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Home My WebLink AboutMiscellaneous - 1160 GREAT POND ROAD 11/30/2015 (2) .. w II State Abatement Professionals, inc. 4 Wilder Drive, Suite 12 866-565-ASAP Plaistow, NH 03865 Fax: 603-378-0610 November 24, 2015 Town of North Andover Health Department 1600 Osgood Street Bldg 20; Unit 2035 North Andover, MA 01845 Phone#: (978) 688-9540 Fax#: (978) 688-8476 Re: Asbestos Abatement @ Brooks School, 1160 Great Pond Road To whom it may concern: All State Abatement Professionals, Inc. (ASAP) is scheduled to perform work for the above referenced project on the following dates: Start Date: 12/8/15 End Date: 12/8/15 All appropriate agencies have been notified for the above referenced project. If you have any questions or need additional information,please do not hesitate to contact me. Sincerely, A {/ y-- i J. Scott Curley President JSC:jab Enclosures Asbestos • Masonry Cleaning ® Selective Demolition Shot/Sand Blasting® Mold Remediation Commonwealth of Massachusetts — ASbeStOS Ot1fiCat1®Il Form ANF-®01 ';100233484 Asbestos Project# )� Project Revision F- Project Cancellation A. Asbestos Abatement Description 1.Facility Location: BROOKS SCHOOL 1160 GREAT POND ROAD Name of Facility Street Address Instructions 1.All NORTH ANDOVER MA 01845 9787256284 sections of this form City/Town State Zip Code Telephone must be completed in NORMAND GRENIER FACILITIES order to comply with MassDEP notification Facility Contact Person Name Facility Contact Person Title requirements of 310 Wor'ksite Location. FARMHOUSE BASEMENT CMR 7.15 and Department of Labor Building Name,Wing,Floor,Room,etc. Standards(DLS) 2. Is the facility occupied? r Yes 1—No notification requirements of 453 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)? F Yes r No MassDEP Use Only 4.Blanket Permit Project Approval,if applicable: Date Received Approval ID# 5.Non-Traditional Asbestos Abatement Work Practice Approval, 2.Submit Original if applicable: Approval ID# Form To: Commonwealth of 6.Asbestos Contractor: Massachusetts ALL STATE ABATEMENT PROFESSIONALS 41MLDER DRIVE SUITE 12 P.O.Box 4062 Boston,MA 02211 Name Address PLAISTOW NH 03865 6033780600 City/Town State Zip Code Telephone AC000331 Contract Type: Written Verbal DLS License# 7. JEFFREY CURLEY AS034502 Name of Contractor's On-Site Supervisor/Foreman DLS Certification# $, Al SPECTRUM SERVICES AA000152 Name of Project Monitor DLS Certification# 9, Al SPECTRUM SERVICES AA000152 Name of Asbestos Analytical Lab DLS Certification# 10, 12/8/2015 12/8/2015 Project Start Date(MM/DD/YYYY) End Date(MM/DD/YYYY) 7-3:30 NONE Work Hours-Monday Through Friday Work Hours-Saturday&Sunday 11. What type of project is this'? r- Demolition F Renovation Repair F- Other-Please Specify: Revised: 11/13/2013 Page 1 of 4 `07, Commonwealth of Massachusetts !100233484 Asbest®s ®tlf1cation F+or F-001 Asbestos Project# r Project Revision (-' Project Cancellation A.Asbestos Abatement Description: (cont.) 12.Abatement procedures(check all that apply): (7 Glove Bag C Encapsulation r' Enclosure r Disposal Only r Cleanup F Full Containment F- Other-Please Specify: 13.Job is being conducted: F,7 Indoors F- Outdoors 14.Total amount of each type of asbestos Containing materials(ACM)to be removed,enclosed,or encapsulated: 85 Linear Feet(Lin.Ft.) Square Feet(Sq.Ft.) Boiler,Breaching,Duct, Transite Pipe Tank Surface Coatings Lin.Ft. Sq.Ft. Lin.Ft. Sq.Ft Pipe Insulation 85 Transite Shingles Lin.Ft. Sq.Ft. Lin.Ft. Sq.Ft. Spray-On Fireproofing Transite Panels Lin.Ft. Sq.Ft. Lin.Ft. Sq.Ft. Cloths,Woven Fabrics Other-Please Specify: Lin.Ft. Sq.Ft. Insulating Cement Lin Ft. Sq.Ft. Lin.Ft. Sq.Ft. 15.Describe the decontamination system(s)to be used: PROVIDE AN ADEQUATE DECONTAMINATION SYSTEM. 16.Describe the containerization/disposal methods to comply with 310 CMR 7.15 and 453 CMR 6.14(2)(g): DOUBLE 6 MIL POLY. 17.For Emergency Asbestos Operations,the MassDEP and DLS officials who evaluated the emergency: Name of MassDEP Official Title of MassDEP Official Date of Authorization(MM/DD/YYYY) Waiver# Name of DLS Official Title of DLS Official Date of Authorization(MM/DDNYYY) Waiver# 18. Do prevailing wage rates as per NI.G.L.c. 149. fi 26,27 or 27A-F apply to this F- Yes ry No project? Revised: 11/13/2013 Page 2 of 4 `07 Commonwealth of Massachusetts 10_0233484 Asbestos Notification Form F-001 Asbestos Project# f r Project Revision J-" Project Cancellation B. Facility Description 1.Current or prior use of facility: RESIDENCE 2.is the facility owner-occupied residential with 4 units or less? (-" Yes f7 No 3,BROOKS SCHOOL 1160 GREAT POND ROAD Facility Owner Name Address NORTH ANDOVER MA 01845 0000000000 City/Town State Zip Code Telephone 4.NORMAND GRENIER 1160 GREAT POND ROAD Name of Facility Owner's On-Site Manager Address NORTH ANDOVER MA 01845 9787256284 City/Town State Zip Code Telephone $,ALL STATE ABATEMENT PROFESSIONAL 4 WILDER DRIVE,STE 12 Name of General Contractor Address PLAISTOW N1 03865 6033780600 Note:Temporary storage of Asbestos City/Town State Zip Code Telephone containing waste FEDERAL INSURANCE COMPANY material is only allowed at the place Contractor's Worker's Compensation Insurer of business of a DLS 0044727722 3/22/2016 licensed Asbestos Policy# Expiration Date(MM/DD/YYYY) contractor or a transfer station that is 6.What is the size of this facility? 4500 2 permitted by MassDEP and operated in Square Feet #of Floors compliance with Solid Waste Regulations l•C. Asbestos Transportation & Disposal 310 CMR 19.000 1.Transporter of asbestos-containing Nvaste material from site of generation: F- Directly to Landfill or I✓ To Temporary Storage Location/Transfer Station ALLSTATE ABATEMENT PROFESSIONALS,INC. 4 WILDER DRIVE,STE 12 Name of Transporter Address PLAISTOW 141 03865 6033780600 City/Town State Zip Code Telephone 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: J.O.B./ROLLOFF,INC. 69 NORMAN STREET Name of Transporter Address EVERETT MA 02149 6173871495 City/Town State Zip Code Telephone Note:Contractor must sign this form for DLS Revised: 11/13/2013 Page 3 of 4 ........ Commonwealth of Massachusetts 100233484 Asbestos Notification Form F-001 Asbestos Project# F— Project Revision J— Project Cancellation uu un uc uun NuiNwoa C.Asbestos Transportation &Disposal: (cont.) 3.Name and address of temporary storage location/transfer station for the asbestos containing waste material: ALL STATE ABATEMENT PROFESSIONAL 4 WILDER DRIVE Temporary Storage Location Name Address PLAISTOW NH 03865 6033780600 City/Town State Zip Code Telephone 4.Name and location of final disposal site(asbestos landfill): TURNKEY LANDFILL WASTE MANAGEMENT OF NH Final Disposal Site Name Final Disposal Site Owner Name 97 ROCHESTER NECK ROAD Address ROCHESTER N1 03839 6033302165 City/Town State Zip Code Telephone D. Certification "I certify that I have personally examined the foregoing and am JUDITH BEREZANSKY JUDITH BEREZANSKY familiar with the information Name Authorized Signature contained in this document and OFFICE MANAGER 11124/2015 all attachments and that, based Position/Title Date(MM/DD/YYYY) on my inquiry of those 6033780600 ASAP,INC individuals immediately responsible for obtaining the Telephone Representing information,I believe that the 4 WILDER DR,STE 12 PLAISTOW information is true,accurate, and Address Cityfrown complete. I am aware that there N-1 03865 are significant penalties for State Zip Code 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." Page 4 of 4 Revised: 11/13/2013