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Home My WebLink AboutAsbestos Notification Form - Miscellaneous - 55 DANA STREET 1/4/2023 E & F ENVIRONMENTAL Cumplumm1aV Environmental/Demolition Contractors Commercial/Industrial/Residential ,,Sr 3 LPN �1� NoovE�` December 23, 2022 OwNO�NO�P��MEty1 Town of North Andover Health Department 120 Main Street North Andover, MA 01845 RE: 55 Dana Street, North Andover, MA 01845 Dear Sir/Madam: Please be advised that we have filed a Notification with the MASS DEP regarding the Asbestos Abatement at the above referenced property and have included a copy of it with this letter. We will be at the property on January 4, 2023 to remove the Asbestos. Kindly contact us with any questions or comments you may have. Very truly yours, Susan A. Pappalardo Office Manager /Enclosures 18 AYERS VILLAGE ROAD, BUILDING 1 , UNIT 5, METHUEN. MA 0 1 844 PHONE: (603) 974-2503 FAX: (603) 974-2471 `T r�----� _ — �7- WCO All alponed"Of v of A f` q- S1 �.''Y On .,w &♦.. 1� t 55 # -•+ t F +` .Va.'I to,n Won.W : hT .o Massachusetts Department of Environmental Protection ��-- BWP AQ 04 (ANF-001) 1100378544 Asbestos PProject# Asbestos Notification Form r Project Revision L I— Project Cancellation A. Asbestos Abatement Description BAN ti 4�Q�3 VEa 1.Facility Location: 10v,1N TH pEPP RESIDENCE 55 DANA STREET Instructions 1.All a.Name of Facility b.Street Address sections of this form NORTH ANDOVER must be completed in MA 01845 9783755798 order to comply with c.City/Town d.State e.Zip Code f.Telephone MassDEP notification N/A N/A requirements of 310 CMR 7.15 and g.Facility Contact Person Name h.Facility Contact Person Title Department of Labor Worksite Location: KnICHEN Standards(DLS) notification i.Building Name,Wing,Floor,Room,etc. requirements of 453 2. Is the facility occupied? W a.Yes r b.No CMR 6.12 3. Is this a fee exempt notification (city,town, district, municipal housing authority, state facility,or owner-occupied residential property of four units or less)? R a.Yes 1" b.No MassDEP Use Only 4.Blanket Permit Project Approval,if applicable: Date Received Approval ID# 5.Non-Traditional Asbestos Abatement Work Practice Approval, if applicable: Approval ID# 6.Asbestos Contractor: E&F ENVIRONMENTAL CORPORATION 411 RIVER STREET a.Name b.Address HAVERHILL MA 01832 6039742503 c.Cityrrown d.State e.Zip Code f.Telephone AC000971 h.Contract Type: (✓ 1.Written I—2.Verbal g.DLS License# 7. GUILLERMO A MARGARIN FRIAS II AS032500 a.Name of Contractor's On-Site Supervisor/Foreman b.DLS Certification# 8. N/A a.Name of Project Monitor b.DLS Certification# 9 ASBESTOS NOTIFICATION LABORATORY AA00208 a.Name of Asbestos Analytical Lab b.DLS Certification# 10. 1/4/2023 1/5/2023 a.Project Start Date(MM/DD/YYYY) b.End Date(MM/DD/YYYY) 7-4 WA c.Work Hours-Monday Through Friday d.Work Hours-Saturday&Sunday 11.What type of project is this? L a.Demolition r— b.Renovation 1` c.Repair r d.Other-Please Specify: REMOVAL Revised: 11/13/2013 Pagel of 4 Massachusetts Department of Environmental Protection ---------- -P BWP AQ 04 (ANF-001) 1100378544 Asbestos Project# Asbestos Notification Form f" Project Revision Project Cancellation A.Asbestos Abatement Description: (cont.) 12.Abatement procedures(check all that apply): f` a.Glove Bag F b.Encapsulation )— c.Enclosure F d.Disposal Only f e.Cleanup r f.Full Containment r g.Other-Please Specify: 13.Job is being conducted: W a.Indoors f b.Outdoors 14 a.Total amount of each type of asbestos Containing materials(ACM)to be removed,enclosed,or encapsulated: 0 350 1.Linear Feet(Lin.Ft.) 2.Square Feet(Sq.Ft.) b.Boiler,Breaching,Duct, c.Transite Pipe Tank Surface Coatings 1.Lin.Ft. 2.Sq.FL 1.Lin.Ft 2.Sq.Ft. d.Pipe Insulation e.Transite Shingles 1.Lin.Ft. 2.Sq.Ft. 1.Lin.Ft 2.Sq.Ft. f. Spray-On Fireproofing g.Transite Panels 1.Lin.Ft. 2.Sq.Ft. 1.Lin.Ft. 2.Sq.Ft. h.Cloths,Woven Fabrics i.Other-Please Specify: 1.Lin.Ft. 2.Sq.Ft. j.Insulating Cement LINOLEUM 350 1.Lin.Ft. 2.Sq.Ft. 1.Lin.Ft. 2.Sq.Ft. 15.Describe the decontamination system(s)to be used: FULL CONTAINMENT 16.Describe the containerization/disposal methods to comply with 310 CMR 7.15 and 453 CMR 6.14(2) (g): ALL METHODS WILL COMPLY 17.For Emergency Asbestos Operations,the MassDEP and DLS officials who evaluated the emergency: a.Name of MassDEP Official b.Title of MassDEP Official c.Date of Authorization(MM/DD/YYYY) d.Waiver# e.Name of DLS Official f.Title of DLS Official g.Date of Authorization(MM/DD/YYYY) h.Waiver# 18.Do prevailing wage rates as per M.G.L.c. 149,§26,27 or 27A—F apply to this f" a.Yes ry b.No project? Revised: 11/13/2013 Page 2 of 4 Massachusetts Department of Environmental Protection i 100378544 �- BWP AQ 04 (ANF-001) Asbestos Project# Asbestos Notification Form Project Revision 1` Project Cancellation B. Facility Description 1.Current or prior use of facility: RESIDENCE 2.Is the facility owner-occupied residential with 4 traits or less? r a.Yes 1— b.No 3 BOB TINE 55 DANA STREET a.Facility Owner Name b.Address NORTH ANDOVER MA 01845 9783755798 c.City(rown d.State e.Zip Code f.Telephone 4.N/A NA a.Name of Facility Owner's On-Site Manager b.Address N/A MA 00000 0000000000 c.City/Town d.State e.Zip Code I.Telephone 5 N/A N/A a.Name of General Contractor b.Address N/A MA 00000 0000000000 c.City/Town d.State e.Zip Code f.Telephone STAR INURANCE COMPANY g.Contractor's Worker's Compensation Insurer 0000000000 12/4/2023 h.Policy# i.Expiration Date(MM/DD/YYYY) 6. What is the size of this facility? 1000 2 a.Square Feet b.#of Floors Note:Temporary C. Asbestos Trans ortation & Disposal storage of Asbestos P P containing waste 1.Transporter of asbestos-containing waste material from site of generation: material is only allowed at the place r- a.Directly to Landfill or rv7 b.To Temporary Storage Location/Transfer Station of business of a DLS licensed Asbestos contractor or a transfer E&F ENVIRONMENTAL CORPORATION 18 AYERS VILLAGE ROAD,BLDG 1,UNIT 5 station that is c.Name of Transporter d.Address permitted by MassDEP and METH EN MA 01844 6039742503 operated in e.City/Town f.State g.Zip Code h.Telephone compliance with Solid Waste Regulations 310 CMR 19.000 2.If a temporary storage location/transfer station is used, list name of transporter of asbestos containing waste material from temporary storage location/transfer station to final disposal site: EA LOGISTIC SERVICES,INC. 106 EGERTON ROAD a.Name of Transporter b.Address LANGHORN PA 19047 3028978545 c.City/Town d.State e.Zip Code f.Telephone Revised: 11/13/2013 Page 3 of 4 Massachusetts Department of Environmental Protection 100378544 L71 � BWP AQ 04 (ANF-001) � �Asbestos Project# Asbestos Notification Form f Project Revision 1— Project Cancellation C.Asbestos Transportation&Disposal: (cont.) 3.Name and address of temporary storage location/transfer station for the asbestos containing waste material: N/A N/A a.Temporary Storage Location Name b.Address N/A MA 00000 0000000000 c.City/Town d.State e.Zip Code f.Telephone 4.Name and location of final disposal site(asbestos landfill): MINERVA LANDFILL WA a.Final Disposal Site Name b.Final Disposal Site Owner Name 8955 MINERVA ROAD c.Address WAYNESBURG CH 44688 3308663435 d.City/Town e.State f.Zip Code g.Telephone Note:Contractor must sign this form for DLS notification purposes A Certification FRANK BALOGH FRANK BALOGH "I certify that I have personally 1.Name 2.Authorized Signature examined the foregoing and am PRESCENT 12/23/2022 familiar with the information contained in this document and 3.Position/Title 4.Date(MM/DD/YYYY) all attachments and that,based 6039742503 E&F ENVIRO on my inquiry of those 5.Telephone 6.Representing individuals immediately 18 AYERS VILLAGE RD.,BLDG 1,#5 METHUEN responsible for obtaining the 7.Address 8.City/town information,I believe that the MA 01844 information is true,accurate,and complete.I am aware that there 9.State 10.Zip Code are significant penalties for submitting false information, including possible fines and imprisonment.The undersigned hereby states that I have read the Commonwealth of Massachusetts regulations governing asbestos abatement (453 CMR 6.00 promulgated by the Department of Labor Standards and 310 CM 7.15 promulgated by the Department of Environmental Protection), and that I am aware that this permit application or notification shall not be deemed valid unless payment of the applicable fee is made." Revised: 11/13/2013 Page 4 of 4