HomeMy WebLinkAbout0338 EEL RIVER ROAD - Health P 338,Eel River Road;(Osterville)-+
e
r � +
Ii
ftimWimmfil a,Rnnvb use Us
hol7elcaflon Fcrm— ANF-001
Asbestos Abatement Descrlptlon . f
1. Facility location:
asrxucnoxs — 'ECEty�
W sa 16M of thisuu c .Z ` \ VC - t l
m nazi be cunp'stad
g&toarnpiywih -t l./�l\
of
mUo°A trnntant ll Nta ti.atrprbeam `, mr,moo
raactlan roUlk9ion OF 6P'R 5 T g
iranalsa(310 CUR2. Is the facility occupied? Yes Cl No � �O�JVHEP�TH pEP
.15(ten rartinp drys '
iar WiNuan is 3. Asbestos Contractor.
New England Surface Maintenance, LLP 850 Washington Street
o)at:ud ft
sputmW of Ubar XLn Ad*w
ndI`deit`ias Weymouth, MA 02189 781-337-2117
.IGtw 1equief ads Y
14S3 CM 6.12 (ren cnr/r_ ap oxr ralpr- -
ys prior no0rsWisu is
aolrW-dAXr AC 000196
proms _._..._.._...........__—_._�.__...___-_..___._..:....-
xaawauto/ = caaaiarrw( +�1
1Jrae Anew or
steel• 4. On-Site Suppeerjvis�arr/.FoLr�eman:
Stbmi OrI&nt Form -6ce—;
W. 97ar /•J DU C.YtetO/OU/
(:aaaa0mailth at -
Ysssachusatts 5. .Project Monitor.
lshastss Program
P.03.1100ti7
lastaa,MA C2112- An ouC441dtae/
CM
6. Asbestos Analytirallab: .
3.This tarm may be :y�]�y(�\
LSed for rditying the l A AJI \ l.i 1/"1:1 _ r, �...
US.Errhwnentai Nan7f _...._....Region
...
1X1 Cuddo'loo/
101-hestosdemoCtiory 7. Project start datQ__1JJSgZenddatdJTiQlspeeifie work hours(Mon.-Fri-)
tencno0e tgetstlass
subW to NES WS(40
GLA&bDn Lq. 8. What type-af project is this? (circle one): damo°am M& mmwem omv(ryum)
y�ty 9. Describe the asbestos abatement procedures to be used (circle): p6r.mv " ir�aara -hrlcarlaamuf dnw._,.,._.a
�r ° aar�soleGm ' dwawoay ' aerr(a�sr)
10. Is the job being conducted, indoors 0 outdoors?
.a. 11. Total amount of each type of'Asbestos Containing Materials(ACM)to be handled on pipes or ducts(linear ftL_2ki(:�rother -
g surfaces(square ft.). LICE to be removed,enclosed or encapsulated
G4nr1$gwre feet
Dale;br&xft d4 trntsufsrraostips... !� therms(sordcar F*v kwAL*r......_J
a urapaWork0Wp;wpixim+dWw...J�) imdstrpmmert..................
spar•on&*rodv..................... ..............
dolts'Nawa 1.`=. .............../ =-Mb bamd Waif beard.............
oow(please desmW.
12. Describe the decontamination systems)to be used:
As required
13. Describe the containeriudon/d'uposal methods to comply with 310 CMR 7.15 and 453 CUR 6.14(2)(g):
Two layers-6 mi1 1ab 1 ed bags
14. For Emergency Asbestos Abatement Operations,the DEP and DU officials who evaluated the emergency
mted.(wnonrYrw Wriu/
4S: Do prevaiting wage rates apply as per M.G.L.e.149.5 26,27.or 27A-F to this project? Oyes J�No
FacllltyDescrlptloil
1. Currant or prior use of faciliy
2. Is the facility owner-occupied residential with 4 units or kss7I Yes 0No
-
3. Facility Owner 0 , `
Sift Addresr
CAK— _ Zb mdr rrepmr -
4. Facility's Owners On-She Manager.
WjYfo.a lb ma Tddar
5. General Contractor. _
lrsme Md—
Cy/roun 210 cods T�iarrorw _ �,,
CmlraCHYJ Nrenaa cmy.Haver Pelcr/
6. _(sq tt) /of floors)
r Y
Asbestos Transpartatlon and Disposal _
1. Transporter of asbastossontainieg waste material from sire to temporary storage site(d necessary)to rural disposal sic
NESM, LLP 850 Washington Street
r1m,e AM=
Weymouth, MA 02189 78.1-337:-2117
�raaYe rmma rgonaae
2 Trartsowler of asbatos-containing wage material from removal/temporary storage site to tool disposal site
Waste Management 209 Pickering Street
man Arms -
Portland, 'CT 06480 860-342-6667
Aob:Traaster ayRaa dvm* r r,p me
stations mast
ply wdh the 3. Refuse transfer station and owner(d app6able):
sarrd Wash
Oivrsioa reQrrra- -xwr dons 310 CUR Amr
1100
CyRaa Aommr Tileprm
4. Fun(Disposal Sits
Valley Landfill USA Waste Services
man omrs riot
Pleasant Valley Road'
AN=
Irwin, PA 15642 412-744-4000
Cy/Te+re Roma, Adair
C81MICatl0n i
The undersigned hereby states,undertha penalties of perjury,that.hdshe has road the Commo? of Massaehusatts Regulations
for the Removal,Containment or Eoapsulatioa of Asbestos.453 CMR 6.00 and 310 CMR 7.15. the information eon 'ed In
this notification is We and correct to the best of his/her Imowledge and b
V)LN � C _a�
m. -
Kate:Contractor
must sign this Partner NESM, LL 781-337-2117
form for oU . .
notdication AarndVllre t+m..="&V rdmran
I.
purports 850 Washington Street ' Weymouth, MA 02189
Avuea r7ryrrmw demo. -
Fee exempt(City.Town.district.municipal housing authority.owner-occupied residential of four units or less) yes p no