HomeMy WebLinkAbout0051 OAK STREET - Health 51 Oak St ��
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Awe fa.T-Hotificatlon Fcna ANF-001
Asbestos Abatement Description
1. Facility location:
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DISTRuen011s AWN area
. r /� I �1 u RECEIVED
1.All sections of Ns _.... el n ..�................................ .1.^..5 _.1.............T
lip
bra,moat be e,molefad Gty/ram
nadwtoeanpfywlh '^ Q NOV 01 1999
hnviton01p lmanlal WaUrr+o�7�bodar7Duo&V AM./-*412fio*,own
Eml+otltrrentsl
Prdectlon nolfralion 2. Is the facility occupied?,0 Yes O No TOWN OF BARNSTABLE
rewieme is of 310 CLO HEALTH DEPT.
7.1S(Wmii 7drys 3. Asbestos Contractor.ptio,rrolira=oon b
regquia aof anyeabdaiw�t iV e�A) n5,g/-d SUrfet�_N i���U-Q 9 0,1wshin Jet' -ef
Dapartmetd of lobar wow
and lndustrtes �,U�V�s .�h (Y�p O 1 6 �1-337-`�I!-]
aotfrdiontequiemuts 1 --._.__.—_.-._._._--!.:_:�..1......__ � _._.-.._...-----_. ..._.....r� ......._.. _.--•---____�
01153 Cf.016.12 (ten Gry/fowt
drys prim rntifac+en a rr ��•y- � L_
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rDataatert pro sd(7esre' IX t ltrw/ Cm7a!type(wrnrW-0
rm Ovae Blear or
sytarel-1. 4. on-Site Project Supervisor/Foreman:
2.Stbmi OrigiW Fofm .�E
To: xrrtc
commeareaftf of
MauscUselts 5. .Project Monitor.
Aslestes Program \�
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_..._..._._.___...._.____—__._.._.— —
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6. Asbestos Analytical Lab:
3.This form maybe
usedA 0� ....._
ed la tta ndifying _.�_"r� _!� 75 S _.LS�Cf :.. __..
US.Emimmataf Nrmr DUr4dfiab?
Ptoledian Agency Becton
I of asbegas domof1W 7. Prcjectsta'rtda- � � �
� enddatespecificviorkhours(Mon.-Fri.) �! (Sat.Sun.)
renovation operation a to NE a __ „
bject -%WS(40 rag dtw(a�lalrrJ
CFRSrbpart►0. S. What type of project is this? (circle one):--;daaxnra,.-... ..:.._..._rw>r.__._...
9. Describe the asbestos abatement procedures to be used (circle): gbrefrap errloaxe uacatYstnd ' deersrp
10. Is the job being conducted 50ndoors ❑outdoors?
tom- ss-
`' 11. Total amount of each type of Asbestos Containing Materials(ACM)to be handled on pipes or ducts(linear It.)—L—Lor other.
surfaces(square ft). to be removed,enclosed or encapsulated:
Fineadsquare feet
boilar,broaching.dudfantsuaaaacoatirrgs...�f grxmaf•som core ppeirwdation......
_�
eomtgefad or h)eed psper pips Irsuldlon.... 1, irsuldinp m7we.................. _�
;Pm— reprao6rp..................... barel/vra cow1hp.............. _J
doffs.worm hbris....................._J rransheboard wad board............._J
odor(pleasedesabe)...................._J
12. Describe the decontamination system(s)to be used:
13. Describe the containerization/disposal methods to comply with 310 CMR 7.15 and 453 CMR 6.14(2)(g):
,.
......................._._..............._.......
............
__..._._...... _ --.._................_._.__.._....___
14. For Emergency Asbestos Abatement Operations,the DEP and DLI oNicWs who evaluated the emergency:
•,.` x':1........ .._........................_......
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f »_.,..,...
Wrmd0rl0eklY fPY ...•.. .
;._'• ::•s, ;- IAk dAdaoAlYa7n�
rK Y
r
. NaardIXicradat r rnk "-----...
!Aled.wnorrryan WYKr/ _ .
45: Do prevailing wage rates apply as per M.G.L.c.149.§26.27.or 27A-F to this project? O Yes P(No
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Fadllty Descriptlon
1. Current or prior use of facility:
....__—.-.............
_......_.._..._.,...___........ ------
2. is the facility owner-occupied residential with 4 units or lass? 15,Yes O No
3. Facility Owner.
— _...._...... 1nae__
........ . :..........._.............
_
Hsme' Addrru
cAY1T m md. Ire#ov
4. Facility's Owner's On-Site Manager.
........._.........V..). ......................................................... _..............._._.
Ctyaa»a —---ZO mac— ---ire —
5. General Contractor.
Addnss .
we .._. �._. rekpOmH�_..
Contractors Worbrr Camp.tnsunr Poky/ Esp.Date
6. What Is the size of the facility?fJW(�C(q It) (1.1 floors)
isAsbestos Transportatlon and Disposal
1. Transporter of asbestos-containing waste material from site to temporary storage site(if necessary)to final disposal she
cihiro» ................. y✓Y1c.C: ..........`..!.(i�. _:..0....2!_ ......:..... .rr� .�...-..3. .-.�11 ) 7 -
2.• Transporter of asbestos-containing waste material from removal/temporary storage site to final disposal site:
USA Uj a3+-e— �O`i �iAdzkw
C�;l�c
_......._.. C. )�,C�r�L....._._.....�=�.... ._.._.0 6'-t �C�.........._._g.�.."._�_`......
Note:Transfer ubAwa lvao* IrepMme
stations must 3. Refuse transfer station and owner(H applicable):
comply wrfh the .
sore Waste
Divislon repuhr-
Nons 9to CMR
d4/la0 zo male- trrpiax
4. Final Disposal Site:
\1 w e\4 t.0 10 ,�1 l _l1-� ��JctS I Sertiiz�._
lawem AWM `—'T ONrn wm.
Cnr/faw 1/poodr Irephau ..
CetfifiW1017
The undersigned hereby states,under the penalties of perjury•that he/she has read the Commonwealth of Massachusetts Regulatlons
for the Removal,Containment or Encapsulation of Asbestos,453 CM 6.00 and 310 CM 7.15,and that the Information contained in
this notification is true and correct to the best of his/her knowiedge and belief.
oilr
PFtame —�•- --___—."AuOa+ltMSyrrwtar / y~Ir
iY -
Nole:Contractor must sign this —J—""_L
form for DU PDAWnre Amrmdlne r —�IdepMne
notdication
purposes —� 1 11f j l �Fl S Uy`S�l._ W f!!a't J ) 10_1 !O 1—
Fee exempt(City,Town•district•municipal housing authority,owner-occupied residential of tour units or less)70 no
Sticker)(from front of form): L ��`3(