76 Asbestos Notification Form 2001 faeliiiOBS .ion
1. . Current or prior use of facility:
Residential
2. Is the facility owner-occupied residential with 4 units or less? ❑Yes tic No
3. Facility Owner:
Northampton, MA
Winn
4. Facility's Owner's On-Site Manager.
John Joey
Mine
aly/Tomi
r Nn th Ri c
Address
01060 (800)826-6202
tp rode Telephone
Same as above
5. General Contractor.
ET&L Corp, - 837 Great Road P 0 9nx 295
Name Address
Stow, MA
01775 (978) 897-4353
Crlyil en Bp code
ekphone
Anders Zurich Polley/ .Date
Conrrzstors Workers Comp.Insurer Pokcyf Frp.Dah
6. What Is the size of the facility?1800 (sq 8) 2 (#of floors)
ElAsbestos Transportation and Disposal
1. Transporter of asbestos-containing waste material from site to temporary storage site(if necessary)to final disposal site
Az affe h Insulation&Gntra;tir�. T„- sit S t ibl+
Name
AA4a
a'racopre, (.q a1013
gdY7Tpm zap 141"jl 5g2_SYIS;
Telephone
2 Transporter of asbestos-containln0 waste material from removal/temporary storage site to final disposal site:
Waste f4ainnoini N.E.&t,Ttc. 25 Silver Street ..
Name Aru
IUCTIOUS
Ran oi 0Ns
be completed .
■comply
Munn(of
mnlal •
m no:icallan
nls 0310 CUM
baking dap
?ninon is
rlagalalemelf
nd uw '1a 7x>`sulaticn&CrnRxtirp, Tic.. Depot Street,-Delta Park
enrol Labor A2rre Abbess
shies
n requhements Chincee M4
M16.12 (lei norm
rnalikrationis
t.4N' PC 000005 Written '
Orono' UUlkwue/ Contract bye(n nimemay
rfin�rur
4. On-Site Project Supervisor/Foreman:
I Original Fmm Randv Daum AS70530
Nsx - . . OUCetilialren/
:wealth of
lusetb ' 5. Project Monitor.
s Program
80007 To he determined
MA02112- x re
Cotn no S alth of Massachusetts
Asbestos Notification Form- ANT-001
Asbastos Abatement Description
11/28/01 07
1. Facility location:
Abahion House
Nemb
76 Chapel Street
Northampton, MA
airflow
-Basement and 1st floor
01060
ra,eon
None
review
Kalb tenIYRvkkeWieni bu)Mrpmnn/,nog noa.man
2, Is the facility occupied? 0 Yes&1 No
3. Asbestos Contractor:
01013 (413) 992-5326
road ranax
NM may be
nptlymg the
mnmenlal
n Agency Region
An demolition/
n ape:aMons
INESHAPS(4o
pall
Wcwktabalf
6. Asbestos Analytical Lab:
Cr•11afi 12/27/01 '12/2000162
name 141-1-4 01. enrarra,/ • 7:30 AM
7. Projectslartdate ?ddale - specilicwmkhaurs(Mon:Fri.)4:00 PM (Sat Sun)
8. What type of project Is Otis? (circle one): l
Nolo:Transfer
Stations most
compywith the
So//pWasla
Division regula-
tions 310CMR
MOO
Note;Contmclor
most sign this
form for D(/
noggration
purposes
LIZP..l.,
Whin rAYN1r
7Nmk
3. Refuse transfer station and owner(ifapplicable):.
WA
tore
i ki "in9-p{�_
cfiiTaxn zmwle
4. Final Disposal Site: .
loatoottine
Scutt-tat Allevhani29 IarlDill 1841 arts faivire) Tm
WmsNam
843 Miller Picldrg Rose
D
novidsVille, PA 1592
/weal? 10 code
814
rerwne
Certification
The undersigned hereby states,under the penalties of perjury,that he/she has read the Commonwealth of Massachusetts Rut
for the Removal,Containment or Encapsulation of Asbestos,453 CMR 6.00 and 310 CMR 7.15,and(hat the information can
this notification is true and correct to the best of hlsmer knowledge and belief:
Mafia St.' '10- /� ,,,....(ff
arxanoe C .ge 1 1G.,- --�� 7 ,- 11/14/01
aumrs tc
ldruitistrative Assistant 7cctf ed-I 7xn jJatikn&
ParNavfue fib, Trr (473) `Il"1_5?Jf.
Iekptw,a ..
ikrot Stnmt, fblta Park Chicolx
AdSecr Gm/fwn ace* .
Fee exempt(City,Town,district,municipal housing authority,owner-occupied residential of four units or less)?(i yes.
Sticker i(from front of form): 75_5_3y4
9. Describe the asbestos abatement procedures to be used (circle- u/omzw ?atom chew
a*,myuan Aspudony d/arr.,,am inoleum and window caulking
10. is the job being conducted ki indoors f outdoors 7
11. Total amountol each type of Asbestos Containing Materials(ACM)to be handled on pipes or ducts(linear lt.) 3 .or other
surfaces(square it.) 21 (1 to be removed,enclosed or encapsulated: 4,
lineal/square fed
boiler,breaching dug laakmbar.
tll c cwfinis...J lend,solid carepip ebsulzlion /
mnWaMiaGl paperPNainsulation.... / iae/kkbgawed --/-
SpM)'-a+Bupmohnd
_/ —/—ddh wow ghunts Jambe wall board
other ooze ArstabeA..1,1,4Alemp.... 12 window caulking. . . . 10
12. Describe the decontamination system(s)to be used:
Two la ers of 6 mil .ol on the all and f.
saminatinnnniT remove inanlation vain
13. Describe the containerization/disposal methods to comply with 310 CMR 7:15 and 453 CMR 0.14(2)(g):
.AG1 to be daiile 1 or wrappEd in 6 nil only ail delivered in a sealed cc:spry
- vehicle to chip site. .. .
14. For Emergency Asbestos Abatement Operations,the DEP and DLI officials who evaluated the emergency:
et hod.
Name dDLF&Tn
nle
Cble waww,vnon
•
N/A
&two, Mel
rd4
Dare cMvtwiaton
Kira/ .
15. Do prevailing wage rates apply as per M.G.L c.149,§26,27,or27A-F to this project? Lt3 Yes 17 No •
c.
V fae//IlyDes _,jl •
1. Current or prior use of facility:
Residential
•2. Is the facility owner-occupied residential with 4 units or less? ❑yes IN No
3. Facility Owner:
Northampton, MA
W 01060 (800)826-6202
6202
4. Facility's Owner's On-Site Manager telephone telephone r.
John Joey
Jim
Same as above
5. General Contractor: e
r.
ET&L Coro
Name
Stow, MA
CpWrown
Cnn�r IerxrL3l ph y
� Zurith 'newer
Polity/
6. What is the size of the facility? 1800 (sq ft) 2_(#of floors)
Asbestos Transportation and Disposal
1. Transporter of asbestos-containing waste material from site to temporary storage site(if necessary)to final disposal site:
Name 3a rrmtlatirn nb
&Qatj 7
Name
Q 1lLQpe fill/ Minis
Wain jp— —__ (473) SR7 Srac
Telephone
a Transporter of ashestos-coniaininp waste material from removal/temporary storage site to final disposal site:
lhste Mai garad N.EET.,7xc. 25 Silver Shit
rr✓,r»
837
Ademse
01775
anvils
(978) 897-4353
Telephone
Erp Gale
Name
Ilatlznrt, CC
Cornatraltb of Massachusetts
Asbestos Notification Form-= ANF-001
NCTIOtI
ions d UNs
be completed
ice ply with
Anson DI
nenlal •
m nolicaUon
nds 01310 CAUL
wwAiegdays
teen is
alanya/ulmxnt
and the ue
nenl'aitahor
.shies
im r
:MB6.12 a1n
6.12 ((MS
rot°IANY 2t/Qf 73
fo/AN
eat nDjan'DRaW'
2niinMrm
TO:
mit OriQinai Fort
LOnwealUt of
acbusetts
nus PnBmin
AMMO
m,MA02112-
Is ion may ea
la nplllyIfl Un
:nvlmnmenlal
Wan Agency Beithe
sreslos demolition/
ration opeatlons
xtilaFESIWPS(40
Su pail Ml.
Asbestos Abatement Description
REVISED 11/28/01 #7
1. Facility location:
babden Hou
h
Basement and 1st floor
1-171fl le pee s&e baker/&nag name t wing flu t man
2. Is the facility occupied? 0 Yes IS)No
3. Asbestos Contractor:
Myna
76 Chapel Street
Wen
• 01060106— None
4 node TNaphaw
w&Cantrx Tac. Divot t Sit, T11 to Pack
Address
01013
MTh
p(/ymuer
4. On-Site Project Supervisor/Foreman:
Da
Project Monitor:
WCittel
Contra We61 m14wie0
AS70530
Of!Creamier"I
(413) 4322-5326
T
6. Asbestos Analytical Lath
¢ i t,
fare 2/13/01 cetWoln/ 7:30 AM
7. ProjectslarfdaWlli2_2101 enddateJ30/01 specilicworkhours(Moo.Frl) ( )
nµ, teovnfkn a(Wrb60
-8. What type at project Is Ws? (circle one):
foie:Tinier
gations must
omp/ywith the
to&M Waste
Walston copula-
ions 310CMR
WOO
Note:Contractor
most sign mis
loan for DL/
notification
purposes •
Cien•om
3. Refuse transfer station and owner(it applicable):
WA
Telephone
Theno
Warn
4. Final Disposal Site:
Southern Anspheaie, iarrifi 7l
taaloasne
843 14f 7Tar Picldrg load
Tpwd
Sc,virc. Tm
Umaskos
Aim
Dauir%villet PA 15928 - (814) 479-2537
C?/rmm nerd - - reMmm
0
Certification
The undersigned hereby stales,under the penalties al perjury,that he/she has read the Commonwealth of Massachusetts Regul
for the Removal,Containment or Encapsulation of Asbestos,453 CMR 6.00 and 310 CMR 7.15,and that the information contai
This notification Is true and correct to the best of his/her knowledge and belief.
AMER St.'t2rage
PrceNmm
•
11 14 01
Accti'H'1l Irsulaf7[xt&
Adnixistl-niive anh.w„.�.u.��r Trc
lro,arovnd Ryrseokay
Depot Strut, Alta Pack
Chicopee, Mk
CfY/rmm
(413) 592-5316
Sig
Q1013
rmrnd
Fee exempt(City,Town,district,municipal housing authority,owner-occupied residential of four units or less)7[ yes E
Sticker I(from front of form): 75 3 3 77
9. Describe the asbestos abatement pmcuuwua wco coo•• r•••�•-. � - ---- -----
eansAaaai &Vont ey epie(a an inoleum and window caulking
10. Is the job being conducted (tl indoors jp outdoors 7
11. Total amount of each type of Asbestos Containing Materials(ACM)to be handled on pipes at duels(linear ft.) 3 .or other
surfaces(square ft.) 210 to be removed,enclosed or encapsulated: _ 4;
lineat/square feat
bal er,tbeaaShg duct tank slulaamaIInes —1 eternal.solWave pipe kutdalicw .__J
caaopelalalayzr&MeiPiPe/amlafrcw -3/ insuatagamed
syray-aafllgmling _I Dvnel/sordieraWings —/— ..
adht no
easeda ifr —/
baa&bren{aallbrard _/_' •:
odre((p/ease )..ljnpj,eule,,,, /3bQ- . window caulking. ., 10
12. Describe the decontamination system(s)to he used:
Two la ers of 6 mil 1 on the wall and f •• - •.. - - • e
dacontaminatinnvnit_ remnve invulntion vain -
13. Describe the containetization/dlsposal methods to comply with 310 CMR 7:15 and 453 CMR 0.14(2)(g):
CM to be daiile 1$gs or w awal in 6 Nil voly an delivered in a sealed CQ1Eary
vehicle to(imp site.
14. For Emergency Asbestos Abatement Operations,the DEP and OL1 officials who evaluated the emergency:
method.
N/
Male orPaP®'Rda
lak
L4tec-4,11W llal
N/A
Wahl/
lkkdAelkoriID6on Waive/
15. Do prevailing wage rates apply as per M.G.L.c.149,§26,27,or 27A-F to this prbjectl Kd Yes l7 No
s
V Faciiity0esl^iion
1. Current or prior use of facility:
Residential
2. Is the facility owner-occupied residential with 4 units or less? ❑Yes al No
3. Facility Owner: •
_Mac anh
him H'gh 3 jlemitraRn t— Nnr h K' C
AdAes
Northampton, MA 01060
(800)826-6202
£blexn
4. Facility's Owner's On-Site Manager.
John Joey
awrom
5. General Contractor.
ET&L Corp.
Name
Stow, MA
Arerrcm 7&n±b
Contractors Workers Comp.Insurer
•'a&
Same as above
7—
telephone
837 Great R d p (1 P 295
ACJ ss
01775 - (978) 897-4353
Zip code Telephone
l'&-37
Poky/
6. What is the size of the facility? 1800 (sq ft)2 (#of floors)
Asbestos Transpoita/ion and Disposal
te/02
fay.Nah
1. Transporter of asbestos-containing waste material from site to temporary storage site(if necessary)to final disposal site
Accrllah Hn-ulatial&Cattra
flint tem
Strpat, fblra zna
chic— , MA 0101,3 (4141 50? 57X,
cbiran - raeae
Tacgnwa
2. Transporter of asbestos-containing waste material from removal/temporary storage site to final disposal site:
Waste PervgerEnt N.E.E.T ,lc 25 Silver Street
Name
Adams
B rthd. Cr
AUCTIONS
liens d this
be completed
comply with
rtment of
nenlal
n notification
sits of 3I0 CAM
'wanting Pays
lkalien is
eyanyadafs:ma
Ind the
lent of Labor
tattles
et requirements
M116.12 (fan
rnotification is
MANI'
I project greater
Ill Original FORD
Commoraftb of Massachusetts
Asbestos Notification Form- ANF 001
n
1.
Asbestos Abatement Description
Facility location:
Ababdon House
Nan
Northampton MA
WOW-
-Basement and 1st floor
HMIs the wttatelttASm2 bulldl,&in aJ,mnl.Awr,mmn
2. Is the Iaciiily occupied? ❑Yes&1 No
3. Asbestos Contractor,
4
nwealth of
:Roselle 5
)s Program
120087
,MA 02112-
lain maybe
nplifying Are
riremrenlal
3n Agency Region
,s os demolition/
on woollens
to NESNAPS 00
bead MI.
76 Chapel Street
01060
None
/Moak
NOV 1 6 2091
[jB L latial&CantCStugL_Icc. 1)epot Stmt, 1k1ta Park.
Name Address
Qtiaa . 141 -01013 • (413) 592-5Th
c,&VTmm - Z{naW Rtrplae
IXIlkauet
On-Site Project Supervisor/Foreman:
Randy Daum
Name
Project Monitor.
To he detprmi rued
Name
Conkat rape amrlkM th4
A570530
01WGatToalim1
IXlC,efartariwf
6. Asbestos Analytical Lab: -
S ell ab A4000162
Name DUlcearkw/ 7:30 AM
7. Project start dalelly 29/Olenddalel1/30/01 specific workhouts(Mon:Fri.)4:00 PM
8. What type at project Is this? (circle one): eWi
a neerrihe tho nchaerne nh
Met
rienaliaa
(Sat.Sun.)
Note:Thins!or
Stations must
campy with the
So/id Waste
Division regula-
tions310CUR
18.00
Note:Contractor
must sign Mrs
norm for DC/
notification
purposes -
uRCx,
Cxy/rowr Ipa4
3. Refuse transfer station and owner(if applicable):.
WA
(414-3r2-3557
Telephone
Noe
ciriromr
4. Final Disposal Site:
Southern Allegbandas Iarclfi'll.
LoaNw,Shre
843 Millar Picking&ni
apwx
lEtt Waste canrire, Trr
omrouNam
Address
Dayirksri71 , PA 15928 (814) 479-9577
Cie/rom, iemk Teleetoe
Certification
The undersigned hereby states,under the penalties of perjury,that he/she has read the Commonwealth of Massachusetts Reg
for the Removal,Containment or Encapsulation'of Asbestos,453 CMR 6.00 and 310 CMR 7.15,and that the information cons
this notification is true-and correct to the best of his/her knowledge and belief. -
AruB,a St.•George '4s.
Rini Name
Nremr&IS:relve
.knflb± Htsralatiat&
hhumstrative Assistant Praha-tom„ T*"- (413) 592-5333
doseteadak /kpeseaaro Tekphmx
,AeI1/14/01
Oft Street, Celia Park Qnrapee, 194 01013
Ackhess G709rwn hpsak
Fee exempt(city,Town,district,municipal housing authodly,owner-occupled residential of four units or less)?R yes
Sticker/(from front of form): 753 3 77
42
endowilim oupualaay arre/wbm inoleum and window caulking
10. Is the job being conducted ({I indoors f3 outdoors 7
11. Total amount ot each type of Asbestos Containing Materials(ACM)to be handled an pipes or ducts(linear ft.) 3 or other
surfaces(square 11.) 210 to be removed,enclosed or encapsulated: .
lineal/square feet`
built',&radii,*deel Mak.nntasewrings... / beam/,solb/tom ppcinsulation _/
corrupted w layered paper pie insulation...._3_1 inmkh'rgmmnt
spray-on&proofing fmut/sprayerctwgs _J
cla wove nkbnis Gauge boar0,nail board
ogsa-(p/eaudpayg0.,lj .1pAgmw 1566 . window caulking. . . . . 10
12. Describe the decontamination system(s)to be used:
Two layers of 6 mil poly on the walls and floor with an ate ar d 3 'stage
darnntaminatiommit remove incnlation acing the negotiate procmme glnvahag
13. Describe the containerization/disposal methods to comply with 310 CMG 7:15 and 453 CMR 6.14(2)(g): method.
,ACM to to ale or rn..,y.e in 6 «d1 a.ly ail delivered in a sealed cotF�'
14. For Emergency Asbestos Abatement Operations,the DEP and DLI article's who evaluated the emergency:
Airs dDEPaLrd
Tab
wredaromenm
N/A
Abi dauaacal
Waive/
LakdAUhpfrabm Mew/
15. Do prevailing wage rates apply as per M.G.L G.149,§26,27,or 27A-F to this project? K7 Yes ❑No
r