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Home My WebLink About0026 CHESTNUT STREET - Health 26 CHESTNUT STREET Hyannis A= 309 -057 3 6 9- 05 - -1-1111111111111 Massachusetts Department of Environmental Protection 100279620 a� BWP AQ 04 (ANF-001) v, Asbestos Project# Asbestos Notification Form 17 Project Revision C Project Cancellation A. Asbestos Abatement Description 1.Facility Location: PATRICIAGAGNIER 26 CHESTNUT ST Instructions 1.All a.Name of Facility b.Street Address sections of this form BARNSTABLE must be completed in MA 02601 5087901285 order to comply with c.City/Town d.State e.Zip Code f.Telephone MassDEP notification PATRICIAGAGNIER OWNER 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) notification i.Building Name,Wing,Floor,Room,etc. requirements of 453 2. Is the facility occupied? 1 .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)? ry 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, 2.Submit Original if applicable: Approval ID# Form To: Commonwealth of Massachusetts 6.Asbestos Contractor: P.O.Box 4062 Boston,MA 02211 AIR SAFE INC 22 WILLOW STREET a.Name b.Address CHELSEA MA 02150 9783395361 c.City/Town d.State e.Zip Code f.Telephone A0000464 h.Contract Type:rv,1.Written 17 2.Verbal g.DLS License# 7. ORLANDO MOLINA AS901826 a.Name of Contractor's On-Site Supervisor/Foreman b.DLS Certification# 8 KATfIA LOPEZ AM900491 a.Name of Project Monitor b.DLS Certification# 9 ASBESTOS IDENTIFICATION LAB AA000208 a.Name of Asbestos Analytical Lab b.DLS Certification# 10. 2/8/2018 2/9/2018 a.Project Start Date(MM/DD/YYYY) b.End Date(MM/DD/YYYY) 7AM-6PM NA c.Work Hours-Monday Through Friday d.Work Hours-Saturday&Sunday 11. What type of project is this? 1— a.Demolition r b.Renovation 1✓ c.Repair r_ d.Other-Please Specify: Revised: 11/13/2013 Page 1 of 4 Massachusetts Department of Environmental Protection 100279620 BWP AQ 04 (ANF-001) Asbestos Project# Asbestos Notification Form r Project Revision r Project Cancellation A.Asbestos Abatement Description: (cont.) 12.Abatement procedures(check all that apply): f— 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 b.Outdoors 14 a.Total amount of each type of asbestos Containing materials(ACM)to be removed,enclosed,or encapsulated: 285 1.Linear Feet(Lin.Ft.) 2.Square Feet(Sq.Ft.) b.Boiler,Breaching,Duct, 35 c.Transite Pipe Tank Surface Coatings 1.Lin.Ft. 2.Sq.Ft. 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 VAT 250 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): 6 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 r b.No project? Revised: 11/13/2013 Page 2 of 4 Massachusetts Department of Environmental Protection 100279620 -� BWP AQ 04 (ANF-001) Asbestos Project# Asbestos Notification Form r Project Revision r Project Cancellation B. Facility Description 1.Current or prior use of facility: RESIDENTIAL 2.Is the facility owner-occupied residential with 4 units or less? rV a.Yes b.No 3 PATRICIAGAGNIER 26 CHESTNUT ST a.Facility Owner Name b.Address HYANNIS MA 02601 5087901285 c.City/Town d.State e.Zip Code f.Telephone 4 PATRICIAGAGNIER 26 CHESTNUT ST a.Name of Facility Owner's On-Site Manager b.Address HYANNIS MA 02601 5087901285 c.City/Town d.State e.Zip Code f.Telephone 5'NA NA a.Name of General Contractor b.Address NA MA 02150 1111111111 c.City/Town d.State e.Zip Code f.Telephone NA g.Contractor's Worker's Compensation Insurer NA 12/31/2018 h.Policy# i.Expiration Date(MM/DD/YYYY) 6. What is the size of this facility? 1200 3 a.Square Feet b.#of Floors C. Asbestos Transportation & Disposal 1.Transporter of asbestos-containing waste material from site of generation: a.Directly to Landfill or b.To Temporary Storage Location/Transfer Station AIR SAFE INC 221MLLOW ST. c.Name of Transporter d.Address Note:Temporary storage of Asbestos CHELSEA MA 02150 9783395361 containing waste e.City/Town f.State g.Zip Code h.Telephone material is only allowed at the place of business of a DLS 2. If a temporary storage location/transfer station is used,list name of transporter of asbestos containing licensed Asbestos contractor or a transfer waste material from temporary storage location/transfer station to final disposal site: station that is permitted by SERVICE TRANS GROUP 58 PYLES LANE MassDEP and a.Name of Transporter b.Address operated in compliance with Solid NEWCASTLE CE 19720 8779999559 Waste Regulations 310 CMR 19.000 c.City/Town d.State e.Zip Code f.Telephone Revised: 11/13/2013 Page 3 of 4 Massachusetts Department of Environmental Protection �100279620 BWP AQ 04 (ANF-001) r Asbestos Notification Form Asbestos Project# )— 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: AIR SAFE INC 22 WILLOW ST a.Temporary Storage Location Name b.Address CHELSEA MA 02150 9783395361 c.City/Town 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 8955 MINERVA RD c.Address WAYNESBURG MA 44688 3308663435 d.City/rown e.State f.Zip Code g.Telephone D. Certification DFW DFW "I certify that I have personally 1.Name 2.Authorized Signature examined the foregoing and am VP 1/17/2018 familiar with the information contained in this document and 3.Position/Title 4.Date(MM/DD/YYYY) Note:Contractor must 9783395361 AIR SAFE,INC sign this form for DLS all attachments and that, based notification purposes on my inquiry of those 5.Telephone 6.Representing individuals immediately 23 WYCHWOOD DR LITTLETON responsible for obtaining the 7.Address 8.City/Town information, I believe that the MA 01460 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