28 ST. PETER STREET - ASBESTOS DEGTAMRECEIVED
ENVIRONMENTAL SERVICES NOV 12 2019
November 6,2019 CITY OF SALEM
BOARD OF HEALTH
Board of Health Agent
120 Washington Street,4 h FL
Salem,MA 10970
Re: St.John the Ba tist 28 St.Peter Street—Basement Boiler Room
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 November 18, 2019 through
November 22, 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,
J "Zaw'
Craig Starkman
Sales Estimator
CS/yb
Enclosure
50 Concord Street,North Reading,MA 01864 ^ P:978.470.2860 F:978.470.1017 • wwwdectam.com
`71 Massachusetts Department of Environmental Protection 100319163 i
BWF AQ 04 (ANF-001) Asbestos Project 4
Asbestos Notification Form
Project Revision
Project Cancellation
A. Asbestos Abatement Description
1.Facility Location:
ST.JOHN THE EkA i1Si 28 sT PETER Si BEET
Instructions 1.All a.Name of Facility b.Street Address
sections of this form SALEM
must be completed in MA 01970 9787441278
order to comply with c.City/Town d.State a.Zip Code i.Telephone
MassDEP notification SHAU14 SIBLEY PROJECT MANAGER
requirements of 310
CMR 7.15 and g.Facility Contact Person Name h.Facility Contact Person Title
Department of Labor Worksite Location: BASBAEN i,BOILER ROOM
Standards(DLS)notification i.Building Name,Wing,Floor,Room,etc.
requirements of 453 2, is the facility occupied? a.Yes T4_b.No
CIAR 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)? r1 &Yes W b.No
MassDEP Use Only
4.Blanket Permit Project Approval,if applicable:
Daie Received Approval ID#
5.Non-Tradhional 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: 17 1.Written r 2.Verbal
g.DLS License#
7. SCOTTAWRIGHT AS032177
a.Name of Contractor's On-Site Supervisor/Foreman b.DLS Certification#
8 TRC ENVIRONMENTAL CORPORATION AA000052
a.Name of Project Monitor b.DLS Certification#
9 TRC ENVIRONMENTAL CORPORATION AA000052
a.Name of Asbestos Analytical Lab b.DLS Certification#
10.
11/18/2019 11/22/2019
a.Project Start Date(MM/DD/YYYY) b.End Date(MM/DD/YYYY)
7AM-5PM N/A
c.Work Hours-Monday Through Friday d.Work Hours-Saturday&Sunday
11.What type of project is this?
a.Demolition W b.Renovation r- c.Repair r- d.Other-Please Specify:
Revised: 11/13/2013 Page 1 of 4
Massachusetts Department of Environmental Protection 1100319163
b3
7 -.
B�VP AQ 04 {ANF-001} --. . ______.. ._.
Asbestos Project#
L
2,~ Asbestos Notification Form f rojer,;Icevisio.i
Project Caacellatior
A.Asbestos Abatement Description: (cont.)
12.Abatement procedures(check all that apply):
.W a.Glove Bag " b.Encapsulation c.Enclosure d.Disposal Only e.Cleanup
f Full Containment '- g.Other-Please Specify:
13.Job is being conducted: 17 a.Indoors b.Outdoors
14 a.Total amount of each type of asbestos Containing materials(ACM)to be removed,enclosed,or
encapsulated:
500 800
1.Linear Feet(Lin.Ft.) 2.Square Feet(Sq.Ft.)
b.Boiler,Breaching,Duct, 300 c.Transite Pipe
Tank Surface Coatings 1.Lin.Ft. 2.Sq.Ft 1.Lin.Ft. 2.Sq.Ft.
c.Pipe Insulation 500 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 DEBRIS 500
1.Lin.Ft. 2.Sq.Ft. 1.Lin.Ft. 2.Sq.Ft.
15.Describe the decontamination system(s)to be used:
THREE CHAMBERED
16.Describe the containerization/disposal methods to comply with 310 CMR 7.15 and 453 CMR 6.14(2)
(g):
2X-6-MIL POLY BAGS W/ASBESTOS&WASTE GENERATOR LABELS
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 a•Yes rV b.No
project?
Revised: 11/13/2013 Page 2 of 4
Massachusetts Department of Environmental Protection f 1OG3191.fi3
BWP AQ 04 (ANF-001) 1100319163
Asbestos Project#
Asbestos Notification Form Froject Revision
Froject Cancellaiton
B. Facility Description
1.Current or prior use of facility: CHURCH
2.Is the facility owner-occupied residential wi.h 4 imits or less? I a.Yes y b.No
3 ARCHDIOCESE OF BOSTON 86 BROOKS DRIVE
a.Facility Owner Name b.Address
SRA n--ZEE IAP. 02184 6/780/9463
c.City/Town d.State e.Zip Code i.Telephone
g SHAUN SIBLEY 66 BROOKS DRIVE
a.(dame of Facility Owner's On-Site Manager b.Address
BRAINTREE MA. 02184 6178019463
c.City/Town d.State e.Zip Code f.Telephone
$ DEC-TAM CORPORA T ION 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
STATE NATIONAL INSURANCE COMPANY
g.Contracior's Worker's Compensation Insurer
NFAO867332 12/28/2019
h.Policy# i.Expiration Date(MM/DD/YYYY)
6.What is the size of this facility? 30000 s
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
allowed at the place _ a.Directly to Landfill or r*7 b.To Temporary Storage LocatiowTransfer Station
of business of a DLS
licensed Asbestos
contractor or a transfer DEC-TAM CORPORATION 50 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 8602182428
c.City/Town d.State e.Zip Code f.Telephone
Revised: 11/13/2013 Page 3 of 4
Y
Massachusetts Department of Environmental Protection 1 fl0319163
---:w ,
BP AQ 04 (ANF-001) Asbestos Project ..._._._
Asbestos Notification Form Project Revision
Project,Cancellation
C.Asbestos Transportation&Disposal: (coat.)
3.Name and address of temporary storage location/transfer siation for the asbestos containing wasie
material:
DEC-TAM CORPORATION 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):
MINERVP.LANDFILL BRUCE SULLIVAN
a.Final Disposal Site Name b.Final Disposal Site Owner Nlame
9000 MINERVP.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 A Certification
CRAIG STARKMAN CRAIG STARKMAN
I certify that I have personally 1.Name 2.Authorized Signature
examined the foregoing and am SALES 11/5/2019
familiar with the information
contained in this document and 3.Position/ title 4.Date(MM/DDIYYYY)
all attachments and that,based 9784702860 DEC-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 g State 10.Zip Code
complete. I am aware that there
are significant penalties for
submitting false information,
including possible fines and
imprisonment.The undersigned
hereby states that 1 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