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Home My WebLink About0441 MAIN STREET (HYANNIS) - Health c�.-7 i--) e Massachusetts Department of Environmental Protection4 €; eDEP Transaction Copy Here is the file you requested for your records. To retain a copy of this file you must save and/or print. Username: OMNIENVIR Transaction ID: 1240008 Document: AQ 04-Asbestos Removal Notification Form ANF-001 Size of File: 231.12K Status of Transaction: In Process Date and Time Created: 11/19/2020:4:12:05 PM Note: This file only includes forms that were part of your transaction as of the date and time indicated above. If you need a more current copy of your transaction, return to eDEP and select to "Download a Copy" from the Current Submittals page. Massachusetts Department of Environmental Protection °=- BWP AQ 04 (ANF-001) PreForm Asbestos Notification Form This is a revision to an existing form. Project ID for existing form to be revised: r.711 This job is being conducted under a Blanket Permit. MassDEP assigned Blanket Authorization ID: Cl This job is being conducted under a Non Traditional Abatement Work Practice Permit. MassDEP assigned Non Traditional Work Practice Authorization ID: CI This job does not require the use of an asbestos contractor licensed by the MA Department of Labor Standards because(please check one box below): r This job involves breaking,shearing or slicing of non-friable asbestos-containing material only(e.g.cement shingles/panels,cement pipe,asphalt roofing or siding,vinyl floor tiles,etc.)in a mariner that does not generate asbestos dust or render the material friable,as allowed by the Department of Labor Standards(DLS)at 453 CMR 6.13(2)(a)5.All work must be done in compliance with the applicable regulations at 310 CMR 7.15;or CI This job involves work on asbestos containing material that is classified by the Department of Labor Standards (DLS)as a`Small-Scale Asbestos Project,' an`Asbestos-Associated Project',or an`Asbestos Response Action' by qualified`in-house' personnel as allowed by the Department of Labor Standards(DLS)at 453 CMR 6.00,and will be perfonned in accordance with all the requirements of 453 CMR 6.13 (1)(a),453 CMR 6.13 (2)(a)1.and 3., and 453 CMR 6.14(1)(a),as applicable. All work must be done in compliance with the applicable regulations at 310 CMR 7.15. r None of the above conditions apply,generate a new form. Revised: 11/13/2013 Page 1 of 1 Massachusetts Department of Environmental Protection 100337578 BWP AQ 04 (ANF-001) Asbestos Project# Asbestos Notification Form J r Project Revision r Project Cancellation A. Asbestos Abatement Description 1.Facility Location: FORMER BOWLING ALLEY 441 MAIN ST Instructions 1.All a.Name of Facility b.Street Address sections of this form BARNSTABLE must be completed in MA 02601 0000000000 order to comply with c.City/Town d.State e.Zip Code f.Telephone MassDEP notification JIM ALBRECHT FACILITY MANAGER requirements of 310 CMR 7.15 and g.Facility Contact Person Name h.Facility Contact Person Title Department of Labor Worksite Location: THROUGHOUT Standards(DLS) i.Building Name,Wing,Floor,Room,etc. notification requirements of453 2. Is the facility occupied? ra.Yes rjb.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)? r 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, if applicable: Approval ID# 6.Asbestos Contractor: OMNI ENVIRONMENTAL LLC 5-7 DELAWARE DRIVE SUITE 4 a.Name b.Address SALEM NH 03079 6034582060 c.City/Town d.State e.Zip Code f.Telephone A0000932 h.Contract Type: r'., 1.Written r 2.Verbal g.DLS License# 7. JEFFRY R TABERSKI AS900109 a.Name of Contractor's On-Site Supervisor/Foreman b.DLS Certification# 8 AXIOM PARTNERS INC AA000179 a.Name of Project Monitor b.DLS Certification# 9 AXIOM PARTNERS INC AA000179 a.Name of Asbestos Analytical Lab b.DLS Certification# 10. 12/7/2020 12/18/2020 a.Project Start Date(MM/DD/YYYY) b.End Date(MM/DD/YYYY) 7AM4PM N/A c.Work Hours-Monday Through Friday d.Work Hours-Saturday&Sunday 11. What type of project is this? ri a.Demolition r b.Renovation r c.Repair r; d.Other-Please Specify: Revised: 11/13/2013 Page 1 of 4 Massachusetts Department of Environmental Protection - L7N 100337578 BWP AQ 04 (ANF-001) ___ __Asbestos Notifica orm tion F Asbestos Project#r"; Project Revision r Project Cancellation A.Asbestos Abatement Description: (cont.) 12.Abatement procedures(check all that apply): r-1 a.Glove Bag❑ 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 r b. Outdoors 14 a.Total amount of each type of asbestos Containing materials(ACM)to be removed,enclosed,or encapsulated: 5800 1.Linear Feet(Lin.Ft.) 2.Square Feet(Sq.Ft.) b.Boiler,Breaching,Duct, 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.S F q q. t. 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/MASTIC 5800 1.Lin.Ft. 2.Sq.Ft. 1.Lin.Ft. 2.Sq.Ft. 15.Describe the decontamination system(s)to be used: 3 STAGE DECON UNIT 16.Describe the containerization/disposal methods to comply with 310 CMR 7.15 and 453 CMR 6.14(2) (g): WET,DOUBLE BAG WITH GENERATOR LABELS 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 100337578 Ll BWP AQ 04 (ANF-001) Asbestos Pro ect# Asbestos Notification Form [• Project Revision r Project Cancellation B. Facility Description tion 1.Current or prior use of facility: FORMER BOWLING ALLEY i 2.Is the facility owner-occupied residential with 4 units or less? 1J a.Yes r b.No 3 STURGIS CHARTER SCHOOL 427 MAIN STREET a.Facility Owner Name b.Address HYANNIS MA 02601 5087781782 c.City/Town d.State e.Zip Code f.Telephone 4 JIM ALBRECHT 427 MAIN STREET a.Name of Facility Owner's On-Site Manager b.Address HYANNIS MA 02601 5087781782 c.City/Town d.State e.Zip Code f.Telephone 5 N/A N/A a.Name of General Contractor b.Address N/A MA 00000 0000000000 c.City/Town d.State e.Zip Code f.Telephone N/A g.Contractor's Worker's Compensation Insurer N/A 12/31/2020 h.Policy# i.Expiration Date(MM/DD/YYYY) 6.What is the size of this facility? 10000 1 a.Square Feet b.#of Floors Note:Temporary storage of Asbestos C. Asbestos Transportation & Disposal containing waste 1.Transporter of asbestos-containing waste material from site of generation: material is only allowed at the place [j a.Directly to Landfill or r b.To Temporary Storage Location/Transfer Station of business of a DLS licensed Asbestos contractor or a transfer SERVICE TRANSPORT GROUP 58 PYLES LANE station that is c.Name of Transporter d.Address permitted by MassDEP and NEW CASTLE DE 19720 3027785930 operated in e.City/Town f.State g.Zip Code h.Telephone compliance with Solid Waste Regulations 310 CMR 19.000 2.If a temporary storage location/transfer station is used,list name of transporter of asbestos containing waste material from temporary storage location/transfer station to final disposal site: a.Name of Transporter b.Address c.City/Town d.State e.Zip Code f.Telephone Revised: 11/13/2013 Page 3 of 4 Massachusetts Department of Environmental Protection 100337578 Ll BWP AQ 04 (ANF-001) [-Asbestos ProjectAsbestos Notification Form ri Project Revision Project Cancellation C.Asbestos Transportation&Disposal: (cont.) 3.Name and address of temporary storage location/transfer station for the asbestos containing waste material: a.Temporary Storage Location Name b.Address c.City/Town d.State e.Zip Code f.Telephone 4.Name and location of final disposal site(asbestos landfill): MINERVA LANDFILL MINERVA a.Final Disposal Site Name b.Final Disposal Site Owner Name 9000 MINERVA ROAD c.Address WAYNESBURG OH 44688 3308663435 d.City/Town e.State f.Zip Code g.Telephone Note:Contractor must sign this form for DLS notification purposes A Certification RICHARD QUINN RICHARD QUINN "I certify that I have personally 1.Name 2.Authorized Signature examined the foregoing and am VICE PRESIDENT 11/19/2020 familiar with the information contained in this document and 3.Positionlritle 4.Date(MM/DD/YYYY) all attachments and that, based 6034582060 OMNI ENVIRONMENTAL on my inquiry of those 5.Telephone 6.Representing individuals immediately PO BOX 1002 SALEM responsible for obtaining the 7.Address 8.City/Town information, I believe that the NH 03079 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 Crocker, Sharon From: Building DivisionMailbox Sent: Wednesday, November 25, 2020 10:59 AM To: Heath DeptMaiIbox Subject: FW:Asbestos abatement project Attachments: 21-102 Sturgis Charter School exp 12-18-20.pdf From: Wood, Daniel On Behalf Of Town Main Mailbox Sent: Tuesday, November 24, 2020 8:11 PM To: Build ingDivisionMailbox Subject: FW: Asbestos abatement project In to the web. Dan From: Kerri Mogavero [mailto:kmogavero@OMNIENVIR.COM] Sent: Tuesday, November 24, 2020 1:28 PM To: Town Main Mailbox Subject: Asbestos abatement project Attached is the MA DEP notification form for an abatement project at 441 Main St Thank you Kerri Mogavero Omni Environmental, LLC 603-458-2060 kmoBavero@omnienvir.com CAUTION This email'originated from outside of the Town of Barnstable! Do not click links,open attachments or,reply, unless you recognize the sender's email address and know the content'is safe'l' I i