1 PICKERING STREET - ASBESTOS (4) Project Details
Site Address: i Pickering St. Salem, MA. 01970
Inspection Date: February 26, 2025
Report Date: February 27, 2025
Prepared For: Peter Dearborn
Dearborn Carpentry
8 Bedford St.
Salem, MA. 01970
Project Scope: Pre-Renovation Asbestos Inspection
Asbestos Inspector: Olga Voytazh
MA DLS License#AF123
MA DLS License#AI901332
Asbestos Containing Materials Identified: Yes
ACA Environmental Lab,LLC - acaenvirolab@gmaiLcom- (603) 918-0501
Kitchen: Yellow Adhesive associated with White
r: Ceramic Tile
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97 Laundry: Yellow Adhesive associated with White
Ceramic Tile
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ACA Environmental Lab,LLC - acaenvirolab@gmail.com- (603)918-0501
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From: Frank Arsenault net
Subject: DEP Notification
Date: Feb 28, 2025 at 9:56:09 AM
peter—dearborn@yahoo.com
Good Morning Peter,
Attached is the DEP for 1 Pickering Street, Salem. I just got in touch with the insurance
company and they are going to send over the COI.
Have a nice day,
Mary
Asbestos Free, Inc.
Massachusetts Department of Environmental Protection -
P 100421887
BWP AQ 04 (ANF-001) Asbestos Project#
Asbestos Notification Form I— Project Revision
)W Project Cancellation
A.Asbestos Abatement Description
1.Facility Location:
MATT MARSHALL 1 PICKERING STREET
Instructions 1.All a.Name of Facility b.Street Address
sections of this form SALEM MA 01970 6174382953
must be completed in - - -
order to comply with c.City/Town d.State e.Zip Code f.Telephone
MassDEP notification PETERDEARABORN PROFECTMANAGER
requirements of 310
CMR 7.15 and g•Facility Contact Person Name h.Facility Contact Person Title
Department of Labor Worksite Location: KITCHEN
Standards(DLS) i.Building Name,Wing,Floor,Room,etc.
notification
requirements of 453 2.Is the facility occupied?W a.Yes 3-b.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)?W a.Yes f— b.No
MassDEP Use Only
lanket Permit Project Approval,if applicable:
Date Received Approval ID#
5. on As '} s Abatement Work Practice Approval,
if appli Approval ID#
6.Asbestos Contractor:
ASBESTOS FREE INC 42 BROADWAY
a.Name
WAKEFIELD Mv. 912454403
c.Cityrrown d.State P-ilICd. f.Telephone
A0000133 h.Contrac Type:iv 1.Written f—2.Verbal
g.DLS License#
7. FRANKLARSENAULT AS053031
a.Name of Contractor's On-Site Supervisor/Foreman b.DLS Certification#
8 EMflROSAFE ENGINEERING DBA AA000131
EL Name of Project Monitor b.DLS Certification#
9 ENVIRONMENTAL REMEDiATI0N SERVICES INC AA000122
a.Name of Asbestos Analytical Lab b.DLS Certification#
10.
3/2112025 3/2112025
a.Project Start Date(MM/DDNYYY) b.End Date(MM/DDIYYYY)
6:30-5 0
c.Work Hours-Monday Through Friday d.Work Hours-Saturday&Sunday
11.What type of project is this?
a.Demolition fv" b.Renovation r- c.Repair f— d.Other-Please Specify:
Revised:11/13/2013 Page I of 4
Massachusetts Department of Environmental Protection 1100421887 i
F
BWP AQ 04 (ANF-001) Asbestos^Project#
Asbestos NotificationForin r Project Revision
h Project Cancellation
i
A.Asbestos Abatement Description:(cant.)
12.Abatement procedures(check all that apply):
I` a.Glove Bag r- b.Encapsulation f c.Enclosure f d.Disposal Only r e.Cleanup
jv f.Full Containment f g.Other-Please Specify:
13.Job is being conducted: ry a,Indoors F b.Outdoors
14 a.Total amount of each type of asbestos Containing materials(ACM)to be removed,enclosed,or
encapsulated:
0 40
i_Linear Feet(Lin.Ft.) 2.Square Feet(Sq.Ft.)
b.Boiler,Breaching,Duct, c.Transite Pipe
1.Lin.FL 2.Sq.Ft. 1.Lin.Ft.
Tank Surface Coatings
2.Sq.Ft.
d.Pipe Insulation e.Transite Shingles
1.Lin.Ft. 2.Sq.Ft. 1.Lin.Ft. 2.Sq.Ft.
f.Spray-On Fireproofing g.Transite Panels
1.Lin.Ft 2.Sq.Ft 1.Lin.Ft. 2.Sq.FL
h.Cloths,Woven Fabrics i.Other-Please Specify:
1.Lin.Ft 2.Sq.Ft
j.Insulating Cement CERAMIC TILE&ADHESIVE 40
1.Lin.Ft. 2.Sq.Ft. 1.Lin.Ft. 2.Sq.Ft.
be the decontamination system(s)to be used:
ECC'
16-Describe the container' n/dispoF 'cods to comply with 310 CMR 7.15 and 453 CMR 6.14(2)
I
Note:Temporary C.Asap .. Tr n,r prtation&Disposal
storage of Asbestos
containing waste 1.Transporter of aF :stos-con ntt�g waste material from site of generation:
material is only
allowed at the place f` a.Directly to Landfill �Wb nporary Storage Location/Transfer Station
of business of a DLS W
licensed Asbestos B_�ADWAY
contractor or a transfer ASBESTOS FREE,INC. - -
station that Is c.Name of Transporter
permitted by 80 2454403
Ma5eDEP and WAKE1D -
operated in e.City/Town f.State g.Zip Code h.Tel
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:
REDTECK INC. 10 NORTHWOOD DRIVE
a.Name of Transporter b.Address
BLOOMFIELD Cr 06002 8602182428
c.City/Town d.State e.Zip Code f.Telephone
Revised: 11/13/2013 Page 3 of 4
Massachusetts Department of Environmental Protection 100421887
BWP AQ 04 (ANF-001) As best os-Project#
Ll Asbestos Notification Forth 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:
ASBESTOS FREE,INC. 42 BROADWAY
a.Temporary Storage Location Name b.Address
WAKEFIELD MA 01880 7812454403
c.Cityfrown d.State e.Zip Code f,Telephone
4.Name and location of final disposal site(asbestos landfill):
MINERVA ENTERPRISES,INC. MINERVA ENTERPRISES,INC.
a.Final Disposal Site Name b.Final Disposal Site Owner Name
8955 UNERVA ROAD
c.Address
WAYNESBURG CH 44688 3308663435
d.City/Town e.State f.Zip Code g.Telephone
Note:Contractor must
sign this form for DLS
notification purposes D. Certification
FRANK ARSENAULT
I certify that I have personally 1.Name 2.Authorized Signature
examined the foregoing and am PRESEENT
familiar with the information 3.PositionRtle 4.Date(MM/DDrfYYY)
contained in this document and
7812464403 ASBESTOS FREE,INC.
I
as auacnmenw anu uiar,uaaesu
n my inquiry of those 5.Telephone 6.Representing
dis . 1s immediately 42 BROADWAY WAKEFIELD
is nsi, ,for obtaining the 7.Address 8.Cityrrown
+,1 b, ve that the MA 01880
ii-orn on" ,r .acc -1te,and g State 10.Zip Code
comple- are at.-4
are significant p ial
submitting false inf,.mation,
including possible fines and
imprisonment.The undersigned
hereby states that I have read the
Commonwealth
of Coto
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