. Check abatement procedures: O ❑Glove bag F-1 Encapsulation o ❑ Enclosure ❑ Disposal only _u_ ❑Cleanup [✓]Other, specify: BTAPE/WSIGNS/PDROP/RMOTENVMETHODS ❑ Full containment b.Describe —z =Q 12. Is the job being conducted: ❑ Indoors? ❑✓ Outdoors? � anf001ap.doc•10!02 Asbestos Notification Form•Page 1 of 3� Commonwealth of Massachusetts 100184324 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 10 encs sulated: —�—� 20 a.Total pipes or ducts(linear ft) 6. 1 otal other su aces square c.Boiler,breaching,duct,tank d.Insulating cement i ------� �� surface coatings Lin.ft. (Sq.ft. (LLiin.ft. Sq.ft. e.Corrugated or layered paper t L�J f.Trowel/Sprayer coatings L� pipe insulation Lin.ft. Sq.ft. Lin.ft. Sq.ft. g.Spray-on fireproofing h.Transite board,wall board Lin.ft. Sq.ft. Lin.ft. I.Cloths,woven fabrics [� L� j.Other,please specify: L 20 Lin.ft. sq.ft. _ Lin.ft. sq.ft. k.Thermal,solid core pipe C� lROOF FLASH ^` insulation Lin.ft. Sq.ft. I.Specify 14. Describe the decontamination system(s)to be used: THREE STAGE 15. Describe the containerization/disposal methods to comply with 310 CMR 7.15 and 453 CMR 6.14(2) (g): MATERIALS WILL BE WETTED AND PLACED IN DOUBLE BAGS AND LABELED FOR TRANSP 16. For Emergency Asbestos Operations, the DEP and DOS officials who evaluated the emergency: a.Name of DEP Officialb.Title cc.Dat /yyyy)of Authorization � d.DEP Waiver# e.Name of DOS Official f.DOS OfficialTitle _ I _ N g.Date(mm/dd/yyyy)of Authorization h.DOS Waiver# � 0 17. Do prevailing wage rates as per M.G.L. c. 149, §26, 27 or 27A—F apply to this project? []✓ Yes[]No B. Facility Description 04 I �o 1. Current or prior use of facility: WASTE WATER TREATMENT PLANT o ❑ 2. Is the facility owner-occupied residential with 4 units or less? ❑Yes No �T TOWN OF NORTH ANDOVER348 OSGOOD STREET �T 3' a.Facilit Owner Name b.Address o NORTH ANDOVER 01845 _ 978.794-1503 o c.Cit /Town d.Zip Code e.Telephone Number area code and extension �LL 4 STEPHEN FOSTER I ISAME AS ABOVE a.Name of Facility Owner's On-Site Manager_ b.On-Site Manager Address Z L( ( �Q c.City/Town d.Zip Code e.Telephone Number(area code and extension) anf001 ap.doc-10102 Asbestos Notification Form-Page 2 of 3 Commonwealth of Massachusetts _ 100184324 Asbestos Notification Form ANF-001 Decal Number LL-A B. Facility Description (cont.) 5. 1 1 L a.Name of General Contractor b.Address c.Cit /Town d.Zip Code e.Telephone Number area code and extension GREAT DIVIDE INS. CO I JWCA15372661012/28/2013 !� f.Contractor's Worker's Comp.Insurer q.Policy Number h.Exp.Date(mm/dd/ 6. What is the size of this facility? 14000 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 Transporter b.Address Stations must (I comply with the c.City/Town d.Zip Code 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 ISERVICE TRANSPORT 158 PYLES LANE a.Name of Transporter b.Address NEW CASTLE, DE 19720 1 18779999559 c,_City/Town d.Zi Code e.Telephone Number 3. 11 L- a.Refuse Transfer Station and Owner b.Address c.Ci /Town d.Zip Code e.Telephone Number 4. IMINERVA ENTERPRISES INC I I(-- ` a.Final Disposal Site Location Name b.Final Disposal Site Location Owner's Name 9000 MINERVA ROAD I IWAYNESBURG c.Final Dis osal Site Address d.Ci /Town OH 44688 e.State f.Zip Code g.Telephone Number CO O cl D. Certification N E �g The undersigned hereby states, under the BRENT MORGENSTERN Brent Morgenstern 0penalties of perjury, that he/she has read the a.Name b.Authorized Signature �o Commonwealth of Massachusetts regulations SALES 8/28/2013 for the Removal,Containment or �.- c.Position/Title d.Date(mm/dd/vvw) _ Encapsulation of Asbestos,453 CMR 6.00 and 1977847028660 DEC-TAM r 310 CMR 7.15, and that the information t contained in this notification is true and correct e.Telephone Number f.Representing _0 to the best of his/her knowledge and belief. 50 CONCORD STREET o q.Address NORTH READING 01864 Z h.City/Town i.Zip Code � 4 anf001 ap.doc•10/02 Asbestos Notification Form•Page 3 of 3 ..,........ ..... �.,J.,»... ....yo.,,..uvY...vY.a..uw.sv.,.urjw,• .uau.wvvN..uo Nn f 1 MassDEP Home i Contact i Privacy Policy MassDEP's Online Filing System Usemame:DECTAM Nickname:DECTANEDEP My eDEP Formscm My Profiles Help [ Receipt r-- �i---- •-- Forms Signature Receipt Summary/Receipt print receipt Exit Your submission is complete. Thank you for using DEP's online reporting system. You can select"My eDEP"to see a list of your transactions. DEP Transaction ID: 590263 Date and Time Submitted: 8/28/2013 1:32:51 PM Other Email : Form Name: AQ 04-Asbestos Removal Notification Form ANF-001 Payment Information DEP code Date Amount($) Billing Info Contractor Contractor Number: AC000035 Name: DEC-TAM CORPORATION Address: 50 CONCORD STREET, NORTH READING, MA 01864 978-470-2860 Supervisor GEORGE A. PAGE Project Monitor Lab Location ROOF-FLASHING Project Start Date 9/12/2013 My eDEP MassDEP Home Contact 1 Privacy Policy MassDEP's Online Filing System ver.11.18.1.0© 2013 MassOEP Of] 8/28/2013 1:33 P.M L Form 3 \ DEOE Fite No CqyrTown North Andover Commonwealth \ — of MassachusettsA,plicaDivision of Public Work A' Notice of Intent Under the Massachusetts Wetlands Protection Act, G.L. c. 131, §40 and Application for a Department of the Army Permit Pori is General Information 1. Location: Street Address 420 Great POnd Road Nori,h Andover • MA Lot Number 2. Project:Type Construction Description Applicant proposes to construct a new water treatment plant, including appurtenant structures, adjacent to. ... Lake Cochichewick in the town of North Andover. S. Registry: County Curren+,Book 8 F2ge Certificate (If Registered Land) N/A 4 Applicant Division of Public Works, Town of No. AndoverTe1 (617) 687-7964 Address 384 Osgood Street, North Andover, MA 01845 5. Property Owner Town of North Andover Tel. 682-6483 Address 120 Main Street, North Andover, MA 01845 6. Representative M. Anthony Lally Associates Te1 (617) 688-1763 Address 100 Belmont Street, North Andover, MA 01845 7. Kave the Conservation Commission and the DEOE Regional Office each.been sent,by cerci",ed mail or hand delivery, 2 copies of completed Notice of intent, with supporting pla is and documents? Yes C No O 3.1 - ;7 t 1 Town of North Andoverf NORTH O "', •1k Office of the Conservation Department 32 FO- A Community Development and Services Division : ice 1600 Osgood Street, Building 20 Suite 2-64 'SS�cHus�t North Andover,Massachusetts 01845 Alison McKay Telephone (978) 688-9530 Conservation Administrator Fax (978) 688-9542 May 11, 2006 Tara McManus Weston & Sampson Engineers 5 Centennial Drive Peabody, MA 01960-7985 RE: Installation of a Fence at the North Andover Treatment Plant—420 Great Pond Road Dear Ms. McManus: I have reviewed a plan submitted by your office showing a proposed chain link around the North Andover Water Treatment facility at the above referenced address. It is my understanding that this fence is being proposed around the facility for security purposes. Upon this review it was noted that a very limited portion of the fence would be located within the 25' No-Disturbance zone of the lake. The Conservation Department has determined however, that this limited disturbance of fence install will not adversely impact the adjacent resource area, is minor in nature, and is further necessary for security at the site. Therefore, the Department has further determined that the installation of the fence in these locations can be allowed without a filing with the North Andover Conservation Commission(NACC). Please be aware, however, that any future activity proposed within 100 feet of this wetland resource area may be subject to a filing with the NACC as required pursuant to the Wetlands Protection Act(Chapter 131, section 40)the North Andover Wetlands Protection Bylaw (Chapter 178 Code of North Andover). Please feel free to contact me at any time should you have any further questions or concerns in this regard. Resp fully, Alison E. McKay Conservation Administrator Cc: Dennis Bedrosian, Superintendent Pamela Merrill, Conservation Associate Lincoln Daley, Town Planner Building File BOARD OF APPEALS 688 9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 � a C5 I 4.1 ! j 1 i'�jiJIWINV• � \ I � ', dN U_ N� pp �o CD>`!IZ. R13A111N WK PKI!�G L � a 170 1 ilr rNi ! Y 1 op TR LN I l 1 H ss f, M AP 1900