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Home My WebLink AboutAsbestos Abatement Notice-DEP - Miscellaneous - 26 YOUNG ROAD 5/5/2026 T : 4 Massachusetts Department of Environmental Protection 100445181 "BWP AQ 04 (ANF-001) Asbestos Project# Asbestos Notification Form r Project Revision r Project Cancellation il ot Nofth Andover A. Asbestos Abatement Description 1.Facility Location: MAY MARK DOCKRAY 26 YOUNG RD Nil Instructions 1.All a.Name of Facility b.Street Address neawl Department sections of this form NORTH ANDOVER must be completed in MA 01845 fi17fi408845 order to comply with c.City/Town d.State e.Zip Code f.Telephone MassDEP notification MARK DOCKRAY oVOJER requirements of 310 CMR 7.15 and g.Facility Contact Person Name h.Facility Contact Person Title Department of Labor Worksite Location: BASEMENT Standards(DLS) i.Building Name,Wing,Floor,Room,etc. notification requirements of453 2• Is the facility occupied? F 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)? Wei a.Yes ri b.No MassDEP Use only 4.Blanket Permit Project Approval,if applicable: Date Received Approval 1D# 5.Non-Traditional Asbestos Abatement Work Practice Approval, if applicable: Approval ID# } 6.Asbestos Contractor: REMEDIATION HOLDINGS LLC 120 LAURIE LN a.Name b.Address VVTIENTHAM MA 02093 4438228520 c.City/Town d.State e.Zip Code f.Telephone AC1147 h.Contract Type: r' 1.Written r1l 2.Verbal 4 g.DLS License# 7. CARLOS AGUILAR AS904380 4 a.Name of Contractor's On-Site Supervisor/Foreman b.DLS Certification# 8. EDWARD C SHEA AM033814 a.Name of Project Monitor b.DLS Certification# 9. ENVIRONMENTAL HEALTH INCORPORATED AA000044 a.Name of Asbestos Analytical Lab b.DLS Certification# 10. 5/22/2026 5/22/2026 a.Project Start Date(MM/DDfYYYY) b.End Date(MM/DDIYYYY) 7AM-4PM 8AM-3PM c.Work Hours-Monday Through Friday d.Work Hours-Saturday&Sunday 11.What type of project is this? r a.Demolition F. b.Renovation r c.Repair r d.Other-Please Specify: Revised: 11/13/2013 Page 1 of 4 i Massachusetts Department of Environmental Protection r a 100445181 BWP AQ 04 (ANF-001) 'V FI: Asbestos Project# Asbestos Notification Form r Project Revision Project Cancellation •r " r A.Asbestos Abatement Description: (cont.) h 12.Abatement procedures(check all that apply): a.Glove Bag r b.Encapsulation r", c.Enclosure 17 d.Disposal Only 17. e.Cleanup 6 . f.Full Containment r g.Other-Please Specify: 13.Job is being conducted: V a.Indoors r b. Outdoors 14 a.Total amount of each type of asbestos Containing materials(ACM)to be removed,enclosed,or encapsulated: 170 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 170 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: THREE CHAMBER DECON 16.Describe the containerization/disposal methods to comply with 310 CMR 7.15 and 453 CMR 6.14(2) (g) DOUBLE 6 MIL POLY BAGS 17.For Emergency Asbestos Operations,the MassDEP and DLS officials who evaluated the emergency: a.Name of MassDEP Official h.Title of MassDEP Official c.Date of Authorization(MMIDDIYYYY) d.Waiver# e.Name of DLS Official f.Title of DLS Official g.Date of Authorization(MMIDDIYYYY) h.Waiver# 18.Do prevailing wage rates as per M.G.L.c. 149, §26,27 or 27A F apply to this r7 a.Yes rv', b.No project? Revised: 11/13/2013 Page 2 of 4 t }- Massachusetts Department of Environmental Protection �* l 00445I81 BWP AQ 04 --0 01 . Asbestos Project# Asbestos Notification Form r Project Revision r Project Cancellation B. Facility Description 1.Current or prior use of facility: RESIDENTIAL t Z Is the facility owner-occupied residential with 4 units or less? R: a.Yes r b.No 3. MARK DOCKRAY 26 YOUNG RD Fa.Facility Owner Name b.Address NORTH ANDOVER MA 01845 6176408846 x c.City/Town d.State e.Zip Code f.Telephone 4.MARK DOCKRAY 26 YOUNG RD a.Name of Facility Owner's On--Site Manager b.Address NORTH ANDOVER MA 01845 6176408846 c.City/Town d.State e.Zip Code f.Telephone 5.NA NA a.Name of General Contractor b.Address NA MA 11111 1111111111 c.City/Town d.State e.Zip Code f Telephone NA g.Contractor's Worker's Compensation Insurer NA 12/31/2026 h.Policy# i.Expiration Date(MMIDDIYYYY) a 6!What is the size of this facility? 2857 2 a.Square Feet b.#of Floors Note:Temporary C. Asbestos Transportation &Disposal storage of Asbestos containing waste 1.Transporter of asbestos-containing waste material from site of generation: material is only allowed at the place """"1 a.Directly to Landfill or F'; b.To Temporary Storage Location/Transfer Station of business of a DLS licensed Asbestos contractor or a transfer REMEDIA11ON HOLDINGS LLC 6 NORMAN ST station that is c.Name of Transporter d.Address permitted by MassDEP and EIIERETT MA 02149 9783395361 operated in e.City/Town f.State g.Zip Code h.Telephone compliance with Solid Waste Regulations 310 CMR 19.000 ,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: a RED TECHNOLOGIES 173 PICK RING ST a a.Name of Transporter b.Address PORTLAND CT 06480 8603421022 c.Cityrrown d.State e.Zip Code f.Telephone 9 Revised: 11/13/2013 Page 3 of 4 Massachusetts Department of Environmental Protection ° 100445181 BMT AQ 04 (ANF-001) 7 Asbestos Project# Asbestos Notification Form 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: REME]IATION HOLDINGS LLC 6 NORMAN ST a.Temporary Storage Location Name b.Address EVERETF MA 02149 9783395361 c.CitylTown d.State e.Zip Code f.Telephone 4.Name and location of final disposal site(asbestos landfill): MINERVA LANDFILL MINERVA ENTERPRISES,INC. a.Final Disposal Site Name b.Final Disposal Site Owner Name 8995 MINERVA DR c.Address WAYNESBURG CH 44688 3308663343 d.City/Town e.State f.Zip Code g.Telephone Note:Contractor must sign this form for DLS notification purposes A Certification RYAN GALLAGHER RYAN GALLAGHER "i certify that I have personally 1.Name 2.Authorized Signature examined the foregoing and am p IDENi- 5/5/2026 familiar with the information 3.Positon contained in this document and lTitle 4.Date�MMIDDIYYYY} all attachments and that, based 9783395361 REMEDIATION HOLDINGS LLC on my inquiry of those 5.Telephone 6.Representing individuals immediately 120 LAURIE LN VvRENTHAM responsible for obtaining the 7.Address 8.City/Town information, I believe that the MA 02093 information is true,accurate,and complete. I am aware that there 9.State 0.Zip Code are significant penalties for submitting false information, including possible fines and imprisonment.The undersigned hereby states that 1 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 1 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