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HomeMy WebLinkAboutMiscellaneous - 723 OSGOOD STREET 4/30/2018r -0 c ZT N —� ? N W O CDCD N O O (D W U1 chCD N' N W N-qg- +) 5' (A (A m O (D D = 3 r ❑ O p �'� o c O CD CD C- (D v o M c� CD 3 M o 3 2 Z M --i O � _ rah Cl) v O S DO D Z CDD 3 vi v DO CD o ` 0 zCD O O o 0 m CD p 3 z ❑ v 00 -n Z CL 0T O �7 N 3 CD r C 0 Z c Q v_o v Z o CD c� C) O OL m in X N N O O ❑ +h D ff��Fm W N O N A DEGTAM ENVIRONMENTAL SERVICES January 23, 2014 Mr. Stephen Foster Town of North Andover 384 Osgood Street North Andover, MA 01845 kECE'IVEli I 0 27 2014 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT RE: Stevens Estate; 723`Osgood'Street; No th Andover, MA 01845 (Gardener House- I" Floor) Dear Mr. Foster: 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 January 30, 2014 thru January 31, 2014 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 Morgenst Sales Estimator BM/cam Enclosure SO Concord Street, North Reading, MA 01864 • P: 978.470.2860 F: 978.470.1017 - www.dectam.com w J Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. ar* INSTRUCTIONS Commonwealth of Massachusetts Asbestos Notification Form ANF -001 A. Asbestos Abatement Description 2 3 1. All sections of this form must be completed in order to comply with 4 DEP notification requirements of 310 CMR 7.15 5 and the Division of Occupational Safety (DOS) notification requirements of 453 CMR 6.12 �o �o N �o �o Q LL Z a. Is this facility fee exempt - city, town, district, municipal housing a residence of four units or less? P Yes F-1 No b. Provide blanket decal number if applicable.- 2 pplicable: Facility Location: ISTEVENS ESTATE a. Name of Facility North Andover_ c. City/Town d. State s 100192028 Decal Number RECEIVED VIAN 27 2014 TOWN OF NCrt T N ANDOVER HEALTH DEPARTMENT ority, own&=occupied— Blanket Decal Number 723 OSGOOD STREET b. Street Address 1845 _� 978 685-0950 e. Zip Code �~ f. Telephone Number Worksite Location: GARDNERS HOUSE -1ST FL � ----------� a. Building Name/Building Location b. Building # c. Wing d. Floor e. Room Is the facility occupied? ❑ Yes R No Asbestos Contractor: DEC -TAM CORPORATION a. Name _ _ NORTH READING 01864 c. Cit /Town d. Zip Code AC000035 f. DOS License Number BRENT MORGENSTERN ,GEORGE A. PAGE 6' a. Name of On -Site Supervisor/Foreman RPF 7' a. Name of Project Monitor RPF 8. a. Name of Asbestos Anal ical Lab 01 /30/2014 9' a. Project Start Date mmldd/ 7A -4P c. Work hours Mon -Fri. 10. a. What type of project is this? ❑ Demolition 0 Renovation ❑ Repair [❑ Other, please specify: 11. a. Check abatement procedures.- E] rocedures: ❑ Glove bag ❑ Enclosure ❑ Cleanup ❑ Full containment ❑ Encapsulation ❑ Disposal only ❑✓ Other, specify: 50 CONCORD STREET b. Address 9784702860 e. Telephone Number g. Contract Type: Q Written ❑ Verbal I b. Describe CRIT BARRJSPLASH GUARDS/NEGAIR/DEC b. Describe 12. Is the job being conducted: .✓Z Indoors? ❑✓ Outdoors? 0 anf001ap.doc•10/02 /quic)(i Y, Asbestos Notification Form - Page 1 of 3 0 r l Commonwealth of Massachusetts LL Asbestos Notification Form ANF -001 L .1 A. Asbestos Abatement Description (cont.) ■ 100192028 Decal Number 13. Total amount of each type of Asbestos Containing Materials (ACM) to be removed, enclosed, or encs sulated: 20 1 1500 a. Total pipes or ducts (linear ft) 6. 1 oral ower su aces square c. Boiler, breaching, duct, tank C= surface coatings d. Insulating cement Lin. ft. Sq. ft. Lin. ft. e. Corrugated or layered paper ` pipe insulation f. Trowel/Sprayer coatings Lin. ft. Sq. ft. Lin . Spray fireproofing J g. -oh h. Transite board, wall board Lin. Sq. Lin i. Cloths, woven fabrics Other, 20 Lin. ft. S ft. j please specify: Lin. ft. k. Thermal, solid core pipe � CAULK/GLAZE1V 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): MATERIAL WILL BE WETTED AND PLACED IN PRELABELED BAGS FOR DISPOSAL 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/ ) of Authorization d. DEP Waiver # e. Name of DOS Official . D 5 OfficialTitle g. Date (mm/dd/yyyy) of Authorization h. DOS Waiver # 17. Do prevailing wage rates as per M.G.L. c. 149, § 26, 27 or 27A—F apply to this project? 0 Yes ❑ No B. Facility Description Current or prior use of facility: GARDNER'S BUILDING 2. Is the facility owner -occupied residential with 4 units or less? ❑ Yes 2] No TOWN OF NORTH ANDOVER 384 OSGOOD STREET 3. a. Facility Owner Name b. Address _ N ANDOVER !�� 01845 9786850950 C. Ci /Town _ d. Zip Code e. Telephone Number (area coc STEPHEN E. FOSTER -FACILITIES DIRECTOR SAME AS # 3 4' a. Name of Facility Owner's On -Site Manager b. On -Site Manaaer Address ■ anf001ap.doc • 10102 c. City/Town d. Zip Code e. amber (area code and extension) Asbestos Notification Form - Page 2 of 3 ■ Commonwealth of Massachusetts t; Asbestos Notification Form ANF -001 Note: Transfer Stations must comply with the Solid Waste Division Regulations 310 CMR 19.000 B. Facility Description (cont.) 5. a. Name of General Contractor c. Cit /Town d. Zip Code GREAT DIVIDE 7 f. Contractor's Worker's Comp. Insurer 6. What is the size of this facility? b. Address 100192028 Decal Number e. Telephone Number area code and extension W CA 153726612 12/28/2014 g. Policy Number h. Exp. Date (mm/ddl �'� 500 L'___ a. Square Feet b. Number of floors C. Asbestos Transportation and Dispotal 1. Transporter of asbestos -containing material from site to temporary storage site (if necessary): a. Name of Transporter c. City/Town d. Zip Code b. Address e. Telephone Number 2. Transporter of asbestos -containing waste material from removal/temporary site to final disposal site: SERVICE TRANSPORT 158 PYLES LANE a. Name of Transporter b. Address _ NEWCASTLE 19720 (877) 999-9559 c. Ci /Town d. Zip Code e. Telephone Number 3. a. Refuse Transfer Station and Owner h Addraec c. city/ I own _ 4. IMINERVA ENTERPRISES INC a. Final Disposal Site Location Name 9000 MINERVA ROAD e. State D. Certification d. Zio Code Owner's 44688 �� C f. Zip Code g. 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. ,YNESBURG tvfrown Number BRENT MORGENSTERN a. Name SALES 1 b. Authorized Signature 11/15/2014 C. Positionrritle _ _ (978) 470-2860 d. Datemm/dd ���� DEC -TAM e. Telephone Number f. Re resenti_ng__ 50 CONCORD ST q. Address N READING 01864 h. City/Town i. Zip Code Go'fo Top 0 anf001ap.doc - 10102 Asbestos Notification Form - Page 3 of 3 0 Jnr - 1Y1assv>1r s viittuCruwg 3ysteut a MassDEP's Online Filing System My eDEP' Formsa ; My Profile= Help` Notifications CReceipt nttps:j/eaep.aep.mass.gov/-VagesiFrintKeeeipt.aspx MassDEP Home I Contact I Privacy Policy Usemame:DECTAM Nickname: DECTAMEDEP 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: 623589 Date and Time Submitted: 1/15/2014 8:28:47 AM 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 GARDNERS HOUSE -1ST FLOOR Project Start Date 1/30/2014 �a 56 My eDEP MassDEP Home I Contact I Privacy Policy MassDEP's Online Filing System ver.12.2.6.0© 2013 MassDEP of 1 01/15/2014 92R AM uEBI CQN5I.i a'r IN(3 6"fing Nrt)uo rut Yaw Stakwn To: Town of North Andover- Health Dept. 1600 Osgood Street, Bldg. 20, Unit 2035 North Andover, MA 01845 Phone #: (978) 688-9540 Re: Telecommunications / Cell Tower MA46685-A 723 Osgood St. North Andover, MA EBI Project No: 61126578 To Whom It May Concern: December 5, 2012 Email: ssawyer@townofnorthandover.com Project Manager: Ms. Stephanie Melvin EBI is an environmental consulting firm acting pursuant to the request of the owners of the above -referenced property to conduct an investigation of current and historical conditions which could potentially impact the environmental condition of the property. Through the Freedom of Information Act (FOIA), we request any available information on file which is related to potential environmental issues concerning the above -referenced property. Specifically, we request your assistance by providing us with information concerning existing or historical conditions for the above -referenced property, including: ■ Required Department environmental permits, registrations, or notifications, and if any, the compliance status and any reported violations (including violation status). (specifically for the telecommunications / cell tower improvements) ■ Petroleum product/hazardous material storage tanks, both aboveground and underground. (specifically for the telecommunications / cell tower improvements) ■ Releases of petroleum products and/or hazardous materials. (specifically for the telecommunications / cell tower improvements) ■ Health Code Violations (specifically for the telecommunications / cell tower improvements) ■ Is there a septic system or municipal sanitary sewer? (specifically for the telecommunications / cell tower improvements) ■ Environmental Permits on file (specifically for the telecommunications / cell tower improvements) Responses may be faxed directly to our office at (225) 635.0240, or mailed to our office: EBI Attn: Ms. Stephanie Melvin PO Box 3750 St. Francisville, Louisiana 70775 Please note the EBI Project Number on all correspondence. If you need additional information to complete this request, please contact me at (917) 406-9418 or email at smelvin@coastaleco.com. Thank you for your prompt attention to this matter. Sincerely, Stephanie Melvin Client Manager / Project Manager EBI Consulting Freedom of Information Act (FOIA) ,j, A. Grant, Michele To: lisa@strategicinspections.com Cc: Sawyer, Susan, Blackburn, Lisa Subject: 723 Osgood Street Dear Ms. Melvin, The North Andover Health Department does not have an existing file on 723 Osgood Street, North Andover Ma. Sincerely Michele E. Grant Public Health Agent Town of North Andover 1600 Osgood St I Suite 2035 North Andover, MA 01845 Phone 978.688.9540 Fax 978.688.8476 Email merant@townofnorthandover.com Web www.TownofNorthAndover.com 1