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HomeMy WebLinkAbout0000 CORPORATION STREET - Health 9 � ' Corporation;Road (roadwork) » Hyannis I a M I l� D 9�s.4�o.2s6o,l fax 978.470.1017 �l- Specialty Contractors April 9, 2013 Barnstable County Health Department 3195 Main Street, P.O. Box 427 _Barnstable„MA.02630 RE: Town of Barnstable, Corporation Street, Hyannis,MA 02601 (Exterior) Dear Sir or Madam: Please be advised that Dec-Tam Corporation will be performing an asbestos abatement projects at the above referenced locations. This work had been scheduled for April 17, 2013 thru. April 18, 2013 All applicable local, state and federal agencies have been notified of this work. Please let me know if you have any questions. Sincerest regards, Craig Starkman Sales Estimator CS/cam Enclosure p ►� w o co :~ Environmental Remediation Services - Surface Preparation - Facilities Services a 50 Concord'5treet - North Reading, MA 01864 www.dectam.c6m - sol'utions@dectam.com f � LI Commonwealth of Massachusetts 100175153 Asbestos Notification Form ANF-001 Decal Number Important: A. Asbestos Abatement Description When filling out p forms on the computer,use 1. a. Is this facility fee exempt-city, town, district, municipal housing authority, owner-occupied only the tab key residence of four units or less?❑✓ Yes ❑No to move your IA cursor-do not b. Provide blanket decal number if applicable: Blanket Decal Wmber use the return key. 2. Facility Location: r TOWN OF BARNSTABLE I CORPORATION STREET a.Name of Facility b.Street Address I-IYANNIS M.A 102601 1 15085624000 ' c.City/Town d.State e..Zip Code f.Telephone Number INSTRUCTIONS 3. Worksite Location: 1.All sections of this EXTERIOR form must be a.Building Name/Building Location b.Building# c.Wing d.Floor e.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 DEC-TAM CORPORATION 50 CONCORD STREET Safety(DOS) a.Name b.Address notification requirements of 453 NORTH READING 19784702860 CMR 6.12 c.City/Town d.Zip Code e.Telephone Number AC000035 g. Contract Type: ✓❑Written ❑Verbal f.DOS License Number CRAIG STARKMAN —� SALES h.Facility Contact Person i.Contact Person's Title GEORGE A. PAGE AS071933 6' a.Name of On-Site Supervisor/Foreman b.Supervisor/Foreman DOS Certification Number N/A iN/A 7. a.Name of Pro'ect Monitor _ b.Project Monitor DOS Certification Number N/A r N/A 8. a.Name of Asbestos Analytical Lab ; b.Asbestos Anai ii&ai Lab DOS Certification Number 4/17/2013 ] 4/18/2013 0 9' a.Project Start Date mm/dd/ �` b.End Date mmldd o , 7A-4P N c.Work hours Mon-Fri. d.Work hours Sat-Sun. _0 10. a. What type of project is this? —o ❑ Demolition ❑ Renovation DOSPOSAL ❑ Repair ✓❑Other, please specify: b.Describe 11. a. Check abatement procedures: o ❑Glove bag ❑ Encapsulation —o ❑ Enclosure ❑✓ Disposal only =LL ❑Cleanup ❑Other, specify: ❑Full containment b.Describe —z —Q 12. Is the job being conducted: ❑ Indoors? ✓0 Outdoors? ■ anf001 ap.doc•10/02 _ Asbestos Notification Form•Page 1 of 3■ :r i -"q"w Commonwealth of Massachusetts _ ■ 100175153 ''d Asbestos Notification Form ANF-001 Decal Number A. Asbestos Abatement Description (cont.) 13. Total amount of each type of Asbestos Containing Materials(ACM)to be removed, enclosed, or encapsulated: 100 0 a.Total pipes or ducts(linear ft) D. I otal other su aces square c.Boiler,breaching,duct,tank d.Insulating cement surface coatings Lin.ft. Sq.ft. Lin.ft. Sq.ft. e.Corrugated or layered paper f.Trowel/Sprayer coatings pipe insulation Lin.ft. Sq.ft. Lin.ft. Sq.ft. g.Spray-uri irrepruofing h.Transite board,vial)board Lin.ft. Sq.ft. Lin.ft. q. i.Cloths,woven fabrics C� j•Other,please specify: 100 0 Lin.ft. S .ft. Lin.ft. S .ft. k.Thermal,solid core pipe u TRANSITE PIPE insulation Lin.ft. Sq.ft. I.Specify 14. Describe the decontamination system(s)to be used: THREE STAGE 15. Describe the containerization/disposal methods to comply with 310 CMR 7.15 and 453 CMR 6.14(2) (g): MATERIALS WILL BE WETTED AND PLACED IN DOUBLE BAGS AND LABELED FOR TRANSP 16. For Emergency Asbestos Operations, the DEP and DOS officials who evaluated the emergency: a.Name of DEP Official b.Title c.Date(mm/dd/yyyy)of Authorization d.DEP Waiver# e.Name of DOS Official ..D Official Title a g.Date(mm/dd/vyyy)of Authorization (� h.DOS V',_ni-esr µ I _ _N —0 17. Do prevailing wage rates as per M.G.L`c._149. §26, 27 -A—F apply to this project? ❑Yes[✓ No _N .B. Facility Description 0 1. Current or prior use of facility: EXTERIOR ROA� �o 2. Is the facility owner-occupied residential with 4 units or less? ❑Yes FZ No TOWN OF BARNSTABLE 367 MAIN STREET 3' a.Facility Owner Name b.Address BARNSTABLE 026011 1508-862-4000 o c.City/Town d.Zip Code e.Telephone Number area code and extension �LL 4 CRAIG TROMBLEY 1 1396 GIFFORD STREET a.Name of Facility Owner's On-Site Manager b.On-Site Manager Address Z FALMOUTH 1 102540 508-364-1827 �Q c.City/Town d.Zip Code e.Telephone Number(area code and extension) ■ anf001ap.doc•10/02 Asbestos Notification Form•Page 2 of 3■ �} Commonwealth of Massachusetts 100175153 Asbestos Notification Form ANF-001- Decal Number B. Facility Description (cont.) LAWRENCE LYNCH 396 GIFFORD STREET 5' a.Name of General Contractor b.Address FALMOUTH 02540 508-548-1800 c.Ci /Town d.Zip Code e.Telephone Number area code and extension GREAT DIVIDE INS. CO I IWCA153726610 1 112/28/2013 f.Contractor's Worker's Comp.Insurer g.Policy Number h.Exp.Date(mm/dd/ym) 6. What is the size of this facility? b.a.Square Feet b.Number of floors C. Asbestos Transportation and Disp®sal 1. Transporter of asbestos-containing material from site to temporary storage site(if necessary): Note:Transfer a•Name of Transporter � b.Address Stations must comply with the c.City/Town d.Zip Code e.Telephone Number Solid Waste Division 2. Transporter of asbestos-containing waste material from removal/temporary site to final disposal site: Regulations 310 CMR 19.000 SERVICE TRANSPORT 58 PYLES LANE a.Name of Transporter b.Address NEW CASTLE, DE 18779999559 c.City/Town d.Zip Code e.Telephone Number 3. a.Refuse Transfer Station and Owner b.Address c.City/Town d.Zip Code e.Telephone Number 4. IMINERVA ENTERPRISES INC a.Final Disposal Site Location Name b.Final Disposal Site Location Owner's Name 9000 MINERVA ROAD !+NAYNESBURG c.Final Dis osal Site Address f_i d.City/Town OH 44F V- e.State IrZlp Code g.Telephonr-N-imbimr. cl o D. Certification N The undersigned hereby states, under the CRAIG STARKMAN JCraig Starkman —� —�° penalties of perjury, that he/she has read the a.Name b.Authorized Si nature O° Commonwealth of Massachusetts regulations ISALES —� 4/5/2013 for the Removal,Containment or c.Position/Title d.Date(mm/ddMrvv) Encapsulation of Asbestos,453 CMR 6.00 and 9784702860 —� DEC-TAM r 310 CM 7.15,and that the information contained in this notification is true and correct e.Telephone Number f.Representing _° to the best of his/her knowledge and belief. 50 CONCORD STREET o q.Address �U_ INORTH READING 101864 Z h.City/Town i.Zip Code anf001 ap.doc•10/02 Asbestos Notification Form•Page 3 of 3