Asbestos Abatement Unit S604 7-22-19 DEGTAM RECEIVED
ENVIRONMENTAL SERVICES
JUL 2 2019
July 22, 2019
CITY OF SAL;EM
BOARD OF HEALTH
Salem Board of Health Agent
120 Washington Street,4 Fl.
Salem, MA 01970
Re: Pe not tli hlands-10-12 First Street—Unit S-604
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 August 19, 2019 through August 20, 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,
�a9a 1�"
Sean Clements
Sales Estimator
SC/yb
Enclosure
50 Concord Street,North Reading,MA 01864 • P:978.470.2860 F:978.470.1017 • wwwdectam.com
Massachusetts Department of Environmental Protection +- - -- -—
I 1100312476
BWP AQ 04 (ANF-001) Asbestos Project#
Asbestos Notification Form i Project Revision
F Project Cancellation
A.Asbestos Abatement Description
1.Facility Location:
PEQUO-r HIGHLANDS 10-12 FIRST STREET
Instructions 1.All a.Name of Facility b.Street Address
sections of this form SALEM
must be completed in MA 01970 9787454884
order to comply with c.City/Town 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: UNIT S-604
Standards(DLS)notification i.Building Name,Wing,Floor,Room,etc.
requirements of 453 2. 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)? a.Yes I✓ b.No
MassDEP Use Only
4.Blanket Permit Project Approval,if applicable:
Date Received Approval ID#
5.Non-Traditional Asbestos Abatement Work Practice Approval,
if applicable: Approval ID#
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: r 1.Written I' 2.Verbal
g.DLS License#
7. SCOTTAWRIGHT AS032177
a.Name of Contractor's On-Site Supervisor/Foreman b.DLS Certification#
$ 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.
8/19/2019 8/2012019
a.Project Start Date(MM/DD/YYYY) b.End Date(MM/DD/YYYY)
8.30AM-5PM N/A
c.Work Hours-Monday Through Friday d.Work Hours-Saturday&Sunday
11.What type of project is this?
r a.Demolition f7p b.Renovation r c.Repair r d.Other-Please Specify:
Revised: 11/13/2013 1100569 Page 1 of 4
Massachusetts Department.of Environmental Protection 1100312476 '
.r ry4� BWP AQ 04 (ANF-001) Asbestos Project#
Asbestos Notification Form
t— Project Revision
C Project Cancellation
A.Asbestos Description: (cent.)
12.Abatement procedures(check all that apply):
a.Glove Bag 7 b.Encapsulation ` c.Enclosure d.Disposal Only e.Cleanup
f.Full Contaimnent T g. Other-Please Specify:
13.Job is being conducted: f7 a. Indoors b. Outdoors
14 a.Total amount of each type of asbestos Containing materials(ACM)to be removed,enclosed,or
encapsulated:
0 250
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 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.
h.Cloths,Woven Fabrics i.Other-Please Specify:
1.Lin.Ft. 2.Sq.Ft.
j._insulating Cement PARQUET FL&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. 144,§26,27 or 27A—F apply to this a•Yes 0 b.No
project?
Revised: 11/13/2013 Page 2 of 4
i
Massachusetts Department of Environmental Protection r -- - - - —
100312476
BWP AQ 04 (ANF-001) i _ - _--- --
y Asbestos Project#
Asbestos Notification Form
r Project Revision
f 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 b.No
3 PEQ.UOTSALEM LIMITED PARTNERSHIP CORP. 33 SILVER STREET
a.Facility Owner Name b.Address
PORTLAND RE 08164 2077819800
c.City/Town d.State e.Zip Code f.Telephone
4 JOAN RUSSELL 10-12 FIRST STREET
a.Name of Facility Owner's On-Site Manager b.Address
SALEM MA 01970 9787454884
c.City/Town d.State e.Zip Code f.Telephone
5 DEC-TAM CORPORATION 50 CONCORD STREET
a.Name of General Coniractor b.Address
NORTH READING MA 01864 9784702860
c.City/Town d.State e.Zip Code f.Telephone
STATE NATIONAL INSURANCE COMPANY
g.Contractor's Worker's Compensation Insurer
NFA0867332 12/28/2019
h.Policy# i.Expiration Date(MM/DD/YYYY)
6.What is the size of this facility? 261000 12
a.Square Feet b.#of Floors
Note:Temporary C.Asbestos Transportation & Disposal
storage of Asbestos lD
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 W b.To Temporary Storage Location/Transfer Station
of business of a DLS
licensed Asbestos
contractor or a transfer DEC-TAM CORPORATION 60 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:
RED TECHNOLOGIES 173 PICKERING STREET
a.Name of Transporter b.Address
PORTLAND CT 06480 8608944605
c.City/Town d.State e.Zip Code f.Telephone
Revised: 11/13/2013 Page 3 of 4
`7Massachusetts Department of Enviromnental Protection 1100312476
_� � �'� Q 04 (�iNF-001)
Asbestos Project#
t Asbestos Notification Form
(" Project Revision
F— Project Cancellation
C:Asbeslfjs Trausporiatlon&, 0-spasst,.
3.Name and address of temporwry storage locationA-unsfer station for the asbestos containing waste
material:
DEC-fAM CORPORATION 50 CONCOP,D STREET
a.Temporary Storage Location Name b.Address
NORTH READING MA 01864 9784702860
c.City/Town d.State a.Zip Code f.Telephone
4."!Tame and location Gf final disposal site(asbestos land ill):
MINERVA LANDFILL BRUCE SULLIVAN
a.Final Disposal Site Name b.Final Disposal Site Owner Name
9000 MINERVA ROAD
c.Address
WAYNESBURG OH 44688 3308663435
d.City/Town e.State f.Zip Code g.Telephone
Aoka:Contractor must
sign this form for DLS
notification purposes
D. Celetificatic
SEAS!CLEMENTS SEAN CLEMENTS
"I Certify that I have personally 1.Name 2.Authorized Signature
a:tamined the foregoing and am SALES 7/1 912 01 9
Familiar with the information
contained in this document and 3.Position/Title 4.Date(MM/DD/YYYY}
all attachments and that,based 9784702860 DEG-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