10-12 FIRST STREET NORTH 510 - ASBESTOS ABATEMENT DEG#TAM
ENVIRONMENTAL SERVICES RECEIVED
ED
December 9, 2021 DEC 13 2021
CITY OF SALEM
BOARD OF HEALThi
Board of Health Agent
120 Washington Street 4th FL
Salem,MA 10970
Re: Peguot Highlands-10-12 First Street-North 510
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 December 23, 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,
y6aw ?X, 4
Sean Clements
Sales Estimator
SC/nap
Enclosure
50 Concord Street.North Reading,MA 01864 • P:978.470.2860 F:978.470.1017 • wwwdectarnmrn
Massachusetts Department of Environmental Protection
1(0357365
BWP AQ 04 (ANF-001) --- -----!
Asbestos Project#
Asbestos Notification Form r Project Revision
r 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 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 510
Standards(DLS)
notification i.Building Name,Wing,Floor,Room,etc.
requirements of 453 2. Is the facility occupied? Wa.Yes 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 iv 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.City/Town d.State e.Zip Code f.Telephone
A0000035 h.Contract Type: S-0 1.Written I"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.
12/23/2021 12/23/2021
a.Project Start Date(MM/DD/YYYY) b.End Date(MM/DDNYYY)
7.30AM-4.30PM N/A
c.Work Hours-Monday Through Friday d.Work Hours-Saturday&Sunday
11.What type of project is this?
r a.Demolition We b.Renovation r c.Repair r d.Other-Please Specify:
01 10 3 3
Revised: 11l13/2013 Page 1 of 4
Massachusetts Department of Environmental Protection -----
BWP AQ 04 (ANF-001) 1100357365 ---_j
1 Asbestos Project#
Asbestos Notification Form i" Project Revision
r Project Cancellation
A.Asbestos Abatement Description: (cont.)
12.Abatement procedures(check all that apply):
F a.Glove Bag f— b.Encapsulation r c.Enclosure r d.Disposal Only r e.Cleanup
V f.Full Containment F g.Other-Please Specify:
13.Job is being conducted: lvo a.Indoors r b.Outdoors
14 a.Total amount of each type of asbestos Containing materials(ACM)to be removed,enclosed,or
encapsulated:
300
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 Fireproofmg 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 300
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 r a.Yes r b.No
project?
Revised: 11/13/2013 Page 2 of
Massachusetts Department of Environmental Protection -- ---
�_. BWP AQ 04 (ANF-001) 1100357365
Asbestos Notification Form Asbestos Project#
F Project Revision
1— 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 PEQUOTSALEM LIMITED PARTNERSHIP CORP 33 SILVER STREET
a.Facility Owner Name b.Address
PORTLAND NE 04101 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 9787454894
c.City/Town d.State e.Zip Code f.Telephone
S DEC-TAM 50 CONCORD STREET .
a.Name 0f General Contractor b.Address
NORTH READING MA 01864 9784702860
c.City/Town d.State e.Zip Code f.Telephone
STAR INSURANCE COMPANY
g.Contractor's Workers Compensation Insurer
WC0871082 12/28/2860
h.POlicy# i.Expiration Date(MM/DD/YYYY)
6.What is the size of this facility? 261000 18
a.Square Feet b.#of Floors
Note:Temporary C.Asbestos Trans ortation & Disposal
storage of Asbestos p
containing waste 1.Transporter of asbestos-containing waste material from site of generation:
material is only p g
allowed at the place r a.Directly to Landfill or rv- 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 compliance with Solid e.City/Town f.State g.Zip Cade 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.City/Town d.State e.Zip Code f.Telephone
Revised: 11/13/2013 Page 3 of 4
Massachusetts Department of Environmental Protection
4 �- - BWP AQ 04 (ANF-001) 1 00357365
Asbestos Notification Form Asbestos Project#
F— Project Revision
I— 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.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 RD
c.Address
WAYNESBURG CH 44688 3308663435
Note:Contractor must d.City/Town e.State f.Zip Code g.Telephone
sign this form for DLS
notification purposes A Certification
SEAN CLEMENTS SEAN CLEMENTS
—I certify that I have personally 1.Name 2.Authorized Signature
examined the foregoing and am SALES 12/9/2021
familiar with the information
contained in this document and 3.Positior Ttle 4.Date(MM/DD/YYYY)
all attachments and that,based 9784702860 DEC-TAM
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