HomeMy WebLinkAboutMiscellaneous - Exception (318)A
Environmental / Demolition Contractors
Commercial / Industrial I Residential
April 29, 2013
Town of North Andover
Health Department, Suite 2035
1600 Osgood Street
North Andover, MA 01845
RE: 29 Normand Road, North Andover, MA
Dear Sir/Madam:
Please find enclosed a copy of the Notification filed with the Mass DEP. The project is
scheduled for May 10, 2013.
Kindly contact us with any questions or comments you may have.
Very truly yours,
pdlygz"
Susan A. Pappalardo
E & F Environmental Services, LLC
/Enclosures
86 CAROLAN AVE, HAMPTON, NH 03842
(603)9742503 FAx: (603)382.3376
RECEIVED
Ii,IAY 0 Z 2013
TOWN OF NORTH ANDOVER
HEALTH DEPARTMENT
Important
When filling out
forms on the
computer, use
only the tab key
to move your
cursor - do not
use the return
key.
Commonwealth of Massachusetts
Asbestos Notification Form ANF -001
100176495
Decal Number
A. Asbestos Abatement Description
1. a. Is this facility fee exempt - city, town, district, municipal housing authority, owner -occupied
residence of four units or less? 0 Yes ^; No
b. Provide blanket decal number if applicable: Blanket Decal Number
2. Facility Location:
GREGORY SHAY
a. Name of Facility
NORTH ANDOVER MA
C. City/Town d. State
3 WO rk it L
INSTRUCTIONS
S e ocation.
I. All sections of this
RESIDENCE
form must be
a. Building Name/Building Location b. Building #
completed in order
to comply with
4.
Is the facility occupied? ✓ Yes No
DEP notification
requirements of 310
CMR 7.15
5.
Asbestos Contractor:
and the Division
of Occupational
E&F ENVIRONMENTAL_ SERVICES LLC
Safety (DOS)
a. Name
notifiction
requirements of 453
HAMPTON 03842
CMR 6.12
c. City/Town d_ Zip Code
AC000767
f. DOS License Number
N/A
h. Facility Contact Person
FRANK BALOGH
6'
a. Name of Onsite SupervisodForeman
N/A
7'
a. Name of Project Monitor
_
N/A
r
8.
a. Name of Asbestos Analytical Lab
�0
9
5/10/2013
a. Project Start Date (mm/dd/yyyy)
0
7-4
�N
c. Work hours Mon -Fri.
�o
10.
a. What type of project is this?
—0
=
Demolition Renovation
--�
Repair ✓ Other, please specify:
–
11.
a. Check abatement procedures:
0
—'—o
Glove bag Encapsulation
Enclosure Disposal only
=LL
Cleanup ✓ Other, specify:
�—
Full containment
.��Z
�Q 12. Is the job being conducted:
anf001ap.doc • 10/02
29 NORMAND�ROAD—
b. Street Address
01845
e. Zip Code t Telephone Number
c. Wing d. Floor
86 CAROLAN AVE
b. Address
6032345581
e. Telephone Number
e. Room
g. Contract Type: . Written Verbal
i. Contact Person's Title
AS030269
b. Supervisor/Foreman DOS Certification Number
b. Project Monitor DOS Certification Number
b. Asbestos Analytical Lab DOS Certification Number
5/10/2013
b. End Date (mm%ddlyYYY), ...
N/A
d. Work hours Sat -Sun.
REMOVAL
b. Describe
POLYSURROUNDING STRUCTURE
b. Describe
Indoors? .✓ Outdoors?
Asbestos Notification Form - Page 1 of 3 0
■
. , a11 . . .
Ll
Commonwealth of Massachusetts
Asbestos Notification Form ANF -001
B. Facility Description (cont.)
N/A
5' a. Name of General Contractor
c. City/Town
f. Contractor's Worker's Comp. Insurer
6. What is the size of this facility?
d. Zip mode
b. Address j
e. Telephone Number (area
g. Policy Number
a. Square Feet
C. Asbestos Transportation and Disposal
1. Transporter of asbestos -containing material from site to temporary
�J
100176495
Decal Number
COW and extension)
h. Exp. Date (mm/dd/yyyy)
b. Number of floors
site (if necessary):
3.
4.
—� M
�O
D. Certification
The undersigned hereby states, under the
penalties of perjury, that he/she has read the
—o Commonwealth of Massachusetts regulations
for the Removal, Containment or
Encapsulation of Asbestos, 453 CMR 6.00 and
310 CMR 7.15, and that the information
—o contained in this notification is true and correct
to the best of his/her knowledge and belief.
LL
r
Q
anf001 ap.doc • 10/02
NEW CASTLE, DE 19720
c. City/Town d. Zip Code
a. Refuse Transfer Station and Owner
c. City/Town d. Zip Code
MINERVA ENTERPRISES INC
a. Final Disposal Site Location Name
9000 MINERVA ROAD
c. Final Disposal Site Address
OH 44688
e. State f. Zip Code
8779999559
e. Telephone Number
b. Address
e. Telephone Number
b. Final Disposal Site Location Owner's Name
WAYNESBURG
d. City/Town
g. Telephone Number j
i
j
i
FRANK BALOGH
E & F ENVIRONMENTAL SERVICES, LL_ C
86 CAROLAN AV
NUE
Note: Transfer
a. Name of Transporter
b. Address
StationsmustHAMPTON,
NH 03842
6039742503
d. Date (mm/dd/vvvv)
comply the
Solid Waste
c. City/Town d. Zip Code
e. Telephone Number
e. Telephone Number
Division
Regulations 310
2. Transporter of asbestos-containin waste material from removal/tempora
9
site to final disposal site:
CMR 19.000
SERVICE TRANSPORT GROUP, INC.
58 PYLES LANE
03842
h. City/Town
a. Name of Transporter
b. Address
3.
4.
—� M
�O
D. Certification
The undersigned hereby states, under the
penalties of perjury, that he/she has read the
—o Commonwealth of Massachusetts regulations
for the Removal, Containment or
Encapsulation of Asbestos, 453 CMR 6.00 and
310 CMR 7.15, and that the information
—o contained in this notification is true and correct
to the best of his/her knowledge and belief.
LL
r
Q
anf001 ap.doc • 10/02
NEW CASTLE, DE 19720
c. City/Town d. Zip Code
a. Refuse Transfer Station and Owner
c. City/Town d. Zip Code
MINERVA ENTERPRISES INC
a. Final Disposal Site Location Name
9000 MINERVA ROAD
c. Final Disposal Site Address
OH 44688
e. State f. Zip Code
8779999559
e. Telephone Number
b. Address
e. Telephone Number
b. Final Disposal Site Location Owner's Name
WAYNESBURG
d. City/Town
g. Telephone Number j
i
j
i
FRANK BALOGH
FRANK BALOGH
a. Name
b. Authorized Signature
OWNER
4/29/2013
c. Position/Title
d. Date (mm/dd/vvvv)
6039742503
E & F ENVIRO
e. Telephone Number
f Representing
86 CAROLAN AVENUE
q. Address
HAMPTON, NH
03842
h. City/Town
i Zip Code
Asbesto N6tification Form • Page 3 of 3
Air Quality Experts, Inc.
(60;3) 894-6465 Asbestos Removal
(800) 621-1189 40 Lowell Road, Unit 1 Residential -Commercial -Industrial
(603) 894-7044 FAX Salem, NH 03079 AirQualityExperts@AQENH.com
July 29, 2004
North Andover Health Department
146 Main Street
North Andover, MA 01845
Dear Sir:
RECEIVED
AUG 0 3 2004
TOWN OF NORTH
ER
HEALTH &PARTMENT
Enclosed please find a copy of notification sent to the state for an Asbestos
Abatement Project.
The job will take place on 08/12/2004.
Project: 29 Norman Rd.
Any questions concerning this matter should be directed to my attention.
Sincerely,
Christopher Thompson
President