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10-12 First Street Asbestos Abatement - South 613 A DEGTAM RECEIVEDCC ENVIRONMENTAL SERVICES June 7, 2021 JUN 17 2021 CITY OF SALEM BOARD OF HEALTH Board of Health Agent 120 Washington Street 4th FL Salem,MA 10970 Re: Pe not Hi lands--10-12 First Street-South 613 Dear°Sir/1VMadam, Please be advised that Dec-Tam Corporation will be performing an asbestos abatement project at t �above referenced location. This work has been scheduled for June 17, 2021 to June 18, 2021. M1 applicable.local,state and federal agencies have been notified of this work. PlQOse let me know if you have any questions. $}Wprest regards, Mn Clements Sales Estimator SC/nap Enclosure 50 Concord Street,North Reading,MA01864 • P:978.470.2860 F:978.470.1017 - wwwdectam.com Massachusetts Department of Environmental Protection 100347346 BWP AQ 04 (ANF-001) - - Asbestos Project# Asbestos Notification Form r Project Revision L J` 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.City/rown 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: SOUTH 613 Standards(DLS) , notification i.BuildingName Win Floor,Room,etc. Wing, requirements of 453 2. Is the facility occupied? P 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)? 1— a Yes Ri 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 I D# 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: ry-, 1.Written r-2.Verbal g.DLS License# 7. SCOTTAWRIGHT 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. 6/17/2021 6/18/2021 a.Project Start Date(MM/DD/YYYY) b.End Date(MM/DD/YYYY) 7.30AM-4:30PM N/A c.Work Hours-Monday Through Friday d.Work Hours-Saturday&Sunday 11.What type of project is this? T— a.Demolition jw b.Renovation ii" c.Repair''f— d.Other-Please Specify: a10 0 0 4 `7 Revised: 11/13/2013 Page 1 of 4 Massachusetts Department of Environmental Protection BWP AQ 04 (ANF-001) �100347346 Asbestos Project# Asbestos Notification Form r Project Revision I- Project Cancellation A.Asbestos Abatement Description:(cont.) 12.Abatement procedures(check all that apply): F a.Glove.Bag r b.Encapsulation f- c.Enclosure r d.Disposal Only r e.Cleanup rvi £Full Containment V- 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: 0 500 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 FLOOR TILE&MASTIC 500 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) u 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 Wo b.No project? Revised: 11/13/2013 Page 2 of 4 Massachusetts Department of Environmental ProtectionLJ7BWP100� 347346 AQ 04 (ANF-001) Asbestos Project# Asbestos Notification Form r 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? t— a.Yes W b.No 3.PEQUOTSALEM UMTED PARTNERSHIP CORP 33 SILVER STREET a.Facility Owner Name b.Address CAMBRIDGE MA 02138 2077819800 c.City/Town d.State e.Zip Code f.Telephone 4 NANCY BURGESS 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 10-12 FIRST 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 h.Policy# i.Expiration Date IMM/DD/YYYY) 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 p containing waste material is only 1.Transporterg of asbestos-containing waste material from site of generation: 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 50 CONCORD STREET station that is c.Name of Transporter d.Address permitted by MassDEP and NORTH READING MA 01864 9784702860 operated in e.Citylrown 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 TECH 173 PICKERING ST a.Name of Transporter b.Address PORTLAND CT 06480 8608944605 c.Cityrrown d.State e.Zip Code t Telephone Revised: 11/13/2013 Page 3 of 4 Massachusetts Department of Environmental Protection 100347346�� BWP AQ 04 (ANF-001) Asbestos Project# Asbestos Notification Form r Project Revision 1" Project Cancellation C.Asbestos Transportation&Disposal: (cont.) 3.Name and address of temporary storage location/transfer station for the asbestos containing waste material: DEG-TAM 50 CONCORD STREET a.Temporary Storage Location Name b.Address NORTH READING MA 01864 9784702860 c.City/Town 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 6/4/2021 familiar with the information 3.Position/Title 4.Date MM/DD/YYYY contained in this document and ) 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.CitylTown information, I believe that the MA 01864 information is true,accurate,and g.State 10.Zip Code complete.I am aware that there p 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