69 Asbestos 2014 JEGTAM
ENVIRONMENTAL SERVICES
May 13, 2014
Mr. Ernie Mathieu
Northampton Health Department
City Hall, 210 Main Street
Northampton, MA 01060
RE: Smith College, 69 Paradise Road, Northampton,MA 01063
(Cutter-Ziskind Dorm)
Dear Mr. Mathieu
Please be advised that Dec-Tam Corporation will be performing an asbestos abatement
projects at the above referenced locations. This work has been scheduled for
May 22, 2014 thru June 13, 2014.
All applicable local, state and federal agencies have been notified of this work.
Please let me know if you have any questions.
Sincerest regards,.-,
vid Patti
Sales Estimator
DP/cam
Enclosure
oncord Street,North Reading,MA 01864 • P:978.470.2860 F:978.470.1017 • wwwdectam.com
Commonwealth of Massachusetts
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Asbestos Notification Form ANF-001
F60193551
Decal Number
A. Asbestos Abatement Description
1. a. Is this facility fee exempt-city, town. district, municipal housing authority, owner-occupied
residence of four units or less?❑Yes 14 No
b. Provide blanket decal number if applicable:
2. Facility Location:
SMITH COLLEGE
a.Name of Facility
Northampton
c.City/Town
3. Worksite Location:
ons of this
be
in order
with 4
cation
nts of 310 5
vision
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nts of 453
a=o
MA
tl.Stale
Blanket Decal Number
69 PARADISE ROAD
b.Street Address
[01063 1 (413)325-5225
e.Zip Code I.Telephone Number
CUTTERZISKIND DORM
a.Building Name/Building Location b.Building
Is the facility occupied? U Yes ❑No
Asbestos Contractor:
[DEC-TAM CORPORATION
a.Name
[NORTH READING
c.City/Town
AC000035
f.DOS License Number
IDAVID PATTI
J
1864 1
P Zip Code
h.Facility Contact Person
GEORGE A. PAGE
6. a.Name of On-Site Supervisor/Foreman
[FLI
7- a.Name of Project Monitor
9
ELI
a.Name of Asbestos Analytical Lab
05/22/2014
a.Project Start Date(mrnldd/yyyy)
7A-4P
c.Work hours Mon-Fri.
10. a. What type of project is this?
❑Demolition Renovation
❑ Repair ❑Other, please specify:
11. a. Check abatement procedures:
❑Glove bag
❑Enclosure
❑Cleanup
Full containment
19
❑ Encapsulation
❑ Disposal only
Other,specify:
12. Is the job being conducted: NI Indoors?
'Clap doe•10/02
J
J
C.Wing
d.Floe
J f 1
e.Room
50 CONCORD STREET
b.Address
9784702860
e.Telephone Number
g. Contract Type: n Written [ 1 Verbal
SALES
i.Contact Person's TNe
AS071933
b.Supervisor/Foreman DOS Certification Number
AA000044
b.Project Monitor DOS Certification Number
[AA000044
b.Asbestos Analytical Lab DOS Certification Number
06/13/2014
b.End Data(mmldtltyyyy)
J
.Work hours Sat-Sun.
1
b.Describe
REG AREA/POLY ON GROUND/CAUTION TAF
b.Describe
Outdoors?
Go To Top
Asbestos Notification Form•Page 1 of 3
Commonwealth of Massachusetts •
1
[100193551
Decal Number
Asbestos Notification Form ANF-001
A. Asbestos Abatement Description (cont.)
13. Total amount of each type of Asbestos Containing Materials(ACM)to be removed, enclosed, or
encapsulated:
4440 30500
a Total pipes or ducts(linear ft) T o t a l o r su aces square
c.Boiler,breaching.duct,tank
surface Coatings
e.Corrugated or layered paper
pipe Insulation
g Spray-on fireproofing
Cloths,woven fabrics
k Thermal,solid core pipe
insulation
I I I_ J
lin ft. Sq.0.
t—� L Trowel/Sprayer coatings
Lin.ft. Sq.R
(3000
Lin.ft. Sq.ft.
Lin.ft. J I ft
2000
Lin.ft. Sq.ft.
d.Insulating cement
14. Describe the decontamination system(s)to be used:
h Transite board.wa!board
j.Other.please specify'
!CAULK/GLAZEN
I.Specify
I 1 1
Lin.ft. Sq.ft.
J 3000 j
Lin.ft. Sq.ft.
( Ti. (1500
Lin.ft Sq.ft
23000 1
Sq.ft.
2440
Lin.ft.
REMOTE DECON
15. Describe the containerization/disposal methods to comply with 310 CMR 7.15 and 453 CMR
6.14(2) (g):
'MATERIAL WILL BE WETTED AND PLACED IN PRELADELED BAGS FOR DISPOSAL
16. For Emergency Asbestos Operations, the DEP and DOS officials who evaluated the emergency:
L Name of DEP Official b.Title
a. d.DEP Waiver
c.Date(mMdd/yyyy)of Authorization
e.Name of DOS Official
g.Dale(mmldtllywy)of Authorization h.DOS Waiver#
—N
17. Do prevailing wage rates as per M.G.L. c. 149, §26, 27 or 27A—F apply to this project? ❑Yes Z No
f.DOS Official T
B. Facility Description
0 1. Current or prior use of facility:
-o
(ACADEMIC
2. Is the facility owner-occupied residential with 4 units or less? ❑Yes No
126 WEST STREET
3. b.Address
4133255225
e.Telephone Number(area code and extension)
!SAME AS#3
b.On-Site Manager Address
!SMITH COLLEGE
a.Facility Owner Name
(NORTHAMPTON ( 01063
c.City/Town d.Zip Cade
(CHARLES CONANT
-o
=u. 4
-Z
a.Name of Facility Owner's On-Site Manager
(c.City/Town ( d.L)Code
Gtapdoc•10/02
!e.Telephone Number(area code and extension)
Asbestos Notification Foml•Pa ea a 2 of 31
1(978)470-2860
e.Telephone Number
150 CONCORD ST
Address
IN READING
h.CityiTown
Commonwealth of Massachusetts
Asbestos Notification Form ANF-001
100193551
Decal Number
B. Facility Description (cont.)
5. a-Name of General Contractor b.Address .-
L _1 I
c.City/Town d.Zip Code e.Telephone Number(area code and extension)
(GREAT DIVIDE LWCA153726612 1 12128/2014 7
.Policy Number h.Ex .Date mMtldfVYril
f.ContracloYS Worker's Camp.Insurer g 0 3
120000
6. What is the size of this facility? a.Square Feet b.Number of floors
C. Asbestos Transportation and Disposal
1. Transporter of asbestos-containing material from site to temporary storage site Of necessary):
ter
ist
the
;310
0
a.Name of Transporter b.Address
L 1 1
City/Town d.Zip Code e.Telephone Number
2. Transporter of asbestos-containing waste material from removal/temporary site to final disposal site:
ISERVICE TRANSPORT 158 PYLES LANE
a.Name of Transporter b.Address
1NEWCASTLE J 119720 1 1(877)999.9559
c City/Town d.Zip Code e.Telephone Number
3. r_ _ 1
a.Refuse Transfer Station and Owner b.Address
_
I _ —1 r
c.City/Town d.Zip Code Ie.Telephone Number
4. !MINERVA ENTERPRISES INC
a.Final Disposal Site Location Name b.Final Disposal Site Location Owner's Name
19000 MINERVA ROAD 1WAYNESBURG
c OHnal Disposal Site Address 1 d.City/Town
e.State
j
144688
f.Zip Code
J
9.Telephone Number
D. Certification
The undersigned hereby states, under the
penalties of perjury,that he/she has read the
Commonwealth of Massachusetts regulations
for the Removal,Containment or
Encapsulation of Asbestos,453 CMR 6.00 and
310 CMR 7.15, and that the information
contained in this notification is true and correct
to the best of his/her knowledge and belief.
01ap.doc•10102
1DAVID PATTI
a.Name
!SALES
c.Position/Title
b.Authorized Signature
211312014
d.Date(mMddlvv)00
DEC-TAM
f Representing
Ft 864
1.Zip Code
1
Go To Top
Asbestos Notification Form•Page 3 of 3
•
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Commonwealth of Massachusetts
Asbestos Notification Form ANF-001
•
100122896
Decal Number
A. Asbestos Abatement Description
1. a.Is this facility fee exempt-city,town, district, municipal housing authority,owner-occupied
residence of four units or less? GI Yes ❑No
b.Provide blanket decal number if applicable:
2. Facility Location:
VACANT BUILDING
a.Name of Facility
NORTHAMPTON
c.City/Minn
3. Worksite Location:
Ms of this
be
in order
MU 4
motion
Its of 310 5
Sion
bona)
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nts of 453
6.
7.
8.
9
VACANT BUILDING
a.Building Name/Building Location
Is the facility occupied? ❑Yes
Asbestos Contractor:
MA
d.State
1
1
b.Bantling#
No
f7
ACCUTECH INSULATION 8.CONTRACTING I
a.Name
LUDLOW
c.C,ty/Town
IAC000005
f.DOS License Number
01056
d.Zip Code
LOUIS HASBROUCK
h.Facility Contact Person
ANTHONY G. ROY SR
a.Name of On-Site Supervisor/Foreman
N/A
a.Name of Project Monitor
N/A
a.Name of Asbestos Analytical Lab
1
11
3/23/2011
a.Project Start Date(mm
8AM-4PM
c.Work hours Mon-Fd.
10. a.What type of project is this?
Co Q Demolition ❑ Renovation
❑ Repair ❑ Other,please specify:
11. a. Check abatement procedures:
—o
LL
❑Glove bag
❑ Enclosure
❑Cleanup
❑ Full containment
❑Encapsulation
Disposal only
❑Other, specify:
17
12. Is the job being conducted: ❑ Indoors?
)1ap.doc•10)02
Blanket Decal Number
113 LAUREL PARK
b.Street Address
01060 L
e.Zip Cade t.Telephone Number
c.Wing
d Floor
e.Room
100 STATE STREET
b.Address
4135835500
e Telephone Number
g. Contract Type:
U Written ❑Verbal
I.Contact Person's Title
LS071233
b.Supervisor/Foreman DOS Oerkfication Number
LN/A
b Project Monitor DOS Certification Number
N/A
b.Asbestos Analytical Lab DOS Certification Number
[3/23/2011
b.E nd Date(mml dd/yyyy)
-1
N/A
d Work hours Sat-Sun.
b.Describe
b Describe
kJ Outdoors?
Asbestos Notifmation Form•Page 1 of 3
b Title
1W-087-11
d.DEP Waiver 4
Commonwealth of Massachusetts
Asbestos Notification Form ANF-001
•
100122896
Decal Number
-o
7o
0-0
womm
MEMo
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-0
=<
A. Asbestos Abatement Description (cont.)
13. Total amount of each type of Asbestos Containing Materials(ACM)to be removed,enclosed.or
encapsulated: 110
a.Total pipes or ducts(linear ft) b.Total other surfaces(square ft)
c.Boiler,breaching.duct,tank
surface coatings
e.Corrugated or layered paper
pipe insulation
g Spray-on fireproofing
1.Cloths,woven fabrics
k.Thermal,solid core pipe
insulation
ft. Sq.ft.
Lin.ft.
Lin.ft.
d.Insulating cement
59_%. 1.Trowel/Sprayer coatings
Sq-fl. 1 h Transite board,wall board
Lin.ft.
Lin ft.
j.Other,please specify
Lin.ft.
Lin.ft.
L_..
Lin.ft.
Sq.ft.
Sq
10
Lin.ft. Sq.ft.
WINDOW GLAZIN
Sq.ft. I.Specify
14. Describe the decontamination system(s)to be used:
!DISPOSAL ONLY. DEMARCATE WORK AREA WITH BARRIER TAPE.
15. Describe the containerization/disposal methods to comply with 310 CMR 7.15 and 453 CMR
6.14(2)(g):
ACM TO BE DOUBLE BAGGED/WRAPPED IN 6 MIL POLY 8 DELIVERED IN A SEALED VEHICL
16. For Emergency Asbestos Operations,the DEP and DOS officials who evaluated the emergency:
1BOB SCHULTZ
a.Name of DEP Official
13/21/2011
c.Date(miNdd/m y)of Authorization
(JANET MCKENNA
e.Name of DOS Official
13122/2011
g.Date(mmlddlyyyy)of Authorization
17. Do prevailing wage rates as per M.G.L.c. 149, §26, 27 or 27A—F apply to this project? [-1 Yes[]No
1
f.DOS Official Title
1SP11-168
h.DOS Waiver p
B. Facility Description
1. Current or prior use of facility:
!RESIDENTIAL
2. Is the facility owner-occupied residential with 4 units or less? ❑Yes No
1212 MAIN STREET
3. b.Address
1413-587-1570
!CITY OF NORTHAMPTON-BLDG COMMISSI
a.Facility Owner Name
NORTHAMPTON
c.City/Town
!PAUL LIPTAK
4. a Name of Facility Owners On-Site Manager
'WESTFIELD , 101085
c.City/Town d Zip Code
101060
d.Zip Code
)lap.doc•10/02
e.Telephone Number(area code and extension)
120 FAIRFIELD STREET
b On-Site Manager Address
1413-562-9465
e.Telephone Number(area code and extension)
Asbestos Notification Form Page 2 of 3 U
1
Commonwealth of Massachusetts
Asbestos Notification Form ANF-001
sfer
ust
h the
is 310
30
=m
=0
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The undersigned hereby states,under the
=-O penalties of perjury,that he/she has read the
C0 Commonwealth of Massachusetts regulations
for the Removal,Containment or
- Encapsulation of Asbestos,453 CMR 6.00 and
310 CMR 7.15,and that the information
- contained in this notification is true and correct
° to the best of his/her knowledge and belief.
- 0
1.100122896
Decal Number
B. Facility Description (cont.)
TRUCK CRANE SERVICE
5. a.Name of General Contractor
WESTFIELD
c.City/Town
01085
d Zip Code
AIG
1.Contractors Workers Comp.Insurer
6. What is the size of this facility?
20 FAIRFIELD STREET
b.Address
413-562-9465
e.Telephone Number(area cod and extension)
WC5318622
q.Policy Number
a.Square Feet
11/4/2011
h.Exp.Date(mmfdd/yyn)
b.Number of floors
C. Asbestos Transportation and Disposal
1. Transporter of asbestos-containing material from site to temporary storage site(if necessary):
ACCUTECH INSULATION&CONTRACTING, I
a.Name of Trans oder
LUDLOW
c.City/Town
01056
d.Zip Code
2. Transporter of asbestos-containing waste material
3
4
RED TECHNOLOGIES
a.Name of Transporter
BLOOMFIELD
c City/Town
06002
100 STATE ST.BLDG 119, PO BOX 376
b.Address
4135835500
e.Telephone Number
from removal/temporary site to
nal disposal site:
10 NORTHWOOD DRIVE
d.Zip Code
a.Refuse Transfer Station and Owner
1
c.City/Town
d.Zip Cade
MINERVA ENTERPRISES INC
a Final Disposal Site Location Name
19000 MINERVA ROAD
c.Final Disposal Site Address
OH
e.State
b.Address
8602182428
e.Telephone Number
b.Address
e.Tele•hone Number
44688
Zip Code
b.Final Disposal Site Location Owners Name
WAYNESBURG
d.City/Town
g Telephone Number
D. Certification
FAITH LEMAY
a.Name
ADMIN ASSIST
c.Position/Title
[4135835500
e.Telephone Number
L.:4 71yrft4t.
FyIh LeMay
Authodzed Signature
3/23/2011
d.Date(mmfdd/yy ry)
ACCUTECH INSULATION
f.Representing
100 STATE ST. BLDG 119, PO BOX 376
g.Address
LUDLOW
h.City/Town
01056
Zip Code
1ap aoc•10/02 Asbestos Natification Form•Page 3 of 3