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HomeMy WebLinkAbout0043 LEWIS BAY ROAD BLDG C UNIT 1 - HAZMAT �3 �e� s /�3ay � � A I G-4 A L , ABATEMENT P.O. BOX 4386 Peabody, MA 01960 (781)589-3161,Fax(781)231-5780 Lmail: inet@a-abatement.com. May 20t" , 2022. TO: Hyanni }d�/ a ,ngInsa; ftalServices/ Fire Department/Health Dept. �� . ¢r r. x li�c JOB DESCRIPTIONS: Asbestos Abatement .43-53 Lewis Bay Road Bldg C Hyannis, Ma �. START DATE'S: June Ist to June 30, 2022 1VIonday-Sunday 7AM- 5PM Please contact us if any questions National Abatement, Inc. Jimmy Net i Massachusetts Department of Environmental Protection 100366129 " - BVUP AQ 04 (ANF-001) Asbestos Project# Asbestos Notification Form Project Revision Project Cancellation A. Asbestos Abatement Description 1. Facility Location: COMMERCIAL BUILDINGS __ _ — ,� 43-53 LEWIS BAY RD.BUIDLIN C a.Name of Facility b.Street Address _ BARNSf LE -- y� MA I 02601— ] �17------8584 c.City/Town d.State e.Zip Code f.Telephone __------- RICH NEWBURG g.Facility Contact Person Name h.Facility Contact Person Title Instructions 1.All Workslte Location: INTERIOR WORKS sections of this form must I.Building Name,Wing,Floor,Room,etc. be completed in order to comply with MassDEP 2. Is the facility occupied? F I a.Yes t— b.No notification requirements t—' of 310 CMR 7.15 and 3. Is this a fee exempt notification (city, town, district, municipal housing authority, state facility, or owner- Department of Labor occupied residential property of four units or less)?L0J a.Yes b.No Standards(DLS) notification requirements 4. Blanket Permit Project Approval, if applicable: r-----J--- —j of 453 CMR 6.12 Approval ID# 5. Non-Traditional Asbestos Abatement Work Practice Approval, if applicable: --_._..___�_ Approval ID# MassDEP Use Only 6 Asbestos Contractor: Date Received i NATIONAL ABATEMENT INC 98 LINCOLN AVENUE a.Name b.Address SAUGUS MA 01906 781-589-3161— --� c.City/Town d.State e.Zip Code f.Telephone I AC000511 h.Contract Type:FLC41.Written ❑2.Verbal g.DLS License# 7. IJtMMY MAO NET OWNER ) LAS000339— _...._—.__..._._-._____...._.._.....__..._... _..._ a.Name of Contractor's On-Site Supervisor/Foreman b.DLS Certification# a.Name of Project Monitor b.DLS Certification# 9. _.—.-----._...._..____-.�__.—..._.....-..-._._..—__ NIA ...... ..___....___—_..._..__.... a.Name of Asbestos Analytical Lab b.DLS Certification# ,--- ---------------- - -----..... -......__._ .. _- 10.106/01/2022 � 06/30/2022 _ ' � - -.— a.Project Start Date(MM/DD/YYYY) b.End Date(MM/DD/YYYY) 8AM 8AM-5-5 _ -__ ____.,--.---..____ _.. c.Work Hours-Monday Through Friday d.Work Hours-Saturday&Sunday 11. What type of project is this? �a.Demolition O b.Renovation c.Repair d.Other-Please Specify: ASBESTOS REMOVAL O O (Ol L=J b_ P_..r,_. w.. 12. Abatement procedures (check all that apply): O a.Glove Bag O b.Encapsulation O c.Enclosure O d.Disposal Only I O e.Cleanup ®jf.Full Containment j�g.Other-Please Specify: ,. ., 13. Job is being conducted: ARa.Indoorsnb.Outdoors 14 a. Total amount of each typLe—ofI asbestos =Containing materials (ACM)to be removed, enclosed, or encapsulated: C -_. 1.Linear Feet(Lin.Ft.) 2.Square Feet(Sq.Ft.) b.Boiler,Breaching,Duct,Tank c.Transite Pipe _J Surface Coatings �f_F_L .Sq.Ft. 1.Lin.Ft. Shi So.ngles Ft. d.Pipe Insulation e.Transite Shihi ngles 1.Lin.Ft. 2.Sq.Ft. 1.Lin,Ft. 2.Sq.Ft. --- f.Spray-On Fireproofing 9•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 OORTII.E,GLUEJOINT COMP_ 100 —______�_--- [7�50011 j 1.Lin.Ft. 2.Sq.Ft. 1.Lin.Ft. 2.Sq.Ft. 15. Describe the decontamination system(s)to be used: `FULL CONTAINMENT I f 16. Describe the containerization/disposal methods to comply with 310 CMR 7.15 and 453 CMR 6.14(2) ALL METHODS WILL BE COMPLY I 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 I_J Fffa.Yes u b.No project? B. Facility Description 1. Current or prior use of facility: [OFFICE SPACES .........._._._._......__._...________—.._..__._.__...__.._.............. _.__.__.._.___... 2. Is the facility owner-occupied residential.with 4 units or less? (�a.Yes C b.No 3, ICENTERCORP 600 LRING AVE a.Facility Owner Name b.Address c.City/Town d.State e.Zip Code f.Telephone 4. ;RICH NEWBURG 600 CORING AVE a.Name of Facility Owner's On-Site Manager b.Address - -t r SALEM I MA - 01970 617-839 8584�—"—�-- i SAME —. --------' �. :SAME —_---- - — a.Name of General Contractor b.Address SAME 1 MA__._._. 01970 ? 617-839-8584-- _� c.City/Town d.State e.Zip Code I.Telephone - --t g.Contractor's Worker's Compensation Insurer UB4484P107 I h.Policy# i.Expiration Date(MMIDDIYYYY) 12 6. What is the size of this facility? Li1500 — ] L____._--.--...—_.--....—._.._......___.__.-__--..._-.i a.Square Feet b.#of Floors Note:Temporary storage of Asbestos containing C. Asbestos Transportation & Disposal waste material is only allowed at the place of 1.Transporter of asbestos-containing waste material from site of generation: business of a DLS a a.Directly to Landfill orC,b.To Temporary Storage Location/Transfer Station licensed Asbestos L-J contractor or a transfer OX _ ...... ATION station that is permitted FNAL ABATEMENT PO B 4386 I by MassDEP and c.Name of Transporter d.Address operated in compliance PEABODY MA 01960 781-589-3161 ._—� with Solid Waste e.City/Town f.State g.Zip Code h.Telephone 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: 1JOB/ROLL OFF SPO BOX 609 f..nex.x.«mvrc....,...mes«nwa.. ✓ev..wmv<N..x..m......wae.........umn+x..s.,..+.x........mm...,.«:.._�»...M...n.-. t.....w..«;.........,......,.,,w,........ .-. . ,........,..<.... .......... .... _., ... a.Name of Transporter b.Address iHAMPSTEAD� 03841�... c.City/Town d.State e.Zip Code f.Telephone 3. Name and address of temporary storage location/transfer station for the asbestos containing waste material: 71;,.COMMERCIAL ST l jSAME..w..,_ a.Temporary Storage Location Name b.Address 781-589-3161 c.City/Town d.State e.Zip Code f.Telephone 4. Name and location of final disposal site (asbestos landfill): WASTES MANAGEMENT OF NH -- _—_— TURNKEY LAND FILL --- — -- —^ —�— a.Final Disposal Site Name b.Final Disposal Site Owner Name 97 ROCHESTER NECK RD. c.Address Note:Contractor must ROCHESTER NH rr03839 i603-330-2165 �� l sign this form for DLS d.City/Town e.State f.Zip Code g.Telephone notification purposes D. Certification "I certify that I have personally examined FJIM NET —� i — 1 the foregoing and am familiar with the 1.Name 2.Authorized Signature information contained in this document - ;-- --��--� SUPERVISOR - -.,,-,1 l___...,___._....___...._........_....__..._._.._.._.____-__.._...._...... and all attachments and that,based on --�'-"-'--'"-'���'----'-'----�'"-'-- �-'��- 3.PositionlTitle --— - 4.Date(MM/DD/YYYY) my inquiry of those individuals immediately responsible for obtaining 781-589-3161 —_� NA,WC —^ I the information,I believe that the 5.Telephone 6.Representing information is true,accurate,and - PO BOX 4386 1 I PEABODY complete.I am aware that there are 7.Address 8.City/Town significant penalties for submitting false Mq 01960 �^ information,including possible fines and 9.State 10,Zip Code 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." MassDEP Home I Contact I Privacy Policy MassDEP's Online Filing System Username:JIMMYNET05 Nickname:MAO My eDEP i FormS00 My Profiled Helpi Notifications LReceipt , Forms Signature Payment Receipt Summary/Receipt upnntrecelpt -; Exit. Your submission is complete. Thank you for using DEP's online reporting system. You can select"My eDEP" to see a list of your transactions. DEP Transaction ID: 1373757 Date and Time Submitted: 5/20/2022 11:17:45 AM Other Email : DEP Transaction ID: 1373757 Date and Time Submitted: 5/20/2022 11:17:45 AM Other Email Form Name: AQ 04 - Asbestos Removal Notification Form ANF-001 Form Name: AQ 04 - Asbestos Removal Notification Form ANF-001 Payment Information DEP code: 223118 Date: 5/20/2022 11:17:37 AM Amount ($): 100 Billing Info: maddie NET --- Payment Transaction Number: 3fb90215-4d9d- 4a76-86a4-079130c3b25a --- Payment Invoice Number: CE2903CE-10A8- 45C0-8723-B428BC82CA22 My eDEP MassDEP Home I Contact l Privacy Policy MassDEP's Online Filing System ver.15.22.1.0© 2022 MassDEP TOXIC AND HAZARD S TERIALS�REGISTRATION FORM --�--�- i I To NAME OF BUSINESS: Board of Health MAILING ADDRESS: _ i--f Town of Barnstable TELEPHONE NUMBER: ;717/ ' JV�Z� P.O. Box 5 CONTACT PERSON: ��L�21 � /��RSK y D%'�G Yhi3N13�,�iK- Hyannis, MAA 02601 KITTY, TAGHER&ASSOCIATES, P.C. 43 LEWIS BAY ROAD To Does your firm store any AN oxlc oar hR2zapaous materials listed below, either for sale or for your own use, in quantities totallin , at any time, more than 50 gallons liquid volume or 25 pounds dry weight? YES NO ` This form must be returned to the Board of Health regardless of a yes or no answer. Use the enclosed envelope for your convenience. If you answered YES above, please indicate if the materials are stored at a site other than your mailing address: ADDRESS: TELEPHONE: LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous characteristics and must be registered when stored ' WORM Please put a check beside each product that you store: Antifreeze gasoline asoline or coolants systems)Y ) Drain cleaners Automatic transmission fluid ,--"Toilet cleaners Engine and radiator flushes Cesspool cleaners Hydraulic fluid (including brake fluid) - Disinfectants Motor oils/waste oils Road Salt (Halite) Gasoline, Jet fuel Refrigerants Diesel fuel, kerosene, #2 heating oil Pesticides (insecticides, herbicides, Other petroleum products: grease, lubricants rodenticides) Degreasers for engines and metal Photochemicals (fixers and developers) Degreasers for driveways & garages Printing ink Battery acid (electrolyte) Wood preservatives (creosote) Rustproofers Swimming pool chlorine Car wash detergents Lye or caustic soda Car waxes and polishes Jewelry cleaners Asphalt & roofing tar Leather dyes Paints, varnishes, stains, dyes Fertilizers (if stored outdoors) Paint & lacquer thinners PCB's Paint & varnish removers, deglossers Other chlorinated hydrocarbons, Paint brush cleaners /(inc. carbon tetrachloride) Floor & furniture strippers ✓ Any other products with "Poison" labels Metal polishes (including chloroform, formaldehyde, Laundry soil & stain removers hydrochloric acid, other acids) / (including bleach) Other products not listed which you feel may Spot removers & cleaning fluids be toxic or hazardous (please list): (dry cleaners) Other cleaning solvents Bug and tar removers v Household cleansers, oven cleaners White Copy-Health Department/ Canary Copy-Business KffTREME. TAGHER&ASSCaATES, P.C. 43 LEWIS BAY FMD TOWN WTV§FMLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair BOAR OF HEALTH O satisfactory 2.3nters .Auto Body Shops O unsatisfactory- 4.Manufacturers COMPANY (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS Class: f 1 7.Miscellaneous QUANTITIES AND STORAGE (IN=indoors;OUT=outdoors) MAJOR MATERIALS Case lots— Drums Above Tanks Underground IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline,Jet Fuel (A) Diesel, Kerosene, #2 (B) waste new motor oil (C) transmission/hydraulic Synthetic Organics: degreasers Miscellaneous: DISPOSAUR.ECLAMATION REMARKS: 1.aown. itary Sewage V2.Water Supply 51n4� �N �Dg- 4, Sewer iOublic V. O 006.0. Z- 0 On-site OPrivate 3. Indoor Floor Drains YES NO � Holding tank:MDC / /,� 0 Catch basin/Dry well 0 On-site system 4. Outdoor Surface drains:YES NO ORDERS: Holding tank:MDC V-pv Catch basin/Dry well 0 On-site system 5.Waste Transporter Name of Hauler Destination Waste Product �c9u.'rNGIhVQ �XC►�P� — ivr�4Tl� YES E . 4dMi9 l�'li9�c1 6WAV,Pic s v�a� s.�_ Xcr��� 2. Person(s) Inte Mewed Inspector . Date