Pequot Highlands-North+South Asbestos Abatement DEGrTAM
ENVIRONMENTAL SERVICES
RECEIVED
December 20, 2019 DEC 2 3 2019
CITY OF SALEM
BOARD OF HEALTH
Board of Health Agent
120 Washington Street 4t'FL
Salem,MA 10970
I
Re: Peguot Hi hlands--14-12 First Floor—Multi le Areas in North& South Buildin
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 January 6,2020 through
January 17,2020.
All applicable local, state and federal agencies have been notified of this work.
Please let me know if you have any questions.
Sincerest regards,
Sean Clements
Sales Estimator
SC/yb
Enclosure
50 Concord Street,North Reading,MA 01864 • R:978.470.2860 F:978.470.1017 • wwwdectam.com
LlMassachusetts Department of Environmental Protection
B"T AQ 04 (ANF-001) 1100321468 J
Asbestos Notification Form Asbestos Project#
T— Project Revision
— - l— Project Cancellation
A. Asbestos Abatement Description
1.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 MA 01970 9787454884
order to comply with c.City/Town d.State e.Zip Code f.Telephone
MassDEP notification JOAN RUSSELL
requirements of 310 PROPERTY MANAGER
CMR 7.15 and 9.Facility Contact Person Name h.Facility Contact Person Title
Department of Labor Worksite Location;Standards(DLS) MULTIPLE AREAS IN NORTH&SOUTH BLDG
notification i.Building Name,Wing,Floor,Room,etc.
requirements of 453 2. Is the facility occupied? W a.Yes T—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 J7 b.No
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.Q town d.State e.Zip Code f.Telephone
AC000035 h.Contract Type: 1*o 1.Written r-2.Verbal
g.DLS License#
7. SCOTfAWRIGHT 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.
1/6/2020 1/17/2020
a.Project Start Date(MM/DD/YYYY) b.End Date(MM/DD/YYYY)
8AM5PM N/A
c.Work Hours-Monday Through Friday d.Work Hours-Saturday&Sunday
11.What type of project is this?
lv a.Demolition I— b.Renovation)"' c.Repair l— d.Other-Please Specify:
Revised: 11/13/2013 Page 1 of 4
6
Massachusetts Department of Environmental Protection -,
�.� 11 0121468
BWP AQ 04 (ANF-001) -
r ` Asbestos Notification Form Asbestos Project#
r Project Revision
- I— Project Cancellation
A.Asbestos Abatement Description: (cont.)
12.Abatement procedures(check all that apply):
r- a.Glove Bag r b.Encapsulation T— c.Enclosure j` d.Disposal Only T— e.Cleanup
j)N f.Full Containment T— g.Other-Please Specify:
13.Job is being conducted: tv— a.Indoors r— b.Outdoors
14 a.Total amount of each type of asbestos Containing materials(ACM)to be removed,enclosed,or
encapsulated:
1000
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 JOINT CMPD&DRY WALL 1000
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 ;'.—T Itle of MassDEP Official
c.Date of Authorization(MM/DDNYYY) 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 r' a•Yes f,,—o b.No
project?
Revised: 11/13/2013 Page 2 of 4
'417
R Massachusetts Department of Environmental Protection
BWP AQ 04 (ANF-001) ,,0321468
Asbestos Notification Form Asbestos Project#
t I— 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 W b.No
3.PEQUOT-SALEM LIMITED PARTNERSHIP CORP. 33 SILVER STREET
a.Facility Owner Name b.Address
PORTLAND ME 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 Contractor b.Address
NORTH READING MA 01864 9784702860
c.Cityfrown d.State e.Zip Code f.Telephone
STATE NATIONAL INSURANCE COMPANY
g.Contractor's Workers 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 storage of Asbestos C.Asbestos Transportation &Disposal
containing waste 1.Transporter of asbestos-containing waste material from site of generation:
material is only p g
allowed at the place 1" a.Directly to Landfill or PF b.To Temporary Storage Location/Transfer Station
of business of a DLS
licensed Asbestos
contractor or a transfer DEGTAM CORPORATION 50 CONCORD STREET
station that is c.Name of Transporter d.Address
permitted by
MassDEP and NORTHREADING MA 01864 9784702860
operated in a.Cityfrown
compliance with Solid 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 Cr 06480 8608944605
c.Cityfrown d.State ;.-Zip Code f.Telephone
i
Revised: 11/13/2013 Page 3 of 4
Massachusetts Department of Environmental Protection
BWP AQ 06 100321472
Notification Prior to Construction or Demolition Asbestos Project#
r Project Revision
r— Project Cancellation
A.Applicability
A Construction or Demolition operation of an industrial, cammPrcial,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 W b.No
2.Blanket Permit Project Approval,if applicable:
#
3.Non-Traditional Asbestos Abatement Work Practice Approval,if applicable: Approval ID
Instructions: B. Facility Description Approval ID#
1.All sections of this
form must be 1.Facility Information:
completed in order to PEQUOT HIGHLANDS 10-12 FIRST STREET
comply with the _.
Department of a.Name of facility b.Street Address
Environmental SALEM MA 019700000 9787454884
Protection c.City/Town d.State e.Zi Code f.Tele hone
notification p p
requirements of 310 JOAN RUSSELL MANAGER
CMR 7.09. g.Facility Contact Person h.Facility Contact Person Title
9787454884 JRUSSELL@WINNNCO.COM
i.Facility Contact Person Telephone j.Facility Contact Person Email
MassDEP Use Only
k.Facility Size:
Date Received 261000 12
1.Square Feet 2.Number of Floors
1.Was the facility built prior to 1980? lO L Yes j"2.No
m.Describe the current or prior use of the facility:
HOUSING
n.Is the facility a residential facility? ry 1_Yes r 2.No o.If yes,how many units?250 `
2.Facility Owner: I— Same address as Facility
PEQUOTSALEM LIMITED PARTNERSHIP CORP. 33 SILVER STREET
a.Facility Owner Name b.Address
PORTLAND NE 081640000 2077819800
c.City/Town d.State e.Zip Code f.Telephone
3.Facility On-Site Manager/Owner Representative: IV Same contact person as facility
W Same address as facility
I— Same address as owner
JOAN RUSSELL 10-12 FIRST STREET
a.On-Site Manager/Owner Representative b.Address
SALEM MA 01970 9787454884
c.Cityfrown d.State ;--Zip Code f.Telephone
Revised:03/17/2014 Page 1 of 3
( o( oo o �
Massachusetts Department of Environmental Protection --
--�� BWP A 06 1100321472��
-.,. Q
+- Asbestos Project#
Notification Prior to Construction or Demolition
`k r Project Revision
r Project Cancellation
C. General Project Description
1.This project is: r New Construction W Demolition i" Renovation
2.Project Dates:
1/6/2020 1/17/2020
a.Project Start Date(MM/DD/YYYY) b.Protect End Date(MM/DDNYYY)
3. General Contractor:
DEC-TAM CORPORATION 50 CONCORD STREET
a.Name b.Address -
NORTH READING MA 018640000 9784702860
c.City/Town d.State e.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
NORTH READING MA 018640000 9784702860
c.City/Town d.State e.Zip Code f.Telephone
SEAN CLEMENTS 9784702860
g.Construction and Demolition On-site Manager h.Teleptwne
5.Licensed Construction Supervisor:
SEAN CLEMENTS CS-096523
a.Supervisor Name b.Construction Supervisor License(CSL)Number
6.Is the entire facility to be demolished? a•Yes J_v' b.No
7.Describe the area(s)to be demolished:
AREAS OF CEILING
8.Describe the building(s)or addition(s)to be constructed:
9 a.Were the structure(s)surveyed for the presence of Asbestos-Containing I.Yes I-"2.No
Material(ACM)?
b. Who conducted the survey?
El-1 A1033813
1.Name of Asbestos Inspector 2.DLS Certification#
Revised:03/17/2014 Page 2 of 3
•
Massachusetts Department of Environmental Protection
BWP AQ 06 i i o 2 472 T _J
` Asbestos Project#
Notification Prior to Construction or Demolition r Project Revision
- t" Project Cancellation
C. General Project Description (continued)
10 a.Was asbestos containing material(ACM)found? I.Yes I•`2.No
General b.If ACM was found during the survey,please provide the Asbestos 100321468
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
operation,all I— a.Seeding rV b.Wetting I— c.Covering)" d.Paving I— e.Shrouding
responsible parties
must comply with 310 f.Other-Specify:
CMR 7.00,7.09,7.15,
and Chapter 21 E of
the General Laws of 12.Is this an Emergency Demolition Operation? Yes b.No
the Commonwealth. a
This would include,
but would not be c.Name of MassDEP Official who evaluated the emergency
limited to,filing an
asbestos removal
notification with the d.Title
Department and/or a
notice of
release/threat of e.Date of Authorization(MM/DD/YYYY) f.MassDEP Waiver Number
release of a
hazardous A Certification
substance to the
Department,if
applicable. "I certify that I have personally SEAN CLEMENTS
examined the foregoing and am 1.Print Name -
familiar with the information SEANCLEMENTS
contained in this document and g,Authorized Signature
all attachments and that,based
on my inquiry of those SALES
individuals immediately 3.PositioWrd_e —
responsible for obtaining the DEC-TAM CORPORATION
information,I believe that the 4.Representing
information is true,accurate,and 12/19/2019
complete. I am aware that there 5.Date(MM/DD/YYYY)
are significant penalties for
submitting false information,
including possible fines and 6.P.E.#
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 3