10-12 First Street Asbestos Abatement - North 1208 } DEG#TAM RECEIVED
ENVIRONMENTAL SERVICES
JUN 21 2021
June 18, 2021 CITY OF SALEM
BOARD OF HEALTH
Board of Health Agent
120 Washington Street 4th FL
Salem, MA 10970
Re: Peguot Highlands-10-12 First Street-North 1208
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 July 26,2021 to July 27, 2021.
All applicable local, state and federal agencies have been notified of this work.
Please let me know if you have any questions.
Sincerest regards,
YMM '�"
Sean Clements
Sales Estimator
SC/nap
Enclosure
50 Concord Street,North Reading MA 01864 • P:978.470.2860 F:978.470.1017 - wwwdectam.com
Massachusetts Department of Environmental Protection 100348078
L
BWP AQ 04 (ANF-001)� Asbestos Project#
Asbestos Notification Form
I— Project Revision
F 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 MA 01970 9787454884
must be completed in
order to comply with c.Cityrrown d.State e.Zip Code f.Telephone
MassDEP notification NANCY BURGESS PROPERTY MANAGER
requirements of 310
CMR 7.15 and g•Facility Contact Person Name h.Facility Contact Person Title
Department of Labor Worksite Location: NORTH-1208
Standards(DLS) ,
notification 1.BuildingName Win Floor,Room,etc.
9.
requirements of 453 2. Is the facility occupied? tw a.Yes r-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)? I— a.Yes WO 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#
5.Asbestos Contractor:
DEC-TAM CORPORATION 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: lv 1.Written T_2.Verbal
g.DLS License#
7. SCOTf A WRIGHT 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.
7/26/2021 7/27/2021
a.Project Start Date(MM/DD/YYYY) b.End Date(MM/DD/YYYY)
8AM-4.30PM N/A
c.Work Hours-Monday Through Friday d.Work Hours-Saturday&Sunday
11.What type of project is this?
L` a.Demolition lv b.Renovation r' c.Repair T- d.Other-Please Specify:
'I1000 0
Revised:11/13/2013 Page 1 of 4
Massachusetts Department of Environmental Protection 100348078
• �� BWP AQ 04 (ANF-001)
r` Asbestos Project#
t Asbestos Notification Form r— Project Revision
I` Project Cancellation
A.Asbestos Abatement Description:(cont.)
12.Abatement procedures(check all that apply):
I— a.Glove Bag r— b.Encapsulation I— c.Enclosure r d.Disposal Only r' e.Cleanup
iv f Full Containment I— g.Other-Please Specify:
13.Job is being conducted: W a.Indoors r b.Outdoors
14 a.Total amount of each type of asbestos Containing materials(ACM)to be removed,enclosed,or
encapsulated:
0 400
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 FLOORING AND MASTIC 400
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 I— a•Yes J7 b.No
project?
Revised: 11/13/2013 Page 2 of 4
s
BWP AQ 04 (ANF-001)
L
Asbestos Project#
Asbestos Notification Form Project Revision
Massachusetts Department of Environmental Protection 100348078
I" 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? f— a.Yes r b.No
3 PEQUOTSALEM LIMITED PARTNERSHIP CORP 33 SILVER STREET
a.Facility Owner Name b.Address
PORTLAND ME 04101 2077819800
c.City/Town d.State e.Zip Code f.Telephone
4 NANCYBURGESS _ 10-12 FIRST STREET
a.Name of Facility Owners On-Site Manager b.Address
SALEM MA 01970 9787454884
c.City/Town d.State e.Zip Code f.Telephone
5.DEC-TAM 50 CONCORD STREET
a.Name of General Contractor b.Address
NORTH READING MA 01864 9784702860
c.City/Town d.State e.Zip Code f.Telephone
STAR INSURANCE COMPANY
g.Contractors Workers Compensation Insurer
WC0871082 _ 12/28/2021
K.—Policy Policy# w I.Expiration Date(MM/DDNYYY)
6.What is the size of this facility? 261000 18
a.Square Feet b.#of Floors
Note:Temporary C.Asbestos Transportation & Disposal
storage of Asbestos p 11
containing waste 1.Transporter of asbestos-containing waste material from site of generation:
material is only p $
allowed at the place r- a.Directly to Landfill or Wo b.To Temporary Storage Location/Transfer Station
of business of a DLS
licensed Asbestos
contractor or a transfer DEC-TAM 50 CONCORD STREET
station that is c.Name of Transporter d.Address
permitted by
MassDEP and NORTH READING MA 01864 9784702860
operated in e.Cityfrown 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:
REDTECH 173 PICKERING ST
a.Name of Transporter b.Address
PORTLAND Cr 06480 8608944605
c.Cityfrown T State e.Zip Code f.Telephone
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D
Massachusetts Department of Environmental Protection 100348078 J
P; BWP AQ 04 (ANF-001) Asbestos Project#
Asbestos Notification Form r Project Revision
r- Project Cancellation
C.Asbestos Transportation&Disposal:(cont.)
3.Name and address of temporary storage location/transfer station for the asbestos containing waste
material:
DEC-TAM 50 CONCORD STREET
a.Temporary Storage Location Name b.Address
NORTH READING MA 01864 9784702860
C.Citylfown d.State e.Zip Code — f.Telephone
4.Name and location of final disposal site(asbestos landfill):
MINERVA LANDFILL BRUCE SULLIVAN
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
"I certify that I have personally 1.Name 2.Authorized Signature
examined the foregoing and am SALES 6/18/2021
familiar with the information
contained in this document and 3.Positionlfitle 4..Date(MM/DD/YYYY)
all attachments and that,based 9784702860 DEC-TAM
on my inquiry of those 5.Telephone 6.Representing
individuals immediately 5000NCORDST NORTH READING
responsible for obtaining the 7.Address 8.City/Town
information,I believe that the MA 01864
information is true,accurate,and g.State
complete. 1 am aware that there 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
goveming 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."
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