A Complete Notification

1
A Complete Notification
Created by Nathan Luedke Wisconsin Department
of Natural Resources Updated 8/05

• A guide to filing a complete notification form
  4500-113

2
Box 1
3
Contractor Project Number

• For the contractors use only.
• DNR does not use Contractor Project Number and
  does not record it.

4
Box 2
5
The Postmark

• The Notification must be Postmarked 10 working
  days prior to the Project Start Date.
• Working days include weekday holidays.

6
Scheduling Example
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Because the waiting period is 10 working days,
prior to the start date, the total number of
calendar days will be 14 in most cases.
Postmark
Postmark
Start Date
Start Date
The exception is when a notification is
postmarked on a Monday.
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Boxes 3 and 4
8
Date Received and DNR File

• Used for DNR organization and filing purposes.
• Specific projects can quickly be found by
  referencing the DNR File Number.

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Box 5
Original
10
Type of Notification Original

• First Notification for a Project.
• A Notification expires once the project end date
  passes.
• A new (original) notification must be filed if
  the first notification expires.
• This includes 10 working day waiting period and
  fee submittal.

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Box 5
Revised
12
Type of NotificationRevisions

• Notification must be revised if
• Project dates change.
• If earlier than the original start date, must
  meet 10 working day requirement.
• If later than the original start date, must be
  revised prior to original start date.
• Contractor, owner, or landfill change.
• RACM amounts change by at least 20.
• Please highlight the word revised.

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Box 5
Cancellation
14
Type of Notification Cancellations

• Cancels project.
• An open notification (has not expired) can be
  revised by a different entity.
• Once the notification is canceled, it can not be
  revised.
• An original notification must be submitted along
  with 10 working day requirement and fee submittal.

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Box 5
EmergencyDate/Hr. Notified
16
Type of Notification Emergency

• Must include date and time of Emergency Notice.

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Box 5
Other
18
Type of Notification Other

• Used for Courtesy Notifications, After-the-Fact
  Notifications, etc.

19
Box 6
Renovation/Abatement
20
Renovation/Abatement

• Altering a facility or one or more facility
  components in any way, including the stripping or
  removal of asbestos from a facility component.

21
Box 6
Emergency Renovation/Abatement
22
Emergency

• Emergency Notification is only for Renovation
  Projects.
• Must be a result of a sudden or unexpected event
  that causes an unsafe condition, equipment
  damage, or an unreasonable financial burden.
• This DOES NOT include poor planning!

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Box 6
Planned Renovation/Abatement (Annual)
24
Planned Renovation (Annual)

• Renovation projects involving individual,
  nonscheduled renovation operations that affect a
  combined amount of RACM which is regulated.
• Small portions of a regulated amount being
  removed over an extended period.

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Box 6
Demolition
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Demolition

• Wrecking or taking out of any load-supporting
  structural member of a facility together with any
  related handling operation or the intentional
  burning of any facility.

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Box 6
Ordered Demolition
28
Ordered Demolition

• A facility is being demolished under an order of
  a state or local government agency issued because
  the facility is structurally unsound and in
  danger of imminent collapse.
• Does not require 10 day waiting period.
• Must be notified as early as possible, but no
  later than the working day following the start
  date.

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Box 6
Fire Training Burn
30
Fire Training Burn

• Demolition by the intentional burning of a
  structure, used solely for live Fire Department
  training.
• The burning of a structure or building materials
  as a method of waste reduction or disposal is
  prohibited.
• Fire Training must be conducted on an in-tact
  structure and only by a Fire Department.

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Box 7
32
Inspection Dates

• Box 7 requires the dates of the inspection to
  ensure that the inspection is current and that it
  has been done.

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Box 8
34
Inspector Certification Information

• Box 8 identifies the Name of the inspector and
  their Wisconsin Inspector Certification Number.
• Ensures that the inspector is properly certified.
• Provides a contact for inspection information.

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Box 9
36
Asbestos Abatement Dates

• States the dates which Asbestos Abatement will
  take place.
• Indicates which shift the asbestos abatement will
  take place.
• Allows the inspector to arrive during abatement
  activity.

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Box 10
38
Reno/Demo (Project) Dates

• States the time frame in which the project is
  active.
• Starting before or after the specified start date
  is a violation.
• Once the end date has passed, the notification
  has expired.
• In order to continue work, a new notification
  must be filed complete with fee and 10 working
  day waiting period.

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Box 11
40
Abatement Contractor

• Lists the abatement contractor information.
• Must be completed for Renovation/Abatement
  notifications or notice is deficient.

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Box 12
42
Demolition Contractor

• Lists demolition contractor information.
• May also list the Fire Department for a Fire
  Training Burn.
• Must be completed on Demolition notifications or
  notice is deficient.

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Box 13
44
Facility Information

• Includes information such as Name and address of
  the facility.
• States which DNR region it is in.
• Also requires general information about the
  structure.
• Used to generate a picture of the project.

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Box 14
46
Facility Owner

• General owner information and contacts.

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Box 15
48
Waste Disposal Site/Transporter

• Name and location of the waste disposal site.
• Used to ensure that material is being disposed of
  at licensed a landfill.

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Box 16
50
Amount of Asbestos

• States Categories of material and whether they
  will be removed.
• Please provide total number of each type of
  material.
• Do not break out materials or write see
  attached to include each individual material.
  Use box 19 for this purpose.
• Cat I or II being removed in a manner that would
  cause it to become RACM should be listed as RACM.

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Box 17
52
Fees

• Contains Fee Table.
• Fee structure has changed as of July 1, 2005.

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Suggested Fee Schedule

• Demolition with less than 160 s.f., 260 l.f. of
  Regulated Asbestos Containing Material (RACM)
  would increase to 75.
• Demolition or Renovation with greater than 160
  s.f., 260 l.f. of RACM, but less than 1000 feet
  combined would increase to 225.
• Demolition or Renovation with equal to or greater
  than 1000 total feet, but less than 5000 total
  feet of RACM would increase to 400.
• Demolition or Renovation with equal to or greater
  than 5000 total feet of RACM would be 750.

54
Current Fees vs. New Fees
Previous Fees New Fees 50
75 150 225 335
400 New Category 750
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Box 18
56
Inspection Methods

• Assumed materials?
• Polarized Light Microscopy (PLM)?
• Combination?

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Box 19
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Description of Asbestos

• State detailed information about the type of
  material(s) and location(s).
• If the list is long, providing a separate list
  (see attached) is acceptable here.

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Box 20
60
Description of Work

• Methods of renovation/abatement.
• Containment?
• Glove Bag?
• Wrap and Cut?
• Methods of Demolition.
• Back hoe?
• Fire Training Burn?

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Box 21
62
ACM Emission Controls

• Practices and engineering control being used at
  the site to prevent ACM emissions.
• Adequate wetting.
• Sealed in leak tight containers.
• Negative Pressure containment.

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Box 22
64
Discovery or Condition Change

• Explanation of the procedure to be used if
  asbestos, previously unidentified, becomes
  visible during work.
• Also explanation of how previously non-friable
  material will be handled if it becomes RACM.
• Appropriate response in most cases is to stop
  work and have the situation assessed to reduce
  the risk of further contamination.

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Box 23
66
Emergency Abatement Info

• Date, hour, and description of incident or
  situation that caused the abatement to be an
  emergency.

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Box 24
68
Ordered Demolition

• Name, Authority, and Date from whom the Ordered
  Demolition originated.
• A copy of the order must be attached to the
  notification to be complete.

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Box 25
70
Authorized Representative

• Verifies that an authorized representative
  trained in the provisions of NR 447 will be on
  site during any work that disturbs RACM.

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Box 26
72
Certification of Information

• Verifies that all information on the notification
  is correct.

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Box 27
74
Mailing Addresses

• If a renovation involves any amount of asbestos,
  DHFS must be notified 1 business day before the
  start date.
• If a renovation has more than 160 square feet or
  260 linear feet, it must be notified to the DNR
  and DHFS.
• The DNR notification must be postmarked 10
  working days prior to the start date.
• The DHFS notification must be postmarked 10
  calendar days prior to the start date.

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Mailing Notifications

• If a demolition does not involve any asbestos
  containing materials, only the DNR needs to
  receive a 10 working day notice.
• If the demolition does include asbestos
  containing materials, DHFS also requires a
  notification.

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Mailing Notifications

• All addresses are included on the notification.
• Please copy the South East Regional Office for
  DNR regulated projects.
• All fees go to the Central Office (asbestos
  coordinator) address.

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Contacts

• Mark Davis [phone]
• (Asbestos Program, Madison)
• Nathan Luedke [phone]
• (Asbestos Program, Madison)
• www.dnr.state.wi.us
• Department of Health and Family Services
• [phone] www.dhfs.state.wi.us

DNR website
Updated form 4500-113