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Home My WebLink About- Miscellaneous - 65 BEVERLY STREET 5/28/2019 Massachusetts Department of Environmental Protection 1332 _BWP AQ 04 (AN&O01) Asbestos Project Asbestos Notificiat1ron � j .t ion Project Cancellation u. A. ItoAbatement 'Desieripti,0111 IN 1.Facllity Location: jr, L 1 INVESTMENTS LLC 65 BEVERLY STREET Instructions 1.All a.Name of Facility b.Street Address sections of this form FORTH AN VE 01845 ' 1 1 9 must� r��nit in order to complywith c.City/Town d.State *Zip Code f.'Telepho,ne MassDEP notification PETER GRAZIANI PROJECT MANAGER requirements 310 CMR 7.15 and! ,.Facility rntact Person Name h.Facility Contact Person Title Department of Labor Work site o ti ► : OUTSIDE SIDING Standards( LS notification L Building,Name,Wrig,Floor,r,Room,etc. requirements f 4 2. Is the facilityoccupied? '' a�Yes 9b.No CMS 6.112 3. Is this a fey exempt,notification (city, town, district, r1 , municipal housingauthority, staff facility, r owner-occupiedresidential property,of four units r less)? ��,�� e Yes fry , b.No assE Use Only .BlanketPei-m i "r j t r 1,if applicable: Date laird', Approval Ili, 5.Non-Traditionat Asbestos,Abatement Work Pt-a t+ Appi-oval, if a l c , le rural Illy . asbestos Contractor: NORTH SHORE ENVIRONMENTAL SER\ACE 505 WASHINGTON AVENUE. a,Name b,Address REVERE 1, 02151 7814851621 c. ity/Fow n di.State .Zip Code f.Telephone AC000,447 h.Contract T 1.Written "I"'2.Verbal . RAYMOND KHAT AS050604 ;a.Name,of Contractor's On-Site Supervisor/Foreman b.DLS Certification . PATRICIA EILEEN RILEY2 pow Name f Project Monitor *DLS Certification 9. ENVIROIE ENGINEERING AA0010131, aw Dame of Asbestos Analytical,Lab b.DLS Certification w a,,Pr ja t Start Date M I .End late MM/ ) NIA : - :3 .Work Hours-Monday Through da► d.,Work Furs-Saturday&Sunday 11.What type of projectis'this? a.Demolition "' �Renovation — .Repah,IV .Othe• Please Specify: Revised: 1/13/2013 Page f ,Massachusetts Department Envir nm t lProtection __... _. rn _., 13832 BWP AQ 04 r 001) Asbestos Pr * A b t1 catr Form I + wr � I oj Project.eat Cancellation A.Asbestos Abatement,Deserliptlioji: (1cont.) 12.Abatement procedures(check all,that apply); a.Glove Bad, ,� .Encapsulation "' . rr l re ' .Disposal Only r e.Cleanup r.Fall,Containment r' g.Other Please Sp ll f REMOVE NON-FRIABLE MATERIAL SIDING SHI 13.Job is being,conducted,: r .Indoors a . Outdoors 1.4 a.Total amount of each type of asbestos Contain Contain I i�rg materialsCM to be removed,enclosed,, r encapsulated: 1500 1.Linear Feet(Lin.Ft, .Square Feet '' MFt) .Boiler,,Breaching,Duct, c.Transite Dips Tank Surface Coatings 1.Lire.Ft. ,Sq.Ft. 1.Lin Ft. 2.S .Ft. d.Pipe Insulation e,Transite Shingles15,00 1.,Lin Ft. 2.Sq.Ft. 1.Lin.Ft. 2.S .Ft... .Spray-On Fireproofing .Transite Panels, 1.Limn.Ft. 2.S .Ft. 1.Lin.Ft. 2.Sq.Ft. 11.Cloths,,Woven Fabrics, L,Other®Please Specify: 1.Lire,.Ft. 2.S .Ft. j,Insulating Cement i.Lin,Ft, 2.Sq.,Ft. 1,Lin.Ft. 2. M Ft. IS.Describe the d coot m.1n til on y t m, to be used: ALL MiETHODS SILL APPLY POLYETHYLENE i OFT ALL AROUND THE UIL I G WATER HOSE AND BUCKET 16.Describe the contai.n.eflzation/disposal methods to comply with 3 10 CMS 7.15 and 453 CM.R6. WET ASBESTOS PACKED IN DOUBLE 6MIL POLYETHYLENE BAG#9 LABELED o" GER' i 17.For Emergency L st , Operations,the'MassDEP and ILLS officials whoalu t d tyre emergency: gin.barns of MassDEP Official b.Title of MassDEP Official If .Date of Authorization I MID Y d.Waiver 0 .Name of DILS,Official t.title f I,LS+ i+"rl .bate of Authorization 1 / D h.Waiver 1 .Igo prevailing wage rates as per M.G.L.c. 1. , §26,27 or 27A. apply to t1u Project? Revised: 11/13/2013, Page L i Massachusetts epart n Intl Protection BWP AQ 04 (ANF-001) Asbestos Proilect# Asbestos Notification v Rcoj visioii RESIDENTIAL .Current,or prior use of lity 2. Is the il ity owner-occupied residentlal with 4 units or less? " .Yes, I b,No 3.VBL I INVESTMENTS,LLC 65 BEVE 1_ 'S -EE u Facility Omer Name b.Address c.City/Town dM State e.Zip Cade f Telephone a.Name of Facility Owner's.On-Site Manager b.Address SAUGUS MA 01906 6175801111 w City/Town d.State m Zip Code f,Telephone ENVIRONMENTAL SERMCES INC. 505 W SHI GTON AVE 5. a.Name of General Contractor b.Address REVERE MA 02151 7814851621 M City[Town d.State e.Zip Code f.Telephone ATLANTIC CHARTER INSURANCE . g.Contractor'sWbd Compensation lnsur r L Expiration Date I I /t I YY 0 2 .What is the size ofthis facility? Note-,Temporary TransportationC. Asbestos storage f Asbestos containing waste 1Transporter€� asbestos-containingwash,material ro site of generation: mate rial i only y �� r, r �trar" atlr� "r��n:r� r�Station allowed .t theplace «� *Directly to Landfill or t �� r po a of business of a DL licensed Asbiestos contractor r transfer N.S.E RONME1" AI�S 1� ES INC. � " � 111 ��" 1�1 AVE station that is c,.Name o "Transporter d..address permitted by MassDEP and REVERE MA 02151 7814,851621 operateid in e.City/Town t.State g.Zip Coda h.`elep o n compliance wit dirt Waste Regulations 310 CMR . 2.If a temporary storage location/trans,fer station is used,,list name of transporter of asbestios containing waste material ial 1'o temporary t r at onl rwansf&station to 1"Taal dip -al site: J.0.13ROLLOFF,INC. P,, . .Name of Transporter b.Address *City/Town d.State e.Zip Code t.Telephone i l - Massachusetts Department of Environmental Protect-ion ................................................... 1,00308732 dp 113WP AQ, 04 (ANF,,001) Asbestos Pr Wet# 01 Asbestos Notification Foitu 1, Project Revision Project Cancellation C.,Asbestos Tram portatlion&Dlisposal: (cont.) 3.Name and address of temporaq storage location/transfers teat ion fit-the asbestos containing waste matedal: SCHOOLSTREET 410 SCHOOL STREET ,a.Temporary St,orage,Location Name b.Address LOWELL MA 0851 9784586222 c.City/Town d.State e.Zip Code f.Telephone 4.Name and location of final, disposal sit e(asbestos landfill): WASTE MANAGEMENT OF NH-TURNKEY LANDFILL WASTE MANAGEMENT OF NH a.,Final Disposal Site Name b.Final Disposal Site Owner Name 97 ROCHESTER NECK ROAD c.Address ROCHESTER NH 0383�9 60,33330216 d.City/T own e.State f.Zip Code g.Telephone Note.,Contractor must sign this form for US notification purposes D. Certification RAWOND"T RAYMONDKHAT I certify that I have personally 1.Ilar 2.Auth�oHzed Signature examined the foregoing and am SUPERMSOR 5/20/2019 farrilliar,with the information contained in this,document and 3,Positiontrifle 4.,Date(MMIDD/YYYY), '7814851621 N.S.ENVIRONMENTAL SERWCES INC. all attachments and that,,based on my inquiry of those 5.Telephone 6.Representing individuals immediately 503 WASI NGTON AVE REVERE responsible for obtaining the 7'.Address 8.CityfFown information,I believe that the MA 02151 information ,true,accurate,and 9,State 'I 0.Zip Code conl1plete. I am aware that there, are significant penalties for submitting false information, i,ncluding,possible fines and imprisonment.The undersigned hereby states that I have read the Commonwealthof Massachusetts regulations governing asbestos abatement (453 CMR 6.00 promulgated by the!Department of Labor Standards and 310 CIVIR 7.15 promulgated by the Department of Environmental Protection), and that I am aware that this permit,application or notification shall not be deemed vali'd unless payment of the applicable fee is made." Revised: 11/13/2013 Page 4 of 4