76 Asbestos Notification Forms 2002 Current or prior use of ham'
Residential
2. Is the facility owner-occupled residential with 4 units or less? 0 Yes KJ No
3. Facility Owner.
Massachusetts Highway Department •North King street-
Nam Mass
Northampton MA 01060 (800) 826 6202
Cliylam Zpm& • !Wow
•
4. Facility's Owners On-Site Manager.
74lin Joey
• M r
• IS 4111
Same ac ahpvn
6. Fenn tgttmctor.
servo KMli i, Corp.
Nola:nensle!
Stall=most
Tpm&
Telephone
Neme .Address - -
Stow MA - 0177s ..,(978) 897-43:
ellyllam - ZIP Cade TelepAiix
American •Znrirh
AwMwtOh WUrken Camp.lnsumr - Patyi etyaite
6. What Is the the of the facility?1,800 (sq ft) 2 (e of floors)
WC-3780489-02_ 11/0A/02
® Asbestos Tianspndafion and Olspesal
1. Transporter of asbestos-containing waste material from site to temporary storage site(if necessary)to final disposal sift
AccuTech Insulation & Contracting, Inc.- Depot Street, Delta Park
Man Address
Chicopee, MA 01013 - (413) 592-5326
cIN/Taea ' Eno* leeplan
2. Transporter of asbestos-containing waste material from removaV temporary storage site to Sinai disposal site:
Logan Trucking Company, Inc. 25.Silver Street
Nave AMrar
Portland, CT . - - 06480 (866) 342-0667
Wean l+cS - - (*home
3. nafii n tranefar ctannn and mmmnr(if annlienhlol•
d
nm
Apia;
Ion/
s
'(40 6. .Whal lypeiotproject is this? (circleone): rest imwiekm °perkalq
Commonwealth of Massachusetts
Asbestos Notification Form— ANF-001
Asbestos Abatement Description
1. Facility WON:
Abandon House •
Dine
Northampton, MA
76 Chanel Street
Adim
01060
Zip code
RaspmPnr and 1 st £1 oar
KHatkO,e natal e kaftan?bwkrg ram/,*Nu Aw,roan
2. Is the lacilit •occupied7 0 Yes t4 No
3. Asbestos Contractor:
AccuTech Insulation & Contracting
athm
MA - 01013
Aetna
Written
Chicopee.
OTyYloan
A0000005
automat
None
g
" a
CG Li
DtrrrMN�
ISM N
Inc. Depot Street, Delta Park
(413)592-5326
Telephone '
4. On-Site Project Suporvisor/Foreman:
Anthony Roy
Nara
5. Project Monitor.
To be determined'.
Coda(rra(nanwl adl
AS71233
W Creation/
lira
6. Asbestos Analytical Lab:
To be determined --
Name alcakaa"" 7:30AM
7. Projactstartdate5-A03/92enddate°5(0E02 specificworkhours(Mon:Frl.) 4:;00P14 (SaLSun.)
• alaakalenf
muswit n ,, n
Solid Waste
Division regula-
tions 310CMR
7Q00
N/A •
nma
Cgirow,
4. Final Disposal Site:
Tatplicas
Southern Alle hanie Land
LaYlmr,�ry lrSA W t S f
. Owss,ypa T
843
na
Davidsville, PA
Remo
•
Nolen Contracta
must sip this.
form for a[/
notification
Purposes •
Ce#/1/caNao
The undersigned hereby states,under the penalties of perjury,that he/she has read the Commonwealth of Massachusetts R
for the Removal,Containment or Encapsulation of Asbestos,453 CMR 6.00 and 310 CMR 7.15,and that the Information cc
Ibis notlflgtlon Is true and correct to the hest of his/her knowledge and bellet.
15928
Ib ma
.(814) 479-2537
r
A alia St 'Ge r e
DaMNxrc
Administrative Assistant AdevTech Insulation d
ire
Depot Street, Delta Park
Adtius
One" =
code
Contractine Inc
rev
Chico
ee
4/19/02
(419) 592-53'
wave
01013
Fee exempt(City,Town,district,municipal housing authority,owner-occupied residential of four units or less)=Ryes
Slicker 1(from front of form): 7S py�_
9. Describe the asbestos abatement procedures used (circle):
mgPsulglon dvaloeh
Lin6um and window caulking
10. Is the job tieing conducted 0 Indoors ❑outdoors 7 3 or other
11. To union of each type of Asbestos C,obenremoveria(s(ACM)to be handled onpiipes or ducts(linear lt.)
surfaces(square ft.) ^ !!near/squaro feet
.
Mermal,solid arepiieinsulalim......_1-
Pal a;brexhioA duct lankawkcecoaebtu... red sal,q ..............ppes on...
sammareealal Pa...... insulation.....J fineeVspcaPSroahe9s.............. .-1
spay-on hr 'ng....................._-J budge board,wallboard........... —.J 10
r......wewnlabrrcs"..linoleum,.,--1—±22-D window caulking.. ..
•
afher(Please dzsres...........
the walls and floor with an attached ethod3, stage
12. Describe the
layers of system(s)pl used: the with
tloa at
Two ntyers tf 6 mil poly
decontamination unit. remove insulation usin_•13. Describe the containerization/disposal methods .to.caomPly with 310 CMD 7.15 and and 453 MB 6.14(2)(0):
ed in 6 mil and delivered in P
v. . .e d.u. - bared . . .
h• 1 tnji4 +
m� m
14. For Emergency Asbestos Abatement Operations,the DEP and Oil officials who evaluated the emergency:
Nam
La reobluthafnlion
Ma*ofeuafwfaf
farcdromolm+e+
15. Do prevailing wage rates apply as per M.G.L c.149,526,27,or 27A-F to this project? ?Yes No
Waiver/
nr
Mins I
i. 'Current oradoruseoL._..,Iy ' '
Residential '
2. • Is the faculty owner-occupied residential with 4 units or less? ❑Yes D No
< 3- Facility Owner -
Massachu setts Ai hwa De art n
abw. dNneth Ri
A61eu
CpmNoithampton_ Ma
rf l fl50
4. Facilitys Owners On-Site Manager.
Joe
Ga�naas
'Srhactoc
•::,lFap..•
ET&L Corp
Naar
Stow MA
MMus
Ibmts
_doles s 7 r a.r x p--^-- —29
m17s.
. {978) 897-435`
Teaphbne
_Am i 7i h WC-3780489-02
Cmd2uMh Worleis Comp.Insurer _ 11l0&T02 syt
6. What Is the size of the facility?' o lours e ' . --�
p�1,800 (sq ft) 2 (t&doors)
Asbestos-Tanspadation and Disppsai
1. Transporter of asbestos-containing waste material from site to temporary
AccuTech Insulation & Cent ractinc Inc.- ➢e.ot Street Delta Park
Saw
Chicopee MA
CW?on
2. Transporter of asbestos-containing waste material from removal/temporary storage site tolinal disposal site:
` Logano'Trucking Cnmpa v 7
25. Silver Street
Aaben
Portland. CT 0§4 (n ) A4 67
Trans for gan 80 yfe
7allensmost -
'ale: rvmea rears;
nnii c 1 S t o d
•
df licablel: -
01013
ate
(4131 9 2—s3s 6
rya
frk
Gommoawealtu ofMassacltusetts
AsbeStUSNOtlfICafhil Form— ANF-DDF
�1 Asbestos Abatement Description
1. Facility location:
im
C-
Region
Illioni
r
= • !AIM ... . •
nrne
Northampton, MA
ucrre»n
REVISED 5/02/02 #7
Wet bNenmrk*lelamrMN bur Megla f, lle ;mon
2. Is Um facility occupied? ❑Yes Ed No
3. Asbestos Contractor: . .
AecuTech Insulation & Contrac
Name
h co eel
awrow
AC000005
NULkaue/
4. On-Slte Protect SUpeNisorfforeman:
5. Protect Monitor.
To be determined
6 Cha
Address
01060
4 ran
rd
� I V t
)
NOHtfAMPIONNOMO OF HEA!"-
nc. Deiot Street, Delta,Park
01013
ado
Written
Colacf Type
AS7 233
IXICertikalian/
MI Cato&
(413) 26
rdrenare
We
6. Asbestos Analytical Lab:
Tomned _ — OIICion! 7;30AM
5/07/02 7:30PM (Sat Sun.)
we 5/06/02 specUlcworkhours(Mon-fd.) 021
enddale:�" =2-
7. ProJeclsiattdate��3� -
-_,i.m9 Iclrcls ono): ,—*nt ^ '`
gMfwLir
ark (WOO
ompry min me
w///Waste
1Hlslon reptile-
Ions 310CMR
r&00
Nolo:•
Contactor
ad sign ibis.
Man forDf/
no00catlon
purposes •
N/A
Adtau
my/taa mmM Tdm!lane
4. Rural Disposal Site:
Southern Alleghenies Landfill - - NSA Weave Service- Tur.
/oral aflame d mmiAm
843 !filler Picki r- Road
Adage
Davideville, PA , 15928 - ; x(814) 479-2537
/hms rdepdar
D
Cerflflcaflcn
The undersignedhereby states,tinderthe penalties of perjury,that he/she has read the Commonwealth of Massachusetts He
for the Remould,Containment or Encapsulation of Asbestos,453 CMR 6.00 and 310 CMR 7.15,and that the information car
gds na0flcation Is true and correct to the best olhismer knowledge and ballet.
Amalie St. .Ceorge
NbOMA.
Administrative Assistant
asahvrib
ammmfsanra
AccuTech Insulation
Contracting Inc
,magma
' Depot Street, Delta Park- Chicopee, `MA
Adhcs
470ffonr
Fee exempt(City,Town,dlstdct,municipal housing authority,owner-occupied residential of Mw-units or less)TRXyes
4/19/02
(413) 592-532
rtrmaa
01013
/brae
Slicker I(from front of forme .Zr k9
g. Describe the asbestos abatement procedures to be used (circle): glow bay enclosure la
p, al only ' Lindleum and window caulking
enapsWaliort
10. Is the lob being conducted El Indoors 12(ouldoors't
11. Total amount of each type of ASbesloS C,onbenrgMatadalIS MGM)to on
ppipes or ducts(linear lt.) 3 or other
Surfaces(square ff.) 2'° linear/square feet
- MeiIS solid core pipe Insulation ____L___,
wool fled paper pUiekBuINfVE-... Insulainq .................. "_J__
cormeeledala)ero9...... i......al...._l coatings.............. ____./
fioaefkPrale+
sprayowovenmbrics ................... keno lehued,,well Gurd........... —_1
ate woven fabrics Lino}.,eum,,, �UU window caulking. ...... 10
•
aner(PleasadesarLeJ.......... . —/
12. Describe the decontamination system(s)to be used:
Two layers of 6 mil poly on the walls and flour with an attached 3, stage
decontamination unit. remove .insulation usin: the 1oveba: ethod.
13. Describe the contalnedzaliuoldispasal methods to.camply wllh 310 CMR 7.16 and 453 dM 6.1lvea)ed in a
dou 1 bated •t wra• .ed in 6 mil
14. For MuerUency Asbestos Abatement Operations,the DEP and 01.1 officials who evaluated the emergency:
ewes n M..
Nolo:Transfer
Stations must
'Current:or prior use of,^Nr.
Residential
2 • Is the facility owner-occupled residential with 4 units or less? ❑Yes ID No
. 9. facility Owner. •
Massachusetts Highway Department North Wing_Stract
Atmo Adam
Northampton MA 01060
CtyJTc. Zb m[8 n
4. Facility's Owner's On-Site Manager.
John Joey
5. General Contractor
ET&L Corp.
Manor
Stow, MA
Wien
(800) 826 6202
SamP ae ahn.m-
Ameri ran •Znrirh
CvnmNaia WWWIY, Cnnrp.fnsnmr
6. what", • o'dthelacillty?1,800 (sq 11)?(e of floors)
01775 '
rode
A
{978) 897-43
WC-3780489-02 11/04/02
Pears Wee
•
flbestos Transpnrtkon and Disposal
1. TionWiter of aspestos-contalnIng waste material from site to temporary storage site(N nesessary)to final disposal el
AccuTech Insulation & Contracting, Inc.- Depot Street, Delta Park
Amax Adds,
Chicopee, MA - 01013 (413) 592-5326
CW/ram ' Loco* raws,'
•
• 2. Transporter of asbestos-containing Waste material from removal/temporary storage site toAlnal disposal site:
` Logano Trucking Company, Inc. 25.Silver Street
Aaos
Portland, CT 06480 (R6n) 342-0667
IpmrM TdgMne
Commonwealth of Massachusetts
Asbestos s fot!icallon Form— ANF001
Asbestos Abatemont Description
1. Facilitylucbhun: REVISED 5/02/02 #7
REVISED 5/07/02 117
Abandon House
76 Chanel Street'
Pone
Northampton, MA
Agars
01060 None
an? • 4inant Telephone
RacemQ t and 1 fi
INmtkMeecrks,e NNW Nanny ew,M/.nah AOU;rtan
2. Is the today-occupied? 0 Yes N7 No
3. Asbestos Conbactur: '
,r AccuTech Insulation & Contracting, Inc. Depot Street, Delta.Park . .
r
Chicopee, MA
Wow
AC000005
IX/[Fmmf
Mtn
01013
r®ma
(413) 592-5326
Written
4. On-Site Project Supervisor/Foreman:
Anthony Rny
Mans
5. Project Monitor.
To he determined
Cim& Dpe ihZkviaM'/
AS71
CLIC ¢l/mf
3
fi 0di fl
CC
YRD rF HEAL
Wm
6. Asbestos Analytical Lab:.
• IXlamaotlm/
To be determined
0 oucea',�ltnnr 7:30AM
Nina 5/06/02 HOLD
7. Pto(actstartdate4 19aenddalea-. +..:A::+=speci6cworkhours(Moa-FtIJ 4::00PM (Sat Sun.)
e a wr.nt hromnr nrnl rr k thin? (circle one): ) nW _ tande l aNni PNIN
"wninflamlIM
SolM Waste
DIvlslon rep la-
tlons370CMR
18.00
•
Noir•Conhactar
most sip this.
loan TOM/
noM0ca0an
purposes
N/A
Name
Address
awro m ryme idaim t
4. Rnal Disposal Site:
Southern Alleghenies Landfill USA Wantr Seroire Tnr
[ealooMme araxaa9m
843 Miller Pir king Road
A
Davidsville, PA
, 15928 .(814) 479-2537
+6 am Telpbx
D
Cth!I/cMNOU
The undersigned hereby states,under the penalties of perjury,that he/she hes read the Commonwealth of Massachusetts R
for the Removal,Containment or Encapsulation of Asbestos,453 CMR 6.00 and 310 CMR 7.15,!and that the Information cc
this nohfleatIon Is true and correct to the best of.his/her knowledge and belief. - •
Analia St. George
&Whim AJirvimf
AccuTach Insulation. &
Administrative Assistant Contracting, Inc (413) 592-53:
naewyaa epereK4g raw„
4/19/02
Depot' Street, Delta Park. Chicopee, 'NA
khan
Fee exempt(City,Town,dlstdct,municipal housing authority,owner-occupied residential of four units or less)78Xyw
Sticker 1(from front of form): .7,5—? «43
01013
avrwe
9. Describe the asbestos abatement procedures to (circle): grow kw Wow, Ad I C miee . ew
enaysuleton asPosal WY ° a Linoleum and window caulking
10. Is the job Ibeiug conducted ID Indoors Vroutdoers 7 -
11. Total amount of each type of Asbestos Containing oba Materials(ACM)t or handled
dled on pipes pr ducts(bear IQ 3 or other
surfaces(square ilj 2'° //near/square feet
anima(sold c reppel�tion _J
can canoe /8,dux,perpo cvwaion.... 3
lcerrlah'ng�at..............:. �
camigandorlalzredpapalPWe insulation. lmn Oprayercoa!mgs _�
"1x -4r rmn:�ieemrd,inward
dalhs'wove"7aMks Linoleum —JU window caulking 10
Wha'(pleasedescnbe)
12. Describe the decontamination system(s)to be used:
Two layers of 6 mil poly on the walls and floor with an attached 3 stage
decontamination unit. remove .insulat ion usin: the :loveba: ethod.
13. Describe the containedzatlon/disposal methods to comply with 310 CMR 7.15 and 453 CMR 6.14(2)(0):
ACM t4 be double boned or wrapped in 6 mil poly and delivered in a
_seal.ed_dompilny v hi i t "T p nit P. ' . .
14. For Emergency Asbestos Abatement Operations;the DEP and DU officials who evaluated the emergency:
Atm [ a
i»ofAuthorAgicn
N/A
I6me alSU6 kip
IIbw/
an r 4..0.r....ein.n TT Van n M..
Nate:Transfer
SWIMS most
cbmp4'WIM the
.i. bummtorprtor use of,,�.
Residential
2. ' Is the facility owner-occupied residential with 4 wills or less? ❑Yes Lcl No
9•
Facility Owner
Maasachu"setts Aiehwa9 Depart
sous .Un rh ei e
Adieu
Wottham tep
C.DvTnae ._D1&am r
npn O) 82 620
z
4. Facility's Owner's On-Site Manager.
I.
John Joe
c
LIP: Corrector
Stow MA ,—(1172.5j_____-____
canon (978p 897-43
. 4'7w* Tebphbn
C;;aGAmn i r d WC-3780489-02 i ---.�_
termfrtocomp.MUmr mar/ __
6. What Is the size of the facility?!>800 Eaaia
N (sq if) 2 (f afllaors)
Asbesla Transpeallan
s and Disposal
1. Transporter of asbestos-contelnIng waste material from site to temporary storage site'(If necessary)to"final disposal site
AccuTech Insulation & Contracting, Inc.- Depot Street,Delta Park
!&ea 4t
Chicopee MA 01013
Carrara Ietma T 13) 75 2
2. Transporter of asbestos-containing waste Material from removal/temporary storage site to!8na1 disposal site:
Lugano'',Trucking Company, Inc.
Nara 25.Silver Street
kites: .
PortlAnd., CT 06480 (Ann) 342-0667
rdm Nark
3. Refuse transfer station and owner of applicable):
Cominenweatio of Massachusetts
AsbestonYclfffcatfon Farm— ANF4101
AsbestosApafemenl Deser/pnen
1. Facilitylochtion:
._..X,_. r ,.
Aare
Northampton, MA
REVISED 5/02/02 117
REVISED. 5/07/02 li7
/.
4ttrafbmexuxnren�M.
2. Is the tasty uccupled? 0 Yes F1 No
3. Asbestos Contractor:
Arcot di. Insulation & Contract
Minx
sow
QUYIwn
AC000005
g avtkaw/
4. On-Sete Protect supetvisorfforeman:
Moe
6. Project Monitor.
To be determined•
.
aeon
ton/
is
REVISED 5/10/02 117
76 Chanel_.treet
Adder
01060
gym&
n
nc. De
010 113---
quote
Written
tten
tamar1
rn
NOIITSSS **W OF HEMS
of Street, Delta Park
(413)592-5326
Nein
tint
0. Asbestos Analytical Lab:
To a determined
Name { trttl'Q N HOLD � �
j•3GAM
1 /02 $2 5/14/02 •
7, Projeclstartdate enddae Imelecworkhourstmoa HL) 4;OOPM
(SaLSun)
Haan Waste
meek-
Nona 310CMR
1800
Molt Conlractgr
Allis!s/gn mfr.
Iona for D[!
notifies/lee
peryasas •
• N/A
Caprnm • .. lhuffi 7Jyd'a@
4. Real Clap.
lsposal Site:
Soathern Alleghenies Land£111 NSA Wonte Spavi re_ Tnr •
ItNeas eta OwmNya,
843 Hiller Picking Road
Atka
Davideville, PA
_ 15928 : x(814) 479-2537
h1• •
thmos rok2ma •
D
Certification
The undersigned hereby states,under the parmltles of perfuty,that he/she has mad the Commonwealth of Massachusetts He
for the RamovM,Centalnment or Encapsulation of Ashestos,453 CMR 6.00 and 310 CMR 7.15,1nd that the Information con
• INe notification h ime and correct to the best of.hlsrher knowledge and belief.
Analia St, 'Ceorge
Administrative Assistant
aaanyna
Depot Street, Delta Park.
Mks
KZ, . A. Y/
A nizalSigaem
AienTech Insulation. &
Contracting Inc
eawfeer/
4/19/02
(419) 592-532
wade
Chicopee, 'MA 01013
RAM
lipcoas
Foe exempt(Cny,Town,dlsiricf,municipal housing authority,owner-occupied residential at four units or lass)7flyas
Slicker 1(from front of form). .7,s--Si Vs
6. •wnat typalm pi uJOUus u lib ruiiwa un•p
9. Describe the asbestos abatement procedures to be used (circle): ykwtea enclosure MI coitub1R1r ' "O"p
emapsvlAW d se* �"/"^ r Linoleum and window caulking
10. Is the job being conducted 141 Indoors alouldoors 7 • - .
11. Total amount of each type of Asbestos Containing Materials(ACM)to be handled on pipes prdeels Pear IL) 3 or other
surfaces{equate(L) 210 to be removed,enclosed or encepsurated:
linear/square feet
vita,Arminq,dud henk soda coalings / thrinel,selidompipaluofaticw _J_..
ceaugatedaffir 'pa0erpdxinsulatiaa....IJ lnsdengreent �—
spray-on Iapumpiq _./ Gmw(kpayer (nraa
dalhz eowpyadks _ / Raman bo :�Alr>a d .1
- r .(p/eaJ.a ttrPos/ Linoleum / 200 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 attached 3_ stage
decontamination unit. remove,insulat ion us log the glovebag method.
13. Describe the containedzalleddisposal methods to.comply with 310 CMR 7.15 and 453 CMR 6.14(2)(8):
ACM t be double bagged or Wrapped in 6 mil_poly and delivered In is
14. For EmetOpncy Asbestos Abatement Operations,the DEP and DU°Metals who evaluated the emergency;
tars tflUOTMd
C§h AAWAaOaaal
N/A
AbdofDiIOW I
Wafts/
Cal eorAUmwtaon - Met