HomeMy WebLinkAboutMiscellaneous - 72 HAROLD STREET 4/30/2018JANE SWIFT
Governor
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
Metropolitan Boston — Northeast Regional Office
Laura McKenna
72 Harold Street
North Andover, Massachusetts 01845
Dear Ms. McKenna:
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IN 082001
RE: NORTH ANDOVER
72 Harold Street
RTN # 3-21152
RELEASE NOTIFICATION
& NOTICE OF RESPONSIBILITY;
MGL c. 21E & CMR 40.0000
BOB DURAND
Secretary
LAUREN A. LISS
Commissioner
On October 12, 2001 at 10:00, p.m., the Department received oral notification of a
release/threat of release of oil/hazardous material at the subject location. The Department has
reason to believe that the release/threat of release which was reported is or may be a disposal site as
defined in the Massachusetts Contingency Plan (MCP), 310 CMR 40.0000. The Department also
has reason to believe that you (as used in this letter "you" refers to Laura McKenna) are a
Potentially Responsible Party (PRP) with liability under Section 5A of M.G.L. c. 21E. This liability
is "strict" meaning that it. is not based on fault but solely on your status as owner, operator,
generator, transporter, disposer or other person specified in Section 5A. This liability is also "joint
and several', meaning that responsible parties are liable for all response costs incurred at a disposal
site even if there are other liable parties.
The Department encourages parties with liabilities under M.G.L. c. 21E to take prompt
action in response to releases and threats of release of oil and/or hazardous material. By taking
prompt action, you may significantly lower your assessment and cleanup costs and avoid the
imposition of, or reduce the amount of, certain permit and annual compliance fees for response
actions payable under 310 CMR 4.00. Please refer to M.G.L. c. 21E for complete description of
potential liability.
This information is available in alternate format by calling our ADA Coordinator at (617) 574-6872.
205A Lowell St. Wilmington, MA 01887 • Phone (978) 661-7600 • Fax (978) 661-7615 • TTD# (978) 661-7679
Z,4 Printed on Recycled Paper
Laura McKenna
Page -2-
GENERAL RESPONSE ACTION REQUIREMENTS
The subject site shall not be deemed to have had all the necessary and required response
actions taken unless and until all substantial hazards presented by the site have been eliminated and
a level of No Significant Risk exists or has been achieved in compliance with M.G.L. c. 21E and
the MCP. In addition, the MCP 'requires persons undertaking response actions at disposal sites to
perform Immediate Response Actions (IRAs) in response to "sudden releases", Imminent Hazards
and Substantial Release Migration. Such persons must continue to evaluate the need for IRAs and
notify the Department immediately if such a need exists.
You must employ orengage a Licensed Site Professional (LSP) to manage, supervise or
actually perform the necessary response actions at the subject site. In addition, the MCP requires
persons undertaking response actions at a disposal site to submit to the Department a Response
Action Outcome Statement (RAO) prepared by an LSP in accordance with 310 CMR 40.1000 upon
determining that a level of No Significant Risk already exists or has been achieved at a disposal site
or portion thereof. [You may obtain a list of the names and addresses of these licensed professionals
from the Board of Registration of Hazardous Waste Site Cleanup Professionals at (617) 556-1091.]
There are several other submittals required by the MCP which are related to release
notification and/or response actions that may be conducted at the subject site in addition to an RAO,
that, unless otherwise specified by the Department, must be provided to DEP within specific
regulatory timeframes. The submittals are as follows:
(1) If information is obtained after making an oral or written notification to indicate that the
release or threat of release didn't occur, failed to meet the reporting criteria at 310 CMR
40.0311 through 40.0315, or is exempt from notification pursuant to 310 CMR 40.0317, a
Notification Retraction may be submitted within 60 days of initial notification pursuant to
310 CMR 40.0335; otherwise,
(2) If one has not been submitted, a Release Notification Form (RNF) [copy attached] must be
submitted to DEP pursuant to section 310 CMR 40.0333 within 60 calendar days of the
initial date of oral notification to DEP of a release pursuant to 310 CMR 40.0300 or from
the date the Department issues a Notice of Responsibility (NOR), whichever occurs earlier;
(3) Unless an RAO or Downgradient Property Status Submittal is provided to DEP earlier, an
Immediate Response Action (IRA) Plan prepared in accordance with 310 CMR 40.0420, or
an IRA Completion Statement (3 10 CMR 40.0427) must be submitted to DEP within 60
calendar days of the initial date of oral notification to DEP of a release pursuant to 310
CMR 40.0300 or from the date the Department issues an NOR, whichever occurs earlier;
and
Laura McKenna
Page -3-
(4) Unless an RAO or Downgradient Property Status Submittal is provided to DEP earlier, a
completed Tier Classification Submittal pursuant to 310 CMR 40.05 10, and, if appropriate,
a completed Tier I Pen -nit Application pursuant to 310 CMR 40.0700, must be submitted to
DEP within one year of the initial date, of oral notification to DEP of a release pursuant to
310 CMR 40.0300 or from the date the Department issues an NOR, whichever occurs
earlier.
(5) Pursuant to the Department's "Timely Action Schedule and Fee Provisions", 310 CMR
4.00, a fee of $750 must be included with an RAO statement that is submitted to the
Department more than 120 calendar days after the initial date of oral notification to DEP of
a release pursuant to 310 CMR 40.0300 or after the date the Department issues an NOR,
whichever occurs earlier, and before Tier Classification. A fee is not required for an RAO
submitted to the Department within 120 days of the date of oral notification to the
Department, or the date the Department issues an NOR, whichever date occurs earlier, or
after Tier Classification.
It is important to note that you must dispose of any Remediation Waste generated at the
subject location in accordance with 310 CMR 40.0030 including, without limitation, contaminated
soil and/or debris. Any Bill of Lading accompanying such waste must bear the seal and signature of
an LSP or, if the response action is performed under the direct supervision of the Department, the
signature of an authorized representative of the Department.
If you have any questions relative to this notice, you should contact the undersigned at the
letterhead address or (978) 661-7600. All future communications regarding this release must
reference the Release Tracking Number (RTN # 3-21152) contained in the subject block of this
letter.
Chief, Notificatio`Branch
Emergency Response's
MBC/cjc
cc: N. Andover Board of Health, 27 Charles St., N. Andover, MA 01845
N. Andover Fire Headquarters, 124 Main St., N. Andover, MA 01845
Attachment: Release Notification Form; BWSC -103
DEP data entry/file -
6/14/2016
20581
This is an e -permit. To learn more, scan this barcode or visit northandoverma.viewpointcloud.com/#/records/20581
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PERMIT FOR PLUMBING
This certifies that Daniel J Doore
has permission to perform complete rough, finish plumbing for single family
plumbing in the buildings of MC KENNA JR, WILLIAM S
at 72 HAROLD STREET, North Andover, Mass.
Lic. No. 24393
Date: June 14, 2016
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TIMELINE
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Jun 13,2015.1911—
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Monday, Jun 13, 2016 09:30 AM
Your request is in progress
We'll let you know of any updates via email. feel free to check the
status at any time by coming back to this page.
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Daniel Doore 72 HAROLD STREET, NORTH ANDOVER,
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MC KENNA JR, WILLIAM S
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Primary Contractor
Search for your contractor using the search bar below. Either the Firm's Name or licensee 9 is
required.
:,rm s (]usine::)'deme ,umber's Nerne (Licensee) "
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Name
The Commonwealth of Massachusetts
Department of IndustrialAccidents
1 Congress Street, Suite 100
= Boston, MA 02114-2017
www massgov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
City/State/Zip: �_�.t� `�7/��-� Phone #:
Are you an employer? Check the appropriate box:
1. ❑Vlaa employer with employees (full and/or part-time).*
2.a sole proprietor or partnership and have no employees working for me in
any capacity. [No workers' comp. insurance required.]
3.FJ I am a homeowner doing all work myself [No workers' comp. insurance required.] t
4. ❑ I am a homeowner and will be hiring contractors to conduct all work on my property. I will
ensure that all contractors either have workers' compensation insurance or are sole
proprietors with no employees.
5. ❑ I am a general contractor and I have hired the sub -contractors listed on the attached sheet.
These sub -contractors have employees and have workers' comp. insurance.$
6. Q We are a corporation and its officers have exercised their right of exemption per MGL c.
152, § 1(4), and we have na. employees. [No workers' comp. insurance required.]
Type of project (required):
7. [] New construction
8. 0 Remodeling
9. ❑ DemoIition
10 ❑ Building addition
I L, Electrical repairs or additions
12.F] Plumbing repairs or additions
13. n Roof repairs
14. ❑ Other
"Any applicant that checks box 41 must also full out the section below showing their workers' compensation policy information.
t Homeowners who suhniif #his affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
#Contractors that check this box must•attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have
employees. 'if the sub-corilractors fiave employees, they must provide their workers' comp. policy number.
I am an employer that is providing workers' compensation insurance for my employees.' Below is the policy and job site
information.
Insurance Company Name:
Policy # or Self -ins. Lie. M Expiration Date:
Job Site Address: �� _� It ,City/State/Zip:
Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by a fine up to $1,500.00
and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a
day against the violator. A copy of this statement may be forwarded to the Office of Investigations of the DTA for insurance
coverage verification.
Ido hereby certify under the pains and p nalties ofperjury that the information provided above istrue and co ect.
sign e: �i ��� Date -T7 /
Official use only. Do not write in this area, to be completed by city or town official
City or Town:
Permit/License
Issuing Authority (circle one): ;
1. Board of Health 2. Building Department 3. City/Town Clerk 4 Electrical Ins ector 5 Plumb in Ins ector
• P g
6. Other P
Contact Person:
Phone
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of &e,
express or implied, oral or written."
An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more
of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the
receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the
dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required"
Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall.
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill -out the workers' compensation affidavit completely, by checking the -boxes that apply to your situation and, if
necessary, supply sub-contractor(s) name(s), address(es) and -phone number(s) along with their certificate(s) of
insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees 'other than the
members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have
employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents fbi confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requested, not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy, please call the Department at the number listed below. Self-insured companies should'enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant
that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current
policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or
town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit.
The Department's address, telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
1 Congress Street, Suite 100
Boston, MA 02114-2017
Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE
Fax # 7-727-7749
Revised 02-23-15 WWw.mass.gov/dia