HomeMy WebLinkAbout0037 MAPLE AVE - Health 3.. Maple Avenue
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FROM :E?S, INC. FAX NO. :5089230929 _ Nov. 03 2009 02:10PM P1
Environmental "Health and Safety is Our Top Priority"
Response P.O.Box 70190,North Dartmouth,MA 02747 Phone(508)998-6229 Fax(508)995-1456
Services, Inc. Middleborough,MA 02346 Phone(508)923-1111 lax(508)923-0929
FAX TRANSMITTAL
Date: November 3, 2009
To: Cynthia.Martin—Hazardous Material Spec.
Company: Barnstable Board of Health
Fax No: 508-790-6304
From: Cynthia B.radstrcct
Telephone No: (508)923-1111
Fax No: (5.08)923-0929
Reference: 37 Maple Ave- Hyannis
Requested copy of Notification
Ms Martin,
Message: There was a request for this to be sent to the Hyannis Board of
Health. Unfortunately there was no contact information, I hope it
was.lust information for your department. If you have any
questions or concerns please don't hesitate to contact me at our
Middleboro office. 508-923-1111, or by m
E-mail ein4ygenvi.roresp.com ,
Thank you
Since y,)
t -� r .�
�t
This message is intended only for use of the individual or entity to whic�' a. .dressed and may
contain information that is privileged, confidential and exempt from disclosure under applicable
law. If the reader of this message is not the intended recipient,you are hereby notified.that any
dissemination, distribution or copying of this communication is strictly prohibited. If you have
received this communication in error,please notify us by telephone. Thant.You.
Number of pages INCLUDING cover sheet: 4
FROM :ERS, INC. FAX NO. :5089230929 Nov. 03 2009 02:11PM P2
c"
Commonwealth of Massachuse
('100096113
Decal Number
Asbestos Notification Form ANF-001
o0
Important:When filling out A. Asbestos Abatement Description
computer,
on the a. Is this facility fee exempt cit ,town, district, municipal housing authority, owner-occupied
computer,use y p y❑ ❑No p 9 y p
only the tab key residence of four units or less? � Yes —
to move your
cursor-do not b.Provide blanket decal number if applicable: Blanket Decal Number w
use the return
key' 2. Facility Location:
nFJENNIFER ARKO��-~.�����_...,____._..__.__� 37 MAPLE AVE�_w________________��_^__-_�
10 Facllla.N 77_499_41 728HYANNIS MA 01Add[
C.Cltylrown d,Stale e.Zip Code f.Telephone Number
INSTRUCTIONS 3. Worksite Location:
1,All sections of this BASEMENT
form must be e,Building Name/Building Location b.Building c,Wing d.Floor a.Room
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 ENVIRONMENTAL RESPONSE SERVICES IN 98 CAMBRIDGE STREET
Safety(DOS) a.Name b.AgdreasnotIfItlo
_ _ __ ___
requireme MIDDLEI30RO 02346 5089986229 _ - - -,
requirements of 463
CMR 6.12 c.Clt /Town d.Zip Code e.Telephone Number
AC000412
f.D s License Number J g.Contract Type: 7 Written ❑Verbal
__.. o t CTontact Person I.Contact Perr+on's_Tille
6. JAMES H. POLLOCK III - ASS04180066
o.Name of nn-Site Supervisor/Foremen b.Su ervlsoWoremen DOS Certification Number
7
SAM COHEN JAM060787
a.Name of Proiecl Monitor __ b.Pro eel Monitor DOS Certi ication Number _
rENVIROTES�T IAA000128�
a.Neme o-fAsbestos Analytical Lab AsbestosAnall}rtic�l I,t1t�D�5 Ceru cat o"q
c9 10/12/2009 1011212009
a.Project tart Date mm/dd/ r b.E nd Data I mm/dell yyyyl _
-�• 0 8AM -4PM
�N c.�M XTioura Mon-Frl. d.Work hours at- un.
�o 10. a. What type of project is this?
—� ❑ Demolition ❑✓ Renovation
Re
.- ❑ pair
❑ Other, please specify: b,Describe
11, a. Check abatement procedures:
H
Glove bag HIDIsposal
Encapsulation
Enclosure only
❑ Cleanup ❑ Other, specify:
[� Full containment b.Describe
�Q 12. Is the job being conducted: Q Indoors? []outdoors?
r anf001ap.doc-10102 Asbestos Notification Form•Pape 1 of 3
FROM :ERS, INC. FAX NO. :5089230929 Nov. 03 2009 02:11PM P3
Commonwealth of Massachusetts ■
100086113
Asbestos Notification Form ANF-001 Pew Number
A. Asbestos Abatement Description (cont.)
13. Total amount of each type of Asbestos Containing Materials(ACM)to be removed, enclosed, or
enca SAi&t&;.:
20 4s
a.Total pipes or Uucta near rt) b.Total Other surfaces square _
c.Boller,breaching,duct,tank 45 d.Insulating cement
surface coatings Lin. t. Lin,ft. S�f�
e.Corrugated or layered paper 20 f.Trowel/Sprayer coatings L
pipe Insulation Lin.ft. CtD
Lln.ft, Sq. 1.
g.Spray-on fireproofing . h.Translle board.wall board F —�Lln.f � Lln L �
I.Cloths,woven fabrics J.Other,please specify;
Lin.ft. S ft. Lln.k. Sq,it.
k.Thermal,solid core pipe � �_�
Insulation Lin.ft. Sq.ft. I.Specify
14. Describe the decontamination system(s)to be used:
THREE STAGE DECON ADJACENT TO WORK AREA
15. Describe the contalnerization/disposal methods to comply with 310 CMR 7.15 and 453 CMR
6.14(2) 9
_
WET ACM AND PLACE IN LABELED, DOUBLE 6 MIL DISPOSAL BAGS
16. For Emergency Asbestos Operations,the DEP and DOS officials who evaluated the emergency:
ANDREW COONEY �NSPECTOR
a.Name o D I IN
10/9I2009 SE09.281
c.Date mmlddyj,of Authorization d.DEP Waiver#
RICK RABIN _ _� INSPECTOR �.
e.Name of DOS Official is a e
10/9/2009 — NWA10095 ---- —
g.Dale mm dd7"- of Authorization ��^ -��----- ` •—•-•�•--__
�N YYYy) h.DOS Waiver#
—0 17. Do prevailing wage rates as per M.G.L.c. 149,§26, 27 or 27A—F apply to this project? ❑Yes 0 No
° B. Facility Description
o 1. Current or prior use of facility: RESIDENTIAL �w_ ��
1209MEWo
Q 2. Is the facility owner-occupied residential with 4 units or less? Yes No
JENNIFER ARKO 37 MA
3' PLE AVE
a,Facllity Owner Name b,Address
HYANNIS _ 02601 (774)994.1728
c.CH /Town d.Zip Code e.Tel_ephone Number area code find extension
�LL 4 NA
a.Name of Facil��Owner's On-Bile Manager b,On-Slltr A Manageddress
2
----a c,City/Town d.Zip Code e.Telephone Number(area code and extension)
■ nnfoolsp.doc•10i02 Asbestos Notification Form-Page 2 of 3■
I FROM. :ERS, INC. FAX NO. :5089230929 Nov. 03 2009 02:12PM P4
III ! Commonwealth of Massachusetts -
100096113
Asbestos Notification Form ANF-001 Decal Number
B. Facility Description (cont.)
rF-
a.Name of General Contractor b.Address _
C.City/Town d.Zip Code e.Telephone Number area code(and extension)
lf� I Ll
f.Contractor's Worker's Comp.Insurer u.Policv Number h.E_xp_Date(mm/dd/yyyy
6. What is the size of this facility?
a,Square Feet b,Number of floors
C. Asbestos Transportation and Disposal
1. Transporter of asbestos-containing material from site to temporary storage site (if necessary):
ERS,INC. 1 198 CAMBRIDGE STREET
Note:Transfer a.Name of Transporter b.Address
Stritlons must IMIDDLE901110 02346 15089231111
comply with the
c.City/Town d.Zip Code e.Telephone Number
Solld Waste
Division 2. Transporter of asbestos-containing waste material from removal/temporary site to final disposal site:
Regulations 310 _
CMR 19.000 RED TECHNOLOGIES, LLC 110 NORTHWOOD DRIVE
a.Name of Transporter b.Address _
BLOOMFIELD 106002 18602182428 _ T�
c.Citygow_n_ _ d,ZIp Code a.Telephone Number _^
3. C- -
a.Rofuso Transfer Station and Owner b,Address
c.City/Town r d.Zip Code e.Telephone Numberp�
4. MINERVA ENTERPRISES INC — IL—
a.Final Disposal Slte Locatlon Name b.Final Disposal Site Locatlon Owner's Name _
9000 MINERVA ROAD I IWAYNESBUR6
c.Flnol q[Moeg d,Cite
e.Slate f.Zip Code g.Telephone Number
D. Certification
N
The undersigned hereby states,under the GARY PELLETIER 1 GRY A PELLETIER _...J
penalties of perjury,that he/she has read the a. 4t0p _ b.Authorized Signature _
�o Commonwealth of Massachusetts regulations BUSINESS MANAGER 10/09/2009
for the Removal,Containment or --� �
c.Poll on/Title "ate(fA0]LAX1(YY1 _,
Encapsulation of Asbestos,� information
CMR B.00 and 5089986229 310 CM 7.15,and that the information ERS, INC.
contained in this notification Is true and correct e.Telephone Number E Represanfing
to the best of his/her knowledge and belief. 9 BLUEBERRY LANE _
.Address —
�u. DARTMOUTHH [0 747
h.Cilyrrown 1.ZfP Code '--
�a
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