Asbestos Abatement South Bldg 5th+6th floors 12-20-18 DEGTAM RECEIVED
ENVIRONMENTAL SERVICES
DEC 9 S 2018
CITY OF SALEM
December 20,2018 BOARD OF HEALTH
Salem Board of Health Agent
120 Washington Street,4t Fl.
Salem, Ma, 01970
Re: Peg uot Highlands-10-12 First Street- South Bldg.-5' & 6"Floor
Dear Sir/Madam:
Please be advised that Dec-Tam Corporation is performing an asbestos abatement project at the
above referenced location. This work is scheduled for December 21, 2018.
All applicable local,.state and federal agencies have been notified of this work.
Please let me know if you have any questions.
Sincerest regards,
yaom ?49W'M4
Sean Clements
Sales Estimator
SC/sl
Enclosure
50 Concord Street,North Reading,AAA 01864 • P:978A70.2860 F:978.470.1017 • wwwdectamacom
Massachusetts Department of Eiiijironrnentat Protection �--- ----
300281
SWP AQ 04 (AZ '-001) ;1sbestosP '�
Asbestos Project tr
Asbestos Notification For4u
Project Revision
Project Cancellation
A. Asbestos Abatement Description
L Facility Location:
PEQUOT HIGHLANDS 10-12 FIRST STREET
Instructions 1.All a.Name of Facility b.Street Address
sections of this form SALEM
must be completed in Ahr. 01970 9787454884
order to comply with c.Cityfrown d.State e.Zip Code f.Telephone
MassDEP notification JOAN RUSSELL PROPERTY MANAGER
requirements of 310
CMR 7.15 and g•Facility Contact Person Name h.Facility Contact Person Title
Department of Labor Worksite Location: SOUTH BLDG5TH&6TH FLOOR
Standards(DLS)
notification i.Building Name,Wing,Floor,Room,etc.
requirements of 453 ?. Is the facility occupied? '+a.Yes 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)? !r` a.Yes W b.No
MassDEP Use Only
4.Blanket Permit Project Approval,if applicable:
Date Received Approval ID#
y.Non-Traditional Asbestos Abatement Work Pracdce Approval,
if applicable: Approval ID#
6.Asbestos Contractor:
DEC-TAM CORPORAIION 50 CONCORD ST
a.Name b.Address
NORTH READING MA 01864 9784702860
c.Cityfrown d.State e.Zip Code f.Telephone
AC000035 h.Contract Type: W 1.Written , 2.Verbal
g.DLS License#
7 SCOTrAWRIGHT AS032177
a.Name of Contractor's On-Site Supervisor/Foreman b.DLS Certification#
8 ENVIRONMENTAL HEALTH INC AA000044
a.Name of Project Monitor b.DLS Certification#
9 ENVIRONMENTAL HEALTH INC AA000044
a.Name of Asbestos Analytical Lab b.DLS Certification#
10.
12/21/2018 12/21/2018
a.Project Start Date(MM/DD/YYYY) b.End Date(MMIDDIYYYY)
8AM-5.30PM N/A
c.Work Hours-Monday Through Friday d.Work Hours-Saturday&Sunday
11.What type of project is this?
a.Demolition r b.Renovation Tr c.Repair d.Other-Please Specify:
Revised: 11/13/2013 Page 1 of 4
Massachusetts Department of Environmental Protection• _,_- -10034G2S1—BWP AQ 04 (A-NF-001) Asbestos Pruje_c---t---.—
_
#
Asbestos.Notification Forth
Project Revision
Pr6jectCanceltation
A.Asbestos Abatement Description:(conk.)
12.Abatement procedures(check all that apply):
1 a.Glove Bag " b.Encapsulation r c.Enclosure f d.Disposal Only e.Cleanup
�+ f.Full Containment g.Other-Please Specify:
13.Job is being conducted: W a.Indoors - b.Outdoors
14 a.Total amount of each type of asbestos Containing maieriais(ACM)to be removed,enclosed,or
encapsulated:
25 50
1.Linear Feet(Lin.Ft.) 2.Square Feet(Sq.Ft.)
b.Boiler,Breaching,Duct, c.Transite Pipe
Tank Surface Coatings 1.Lin.Ft 2.Sq.Ft. 1.Lin.Ft 2.Sq.Ft.
d.Pipe Insulation 25 e.Transite Shingles
1.Lin.Ft 2.Sq.Ft. 1.Lin.Ft 2.Sq.FL
f.Spray-On Fireproofing g.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 DRYWALL&JOINTCOMPOUND 50
1.Lin.Ft 2.Sq.Ft 1.Lin.Ft 2.Sq.Ft.
15.Describe the decontamination system(s)to be used:
THREE CHAMBERED DECONTAMINATION SYSTEM
16.Describe the containerization/disposal methods to comply with 310 CMR 7.15 and 453 CMR 6.14(2)
(g):
MATERIAL WILL BE WETTED,WRAPPED AND LABELLED FOR DISPOSAL
17.For Emergency Asbestos Operations,the MassDEP and DLS officials who evaluated the emergency:
PEfERSEWARD INSPECTOR
a.Name of MassDEP Official b.Title of MassDEP Official
1 211 9/2 0 1 8 NAW1812127
c.Date of Authorization(MM/DD/YYYY) d.Waiver#
MELISSA BUTTS INSPECTOR
e.Name of DLS Official f.Title of DLS Official
12/19/2018 24506-2018
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 r a•Yes b.No
project?
Revised: 11/13/2013 Page 2 of 4
Massachusetts Department of Environmental Protection
100300291
Y BWP AQ 04 (ANF-001) Asbek6s Project#
Asbestos.Notification Form Project Revrision
Projeet.Caucellation
B. Facility Description
1.Current or prior use of facility: HOUSING
2.Is the facility owner-occupied residential with 4 units or iess? a.Yes SW b.No
3 PEQUOTSALEM LIMITED PARTNERSHIP CORP. 33 SILVER STREET SUITE 3C0
a.Facility Owner Name b.Address
PORTLAND its 04101 2077819800
c.City/Town o.State e.Zip Code f.Talephone
4 CHRISTOPHER PODUN 10-12 FIRST STREET
a.Name of Facilih,Oinrner's On-Site Manager b.Address
SALEM lviA W 970 2077809800
c.City/Town d.State e.Zip Coda T.Telephone
5 DEC-TAM CORPORATION 50 CONCORD STREET
a.Name of General Contractor b.Address
NORTH READING MR. 01864 9784702860
c.City/Town d.State e.Zip Code f.Telephone
STATE NATIONAL INSURANCE COMPANY
g.Contractor's Worker's Compensation Insurer
NFA0867332 12/28/2018
h.Policy# I.Expiration Date(MM/DDNYYY)
6.What is the size of this facility? 441000 12
a.Square Feet b.#of Floors
Note:Temporary storage of Asbestos C.Asbestos Transportation & Disposal
containing waste material is only 1.Transporter of asbestos-containing waste material from site of generation:
allowed at the place " a.Directly to Landfill or b.To Temporary Storage Location/Transfer Station
of business of a DLS
licensed Asbestos
contractor or a transfer DEC-TAM CORPORATION 50 CONCORD STREET
station that is c.Name of Transporter d.Address
permitted by
MassDEP and NORTH READING MA 01864 9784702860
operated in e.City/Town f.State g.Zip Code h.Telephone
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:
SERVICE TRANSPORT 58 PYLES LANE
a.Name of Transporter b.Address
NEW CASTLE CE 19720 3027785930
c.Cityfrown d.State e,Zip Code T Telephone
Revised: 11/13/2013 Page 3 of 4
Massachusetts Department of Environmental protection !]00300281
- BWP AQ 04 (ANF-001)
c = Asbestos Pro3ect
Asbestos Notification Form Project Revision
Project.Cancellation
C.Asbestos Transportation&Disposal:(cont.)
3.Name and address of temporary storage locaiion/transfer station for the asbestos containing waste
material:
DEC-TAM CORPORATION 50 CONCORD STREET
a.-i amporary Storage Location Name b.Address
ii,1ORTH,READING MA 01864 9784702860
a Cityfrown d.State e.zip Code f.Telephone
4.Name and location of final disposal site(asbestos landfill):
MINERVALANDRL C/O RANDY BRIDGES
a.Final Disposal Site Name b.Final Disposal Site Owner Name
9000 MINERVA 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
SEAN CLEMENTS SEAN CLEMENTS
1 certify that 1 have personally 1.Name 2.Authorized Signature
examined the foregoing and am SALES 12/19/2018
familiar with the information 3.Positionfritle 4.Date(MM/DDIYYYY)
contained in this document and
all attachments and that,based 9784702860 DEGTAMCORPORATION
on my inquiry of those 5.Telephone 6.Representing
individuals immediately 50 CONCORD STREET NORTH READING
responsible for obtaining the 7.Address 8.City/Town
information, I believe that the MA 01864
information is true,accurate,and
complete.I am aware that there 9.State 10.Zip Code
are significant penalties for
submitting false information,
including possible fines and
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."
Revised: 11/13/2013 Page 4 of 4