HomeMy WebLinkAboutMiscellaneous - 53 MAY STREET 4/30/2018 e
53 MAY STREET
�. 210/018.0-0004-0000.0
r
i
it Quality Experts, Inc.
Asbestos Removal
Christopher Thompson 40 Lowell Road, Unit 1
(603) 894-6465 Residential-Commercial-Industrial
Salem, NH 03079 1-800-621-1189
May 10, 1999
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 May 21, 1999.
Project: 53 May Street
Any questions concerning this matter should be directed to my attention.
Sincerely,
Christopher Thompson
President
f Sc
�sdestosNotificationMR-AYf001
AsbestosAbateme�tDesciiptio� # 4, ,. to �:..
1. Facility location:
William Deyermonp 53 May Street
Name Address
INSTRUCTIONS North Andover,MA 01844 (978)683-0382
1.All sections of this ClWown Zip code Telephone
form must be
completed in order to Basement
comply with the What is the worksite location?9111/ding name,#, wing,flool,room
Department of
Environmental 2. Is the facility occupied? ® Yes ❑ No
Protection
notification
requirements of 310
CMR 7.15(ten working 3. Asbestos Contractor:
days prior notification
Is required of any Air Quality Experts,Inc. 40 Lowell Road Unit 1
abotementproject)
and the Department Name Address
of Labor and
Industries Salem,NH 03079 (603) 894-6465
notification ClolITown Zip code Telephone
requirements of 453
CMR 6.12(ten dayAC 000167 Written
's
prior notification is DLI License# Contract Type(Written or verbal)
required ofANr
abatementproject 4. On-Site Project Supervisor/Foreman:
greater than three
linear or square feet)
2.submit original Joseph Sharpe AS 30725
Form To: Name DLI Certification#
Commonwealth of
Massachusetts 5. Project Monitor:
Asbestos Program
P.O.B.120087-0087
NorMast Environmental AA000153
3.This Form may be Name DLI CeiVflcation#
used for notifying the
U.S.Environmental
Protection Agency 6. Asbestos Analytical Lab:
Region 1 of asbestos
demolition/renovation
operations subject to Same
NESHAPS(40 CFR Name &ICettiflcation#
Subpart M).
7. Project start date 05/21/1999 end date 05/21/1999 specific work hours(Mon.-Fri.)7am4nm(Sat.-Sun.)
For Official Use Only
B. What type of project is this? demolition repai ovatio 0ther(exp/a/n)
NotiFlwtion# ren
9. Describe the asbestos abatement procedures to be used: lovebag enclosure lcontainmen
Receive date cleanup encapsulation d/5,0058/only other(explain)
Receiver
10. Is the job being conducted ®indoors ❑outdoors?
Permit Approve/Denied
Decision date 11. Total amount of each type of Asbestos Containing Materials(ACM)to be handled on pipes or ducts(linear ft.) 170 or other
surfaces(square ft.) to be removed,enclosed or encapsulated:
Linear Square feet Linear Square feet
Boileibleaching,duct,tank surface matings Thermal,so/id core pipe insulation
Corrugated or layered paper pipe insulation 170 Insulating cement
5p-y-on Areprrwfing Trowe//sprayer—&ngs
Cloths,woven fabric Transite board,wall board
other(please describe) Other(please de—lbe)
12. Describe the decontamination system(s)to be used:
13. Describe the containerization/disposal methods to comply with 310 CMR 7.15 and 453 CMR 6.14(2)(g):
Wet removal into 6 mil Poly Asbestos Labeled Bags.
14. For Emergency Asbestos Abatement Operations,the DEP and DLI officials who evaluated the emergency:
Name of DEP OlAnal Title
Date ofAuthorizalion Waiver#
Name ofDLIOf>icial Title
Date ofAuthotization Waiver#
Rev.6/92 15. Do prevailing wage rates apply as per M.G.L.c. 149,§26,27,or 27A-F to this project? ❑Yes 0 No
t
faci/ify0escription
1. Current or prior use of facility:
Residentail
2. Is the facility owner-occupied residential with 4 units or less? ®Yes ❑No
3. Facility Owner:
William Deyermonp 3 May Street
Name Address
North Andover,MA 01844 (978)683-0382
04ty17bwn Z/p code Telephone
4. Facility's Owner's On-Site Manager:
Name Address
CityWTown Zip code Telephone
5. General Contractor:
Name Address
CiIVTown Zip code Telephone
Contractor's Workers Camp.Insurer Po//ry# Exp.Date
6. What is the size of the facility?3.000(sq ft)2(#floors)
AsheslosTransportationandDisposa/ - - -
1. Transporter of asbestos-containing waste material from site to temporary storage site(if necessary)to final disposal site?
Air Quality Experts,Inc. 40 Lowell Road,Unit 1
Name Address
Salem,NH 03079 (603)894-6465
C/tyWTown Zip code Telephone
2. Transporter of asbestos-containing waste materials from removal/temporary storage site to final disposal site:
J.O.B.Rolloff P. O.Box 6037
Name Address
Chelsea,MA 02150 (617)387-1495
00ty17own Z/p code Telephone
Note;Transfer 3. Refuse transfer station and owner(if applicable):
Stations must
comp/y with the Name Address
So/id Waste,
Division regula-
tions 310 CMR civrown Zip code Telephone
18.00
4. Final Disposal Site:
USA Waste of Connecticut,'Inc. L
Location Name Owners Name
203 Pickering Street
Address
Portland,CT 06480 (860)342-0667
GVTown Zip code Tel-'phone
Cerfiffewfon
The undersigned hereby states,under the penalties of perjury, that he/she has read the Commonwealth of Massachusetts Regulations
for the Removal, Containment or Encapsulation of Asbestos,453 CMR 6.00 and 310 CMR 7.15, and that the information contained in
this notification is true and correct to the best of his/her knowledge and belief.
Christopher Thompson C�C�1�iv R��ti 05/10/1999
Print Name Authorized Signature Date
Note:Contractor President Air Quality Experts,Inc. (603)894-6465
must sign this Posidon171-Ne Representing Telephone
form for DLI
notrfrcation 40 Lowell Road,Unit 1 Salem,NH 03079
purposes Address C/Vrown Zip code
Fee exempt(City,Town,'district,municipal housing authority,owner-occupied residential of four units or less)?®Yes ❑No
Sticker# (from front of form): 733966