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Asbestos Abatement Unit N805 2-22-19
DEGTAM {DECEIVED ENVIRONMENTAL SERVICES r FEB 25 2019 CITY OF February 22, 2019 BOARD OF HEALTH Salem Board of Health A ent 120 Washington Street,4 Fl. Salem,Ma. 01970 Re: Pe not Hi hlands-10-12 First Street-North Building Unit 805 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 March 7, 2019 through March 8, 2019. All applicable local, state and federal agencies have been notified of this work. Please let me know if you have any questions. Sincerest regards, Jeam ?4 Sean Clements Sales Estimator SC/nap Enclosure 50 Concord Street,North Reading,AAA 01864 - P:978.470.2860 F.978.470.1017 - www,dectam.cam Massachusetts Department of Envrironme BWP A 04 AN -001. 1"tCOVED 100303356 Asbestos Project#Asbestos Notification Form FEB 2 5J 2019 Project Revision Ptviect Cancellation CITY OF SALEM 00AMI)OF HEALTH A. Asbestos Abatement Desuiption 1.ljacility Location: PEQUOT HIGHL 440S 1 G-12 FIRST'STREET' Instructions 1.All a.Name of Facility b.Streei Address sections of this form SALEM must be completed in MA O i 37U 9787454884 order io comply with a Citylibwn d.State a.Zip Code ;.Telephone MassDEP notification JOAN RUSSELL ?ROJ4=CTWANAGER requirements of 310 CZAR 7.15 and g.Facility Corfiaaet Perrson Name h.Facility Contact Person Title Department of Labor Wotksite Location: NORTH BUILDING UNIT805 Standards(DLS) notification i.Building Name,Wing,Floor,Room,etc. requirements of 453 2. Is the facility occupied? W a.Yes b.No CMR-5.12 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)? I— a.Yes iv b.No iviassDEP Use Only 4.Blanket Permit Project Approval,if applicable: Date Received Approval ID# 5.Non-Traditional Asbestos Abatement Work Practice Approval, if applicable: Approval tD# 6.Asbestos Contractor: DEC-TAM CORPORATION 50 CONCORD ST a.Name b.Address NORTH READING MA 01864 9784702860 c.City/Town d.State e.Zip Code f.Telephone AC000035 h.Contract Type:fv_� 1.Written 2.Verbal g.DLS License# 7. SCOTTAWRIGHT AS032177 a.Name of Contractors 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. 3/7/2019 3/8/2019 a.Project Start Date(MM/DD/YYYY) b.End Date(MM/DDIYYYY) 8.30AM-5PM NIA c.Work Hours-Monday Through Friday d.Work Hours-Saturday&Sunday 11.What type of project is this? a` a.Demolition W b.Renovation r c.Repair I— d.Otber-Please Specify: Revised: 11/13/2013 �1 O Lao 67 Page i of 4 t Massachusetts Department of Environmental Protection 100303356 sWP AQ 04 (ANF-001.) - --—t©-Project 4 Asbestos Notification Form Project Revision T- Project Cancellation A.Asbestos AbatemerntDeseription:(cont.) 1.2.Abatement pTocedures(check all that apply): a.GIove Bag u.Encapsulation c.Enclosure f d.Disposal Only F" e.Cleanup rw f Full Containment F- g.Other-Please Specify: 1.3.Job is being conducted: 9 a.Indoors -` b.Outdoors 14 a.Total arrount of each type of asbestos Containing inaterials(ACM)to be removed,enclosed,or encapsulated: 250 1.Linear Feet(Lin.Ft) 2.Square Feet(Sq.Ft.) b.Boiler,Breaching,Duct, c.Transite `Iipe Tank Surface Coaiings 1.Lin.Ft. 2.Sq.Ft. 1.Lin.Ft 2.Sq.Ft. d.Pipe Insulation e.'Tratrsite Shingles 1.Lin.Ft 2.Sq.Ft. 1.Lin.Ft. 2.Sq.Ft f.Spray-On Firel)roofing g.Transite Paaels 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 PARQUETFLOORING&MASTIC 250 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: a.Name of MassDEP Official b.Title of MassDEP Official c.Date of Authorization(MM/DD/YYYY) d.Waiver# 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 a.Yes ry b.No project? Revised: 11/13/2013 Page 2 of 4 Massachusetts Depattment of Environmental Protection 1003o3356 ., BWP AQ 44 (A1�TI{-Q0l.) Asbestos Project# -- Asbestos Notification Fotln 1" Project Revision F Project Cancellation B. Facility Desuiption 1.Current or prior use of facility: HOUSING 2.Is the facility owner-occupied residential with 4 units or less? . a.Yes W b.No 3 PEQUOTSALEM LIMITED PARTNERSHIP CQ,RP. 33 SILVER STREET a.Facility Owner Name• b.Address PORTLAND NE 08164 2077819800 C.City/Town d.State e.Zip Code f.Telephone 4.JOAN RUSSELL 10-12 FIRST STREET a.Name cf Facility Owner's On-Site Manager b.Address SALEM MA 01970 9787454884 a CiVTown d.State .-Zip Code i.Telephone 5'DEC-TANI CORPORATION 50 CONCORD STREET a.Name of General Contractor b.Address NORTH READING NA 01864 9784702860 c.City/Town d.State e.Zip Code f.Telephone STATE NATIONAL INSURANCE COMPANY g.Contractor's Worker's Compensation Insurer NFA0867332 12128/2019 h.Policy# i.Expiration Date(MM/DDNYYY) 6.What is the size of this facility? 261000 12 a.Square Feet b.#of Floors Note:Temporary storage of Asbestos C. Asbestos Transportation & Disposal containing waste 1.Transporter of asbestos-containing waste material from site of generation: material is only allowed at the place a.Directly to Landfill or P 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 compliance with Solid e.CityfTown f.State g.Zip Code h.Telephone 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: RED TECHNOLOGIES 173 PICKERING STREET a.Name of Transporter b.Address PORTLAND CT 06480 8608944605 c.CiWown d.State e.Zip Code f.Telephone Revised: 11/13/2013 Page 3 of 4 Massachusetts Department of Environmental Protection 1(IQ3(i335Es BWP AQ 04 (ANF-001) Asbestos Pr©jcac°t S Asbestos Notification Form r Project Revision f— Project Cancellation C.Ashestos Transportation&Disposal:(coat.) 3.Name and address of temporary storage location/transfer station for the asbestos containing waste material: DEC-TAM OO ORATION 50 CONCORD STREET a.Temporary Storage Location Name b.Address NORTH READING KfJA 01864 9784702860 c.City/Town d.State e.Zip Code f.Telephone 4.Nanie and location of final disposal site(asbestos landfill): MINERVA LANDFILL BRUCE SULUVA]V a.Final Disposal Site Name b.Final Disposal Site Owner dame 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 I certify that I have personally 1.Name 2.Authorized Signature examined the foregoing and am SALES 2/21/2019 familiar with the information contained in this document and 3.Positionmtle 4.Date(MM/DD/YYYY) all attachments and that,based 9784702860 DEC-TAM CORPORATION 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