HomeMy WebLinkAboutMiscellaneous - 52 PHILLIPS COURT 4/30/2018 i
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Air Quality Experts, Inc.
(603)'894-6465 Asbestos Removal
(800) 621-1189 40 Lowell Road, Unit 1 Residential-Commercial-Industrial
(603) 894-7044 FAX Salem, NH 03079 AirQualityExperts@AQENH.com
October 11, 2004 C�IV
OCT 14
rowiv of;
North Andover Health Department _HEALa41
146 Main St
No. 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 10/29/04.
Project: 52 Phillips Court
Any questions concerning this matter should be directed to my attention.
Sincerely,
Christopher Thompson
President
Commonwealth of Massachusetts _
100010176
Asbestos Notification Form ANF-o -'---RE
Decal Number
� �.. _..__.
E
(
OCT 1-4 2004 e
4
Important: VV N U F N 0 RT
When filling out A. Asbestos Abatement Description HEALTH DEP'• Tt`�a`,! ..._S
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? Z Yes 0 No _
to move your
cursor-do not b. Provide blanket decal number if applicable: Blanket Decal Number
use the return
key. 2. Facility Location:
SUSAN ARMITAGE 52 PHILLIPS COURT
a. Name of Facility b.Street Address _
north andover MAT 101845 (978)794-0372
c.City/Town d.State e.Zip Code f.Telephone Number
INSTRUCTIONS 3. Worksite Location:
1.All sections of this BASEMENT
form must be a.Building Name/Building Location b.Building q c.Wing d. Floor e.Room
completed in order
to comply with 4. Is the facility occupied? ✓(Yes n No
DEP notification
requirements of 310
CMR 7.15 5. Asbestos Contractor:
and the Division
of Occupational AIR QUALITY EXPERTS INC 140 LOWELL RD UNIT 1
Safety(DOS) a. Name ~ _ b.Address
notification SALEM 03079m� 6038946465
requirements of 453
CMR 6.12 c.Cit /Town d.ZiCode e.Telephone Number
AC000167
f.DOS License Number g. Contract Type: �✓ Written ❑Verbal
g8GER�fANPOSADA
Contact Person i.Contact Person's Title
6 ZINIGA AS032579m
a. Name of On-Site Supervisor/Foreman b.Supervisor/Foreman DOS Certification Number
RICHARD SALVATELLI JAM030636
7' a.Name of Project Monitor �� b Project Monitor DOS Certification Number
N/A N/A
8' a.Name of Asbestos Analytical Lab b.Asbestos Anal tical Lab DOS Certification Number
10/29/2004 10/29/2004
W_0 9. a. Project Start Date mm/dd/ _ b. End Date mm/dd/yyyy) "�
_..___.� _S Y�Y��____ _ . _
0 7AM-4PM Ij
�N c.Work hours Mon-Fri. d.Work hours Sat-Sun.
0 10. a.What type of project is this?
==0 ❑ Demolition Q Renovation
❑ Repair E]Other, please specify: b.Describe
11. a. Check abatement procedures:
o El Glove bag Encapsulation
o [l Enclosure [_1 Disposal only
�,_ ❑Cleanup 0 Other, specify:
�— Q Full containment b.Describe
Q 12. Is the job being conducted: F71 Indoors? El Outdoors?
anf001 ap.doc-10/02 Asbestos Notification Form-Page 1 of 3
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Commonwealth of Massachusetts 13
F9910176
_----
----------
._...........
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
enca sulated:
100 50 �
a.Total pipes or ducts(linear ft) b.Total other surfaces (square ft)
c.Boiler,breaching,duct,tank 50d. Insulating cement
surface coatings Lin.ft. Sq.ft. Lin.ft. Sq.ft.
e.Corrugated or layered paper
pipe insulation Lin,ft. Sq f.Trowel/Sprayer coatings Lin.ft. Sq.ft.
g.Spray-on fireproofing Lin.ft. Sq 1 h.Transite board,wall board Lin.ft. Sq.
L Cloths,woven fabrics L�----J i.Other,please specify: F �
Lin.ft. S ft. Lin.ft. SQ..ft.
k.Thermal,solid core pipe 100
insulation Lin.ft. Sq.ft. I.Specify
14. Describe the decontamination system(s) to be used:
3 CHAMBER DECON
15. Describe the containerization/disposal methods to comply with 310 CMR 7.15 and 453 CMR
6.14(2) (g): _
2 PLY WET POLYBAG
16. For Emergency Asbestos Operations,the DEP and DOS officials who evaluated the emergency:
a.Name of DEP Official b.Title
c.Date mm/dd/ yy)of Authorization d.DEP Waiver r*
e.Name of DOS Official f.DOS Official Title
W�N g.Date (mm/dd/yyyy)of Authorization h. DOS Waiver N �_-
��0 17. Do prevailing wage rates as per M.G.L. c. 149, §26, 27 or 27A-F apply to this project? 0 Yes Z No
=o
B. Facility Description
�0 1. Current or prior use of facility: RESIDENCE
�o
2. Is the facility owner-occupied residential with 4 units or less? C✓ Yes [-I No
3 SAME AS LOCATION
�� a.Facility Owner Name ( b.Address
o cc.City/Town
_ _ d.Zip Code e.Telephone Number area code and extension
.mow_ 4.
a.Name of FacilityOwner's On Site Manager b.On-Site Mana er Address
�Q c.City/Town d.Zip Code e.Telephone Number(area code and extension)
anf001 ap.doc•10/02 Asbestos Notification Form•Pa e 2 of 3
Commonwealth of Massachusetts 93
100010176
Decal Number
Asbestos Notification Form ANF-001
B. Facility Description (cont.)
5' a.Name of General Contractor T b.Address
c.Cit /Town d.ZiECode e.Telephone Number area code and extension
f.Contractor's Worker's Comp.Insurer . Policy Number h.Exp.Date mm/dd/yyyy
6. What is the size of this facility? a--��
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):
AIR QUALITY EXPERTS, INC ___
Note:Transfer aa.Name of Transporter b.Address
Stations must
comply with the c.City/Town d.Zip P 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 SERVICE TRANSPORT GROUP W� PO BOX 2132
a. Name of Transporter b.Address
BRISTOL _ 19007 ®� (877)999-9559
c.Cit own d.Zi Code e.Telephone Number
3.
a.Refuse Transfer Station and Owner b.Address
c.Cit /Town d.Zi Code e.Telephone Number
4. A 8r L SALVAGE INC
a.Final Disposal Site Location Name b.Final Disposal Site Location Owner's Name
11225 STATE ROUTE 45 T !LISBON �
c.Final Disposal Site Address _ d.Cit /Town
OH
�M e.State f.Zip Code g.Telephone Number
0
®o D. Certification
N _
�
HRISTOPHER THThe undersigned hereby states, under the COMPS
penalties of perjury,that he/she has read the a. Name b.Authorized i nature
�o Commonwealth of Massachusetts regulations PRESIDENT 10/11/2004
for the Removal, Containment or
c. Position/Title d. Date(mm/dd/vvv
Encapsulation of Asbestos,453 CMR 6.00 and (603)894-6465 {AIR QUALITY EXPERTS,
310 CMR 7.15, and that the information
contained in this notification is true and correct e.Telephone Number f.Re resp-
into the best of his/her knowledge and belief. 140 LOWELL RD UNIT 1
.Address _
�u SALEM �� 03079 __
Z
h.City/Town i.Zip Code
Q
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