Asbestos Abatement Unit N512 3-22-18 PEOTAM
'ENVIRONMENTAL SERVICES RECEIVED
March 22, 2018 MAY 3 0 2018
CITY OF SALEM
BOARD OF HEALTH
Salem Board of HealthAgent
120 Washington St. 41h Floor
Salem,MA 10970
Re: Peauot Highlands-10-12 First St. North Unit 512
Dear Sir/Madam,
Please be advised that Dec-Tam Corporation will be performing an asbestos abatement project at
the above referenced location. This work has been scheduled for June 13, 2018 through June 15,
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,
Jet� ?fr�r7e�
Sean Clements
Sales Estimator
SC/sl
Enclosure
0
I
I
50 Concord Street,North Reading,MA 01864 • P:978.470.2860 F:978.470.1017 • www.dectam.wm
Massachusetts Department of Environmental Protection
IL
- BWP AQ 04 (ANF-001) 100287070
Asbestos Project#
Asbestos Notification Form r Project Revision
f Project Cancellation
A. Asbestos Abatement Description
1.Facility Location:
PECUOTHIGHLANDS 10-12 FIRSTSTREET
Instructions 1.All a.Name of Facility b.Street Address
sections of this form
must be completed in SALEM MA 01970 2077809800
order to comply with c.City/rown d.State e.Zip Cade f.Telephone
MassDEP notificationtof 30CHRISTOPHER POULIN MANAGER
requirements of 310
CMR 7.15 and 9.Facility Contact Person Name h.Facility Contact Person Title
Department of Labor Worksite Location:
Standards(DLS) NORTH UNfr512
notification i.Building Name,Wing,Floor,Room,etc.
requirements of 453 2. Is the facility occupied? I✓a.Yes I—b.No
CMR 6.12
3. Is this a fee exempt notification (city, town, district, municipal housing authority,state facility,or
MassDEP Use Only owner-occupied residential property of four units or less)? r a.Yes rV b.No
4.Blanket Permit Project Approval,if applicable:
Date Received Approval ID#
5.Non-Traditional Asbestos Abatement Work Practice Approval,
2.Submit Original if applicable:Form To: Approval lD#
Commonwealth of
Massachusetts 6.Asbestos Contractor:
P.O.Box 4062
Boston,MA 02211 DEC-TAM CORPORATION 6000NCORDST
a.Name b.Address
NORTH READING MA 01864 9784702860
c.City/rown d.State e.Zip Code f.Telephone
AC000035 h.Contract Type: r 1.Written r 2.Verbal
g.DLS License#
7. GEORGEAPAGE AS071933
a.Name of Contractor's On-Site Supervisor/Foreman b.DLS Certification#
8. BRIANAPICCOLO AM041519
a.Name of Pro ect Monitor r
1 b.DLS Certification#
9 BOCK&CLARK ENVIRONMENTAL,LLC AA000227
a.Name of Asbestos Analytical Lab b.DLS Certification#
10.
6/13/2018 6/15/2018
a.Project Start Date(MM/D I/YYYY) b.End Date(MM/DD/YYYY)
SAM4.3OPM NIA
c.Work Hours-Monday Through Friday d.Work Hours-Saturday&Sunday
11.What type of project is this?
r a.Demolition ry b.Renovation J— c.Repair r d.Other-Please Specify:
Revised: 11/13/2013 O r U 5 Page I of 4
\`^ Massachusetts Department of Environmental Protection
BWP AQ 04 (ANF-001) 100287070
s� Asbestos Notification Form Asbestos Project#r Project Revision
1 r Project Cancellation
A.Asbestos Abatement Description: (cont.)
12.Abatement procedures(check all that apply):
I a.Glove Bag r b.Encapsulation r c.Enclosure r d.Disposal Only r e.Cleanup
r f.Full Containment r g.Other-Please Specify:
13.Job is being conducted: r a.Indoors r b.Outdoors
14 a.Total amount of each type of asbestos Containing materials(ACM)to be removed,enclosed,or
encapsulated:
0 1200
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.FL 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.Ft.
It.Cloths,Woven Fabrics i.Other-Please Specify:
1.Lin.Ft 2.Sq.FL
j.Insulating Cement DRYWAWJOINTCMPD 1200
1.Lin.Ft. 2.Sq.Ft. 1.Lin.Ft. 2.Sq.FL
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):
MATERKI.WILL BE WETTED,WRAPPED AND LABELLED FOR DISPOSAL
i
17.For Emergency Asbestos Operations,the MassDEP and DLS officials who evaluated the emergency:
a.Name of Maw EP Official b.Title of MassDEP Official
C.Date of Authorization(MM/DD/YYYY) d.Warver#
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 r a.Yes I✓ b. No
project?
Revised: 11/13/2013 Page 2 of 4
Massachusetts Department of Environmental Protection
BWP AQ 04 (ANF-001) Asbestos stos P
Assb Project#
(1, Asbestos Notification Form 1— Project Revision
r Project Cancellation
B. Facility Description
1.Current or prior use of facility: HOUSING
2.Is the facility owner-occupied residential with 4 units or less? r a.Yes 17 b.No
3.PEOUOTSALEM LIMITED PARTNERSHIPOORP. 33 SILVER STREET SURE 200
a.Facility Owner Name D.Address
PORTLAND RE 04101 20T7819800
c.City?own d.State e.Zip Code f.Telephone
4.CHRISTOPHER POULIN 10-12 FIRST STREET
a.Name of Facility Owner's On-Site Manager b.Address
SALEM MA 01970 2077809800
c.City/Town d.State e.Zip Code L Telephone
5.DEC-TAM CORPORATION 50 CONCORD STREET
a.Name of General Contractor b.Address
NORTH READING MA 01864 9784702860
c.City/Town C.-State e.Zip Code f.Telephone
STATE NATIONAL
g.Contractor's Workers Compensation Insurer
NFA0867332 12/28/2018
h.Policy# 1.Expiration Date(MM)DDMW)
6. What is the size of this facility? 255090 12
a.Square Feet b.#of Floors
C. Asbestos Transportation & Disposal
1.Transporter of asbestos-containing waste material from site of generation:
1— a.Directly to Landfill or TV b.To Temporary Storage Location/Transfer Station
DEC-TAM CORPORATION 50 CONCORD STREET
Note:Temporary c.Name of Transporter d.Address
storage of Asbestos NORTH READING MA 01864 9784702860
containing waste e.City/Town f.State Zi
material is only 9• P Code h.Telephone
allowed at the place
of business of a DLS 2.If a temporary storage location/transfer station is used,list name of transporter of asbestos containing
licensed Asbestos
contractor
or or a transfer material from temporary porary storage location/transferstatton to final disposal site:
station that is
permitted by SERVICETRANSPORTATIONGROUP 58 PYLES LANE
M and
operated
in a.Name of Transporter b.Address
eratetl
compliance with Solid NEW CASTLE DE 19720 8779999559
Waste Regulations c.CI /Town
310 CMR 19.000 b d.State e.Zip Code f.Telephone
Revised: 11/13/2013 Page 3 of
Massachusetts Department of Environmental Protection 100287070
BWP AQ 04 (ANF-001)
Asbestos Notification Form Asbestos Project#
«` r Projec[Revision
r Project Cancellation
C.Asbestos Transportation&Disposal:(cont.)
i
3.Name and address of temporary storage location/transfer station for the asbestos containing waste
material:
DEC-TAM CORPORATION 50 CONCORD STREET
a.Temporary Storage Location Name b.Address
NORTH READING MA 01864 9784702860
c.Cityrrown d.State ;.Zip Code f.Telephone
4.Name and location of final disposal site(asbestos landfill):
MINERVA LANDFILL C/O RANDY BRIDGES
a.Final Disposal Site Name b.Final Disposal Site Owner Name
9000 MINERVA ROAD
c.Address
WAYNESBURG CH 44688 330866MB
it.Cityrrown e.State f.Zip Code g.Telephone
D. Certification
SEAN CLEMENTS SEAN CLEMENTS
"I certify that I have personally 1.Name 2.Authorized Signature
examined the foregoing and am SALES 5/22/2018
familiar with the information
contained in this document and 3.Positionrl"Ne 4.Date(MM/DD/YYYY)
Note: for must
sign this s form
orm for DLS all attachments and that,based 9784702860 DECGTAM CORPORATION
notification purposes on my inquiry of those 5.Telephone 6.Representing
individuals immediately 50 CONCORD STREET NORTH READING
responsible for obtaining the 7.Address 8.cityrrown
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
Massachusetts Department of Environmental Protection
-- BWP AQ 06 100287075
L71 Notification Prior to Construction or Demolition Asbestos Project#
f Project Revision
r Project Cancellation
A.Applicability
A Construction or Demolition operation of an industrial,commercial,or institutional building,or residential
building with 20 or more units is regulated by the Department of Environmental Protection(MassDEP),Bureau of
Waste Prevention,Air Quality Division,under Regulations 310 CMR 7.09.Notification of Construction or
Demolition operations is required under 310 CMR 7.09(2)ten(10)working days prior to any work being
performed.The following information is required pursuant to 310 CMR 7.09.
1.Is this a fee exempt notification(city,town,district,municipal housing authority,state facility,owner-occupied
residential property of four units or less)?
r a.Yes Iv b.No
2.Blanket Permit Project Approval,if applicable:
3.Non-Traditional Asbestos Abatement Work Practice Approval,if applicable: Approval ID#
Instructions: Approval ID#
B. Facility Description
1.All sections of this
form must be 1.Facility Information:
completed in order to PEQUOT HIGHLANDS
comply with the 10.12 FIRST STREET
Department of a.Name of facility b.Street Address
Environmental SALEM MA 019700000 2077809800
Protection c.Cityrfown
notification d.Slate e.Zip Code f.Telephone
requirements of 310 CHRISTOPHERPODUN MANAGEMENT
CMR 7.09. g.Facility Contact Person h.Facility Contact Person Title
2.Submit Odginal 2077809800 CPOULIN@SILVERSTREETGROt1PCOM
Forth To: i.Facility Contact Person Telephone Commonwealth of P ).Facility Contact Person Email
Massachusetts k.Facility Size:
P.O.Box 4062
Boston,MA 02211 255090 12
1.Square Feet 2.Number of Floors
MassDEP Use Only 1.Was the facility built prior to 1980? C✓1.Yes r 2.No
Data Received m.Describe the current or prior use of the facility:
HOUSING
n.Is the facility a residential facility? (y I.Yes r 2.No o.If yes,how many units?250
2.Facility Owner: r Same address as Facility
PEQUOTSALEMILIMnIDPARTNERSHIPCORP 33 SILVER STREEfSUITE 200
a.Facility Owner Name b.Address
PORTLAND M= 041010000 2OT7809800
c.Cityfrown d.State e.Zip Code f.Telephone
3.Facility On-Site Manager/Owner Representative: r Same contact personas facility
r Same address as facility
r Same address as owner
CHRISTOPHERPODUN 10-12 FIRST STREET
a.On-Site Manager/Owner Representative b.Address
SALEM MA 01970 2077809800
a Cilyffown d.State e.Zip Code f.Telephone
Revised:0311112014 Pagel of3
� go( va55
Massachusetts Department of Environmental Protection
075
BWP AQ 06 Asbestos
Assbes P
• � � tos Project#
�1 Notification Prior to Construction or Demolition r Project Revision
r— Cancellation
C. General Project Description
I.This project is: r New Construction r Demolition r Renovation
2. Project Dates:
6/13/2018 6/1512018
a.Project Start Date(MM/DD/YYYY) b.Project End Date(MM/DDNYYY)
3. General Contractor:
DEC-TAM CORPORATION 5o CONCORD STREET
a.Name b.Address
NORTH READING MA 018640000 9784702860
c.City/Town d.State ;.Zip Code f.Telephone
SEAN CLEMENTS 9784702860
g.General Contractors On-site Manager/Foreman h.Telephone
4.Construction or demolition contractor: Same as General Contractor
DEC-TAM CORPORATION 50 CONCORD STREET
a.Contractor Name b.Address
NORTHREADING MA 018640000 9784702860
c.City/Town d.State e.Zip Code f.Telephone
SEAN CLEMENTS 9784702860
g.Constmclion and Demolition On-site Manager h.Telephone
5.Licensed Construction Supervisor:
SEAN CLEMENTS CS096523
a.Supervisor Name b.Construction Supervisor License(CSL)Number
6.Is the entire facility to be demolished? r a.Yes r b.No
7.Describe the area(s)to be demolished:
CEILING REPAIR
8.Describe the building(s)or addition(s)to be constructed:
9 a.Were the structure(s)surveyed for the presence of Asbestos-Containing r 1.Yes r 2.No
Material(ACM)?
b. Who conducted the survey?
BRIAN A PICCOLO A1061526
1.Name of Asbestos Inspector 2.DLS Certfimbon#
Revised:0311 7/2 01 4 Page 2 of 3
Let
Massachusetts Department of Environmental ProtectionB" AQ 06 sbe s os P Asbestos Project#
Notification Prior to Construction or Demolition r Project Revision
r- Cancellation
C. General Project Description (continued)
10 a.Was asbestos containing material(ACM)found? I✓ 1.Yes r 2.No
General b.If ACM was found during the survey,please provide the Asbestos 100287070
Statement:If Notification Form(ANF)Project Number.
asbestos is found
during a Construction 11.For demolition and construction projects,indicate dust suppression techniques to be used:
or Demolition
r
operation,all a.Seeding r7o b.Wetting r c.Covering r d.Paving r e.Shrouding
responsible parties (— f.Other-Specify:
must comply with 310
CMR 7.00,7.09,7.15,
and Chapter 21 E of
the General taws of 12.Is this an Emergency Demolition Operation? r-a.Yes r b.No
the Commonwealth.
This would include,
but would not be c.Name of MassDEP Official who evaluated the emergency
limited to,filing an
asbestos removal d.Title
notification with the
Department and/or a
notice of e.Date of Authorization(MWDD/YYYY) f.MassDEP Waiver Number
release/threat of
release of a hazardous A Certification
substance to the
Department,if "I certify that I have personally SEAN CLEMENTS
applicable. examined the foregoing and am 1.Print Name
familiar with the information SEAN CLEMENTS
contained in this document and 2.Authorized Signature
all attachments and that,based SALES
on my inquiry of those
individuals immediately 3.Posltienrrltle
responsible for obtaining the DEC-TAM CORPORATION
information, I believe that the 4.Representing
information is true,accurate,and 5/2212018
complete.1 am aware that there S.Date(MM/DD/YYYY)
are significant penalties for
submitting false information,
including possible fines and 6.RE#
imprisonment.The undersigned
hereby states,under the
penalties of perjury,that I am
aware that this permit
application or notification shall
not be deemed valid unless
payment of the applicable fee is
made."
Revised:03/17/2014 Page 3 of