HomeMy WebLinkAboutCottage St. #20 - 6/13/200178r'xyk a Mss-nfdusetts
Aim& l - a4otiffcatfon Fenn _ ANF-001
Asbestos Abatement Description
1. !Facility location niq
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unn %Pl S A_{i�.Sl 92.0 al?)
NeaeMw 11e 7aueDtip➢.q /. aea Bev,ram
2. Is the facility occupied? ayes O No
3. Asbestos Contractor.
%New England Surface Maintenance, LLP 850 Washington Street
R. Aaaaes
Weymouth, MA 02189 781-337-2117
Lymde re. mW .
AC 000196
arrtMs./ rr».ar
4. On-SAe Proled Supervisor/Foremam
>b➢. Oft p.lnaam,
5.. Project Monitor. _
S • _
w➢W aarnerlM/
6. Asbestos Analytical Lab:
Coo
Duce,➢e /
7. Prointslartdai6-�g3/C24nddategy_13�Qispaalcworkhours(Mom-frL) (s LSun)
8. What type of Project is this? (circle one): d.aoaeoe note ( mowm ) o1wte;aw)
9. Describe the asbestos abatement procedures to be used (circle): ob.ebq d.W
ryawau, ➢eomOerr onotegea0l
10. Isthejob beingeonduded ytYindoors Ooutdoors?
11. Total amount of each type_pbestos Containing Materials (ACM) to be handled on pipes or ducts@near N.), orother
surfaces (square R), mIto be removed enclosed or encapsulated
linear/square eel
boilr, GeW➢51M. duct tanesvGamafirpl... Umnai, sardcwepi k sla&n......
a wmpdedwe)eedpWp*vkw albn... 12 Y 1. .................. _J
swam+ 6rwoorwp..................... .............. J
dolts, Waver hbd=..................... �f aasfle beard, W]ibower ............. �I
edwtpks dsolbri...................
12. Describe the decontamiratioa system(!) to be used:
- As required
13. Describe the containeritatloo/disposal methods to campy with 310 CMR 7.15 and 453 CMR 6.14(2)(g):
Two lavers-6 mil. Iaheled hags
14. For Emergency Asbestos Abatement Operations, the DEP and DLI officials who evaluated the emergency:
panW dn/ Doer
(Se d.wrodraM Y— NMw/
eaeadaraa� ore
...................................----------- ...._...._..._............_
med.woa�uaa�
45: Do prevailing wage rates appy as per M.O.L. e. 149. § 26, 27. or 27A - F to this project? ❑ Yes ,e0 No
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Facility Descr/p11017
1. Current or Prior Use of
`4•`
2. Is the facility owner -occupied residenliaj with units o1r less? XYes O No
3. Facility Owner.
.
UyAe+n zonxk
lrrptav
4. Facility's Owners On -She Manager.
Gyrrpn 10aasi
rlepbe
5. General Contractor.
kame Manx
-
avg.. tar cW,
rdpeaw
Cma r$Weean Coma.y r Poky/
LWA.M
6. What is the size of the luility!` It)(if of loots)
Asbastas TrMnspodaffan and Dlsposa!
1. Transporter of asbestos -containing waste material from site to temporary storage she ('d necessary) to first disposal offer
NESM, LLP 850 Washington
Street
xm ieaaa
Weymouth, MA _ 0218.9_ __
78.1-U7=2 17
GyAan mmfr
7lmemr
• 2 • Transporter of asbestos-conlaining waste material from removal/ temporary storage silo to foal disposal site:
Waste Management 209 Pickering
Street
we. ,aye
Portland,'CT 06480
860-342-6667
Nair, Tmear
_
Gyisow sbcw
rYavure
ust
comply itht
comply With the
3. Refuse transfer station and owner(K applicable):
Sorid Waste
Division repine-
,A,,, am>a
dams 310 CAMH
18.00
'
Gylrao IBcar
l�e>tuv
4. Foul Disposal She:
Valley Landfill USA Waste
Services
smrcxm a.a.awr.
Pleasant Valley Road'
Irwin, PA 15642
412-744-4000
Gyrrae mmr.
r1w,
a cer8ffeatlan /
The undersigned herebystale; under the ponaffles of perjury, ft' e/the has read Ccmmoiewaahh of Massachusetts Roquhllpns
for the Removal, Containment or Encapsulalon of Asbestos, 453 CMR 6.00 and 3 OC R7.16, and that the lnfo=gw contafnodin
this noURullon Is We and currectlo the best of bluber owwledge and belici_
Sy+Yve de
Kate: Contractor
must sign this Partner N M, L L P 781-337-2117
form for OLi ibwbvnor am*s•+yq roerw
not6ation
purposes 850 Washington Street Weymouth, MA 02189
Aavea GryAww ryap
Fee exempt (City, Town, district, municipal housing authority, owner -occupied residential of four units or less) 7'Q yes p no
J) �/` -.... .. .... _. _. Slicker 7(from front of famnl: 51 `C,