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191 FEDERAL STREET UNIT 21 LEAD DETERMINATION REPORT 10-4-2023 Referral to CLPPP: "20 Negative Determination" or PCAD Use this form when (a)you tested 20 painted 'Loose," "Friction," "Accessibe-Mouthable,"or "Moveable-Impact"surfaces but could confirm lead, or (b) the unit already has a Letter of Full Deleading Compliance or Initial Inspection Compliance. Date of Referralj�21D _/Z 3 Code Enforcement Lead Determination Inspector: v License Number: N22 Board of Health: Sa em R0,11d. BOH mailing address: 9 R a Y1 iolo4 Sfre_e_� 3v-J QQQe - mA at q70 Telephone Number: OM 7Lf_17-VOD Email: 6,L�JAQ SCjem,c m Address of Inspection: 191 Apt. No./Floor: 22 In accordance with 105 CMR 410.750(J) and 105 CMR 460.700(B), I conducted a lead determination at the above address on 1nj63/2_023 (date of determination). A copy of the determination report is enclosed --Or-- ❑ In conformance with 05 CMR 460.760(E) I received the completed last page of the order to correct within 14 days. I am forwarding you all lead-related documents I received for this address. I am referring this case to the Childhood Lead Poisoning Prevention Program for a CLPPP code enforcement inspector to do the follow-up Post Compliance Assessment Determination (PCAD). Ins _ctor's signature Please scan and e-mail this document to: Joe.Panetta@MassMail.State.MA.US r� CITy oF 5ALE,\4 .NLL1SSACHLISEET'I'S s BcsAxnoFHEALTH 8 W:sHNG-,oN STREET,311L,l=''Looa PL Fie ,r Orud•cE'' T`EL. (978)742-ISGO DO'N+TiCK P.f-NGALJ-o health Gsalem.com �� c D '�7 GRE.Fi�IS��iL]ii.R- 13I OR HE-1I.TE.AGE-1-,T LEAD DETERMINATION REPORT FORM St.# Street Name Street Type Unit a1 1 12-L city Zip Code —S!,., 1 a o (�t , ko-s ;s proper+y K OddaS 36-3g Bo54on S+ +,)Date of Determination:10/ /2023 Sodium Sulfide expiration date: QO/202-3 Number of Rooms in Unit X-Ray Fluorescence: Model: Serial#: Owner: Mn_Ms., rY-IA��7 LLB Property Type: Owner Address: ❑Single Family Multi Family #of Units Contact Information: - g0 Condominium #of Units Home built before 1978? Yes ❑No ❑Day Care ❑Other LEAD HAZARDS? Yes No Property Diagram/Unit Labels Floor# 2 (level within building of unit being inspected) C b B, B i Id B r i � ------------------------------------------------------- D 4 14",I lCo mo ) 2 Uni1'21, un,1420 --------------------------------------------------- _--- —-------------------------- A(Street Side) A(Street Side) Start Here A gray or black reaction to sodium sulfide or an X-ray fluorescence reading equal to or greater than 1.0 mg/cmz indicates a dangerous level of lead and constitutes a positive determination and violation of the Lead Law. Deleading must not be undertaken based on this report. A licensed Lead Inspector must do a full inspection identifying all lead hazards before licensed or authorized individuals do the work in order for the unit to qualify for a Compliance Letter. 10 by�23 Inspectors Name License# Af ignature Date `f Page 2 of 3 J D ID6�12g2' Inspector print) I Lic# IlAiVAture Date Address of Property V1 FJ r,,i S trot U,;f 2J - # SIDE LOCATION SOURCE Pb Hazard Type (circle one) (circle one) (circle one) (circle one) (circle) A B©D Child's bedroom*OR OR Rm# indow sill POS BG INC 2 A C D Child's bedroom/OR Rm# V'p ow Int sash /Ext sash/ Exterior sill POS INC M/I B C D .Child's bedroom 2OR Rm#V Door edge Door jam POS QINC (F L A B C D Child's bedroom &/OR Rm# Baseboard/Window casing CDoor POS (E'g INC L TN A B�D Child's bedroom&/OR m#� Base /Window casing/Door casing POS EG INC 5 A BCD 'tche Bath OR Room# Window sill Handrail Railing ca QPOS 0 INC A/Mo A C D � itchen Bath OR Room# Window sill / Handrail/Railing cap POS NEG .'C L OR B C D I Kitchen/Bath OR oom# Wig ow Int sash /Ext sash/ Exterior sill POS BG INC M/I ath OR Room# b — Int sash /Ext sash/ Exterior sill POS INC M A B(D D Kitchen/ / B C D Kitchen)/Bath OR Room# Door edge oor jamb POS INC F L 17-�A B C D itche /Bath OR Room# Door edge oor jam POS INC Q L A B C(9 nterior allw t a i r tread / Door edge Door jamb � POS tE.QINC F0I A B C nterior hallway Window Int sash /Ext sash /Exterior sill POS INC M/I L (common area) B C D error hallway Stair tread / Door edge b POS INC F® (common area) CA) B C D nterior a Windowsill / Handra' cap POS INC A/M(T (common area) Intenor stairw A B C D Stair tread/ Door edge /Door jamb POS NEG INC F L (common area) A B C D Porch Stair tread/ Door edge /Door jamb POS NEG INC F L A B C D Porch Railing cap/Handrail/Window sill below 5' POS NEG INC A/M L A B C D Exterior Cellar window sill POS NEG INC A/M L A B C D Exterior Window sills below 5' POS NEG INC A/M L A B C D Exterior—Main Entry Stair tread / Door edge / Doorjamb POS NEG INC F L A B C D Exterior Main entry door casing POS NEG INC L A B C D Exterior Siding/Window casings/Door casings POS NEG INC L A B C D Garage/Outbuilding Siding/Window casings/Door casings POS NEG INC L A B C D Garage/Outbuilding Window sills below 5' POS NEG INC A/M L O B C D POS INC A B C EPOS INC A B®D POS 10 INC I L 7 r&B C D POS M INC Key for Hazard type. N =Accessible/Moutha le L= Loose F=Friction M/I=Moveable/Impact Pb(lead) column: POS (positive for hazardous level of lead),NEG(negative, less than 1.0 mg/ Page 3 of 3 cm2),INC (inconclusive sodium sulfide result) Inspector print) Lic# gn re Date Address of Property' 191 FiII ewJ S4re&4 f # SIDE LOCATION SOURCE Pb Hazard Type (circle one) (circle one) (circle one) (circle one) (circle) A B C D Child's bedroom &/OR Rm# Window sill POS NEG INC A/M L A B C D Child's bedroom&/OR Rm# Window Int sash /Ext sash/ Exterior sill POS NEG INC M/I L A B C D Child's bedroom&/OR Rm# Door edge Doorjamb POS NEG INC F L A B C D Child's bedroom&/OR Rm# Baseboard/Window casing/Door casing POS NEG INC L A. B C D Child's bedroom&/OR Rm# Baseboard/Window casing/Door casing POS NEG INC L A B C D Kitchen/.Bath OR Room# Window sill Handrail Railing cap POS NEG INC A/M L A B C D Kitchen/Bath OR Room# Window sill / Handrail/Railing cap POS NEG INC A/M L A B C D Kitchen/Bath OR Room# Window Int sash /Ext sash/ Exterior sill POS NEG INC M/I L A B C D Kitchen/ Bath OR Room# Window Int sash /Ext sash/ Exterior sill POS NEG INC M/I L ABC ® itchen Bath OR Room# Door edge / oor jam POS INC F L A B C D Kitchen/Bath OR Room# Door edge /Door jamb POS NEG INC F L A B C D Interior hallway Stair tread / Door edge Doorjamb POS NEG INC F L A B C D Interior hallway Window Int sash /Ext sash /Exterior sill POS NEG INC M/I L (common area) A B C D Interior hallway Stair tread / Door edge / Doorjamb POS NEG INC F L (common area) A B C D Interior hallway Window sill / Handrail / Railing cap POS NEG INC A/M L (common area A B C D Interior stairway Stair tread/ Door edge /Doorjamb POS NEG INC F L (common area) A B C D Porch Stair tread/ Door edge /Door jamb POS NEG INC F L A B C D Porch Railing cap/Handrail/Window sill below 5' POS NEG INC A/M L A B C D Exterior Cellar window sill POS NEG INC A/M L A B C D Exterior Window sills below 5' POS NEG INC A/M L A B C D Exterior—Main Entry Stair tread / Door edge / Doorjamb POS NEG INC F L A B C D Exterior Main entry door casing POS NEG INC L A B C D Exterior Siding/Window casings/Door casings POS NEG INC L A B C D Garage/Outbuilding Siding/Window casings/Door casings POS NEG INC L A B C D Garage/Outbuilding Window sills below 5' POS NEG INC A/M L A B C D POS NEG INC A B C D POS NEG INC A B C D POS NEG INC A B C D POS NEG INC Key for Hazard type: A/M=Accessible/Mouthable L=Loose F=Friction M/I=Moveable/Impact Pb (lead)column: POS (positive for hazardous level of lead),NEG(negative, less than 1.0 mg/ Page 3 of 3 cm2), INC (inconclusive sodium sulfide result) S i � CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 98 WASHINGTON STREET 3'D FLOOR 1PubliCHealth Prevent.Promote.Protect. TEL. (978) 741-1800 ROBERT MCCARTHY healdi@salein.com DAVID GREENBAUM,KS ACTING MAYOR HEALTH AGENT REQUEST FOR DETERMINATION OF LEAD HAZARDS AND ENFORCEMENT OF THE LEAD LAW Date: 20 — Ltlt-� S - )o of R i,., , request that the print name of occupant print name of local Board of Health inspect my residence or dwelling unit for lead paint. + � �l The address of this residence or unit: Street number, Street, and Apartment Number Massachusetts. City or Town Zip code The telephone number to reach me there is: ( 1"r ) C� - W 14 Y Phone Number My email address: WQ Ls- Child or children under the age of six (6) years who reside(s) in this household: 03(or�aa�,� Name Birth date Name Birth date Name Birth date Name Birth date The following Race/Ancestry information is optional. Please circle one: Cl>) Iack, non Hispanic (2) Hispanic (3) White, non Hispanic (4) Asian/Pacific Islander (5) American Indian/Alaskan Native (6) Other Was the residence built before 1978? Yes No 1 I understand that the lead determination requested may include all rooms of the dwelling unit or residential premises, common areas,porches and accessible exterior areas, as well as other buildings within the property lines. I further understand that if there is a child under six (6)years of age in residence, and the determination hereby requested identifies lead hazards in violation of Massachusetts General Laws, chapter 111, section 197, and Regulations for Lead Poisoning Prevention and Control, 105 Code of Massachusetts Regulations 460.110 and .750, such violations must be either deleaded for full compliance, or the unit must be brought under interim control, at the property owner's expense. The property owner must correct all violations, whether for full compliance or interim control, within 120 days of the receipt of an Order to Correct Violations. The property owner must also submit within 60 days of the receipt of such an Order, a copy of a signed contract with a licensed deleader, if one will be necessary for the required work. If the owner or his/her agent is going to perform owner/agent deleading work, the owner must also submit a special form within 60 days. If the owner fails to comply with the Order to Correct Violations, then the Board of Health shall initiate judicial proceedings against the owner to enforce the Order. The Massachusetts Department of Public Health, Childhood Lead Poisoning Prevention Program (CLPPP) conducts random audits of inspections conducted by private inspectors and risk assessments conducted by private risk assessors following lead determinations. Such monitoring is performed to assure the quality of services being provided to the public. By requesting this determination, you also agree to allow CLPPP access to your residential premises or dwelling unit during or after the initial determination, and prior to your returning once any deleading, whether for full compliance or interim control, is completed. Not all private inspections or private risk assessments will be audited, so you may not hear from CLPPP requesting access for these additional visits. Please complete both sides of this form, sign, and return it to: DPH/CLPPP 250 Washington Street, Vb Floor Boston, MA 02108, nature of ant 2