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Home My WebLink AboutAsbestos Abatement - Miscellaneous - 723 OSGOOD STREET 5/17/2023 Massachusetts Department of Environmental Protection eDEP Transaction Copy Here is the file you requested for your records. To retain a copy of this file you must save and/or print. Username: ACCOLADE Transaction ID: 1567387 Document: AQ 04 -Asbestos Removal Notification Form ANF-001 Size of File: 231.39K Status of Transaction: In Process Date and Time Created: 5/17/2023:3:27:05 PM Note: This file only includes forms that were part of your transaction as of the date and time indicated above. If you need a more current copy of your transaction, return to eDEP and select to "Download a Copy" from the Current Submittals page. V'sc NOR-�No M�N� �Q NN�Of N EP P LIMassachusetts Department of Environmental Protection BWP AQ 04 (ANF-001)PreForm Asbestos Notification Form r This is a revision to an existing form. Project ID for existing form to be revised: r This job is being conducted under a Blanket Permit. MassDEP assigned Blanket Authorization ID: r This job is being conducted under a Non Traditional Abatement Work Practice Permit. MassDEP assigned Non Traditional Work Practice Authorization ID: r This job does not require the use of an asbestos contractor licensed by the MA Department of Labor Standards because(please check one box below): r This job involves breaking,shearing or slicing of non-friable asbestos-containing material only(e.g.cement shingles/panels,cement pipe,asphalt roofing or siding,vinyl floor tiles,etc.)in a manner that does not generate asbestos dust or render the material friable,as allowed by the Department of Labor Standards(DLS)at 453 CMR 6.13(2)(a)5.All work must be done in compliance with the applicable regulations at 310 CMR 7.15;or r This job involves work on asbestos containing material that is classified by the Department of Labor Standards (DLS)as a`Small-Scale Asbestos Project,'an`Asbestos-Associated Project',or an`Asbestos Response Action' by qualified`in-house'personnel as allowed by the Department of Labor Standards(DLS)at 453 CMR 6.00,and will be performed in accordance with all the requirements of 453 CMR 6.13(1)(a),453 CMR 6.13(2)(a)1.and 3., and 453 CMR 6.14(1)(a),as applicable.All work must be done in compliance with the applicable regulations at 310 CMR 7.15. None of the above conditions apply,generate a new form. Revised: 11/13/2013 Page 1 of 1 Massachusetts Department of Environmental Protection 100386433 BWP AQ 04 (ANF-001) Asbestos Project # LL7� � Asbestos Notification Form I- Project Revision r Project Cancellation A. Asbestos Abatement Description 1.Facility Location: OSGOOD BUILDING 723 OSGOOD ST Instructions 1.All a.Name of Facility b.Street Address sections of this form NORTH ANDOVER MA 01845 9786889510 must be completed in order to comply with c.City/Town d.State e.Zip Code f.Telephone MassDEP notification LAURIE BURZLAFF GC CONTACT requirements of 310 CMR 7.15 and g.Facility Contact Person Name h.Facility Contact Person Title Department of Labor Worksite Location: PIPE INSULATION Standards(DLS) notification i.Building Name,Wing,Floor,Room,etc. requirements of 453 2. Is the facility occupied? r 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 r 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: ACCOLADE ENVIRONMENTAL CONTRACTING CORP 2 NASON LN a.Name b.Address KINGSTON MA 03848 6036086545 c.City/Town d.State e.Zip Code f.Telephone AC000584 h. Contract Type: r 1.Written r 2.Verbal g.DLS License# 7 GLENN KASABIAN AS000967 a.Name of Contractor's On-Site Supervisor/Foreman b.DLS Certification# 8 JOHN A.BACHAND AM031319 a.Name of Project Monitor b.DLS Certification# 9 ASBESTOS IDENTIFICATION LAB AA000208 a.Name of Asbestos Analytical Lab b.DLS Certification# 10. 5/31/2023 5/31/2023 a.Project Start Date(MM/DD/YYYY) b.End Date(MM/DD/YYYY) 7AM-3:30PM NA c.Work Hours-Monday Through Friday d.Work Hours-Saturday&Sunday 11. What type of project is this? r a.Demolition r b.Renovation r c.Repair r d. Other-Please Specify: Revised: 11/13/2013 Page 1 of 4 Massachusetts Department of Environmental Protection 100386433 BWP AQ 04 (ANF-001) Asbestos Project # 1 Asbestos Notification Form 1, r Project Revision r Project Cancellation A.Asbestos Abatement Description: (cont.) 12.Abatement procedures(check all that apply): [J a.Glove Bag r b.Encapsulation r c. Enclosure r d.Disposal Only r e.Cleanup r f.Full Containment r g.Other-Please Specify: ' 13.Job is being conducted: r a.Indoors r b.Outdoors 14 a.Total amount of each type of asbestos Containing materials(ACM)to be removed,enclosed,or encapsulated: 14 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.Ft. 1.Lin.Ft. 2.Sq.Ft. d.Pipe Insulation 14 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 1.Lin.Ft. 2.Sq.Ft. 1.Lin.Ft. 2.Sq.Ft. 15.Describe the decontamination system(s)to be used: 3 CHAMBER DECON 16.Describe the containerization/disposal methods to comply with 310 CMR 7.15 and 453 CMR 6.14(2) (g): 2X LAYER SIX MIL POLY BAGS 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 r a.Yes F7 b.No project? Revised: 11/13/2013 Page 2 of 4 Massachusetts Department of Environmental Protection 100386433 BWP AQ 04 (ANF-001) Asbestos Project# Asbestos Notification Form l r Project Revision r Project Cancellation B. Facility Description 1.Current or prior use of facility: HISTORICAL BUILDING 2. Is the facility owner-occupied residential with 4 units or less? r a.Yes r' b.No 3 TOWN OF NORTH ANDOVER 384 OSGOOD ST. a.Facility Owner Name b.Address NORTH ANDOVER MA 01845 9786850950 c.City/Town d.State e.Zip Code f.Telephone 4 STEPHEN FOSTER 384 OSGOOD ST a.Name of Facility Owner's On-Site Manager b.Address NORTH ANDOVER MA 01845 9786850950 c.City/Town d.State e.Zip Code f.Telephone 5 ACCOLADE ENVIRONMENTAL PO BOX 1256 a.Name of General Contractor b.Address PLAISTOW NH 03856 6036086545 c.City/Town d.State e.Zip Code f.Telephone A.I.M. g.Contractor's Worker's Compensation Insurer 001005986 6/6/2023 h.Policy# i.Expiration Date(MM/DD/YYYY) 6.What is the size of this facility? 1600 2 a.Square Feet b.#of Floors Note:Temporary storage of Asbestos C. Asbestos Transportation & Disposal 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 r7o b. To Temporary Storage Location/Transfer Station of business of a DLS licensed Asbestos contractor or a transfer ACCOLADE ENVIRONMENTAL CONTRACTING CORP. PO BOX 1256 station that is c.Name of Transporter d.Address permitted by MassDEP and PLAISTOW NH 03865 6036086545 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: SERVICE TRANSPORT GROUP 28 PRIVILEGE ST a.Name of Transporter b.Address WOONSOCKET R 02895 8779999559 c.City/Town d.State e.Zip Code f.Telephone Revised: 11/13/2013 Page 3 of Massachusetts Department of Environmental Protection 100386433 BWP AQ 04 (ANF-001) Asbestos Project# t •.• Asbestos Notification Form r Project Revision r Project Cancellation C.Asbestos Transportation&Disposal: (cont.) 3.Name and address of temporary storage location/transfer station for the asbestos containing waste material: SERVICE TRANSPORT GROUP 58 PYLES LN a.Temporary Storage Location Name b.Address NEW CASTLE CE 19270 8779999559 c.City/Town d.State e.Zip Code f.Telephone 4.Name and location of final disposal site(asbestos landfill): MINERVA LANDFILL MINERVA LLC a.Final Disposal Site Name b.Final Disposal Site Owner Name 8955 MINERVA RD 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 D. Certification GLENN KASABIAN GLENN KASABIAN "I certify that I have personally 1.Name 2.Authorized Signature examined the foregoing and am GENERALMANAGER 5/17/2023 familiar with the information contained in this document and 3.Positionffitle 4.Date(MM/DD/YYYY) all attachments and that, based 6036086545 ACCOLADE on my inquiry of those 5.Telephone 6.Representing individuals immediately PO BOX 1256 PLAISTOW responsible for obtaining the 7.Address 8.City/Town information, I believe that the N..I 03856 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 CMR 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