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Home My WebLink AboutMiscellaneous - Exception (27)Dec q4 �i2 01:53p Everett L Whipple III 978-794-3979 p.2 DEVAL L. PATRICK GOVERNOR TIMOTHY P. MURRAY LIEUTENANT GOVERNOR JUDYANN BIGBY, MD SECRETARY JOHN AUERBACH COMMISSIONER The Commonwealth of Massachusetts Executive Office of Health and Human Services Department of Public Health Bureau of Environmental Health Donovan Health Building, 1s' Floor 5 Randolph Street Canton, MA 02021 800-532-9571 — 'rn Eu 04 NII TOWN OF NORj.H ANDOVE#t HEALTH DEPARTMENT YOUR AUTHORIZATION NUMBER IS 13973 -AL EVERETT WHIPPLE 455 MAID ST NORTH ADAMS, MA 01845 Dear EVERETT WHIPPLE: Congratulations, as of 11/27/2012 you have successfully completed the low risk deleadina training. Based on the training booklet that you reviewed and the quiz that you submitted, you are trained to do the following low risk activities: ❑ Covering surfaces with approved coverings used appropriately (this includes vinyl siding exteriors) ❑ Removing and replacing the following components ONLY: Doors (on hinges) Cabinet doors (on hinges) Shutters (on hinges) Drawers Shelves that are not affixed (nailed or glued down) ❑ Capping baseboards with quarter -round or similar molding. Please note you are NOT authorized to apply encapsulants. Deleading Notification: Before any deleading work can begin, you must give certain people and agencies notice of the upcoming work. A copy of the "Deleading Notification" form has been enclosed. It must be -C '4 42 01:52p Everett L Whipple III 978-794-3979 p.l Department of Public Health - Childhood Lead Poisoning Prevention Nogratn ` Deleading Notificatioll Please complete all secrtions of this form clearly. Incomplete or illegible forms will be returned. /r— :Lead Paint Inspector t✓-_-�1i� License #.) Property Properly .Aiirhflr ized }�drsun pt4gg r!g .Address of authorized person_ Telephone Number G.-zk ?9 Address whtro the work will be done: Inspection Date 4A�&/ -- Zip Code �.j=L2-1- _ Lia#iAutli: 13.9g 3.-.A ,to- Zip Code D / k� Building Name (if any) Floor Street Address_ Apt No. City ANS', P.P /'1dZip Gode� ,�- The property is a multi -family single family. D eleadin? Method(&): ❑ Making paint u:tact (high risk) ❑ Making paint intact (mocerate ct Applying vinyl siding on exterior ❑ Demolition rials) • )d, Component removal (low risk d Scraping o Liquid encapsulaw components.) 9 . Component removadl/replacement Covering a Other, Q Dipping ❑ Capping baseboards The work will begin on 121 1!2 and will finish by l Z 1X11 /j �, The work will be done in tho Lain _pin or � weekends, in Case of Emergency C ntact � f�iAJ �` VV , Daytime phone tvening Phon The Property Owner uaust complete and sign the following information: 1 certify that only authorized persons who have complied with the hviuing requirements of the Massachusetts Lead Poisoning Provention and Control Regulations, 105 CMR 460.000, will conduct deleading work. I further certify that the authorized persons) will not exceed the sccpe of his/her authority and will be performing only those activities indicated above. All ofthr information contained hi this docutn.cnt is true and to the best of my kn edge and bel;, --f. Date_ /Zz, Sim i• The folloNving peoplelagencies mast be notified ten d s before beginning work: 1. Occupants of the dwellvig unit 2. All other occupants of the re.sidential prrm.ises; if any work will be done in the common areas 3. t hilcihood Lead Poisoning Prevention Program, DP11 Fax (781) 774-6700 ATWRHO S Randolph Street, Canton, ?AA. 02021 4. Asbestos and Lead Program, DLS 19 Staniford St, l'. Floor, Boston, MA 02114 Fax (617) 626-6965 5. Local Bcard of Health/Code Enforcement Agenay ;1f the home h on the State Register of Hhtoriz Places, call the MA Historical Commission ut (617) 727-8470. ABA TEMENT CONTROL SERV/CES, INC. ENVIRONMENTAUDEMOLITION CONTRACTORS FEBRUARY 28, 2002 NORTH ANDOVER BOARD OF HEALTH 27 Charles Street North Andover, MA. 01845 DEAR SIR/MADAM ENCLOSED PLEASE FIND A COPY OF NOTIFICATION SENT TO THE STATE FOR AN ASBESTOS ABATEMENT PROJECT. THE JOB WILL TAKE PLACE ON: MARCH 13, 2002 LOCATION: BASEMENT OF 33 COLUIV�BIA.ROAD� N. ANDOVER, MA 01845 ANY QUESTIONS CONCERNIG THIS MATTER SHOULD BE DIRECTED TO MY ATTENTION. SINCERLY, fTO OF i �v NORl H AIVUC BOARD OF FIEALTI� FRANK BALOGH PRESIDENT — 4 2002 2 INDUSTRIAL WAY • SALEM, NH 03079 • NH (603) 898-9472 • MA (888) 870-9292 • FAX (603) 898-1846 ,• � Codrmoowoa/1bol��ssacbasells �� . �+��"�'. REM AsaoslosNoUllcaUoafoior—�iY�001t i 3,p��jp>r,�lOmOOlOOSC/%pd0o 1. Facility location: N/A UNdThfForg'::.��-srs'�; A6Y1M DYICeib/Icalbn! u.5. Envlro(unarWl ° Protection Agency L' AsbestosAna"cal tab: Region i of asbesOos . • _,; • ; .: , ; demouiwNrerwvatiori. • • N/A AA33000085 operaum sublea tD + AtinM WC&Oftictwr J' W- MAPS (40 CFR suewrtM) 1'3 / q 7 Project start date 3 / date 3 1 specific work hours (Mon. -Fri.) 7 em 4 nm (Sat -Sun.) L What type of project is this? ddm(tbav repar renovation odle�(eYain) SBESTOS REMOVAL noneonar♦ 9':.,; Describe the asbestos abatement procedures to be used: OveAv endawe fa AenM00 aattawM�ient dewtup ax wzda&w ooher(epWn) PAO*W. 30.. Is the job being conducted Elindoors ❑ outdoors? wm�t�aca.e0 11. Total amount of each type of Asbestos Containing Materials (ACM) to be handled on pipes or ducts (linear ft.) 89 or other oeomn oft b surfaces (square ft.) 0 to be removed, enclosed or encapsulated: - uneer SQUam tell Unear sQuare (m moi ' dpi Avit—b-ava W 71WMACmWavva v&wA4w a'�'tbfairi� lRAfdaGb�lCCl,ae9t MOKYI,f�w.b.'Cq.� 7Yazo A wg *W_-* d G�Kw(ir�t�..,..•+Y •/ .! QikY(Af9t0. ddVIG'i 22. Describe the decontamination systems) to be used: GLOVEBAG PROCEDURES 13. Describe the eontaineriratlWdisposal methods to comply with 310 CMR 7.15 and 453 CMR 6.14(2)(g): Wet removal into 6 mil Poly Asbestos'Labeled E ags.;- 14. Asbestos Abatement Operations, the DEP and DU officials who evaluated the emergency: nAW* 410C~ Toe sn wA:aAtpiA7trdm WaAW f ` tlwl,eaacrcrhaw We / uuea.Wpia7tiaM W&IMY0 15. Do prevailing wage rates apply as per M.G.L G 149, § 26, 27, or 27A -F to this project? ❑ Yes No Rev. 6/92 RnRFRT T nRANrF'R 33 COLUMBIA ROAD NAM AdWIVZ INSTUIW N ANDOI�R MA. 01845 978-407-2717 1. AN sewo(rs d nus Gy/roam zip trade Te✓�P?' form erstbe ftA BASEMENT ^: ':,-WNt/fdM GW#yye ththe aortiply with the hg&M7Bu/•(d/Vfl", A,, w//4 �fiacr, f" Dwartment of Prote 2: IS the faciGW. ooptpled7 _ Yes C1N� ' naurlotgn roquManend d 310" CMR 7.35 (aa 3"' , Asbestos Con<ract�::.', ., :-kABATEMENTI CONTROL SVC,INC. 2 INDUSTRIAL*WAY aWtemmtPei it NOV Add�sr oftaab" SOW SALEM, NH 03079 603-898-9472 flawatlon IGTy/lor"7 LP ac* TeAgaaaae rMqulran Oof453' CMR L12 (kn dayf, AC000362 Written 0kr1=W"AW B LYJL(cwWa f Ccnvacr bw (Written or ve twJ ,esrx,r'adauvY O7'°x 4. On -Site Project Supervisor/Foreman: CHRISTOPHER DEMONACO AS33137 2.s&WGrow Form To: AWW zuCemkabioa o Camomaw"M f- ' MassacimmmW mProgram-' : -.... 'S. ' Project MoNtw P.0.0.law-ow N/A UNdThfForg'::.��-srs'�; A6Y1M DYICeib/Icalbn! u.5. Envlro(unarWl ° Protection Agency L' AsbestosAna"cal tab: Region i of asbesOos . • _,; • ; .: , ; demouiwNrerwvatiori. • • N/A AA33000085 operaum sublea tD + AtinM WC&Oftictwr J' W- MAPS (40 CFR suewrtM) 1'3 / q 7 Project start date 3 / date 3 1 specific work hours (Mon. -Fri.) 7 em 4 nm (Sat -Sun.) L What type of project is this? ddm(tbav repar renovation odle�(eYain) SBESTOS REMOVAL noneonar♦ 9':.,; Describe the asbestos abatement procedures to be used: OveAv endawe fa AenM00 aattawM�ient dewtup ax wzda&w ooher(epWn) PAO*W. 30.. Is the job being conducted Elindoors ❑ outdoors? wm�t�aca.e0 11. Total amount of each type of Asbestos Containing Materials (ACM) to be handled on pipes or ducts (linear ft.) 89 or other oeomn oft b surfaces (square ft.) 0 to be removed, enclosed or encapsulated: - uneer SQUam tell Unear sQuare (m moi ' dpi Avit—b-ava W 71WMACmWavva v&wA4w a'�'tbfairi� lRAfdaGb�lCCl,ae9t MOKYI,f�w.b.'Cq.� 7Yazo A wg *W_-* d G�Kw(ir�t�..,..•+Y •/ .! QikY(Af9t0. ddVIG'i 22. Describe the decontamination systems) to be used: GLOVEBAG PROCEDURES 13. Describe the eontaineriratlWdisposal methods to comply with 310 CMR 7.15 and 453 CMR 6.14(2)(g): Wet removal into 6 mil Poly Asbestos'Labeled E ags.;- 14. Asbestos Abatement Operations, the DEP and DU officials who evaluated the emergency: nAW* 410C~ Toe sn wA:aAtpiA7trdm WaAW f ` tlwl,eaacrcrhaw We / uuea.Wpia7tiaM W&IMY0 15. Do prevailing wage rates apply as per M.G.L G 149, § 26, 27, or 27A -F to this project? ❑ Yes No Rev. 6/92 1 %OBSC✓IplloO 1. Current or prior use of fatuity: RESIDENCE 2. IS the facility owner -occupied residential with 4 units or less? 93Yes ❑ No 3. Facility Owner. _.m., ROBERT LORANGER 33.COLUMBIA ROAD Ahmf Aa(aFess• N. ANDOVER, MA. 01845 978-407-2117 QW&W zo CA* rdept- 4, Facility's Owner's On-5Re Manager: ,, . Q17CX%Y� NgdpiliYr�ct GisiMH� ihGcyi SP Date 6.' what Is the slu of the facility? i ., 0 0(q ft) 2 (# floors) G&AMW =tlaa►1"AAApase/ 1.' Transporter of itsbesto6•=0ining .waste material from site to temporary storage site (if necessary) to final disposal site? ABATEMENT CONTROL SERVICES,INC. 2 INDUSTRIAL WAY Nannie • ' . Address SALEM, NH 03079 603-898-9472 QKbwa zo C e . Te�diare 2. .Tr pporter of asbestos containing waste materials from removal/temporary storage site to final disposal site: •. ANvnil . , • . .. ,IGfd/ess G{b,/oMn zo C04* Tafephax �yppQ; Ti�u� 3. Refuse transfer station and owner. (if applicable): .Sradasmresr awn* *0 #v .A** '. Alafto sad W.W pvtoicvt tey�rrla• daes3l0U7,4: :.... 'fipylorn.. z(oCo* NWIV- idA7 ---• •----. A• Hnal Dl�asal Site:. ' .:__ ...;..___ . ; .. ... _. . _ ;:. TURNKEY LANDFILL WASTE MGMT OF NH [aaatswHr»s a»:,.wsnG�rre '90'ROCHESTER•NECK RD AGi W ROCHESTER,- NH 03067:.: 603-332-2386 Grjj7arn zo awb Towh" 1 The tmidersignod hereby states, under the penalties of perjury, thaCWshe 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 inforrnabon contained in this. notification IS true and correct to the best of his/her knowledge and belief. BALOGH • r?� /hrXAW,,, Ar�xvlred Alto PRESIDENT ABATEMENT CONTROL SVC,INC. .603-898-9472 ANltlaV7U Rep -by T _2 INDUSTRIAL WAY SALEM, NH 03079 Aatiesi .. 01y9own zo axle Fee exempt (City, Town, disbict, municipal housing authority, owner -occupied residential of four units or less)? Yes ❑ No Stldter'#t (from front of form): 756509 ,ii i