HomeMy WebLinkAboutMiscellaneous - 522 MAIN STREET 4/30/2018 (2) 522 MAIN STREET
210/071.0-0044-0000.0
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Air Quality Experts, Rnea
(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
November 18, 2005
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D
005
North Andover Health Department
146 Main St. T ATH NDOVER
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 11/15105.
Project: 524 Main St
Any questions concerning this matter should be directed to my attention.
Sincerely,
r
Christopher Thompson
President
i
Commonwealth of Massachusetts
025293
Asbestos Notification Form ANF-00Ll
R p
Nov r �
5 2005
T WN
Important:
When filling out p 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? i✓/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:
Maureen Cushing 1524 Main St
a.Name of Facility _ b.Street Address
North Andover ___._� .IMA 01845 f978)682-6257 _ _7
c.City/Town d.State e.Zip Code f.Telephone Number
INSTRUCTIONS
3. Worksite Location:
1.All sections of the I[�aSement
form must be a.Building NameiBuilding Location b.Building# c.Wing d.Floor e.Room
completed in order
to comply with 4. Is the facility occupied? Z Yes El No
DEP notification
requirements of 310
CMR 7.15 5. Asbestos Contractor:
and the Division - — -------- —
of Occupational AIR QUALITY EXPERTS INC 40 LOWELL RD UNIT 1_
Safety(DOS) a. Name _ b.Address
notication
i
requirements of 453 M SALE03079` 11603-894-6465
e ume
CMR 6.12 c.City/Town_ d.Zip Code e.Telephone Number
AC000167
f.DOS License Number �� g. Contract Type: ❑Written IE/]Verbal
h.Facility Contact Person i.Contact Person's Title
GERMAN POSADA ZINIGA - `-� AS032579
6' j-,—N 1
ame of On-Site Supervisor/Foreman _ b.Supervisor/Foreman DOS Certification Number
7 Crichard salvatelli IAM030636 _
a.Name of Project Monitorn/a b. Project Monitor DOS_Certification Number
� �._.� n/a
8. a.Name of Asbestos Analytical Lab b.Asbestos Analvtical Lab DOS Certification Number
ate�mm/
a.Project Start Ddd/yyyy) _ b.End Date(mm/dd/yyyy) _ A
=o Sam-4pm
N C.Work hours Mon-Fri. d.Work hours Sat-Sun.
�o 10. a. What type of project is this?
�o ❑ Demolition Renovation
❑ Repair �, Other, please specify: b.Describe
11. a. Check abatement procedures:
�e
° ❑ Glove bag L7 Encapsulation
o ❑ Enclosure Disposal only
�LL ❑Cleanup C] Other, specify:
�— FY] Full containment b.Describe
r--Q 12. Is the job being conducted: ✓[] Indoors? ❑Outdoors?
® anf001 ap.doc•10/02 Asbestos Notification Form•Page 1 of 3
Commonwealth of Massachusetts _
100025293
Asbestos Notification Form ANF-001 Decal Number
Ll
�I
A. Asbestos Abatement Description (cont.)
13. Total amount of each type of Asbestos Containing Materials(ACM)to be removed, enclosed, or
X90encapsulated: 40
�. _._._.._._._._..._..._
Ia.Total pipes or ducts(linear ft) E b`T0 aTother surfaces squared _
c. Boiler,breaching,duct,tank 40
d,Insulating cement
surface coatings Lin.ftwSq.ft. Lin.ft. (S�q.ft.
e.Corrugated or layered paper 90»- = ( !
pipe insulation f.Trowel/Sprayer coatings �'�'`�
Lin.ft. Sq.ft. Lin.ft. Sq.ft.
r--
g.Spray-on fireproofing — = h.Transite board,wall board
Lin.ft. Sq.ft. Lin.ft. Sq.ft.
L Cloths,woven fabrics �--- j.Other,please specify: —— t _J
Lin.ft. Sq.ft. Lin.ft. S ft.
k.Thermal,solid core pipe = = I _��._
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):
wet 2 ply poly
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/yyyy)of Authorization (dd..DEP Waiver#
e.Name of DOS Official f. ;;Official Title
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? E]Yes 0 No
_0 B. Facility Description
�o N i--- --_
�0 1. Current or prior use of facility: residence
�o
2. Is the facility owner-occupied residential with 4 units or less? [✓j Yes 0 No
3'
same as location
a.Facility Owner Name b.Address _ _f
o c.City/Town d.Zip Code e.Telephone Number(area code and extension)
ILL
��- a.Name of Facility Owner's On-Site Manager b.On-Site Manager Address
�Q c.City/Town d.Zip Code e.Telephone Number(area code and extension)
• anf001 ap.doc•10/02 Asbestos Notification Form•Page 2 of 3
Commonwealth of Massachusetts
100025293
Asbestos Notification Form ANF-001 Decal"umber
Ll
B. Facility Description (cont.)
5. a. Name of General Contractor b.Address
c.City/Town d.Zip Code e.Telephone Number(area code extension
f.Contractor's Worker's Comp.Insurer g.Policy Number h.Exp.Date mm/d�yyy
6. What is the size of this facility?
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):
lAtr Quality Experts,Inc
E.�..�.
Note:Transfer a.Name of Transporter b.Address
Stations must I --�� E-- =
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 (Service Transport group po=box
a.Name of Transporter _ b.Address
(bristol _ __ 19007_ x(877 99 9559 �—�
c.City/Town d.Zip Code e.Telephone Number _�
3. .
a.Refuse Transfer Station and Owner b.Address
c.City/Town _ _ d.Zip Code e.Telephone Number
4. 1&L SALVAGE INC 7
a.Final Disposal Site Location Name b.Final Disposal Site Location Owner's Name
11225 STATE ROUTE 45 _ _ ,LISBON
c.Final Disposal Site Address _ d.City/Town
OH 44432
�M e.State f.Zip Code g.Telephone Number
�o
D. Certification
aN
The undersigned hereby states, under the christopher thompson
penalties of perjury,that helshe has read the a.Name b.Authorized Signature
Commonwealth of Massachusetts regulations —��
��- president
for the� Removal,Containment or.- c Position/Title d. Date mm/dd/wyy
Encapsulation of Asbestos,453 CMR 6.00 and
r 310 CMR 7.15, and that the information (603)894-6465 _] air quality experts, inc
-� contained in this notification is true and correct e.Telephone Number f.Representing
to the best of his/her knowledge and belief. 40 lowell rd unit 1 _�
G g.Address _
i u_ Isallern 03079
Z h.City/Town i.Zip Code
® anf001ap.doc•10102 Asbestos Notification Form•Page 3 of 3