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Home My WebLink About3291 MAIN ST./RTE 6A(BARN.) - Health 3291 Main Street Barnstable • 299-015 Massachusetts Department of Environmental Protection 1100195413 LI Bureau of Waste Prevention—Air Quality Decal Numb®r Project Revision Notification For Asbestos Notification ANF-001 and AQ 06 t"hop fillip A Facility Location Whgn filling out A. 4onm on the JOHN LEW S computor;use only the tab key 1.Name of Facility to mavo your 3291 F1T.6A cursor-do not 2.Street Address u80 the return key. BARN$TABLE MA 3.Ci 4.State 5.7rp Code �e 6.Telephone Number INSTRUCTIONS B. Project Cancelled - -- _ 1. This form Is only available for ❑Check here if this project is/was cancelled: cnlina filing of grated date t r®vi8i0nS• . 3. Enter e C. Project Dates ' �grgl number,, th a. validate that the project 04/02/2014 04/02/2014 location is rorrgct 1.Cri final Start Date ern/ddl ri i gt End QLt2mml ini the entered dotal. 3.Latest Revised Start Date(mm/ddlyyyy) 4.Lateat Revised End Date(mr►Vddlyyyy) 4. Entor your new project dates. b. Certify your notification. D. Revised Project Dates Submit date r,.hongoo, 03/31/2014 1 104101/2014-- 1.Revised Start Date(mmld yyyy) 2.Reviwd End Date Dale(mlluatuyyyy) E. Other Project Revisions SCOPE HAS BEEN REDUCED TO GLOVE BAG REMOVAL OF APPROX.120LF F. Revision History anUpdm.doc°rev.V6104 I MAR-31-2014 11:48 FROM: TO:15087906304 P.3 Commonwealth of Massachusetts +L 1100195413 Decal Number Asbestos Notification Form ANF-001 'p° n W ilfi A. Asbestos Abatement Description when rtung out p forms on the computer,use 1. a. is this facility fee exempt-cit town,district.t.municipal housing authority, owner-occupied only the tab key residence of four units or less?L0 Yes st to move your cursor•do not b. Provide blanket decal number If applicable: elank8t beryl Number use the return key. 2. Facility Location: VolJOHN LEWIS 3291 RT.6A a Namg of Facility b 2troet Ad or s BAFINSTABLE MA 02f37 i c.Cityrrown d.Shale e.Zip code f.Telephone Number INSTRUCTIONS 3. Worksite Location: f.All sections of this SAME form must be 8.Building Nome/13uilding Location D.Building.# c.Wing d.Floor e.Room comploted in order to comply with 4. Is the facility occupied? Yes ❑No DEP notification requlromont8 of 310 CMR 7.15 5. Asbestos Contractor: and the Division of occupational AIR SAFE INC 61 ENDICOTT sum - Safety(D05) a.Name b.Address ruame NOAWOOD roqw1ulrlrmments of 453 02062 1 7817623390 i CMR 6.12 c.cityrrown d.Zi Code e.Telephone Number AC000464 f DOS License Number 8. Contract Type: ®Written Verbal h, aq' ontact amon i.ContBot Person's Title JAIME E AMAYA A$060847 6' tt,Name of On-Site Su ervisor/Fo man u i r F reFnan ificatfo Nu tier 7. NA NA a.Name of Pr "ed M nit r b.Pro ct Monitor OOS cerllFlcation Number NA NA a' a_Name of Asbestos Anal +cal Lab I ti a b DO rtiflcation Number 9 0M02/2014 04102=14 A.Project start Date nrmlddr b.End Data mm/cl ° 7AM-13PM a Work hours Mon-Fri. d.Work hours Sat-Sun. 0 10_ a. What type of project is this? �o [�Demolition Renovation ❑ Repair [ Other, please specify: b.Describe 11. a. Check abatement procedures: ° Glove bag Encapsulation a Enclosure Disposal only 21 Cleanup Other,specify: (]Full containment b.oescribe z Q 12. Is the job being conducted: Q Indoors? []Outdoors? . anfMol ap.d0c•1=2 Asbestos Notification Form•Page 1 of 3 MAR-31-2014 11:48 FROM: TO:15oe7906304 P.4 Commonwealth of Massachusetts - ■ryF! y001s;a13 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 enca sula ed- 250 Q a.Total pipes or clums, meat o 3Tk of el a s�ua'ct square 11) a,Boiler,breaching,dud.tank � I 1 d Insulating cement surface Coatings Lin.ft_ Sq.ft. Line-fL Sq. ft. e.Corrugated or layered paper f.'rrowel4prayer coatings pipe insulation �r Lin,it � S ft. (L'i"n�t"t '� Sq.ft, p.Spray-on fireproofing *{/ Lin►— J Sq h.Translie board'wall board i.Cloths,woven fabrics in:. j.Other,please spedfy:, e. It.Thermal,solid core pipe insulation n.ft. q I.Specify 14. Describe the decontamination system(s)to be used: 3 CHAMBER DECON 15. Describe the containerization/disposal methods to Comply with 310 CMR 7.16 and 453,CMR 6.14 2 ( 6 MIL POLY BAGS 16. For Emergency Asbestos Operations, the DE and DOS officials who evaluated the emergency-, a Name of DEP,Official b, itl® • a o.Date mmldi! of Authorization d.DEP Waiver# a.Name o D S official T DOS iciel'fille --- N g.Date mmlddlyyyy)of Authorization h. DOS Waiver# 17. Do prevailing wage rates as per M.G.L. c.°149,§26,27 or 27A—F apply•to this project? Yes ✓[ No B. Facility Description = a ' 0 1. Current or prior use of facility: . RESIDI=N7tAL ® 2, Is tho facility owner-occupied residential with 4 units or less? Yes []No 3 SAME a.Facility Owner Name . J b.Address a �Illllillillllilla c.City/Town d.ZipCode e,Tale hone N_ , umber area code and extension a.Name of Facility Owners Own-Slid Manager b.On-Sitb Manager Address c.day/Town d.Zip Code a Telephone Number(area Code and•extension) ■ anf001 ap.doe•10102 Asbestos Notification Form•Pa e 2 of 3 r MAR-31-2014 11:49 FROM: TO:15097906304 P.5 L Commonwealth of Massachusetts��, 10ols5413 ' Asbestos Notification Form ANF-001 Decal Number B. Facility Description (cont.) 5. a.Name of General Contractor b.Ad ress c.Cityffown d.Zip Code a.Tale hone Number area Code and extanslon 1.Contractors Worker's Comp.Inqurer a.Polioy Number h.EXP.Date mmlddl 6. What 19 the SIZ9 Of this facility? I a.Square Feet b.Number of floors C. Asbestos Transportation and Disposal 1. Transporter of asbestos-Containing material from site to temporary storage site(if necessary): AIR SAFE Note:Transfer a Name of Transporter b.Address Stations must comply nth the c.Cityylrown d.Zip Code e.Telephone Number Solid Waste Division 2. Transporter of asbestos-containing waste material from removal/temporary site to final disposal site. ftulations 310 CMR 19.000 a.Name of Trans orter b.Address c.Citvrrown d.Zo Code e.Telephone Number 3. a.Refuse Transfer Station and Owner b.Address o,C frown dd. ie r.J e,Tele hone Number 4. IMINERVA ENTERPRISES INC a.Final Dismal Site Location Name b Final 101s oral She location Ownerq Name 9000 MINERVA ROAD WAYNESBURG c.Final Dis sal Sita Addemd.Cityfrown OH 44888 e.State f.Tip Code 9.Telephone Number O D. Certification N ® The undersigned hereby states,under the DAVICI F.WALSH a penalties of perjury,that helshe has reed the a.Name b.Authorised Signature Commonwoalth of Maesachusette regulations IVP for the Removal Containment or ' c.PositionITitle d Datq Qrrn1ddt& Encapsulation of Asbestos,453 CMR 6.00 and 310 CMR 7.15,and that the information (781)762.3390 AS contained in this notification is true and correct o-Tele hone Number f.Re resantin ° to the best of his/her knowledge and belief. 161 ENDIC_O_TT D Address ®u. INORWOOD T� 02062 —� h,Clylrown i.Zip Code Z W Page: 1 CERTIFICATE OF ANALYSIS Barnstable County Health Laboratory Report Dated: 7/28/2004 Report Prepared For: Order No.: G0426641 Arthur Ryley P O Box 730 Barnstable, MA 02630 Laboratory ID#: 0426641-01 Description: Water-Drinldng Water Sample#: 26641 Sampling Location 3291 Main St Barnstable MA Collected: 7/20/2004 Collected by: A Ryley Received: 7/20/2004 Test.Parameters ITEM RESULT UNITS RL MCL Method# Tested LAB: Metals Lead 0.003 mg/L 0.001 0.015 EPA 200.9 7/27/2004 Routine ITEM RESULT UNITS RL MCL Method# Tested .LAB: Inorganics Nitrate as Nitrogen 0.6 mg/L 0.1 . 10 EPA 300.0 7/20/2004 LAB: Metals Copper 0.2 mg/L 0.1 1.3 SM 311113 7/21/2004 Iron 0.2 mg/L 0.1 0.3 SM 3111B 7/21/2004 Sodium 12 mg/L 1.0 20 SM 3111B 7/21/2004 LAB: Physical Chemistry Conductance 260 umohs/cm I EPA 120.1 7/20/2004 PH 6.9 pH-units 0 EPA 150.1 7/20/2004 Water sample meets the recommended Iimits for drinking water for all above tested parameters. Approved By: (La hector) { i ' S RL= Reporting Limit MCL=Maximum Contaminant Level Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph: 508-315-6605