The URL can be used to link to this page

Home My WebLink About0070 SPRING STREET - HAZMAT lb s f r ,`m 7 \ AQ 04 Asbestos Removal Notification Form ANF-001- Transaction#1128785 Page 1 of 4 Massachusetts Department of Environmental Protection 1100313876 BWP AQ 04 (ANF-001) Asbestos Project# Asbestos Notification Form ;J Project Revision I„ Project Cancellation R: fX A. Asbestos Abatement Descriptions 1. Facility Location: ¢, CHARLIE GEORGALIS 70 SPRING STREET a.Name of Facility b.Street Address BARNSTABLE --�j MA 02061 508-778-6997 _ ❑ c.City/Town d.State e.Zip Code f.Telephone SAME JOWNER �I g.Facility Contact Person Name h.Facility Contact Person Title Instructions 1.All WOrkSlte Location: ATTIC �� 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? 9a.Yes b.No notification requirements 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)? ,di a.Yes C_I b.No Standards;DLS) notification requirements 4. Blanket Permit Project Approval, if applicable: of 453 CMR 6.12 Approval ID# 5. Non-Traditional Asbestos Abatement Work Practice Approval, if applicable: ❑- ��i MassDEP Use Only <<'ApprovaL I D#. 6.Asbestos Contractor Date Received NEW ENGLAND SURFACE MAINTENANCE LLP ya 850 WASHINGTON ST —� a.Name b.Address WEYMOUTH MA �02189 781-337_2117 ----- c.City/Town d.State e.Zip Code f.Telephone C000196 h.Contract Type: 1.Written E 4�2.Verbal g.DLS License#. . 7. JOHN P.VALLIQUETTE S060773 a.Name of Contractor's On-Site Supervisor/Foreman b.DLS Certification# 8. RICHARD K.BOWEN M061044 I a.Name of Project Monitor b.DLS Certification# 9. FLI ENVIRONMENTAL INC AA000144 a.Name of Asbestos Analytical Lab b.DLS Certification# 10. J 109/18/2019 i a.Project Start Date(MM/DD/YYYY) b.End Date(MM/DD/YYYY) 7-5 c.Work Hours-Monday Through Friday d.Work Hours-Saturday&Sunday. - 11.What type of project is this? a.Demolition [��/` b.Renovation c.Repair t" d.Other-Please S eci -. V _ 711 2'�Abatement procedures(check all that apply): - - t❑a.Glove Bag ❑b.Encapsulation 7" c.Enclosure (❑d.Disposal Only f'"i e.Cleanup R]f.Full Containment 8.._..1 4.if. l� e.,..� g.Other-Please Specify: 1 https://edep.dep.mass.gov/eDEP/WebForms/Asbestos/BWPANFOOI.aspx 8/12/2019 AQ 04 - Asbestos Removal Notification Form ANF-001- Transaction#1128785 Page 2 of*4 13. Job is being conducted: d]a.Indoors k b.Outdoors 14 a.Total amount of each type of asbestos Containing materials(ACM)to be removed, enclosed, or encapsulated: L1175 I 1.Linear Feet(Lin.Ft.) 2.Square Feet(Sq.Ft.) b.Boiler,Breaching,Duct,Tank ��E --D c.Transite Pipe Surface Coatings 1.Lin.Ft. 2.Sq.Ft. 1.Lin.Ft. 2.Sq.Ft. d.Pipe Insulation Q e.Transite Shingles 1.Lin.Ft. 2.Sq.Ft. 1.Lin.Ft. 2.Sq.Ft. f.Spray-On Fireproofing I-� g.Transite Panels F_ 1.Lin.Ft. 2.Sq.Ft. 1.Lin.Ft. 2.Sq.Ft. h.Cloths,Woven Fabrics ��L i.Other-Please Specify: 1.Lin.Ft. 2.Sq.Ft. j.Insulating Cement VERMICULITE E= 1175 1.Lin.Ft. 2.Sq.Ft. 1.Lin.Ft. 2.Sq.Ft. 15. Describe the decontamination system(s)to be used: AS REQUIRED i ^� I V� 16. Describe the containerization/disposal methods to comply with 310 CMR 7.15 and 453 CMR 6.14(2) (g): AS REQUIRED Ai 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# 1 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 ja.Yes ] b.No project? B. Facility Description 1. Current or prior use of facility: IRESIDENCEi`--- -�-� 2. Is the facility owner-occupied residential with 4 units or less? a.Yes F1711 b.No 3. IGEORGALIS 70 SPRING ST a.Facility Owner Name b.Address BARNSATBLE MA 02061 508-778-6997 c.City/Town d.State e.Zip Code f.Telephone 4. [NA � SAME a.Name of Facility Owner's On-Site Manager b.Address SAME MA 02061 508-778-6997 c.City/Town d.State e.Zip Code f.Telephone 5. NA NA a.Name of General Contractor �- b.Address https://edep.dep.mass.gov/eDEP/WebFonns/Asbestos/BWPANFOOI.aspx 8/12/2019 AQ 04- Asbestos Removal Notification Form ANF-001- Transaction#1128785 Page 3 of 4 N_A CT o0000 000-000-000 �— c.City/Town d.State e.Zip Code f.Telephone NA g.Contractor's Worker's Compensation Insurer NA Ir01/01/2020 h.Policy# i.Expiration Date(MM/DD/YYYY) 6.What is the size of this facility? 12000 � 2 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 �I a.Directly to Landfill or b.To Temporary Storage Location/Transfer Station licensed Asbestos static contractor or is transfer NEW ENGLAND SURFACE MAINTENANCE,LLP 850 WASHINGTON STREET station that is permitted — ----- by MassDEP and c.Name of Transporter d.Address operated in compliance p p WEYMOUTH MA 02189 781-337-2117 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: RED TECHNOLOGIES 110 NORTHWOOD DRIVE a.Name of Transporter b.Address JBLOOMFIELD I cT 06002 860-218-2428 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: NA `I NA a.Temporary Storage Location Name b.Address NA MA 00000 781-337-2117 I c.City/Town d.State e.Zip Code f.Telephone 4. Name and location of final disposal site(asbestos landfill): MINERVA ENTERPRISES MINERVA a.Final Disposal Site Name b.Final Disposal Site Owner Name 9000 MINERVA ROAD c.Address Note:Contractor must WAYNESBURG OH 44688 330-866-3435 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 JIM DOYLE I JIM DOYLE the foregoing and am familiar with the 1.Name 2.Authorized Signature information contained in this document PARTNER OS/12/2019 and all attachments and that,based on my inquiry of those individuals 3.Position/Title 4.Date(MM/DD/YYYY) immediately responsible for obtaining 781-337-2117 NESM,LLP the information,I believe that the 5.Telephone 6.Representing information is true,accurate,and 850 WASHINGTON STREET WEYMOUTH — ----� complete.I am aware that there are 7.Address 8.City/Town significant penalties for submitting false �7 information,including possible fines and MA _ I 02189 imprisonment.The undersigned hereby 9•State 10.Zip Code states that I have read the https:ftedep.dep.mass.gov/eDEP/WebForms/Asbestos/BWPANFOO I.aspx 8/12/2019 i AQ 04- Asbestos Removal Notification Form ANF-001- Transaction#1128785 Page 4 of 4 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." https://edep.dep.mass.gov/eDEP/WebForms/Asbestos/BWPANFOOI.aspx 8/12/2019