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57 DOW STREET UNIT 2 LEAD DETERMINATION RECORDS 12-8-2018 } ! k CITY OF SALEM, 00 MASSACHUS Bo<�xD of H ETTS 98 W'�SHINGT( STREET E.�LTj BEET,31tll FLOOR KIMBERLEy DRISCOLL TEL. (978) 741.1800 Publicnealth Prevent.promote.Protect, MAITOR wth a)salem.com El,'ZAB1 '1TI G;IGAK1S,125�121s1IS Ac'1'1N(;IIliA7,1'11r,(li;N"1' ° DATE: L v r �1 Dear P w • I did a lead determination at the home s7 or apartment y°U own at w This determination found lead in violation of the State Sanitary Lead Last, Regulations (CMR)410.750 J . �Y Code, 105 Code Massachusetts General Laws ( ) This violation also constitutes a Violation o for Lead Poisoning Prevention (MGL) and Control, 10, chapter 111, section 197 f the Department of Public Health CMR 460.000 ' and the Regulations to have lead violations deleaded for requires owners , set forth by the Massachusetts child of homes or apartments built before 1978 under six a full compliance or brow You a lead inspe�on/nsk Ives there. A private risk assessor brought under interi must do a risk assessment control when a Private lead inspector assessment report before inspection report befo e ust do a com You can proceed with ent and give prehensive initial lead inspection and control. A have a Letter of Com Y°U can Proceed with deleadin for Correct and send it to Lance for this g full compliance.give you a lead me within h darope�'please complete plianCe. If You already plete the last page of the Order to The Order to Correct that comes with this letter h • what you need to do asimportant • information telling you: what deadlines to • what documents You meet • who can do must send to this agency the necessary deleading work • what the penalties are for not meetin • what your o tions g the require m Y Bar ents in the order to Correct P are if the Property has been previousl Please call me Jeffrey Y deleaded how to meet there osy' Sanitarian quirements. The followin soon as Possible to discuss this Order to Correct an Property has not been deleaded previously, g information explains the deleadin d g process, if the Revised 3/20I 6 I Hirin a Lead Ins ector To help you take the first step Private lead inspectors is en osedetting a full inspection or risk assessment— the lead inspector is still licensed before Kirin a list of licensed We recommend that you check references and calling the Massachusetts De g him or her. You can check on thema sure that Program (CLPPp Department of Public Health's risk assessors for interim oontrol an 1 Childhood Lead Poisoning license by CLPPp can also provide you g Prevention difference between deleadin d Other hel Y vt'itli a list of licensed pfiil materials, including private by calling CLPPP at 1-800-532 g l compliance and interim control.A brochures explaining e y checking our website at gain, you can get these www.state.rna,us/d h/cl Requirements for Doing Deleadin a -risk deleadin : If you need to or choose to have g Work having lead paint stripped licensed Deleadin peed or scraontractors isped, y°U must hire a license Delead ng work done, such as YOU check references and make su en esed. Just as in the case of inspectors,g Contractor. A list of contract. You can check license lure the Dn b din p ors, we recommend that g Contractor is still licensed before signing a (DLS) at 617-626-6975. Y calling the Department of Labor Standa rds Moderate-risk deleadin, removing andBefore you or your agent can do moderate-risk delea ' number from the Massachusetts woodwork, you must take a course ding work, such as courses are Childhood Lead Poisoning Prevention pro get an authorization For a list ofva by a number of groups and or Program (CLPPP . approved moderate-risk deleading t�ainin organizations at various places, times ) These or visit our website at w g providers, call CLPPP and prices. deadlines listed in the Order toaCorrect. f a ours Remember that you still have to meet the 571 risk deleading is not available at a cony e for Owners Order to Correct Dent time or pla rd iieir agents to do YOU won't be able to do mod time deleadin u to meet moderate- you will then have to use other the deadlines of this licensed Deleadin ractormethods to del g.Fork yourself. In that case, kinds of hazards found and hoWicense number will begin a licensed Deleadin g with a DC. D g Contractor. The Professional to do y°U 'ant to address them Vending upon the have completed the °hour Lead-Safe Renovator You in Y also be able to g This person, called a Lead-Safe Renovator, a moderate-risk deleadin o izati training plus an additional 4 hour trains list of these licensed professionals,hor to heck authorization number will begin 6975. g with an "MR."To get aon their license information, call DLS at 617-626- Low-risk deleadin : Before surfaces, you must read you or your agent can do low-risk delea Will take aself- the CLPPp low_risk deleadin corrected exam and g work booklet.After dmg Work' such as covering reviews it mail it in to CLPPp• ``,ft reading the bookie suitable del adin ill be assigned a low-risk deeadin Once CLPPp receives the exam acid suitable g method for your pro ert s authorization number reading the booklet p Y, You must read CLPPp' If encapsulation is a receives the exam ' You will take aself--corrected ex s encapsulation booklet. After and reviews it, You will be am and send it in to CLPPp assigned an and n Once CLPPP number. To get a free copy Revised 312016 2 Of the low-risk deleading booklet, or 532-9571, A � the encapsulation training .state-ma.us/d of thelow-risk deleading work booklet ca also call CLPPP under the Del ng on a found on our a 1-800- Interim control work: If My Own quick link, website at structural repairs and cleaning o Your f lead dent will be doing way described in the CLPPP booklet for trite ' other work for interim control, such as booklet, call CLppp at 1-800- dust you must take safety precautions 532-9571. Plea es be advicontrsed o and clean up in the licensed Deleading Contractor, licensed moderate get a copy of this interim control have completed the 8 hour Lead-Safe Renovator that some work can Only be done risk g plus aeader(Lead-Safe Renovators who by a moderate risk deleading whose license be for training authorized o g plus an additional 4 hour training on caner/agent. glass with MR####), or low/moderate risk Deleading work has to be done carefully to be safe. T or apartment,you have to keep them out of the home or rotect the people who live in the home these ways: apartment, or area being worked on, in All people and pets have to be t 1=that hi em °r�l moved from the home or a high- or moderate-risk deleading work is talon You have to provide the residents with a reasonable hrtment for the whole People and pets who have been tem or g Place in the home or aparent. ternative place to live for this period. come back after a licensed p anly moved from safe for th private lead inspector or licensed home or apartment can only em to return. The inspector or risk assessor does private risk assessor says it is including taking dust samples to assure that lead dust reinspection will be done at least three hours this after reinspecting the home, levels meet approved standards. • People and pets have to stay out of the work area eadin This low-risk deleadin g work is all done. g work, structural repairs, or cleaning le you or your agent complete most out of the work area while an home or a Y deleadin �g°f lead dust. They also have to stay. Partment. In this case, the g Fork is being done in common areas outside the in and out of the buildin Y must have another re is cleaned up. g and they can use the area once theulwork is done and escape) to go • People and pets have to stay a work area agent apply encapsulants with f the home or a done for the workda during deleading in common area when tpPr Prayer The while you or your escape) Y also have to stay out for the day to go in and out of the building. y do not have another apartment for the dayg When people and regular way(not a fire the end of the workda It means the c p pets are out of their home or Y an come back r the home or apartment after cleanup at Y, and don t have to be out overnight. All work for deleadin p way, and the home or a and interim control has to be neatly the State thepent has to be returned to a condition that Properly e s the requirements a Sanitary Code, 105 C � professional until after the MR 410.000. Deleaded surfaces cannot be equiremeni to assessor, Y have passed reinspeCtion by a licensed private lead ' primed or repainted in or risk You have to give written notice about co the building. The "Notice to Tenants of Lead paint lead Paint violations to all other residents of Hazards,,is enclosed for that purpose. Revised 3/2016 3 You also have to send a copy of the lead inspection r report and any reinspection r report or lead inspection/risk assessment reports to all mortgagees and lienholders of record. If your property has been previously deleaded Period. Please fill out the last page of the Order to Correct anagible for 30-da take advantage of this oreturn it to me w b maintenance s t g option. If you have questions about the DepartmentY o Control Regulations, 105 CMR 460.000, of Public Health's Lead Poisonin YOU can ask me, or call CLPPP atl-OOr532_9571.If You have questions about the DLS Deleadin 22.00, you can ask me, or call DLS at 617-626 697g and 5.ead-Safe Renovation Regulations, 454 CM R Remember to refer to the attached Order to Correct for more ' do. a information about what you have to Sincerely, Jeffrey Barosy Sa i 'a Salem Board of Health Telephone:IM_711_ _��n� Revised 3/2016 4 00 CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 98 W-1SHINGTON STREET,3 iti)FLOOR KIMBERLEY TEL. (978) 741-1800 PublicHealth Prevent. DRISCQT promote.protect. MAYOR 1L health salem.com ELIL,1BET11 Gm;AKIS,RS/RIiIIS Acl'IN(,HI.,�I;rrlAct.7vl ORDER TO CORRECT VIOLATION S DATE: Owner or agent of the property located at: 57 Dow Street Unit Be advised that aria 2 gent of the Salem Board of Health has determined certain residential property to be in violation of the State Sanitary Code portions of Regulations (CMR)to be i 0 i . T , 105 Code of Massachusetts s ( ) his violation also constitutes a violation of the Lead Law Massachusetts General Laws(MGL), chapter 111, section 1 97 Poisoning Prevention and Control, 105 CMR 460.000, set forth by the Massachusetts Department of Public Health. The law requires ow ' and the Regulations for Lead to have lead violations deleaded for full com 1' I owners of homes or apartments built before 1978 child under six years old lives there. If you already have a Lett of Co cor brought property,please complete the last page o under interim control when a Letter mpliance for this enforcement lead inspector within 14 aysthis Order to Correct and send it to your code Conditions exist in this residence which may endanger occupants of these premises. and/or materially impair the health of the DECLARATION OF EMERGENCY The Director of the Massachusetts Childhood Lead Poisoning the presence of this violation of the Lead Law and the Renmg Prevention Pro gram Prevention and Control constitutes an emergency declares that g y pursuan�o the Lead Law,MGL rng section 198 and within the meaning of the State Sanitary Code 105 CMR 400.200(B).chapter 111, CORRECTION OF LEAD VIOLATIONS ' The Lead Law, MGL, chapter 111, sections 189A-199B Prevention and Control, 105 CMR 460.000,require the owner o , and the Regulations for Lead Poisoning dwelling unit built before 1978 in which a child under the age o f i residential premises or violations either abated or contained (referred to as "deleadin " under interim control. The steps that you must g f six lives have lead pit g )for full compliance or brought follow are in the "Order"section. Revised 3/2016 1 The Lead Law, the Regulations for Lead Poisoning Prevention T Labor Standards' require that Standards, (DLdeleading work be noon and Control, and he De Deleading and Lead-Safe Renovation Re Department Will determine the method of deleadingdone by authorized people.gulations, 454 CMR 22.00, that can be done. p p The ells of authorization There are three levels of deleading: High Risk Deleading Only licensed Deleading Contractors or Deleading Supervisors, who will be on-site conducting and/or overseeing deleading activities, can do hi isk include scraping, slipping, demolition, and making large deleading activities. These activities type of work is done on the interior of a unit, then the occupants amounts of loose paint intact. If this until he work is complete and the unit has passed a reoccu pants must be temporarily relocated Moderate Risk Deleading pan0y reinspection. Moderate risk authorized owners/agents and licensed mod Renovators who have completed the 8 hour Lead-Safe Renovator Ong on moderate risk deleading moderate risk deleadrs (Lead-Safe hour training ovator training moderate(and low risk) deleading- g whose license be g Plus an additional 4 components such as windows begins wit an MR# #) can do g These activities include removal and replacement of build' work is done on the interior of a d mpg a small amount of loose paint intact. If this t unit, then the occu building work is complete and the pants must be temporarilytype of becoming trained and authorized to do moderatPassed a e u' relocated until the Fancy reinspection. Owners interested in 532-9571 for more information. risk deleading should contact CLPPp at 1-800- Low Risk Deleading Low risk authorized owners and agents can do some minor surfaces with approved coverings deleading activities such as covering capsula becoming trained and authorized to do low risk deleading approved surfaces. ownersg 9571 nterested in for more information, g should contact CLPPPIat 1 800-532- These rules on who is authorized to perform what kind of work is being done for full compliance or for interim control. also make structural r deleading work apply whether the repairs, as defined in 105 CMR 460.020 An owner or owners agent may required for interim control. and clean lead dust, as may be Revised 3/2016 2 ORDER You are hereby ordered to remedy all violations of MGL, chapter 111, section 197 and 105 CMR 460.000, as identified by a licensed private lead inspector. If you wish to pursue interim control, You must remedy all urgent lead hazards identified by a licensed private risk assessor. Whether You pursue full compliance or interim control, you must correct the relevant violations in accordance with the following schedule: Within sixty (60) days of your receipt of this Order to Correct, you must rovide proof of the following: p 1. A complete analysis of the property for lead hazards. Proof consists of one of the following: • A comprehensive initial lead inspection report done by a licensed private lead inspector. The inspector must inspect the interior of the unit and the common areas of the unit, including the exterior. A comprehensive initial lead inspection and risk assessment report done by a licensed private lead inspector who is also licensed as a risk assessor. This is only necessary if you have decided to pursue the option of interim control. For more information on the interim control program,please contact CLPPP at 1-800-532-9571. • done by a code enforcement lead inspector. If you have a previously complied For previously deleaded properties, a post-compliance assessment determination (PCAD) property and fail to return the last page of this Order to Correct within 14 days, then you may no longer be eligible for a maintenance period;however, you must still have the assessment done. Only a code enforcement lead inspector can do this assessment. 2. An established deleading plan detailing who will be deleading and when the work will be done. Proof consists of at least one of the following: • A contract with a licensed Deleading Contractor, licensed moderate risk deleader(Lead- Safe Renovators who have completed the 8 hour Lead-Safe Renovator training plus an additional 4 hour training on moderate risk deleading whose license begins with an MR####), or low/moderate risk authorized owner/agent. To check on the license for Deleading Contractors and Lead-Safe Renovators who have completed the 8 hour Lead- Safe Renovator training plus an additional 4 hour training on moderate risk deleading whose license begins with an MR####, contact the Department of Labor Standards at 617-626-6975. To check on the authorization for low risk agents, such as vinyl siders or carpet layers, contact CLPPP at 1-800-532-9571. • If you or your agent will be doing the work, a copy of the authorization letter and a completed"Documentation of Training to be an Authorized Owner/Agent And Intention to Comply with the Order to Correct"form verifying that all work will be done within required timelines(see 90 day and 120 day requirements). This form is included in this package. Revised 3/2016 3 Contracts with licensed/authorized people as well as an authorize completed "Documentation o d owner or agent's Intention to Comply with the Order a n'ngi-eto be an form mu uthorized Owner/Agent And meet acceptable lead dust levels under 105 C must also specify that the licensed lead inspector or risk assessor's dust wipe 460.170t will as determined by the samples fail to meet acceptable standards, the lat authoam rized Should any of the dust high- or moderate-risk work will be r person who performed samples meet acceptablerequired to reclean the entire unit until all deleadin levels. If a low or moderate risk authorized person did the g and dust samples fail three required to reclean the entire unit until times,dust samples meet acceptable g Contractor will be Within nine �eptable levels. ninety (90) days of your receipt of this Order to Correct the work must be completed and reinspected (including following required): ( ' g passing dust wipes if 1. All high and moderate risk deleading on the interior of the unit must be complete,pass the visual reinspection, and dust wipes. Please note that if high or moderate risk activities are done on the i encapsulation cannot be done until after all of the hi nterior, then reinspected and dust wipes have passed. high and moderate risk work has been 2• Removal and replacement of doors, if chosen as the method of and pass visual reinspection. deleadin g, must be complete 3. Loose surfaces in the interior of the unit must be made intact b t Person, be covered, or otherwise deleaded and reinspected- y he a being prepared for encapsulation(DO NOT encapsulate theseappropriately authorized successful reoccupancy reinspection). M p This includes loose surfaces surfaces until after a dust wipes at the reinspection. There c Making p yt intact on the interior of a unit requires day. cannot be an loose paint in the unit by the ninetieth 4. For those owners pursuing the interim control option, rules 1-3still "urgent"lead hazards are required to be corrected. In addition, all re apply;' structural repairs relevant to the interior of the unit must b however, only reinspection and dust wipes, if required. required safeguards and e complete and have passed Proof of this work consists of a co py of a reinspection risk assessor and copies of passing dust wipe results, if dusortw frlpes were required. Copies of these om a licensed lead inspector or documents must be provided to this agency by the 90t'day. Within one hundred and twenty (120) days Of our r Correct, the following work must be completed and reinspected of this Order to dust wipes if required): nspected (including passing Revised 3/2016 4 1 Any low risk activities on the interior of the unit that were not done by the 90a'day dey must be complete. This includes encapsulation of interior surfaces that were previouslymade intact. 2. All required deleading in the interior common areas and on the exterior must be complete, Pass the visual reinspection, and dust wipes if they were not needed for a reoccupan reinspection. y 3. For those owners pursuing the interim control option; all of the"urgent"lead hazards must be corrected on the interior, common areas, and the exterior.Also, all required safeguards and structural repairs relevant to the interior common areas and the exterior must be complete and have passed reinspection. For interim control, a final set of dust wipes is required to be t at the final reinspection even if dust wipes ,ere taken previously for a reoccupanc aken reinspection. This means that two sets of passing dust wipes are needed for interim control when a recoccupancy reinspection is completed; one set for the reoccupancy reinspection one set for the final reinspection. and Proof of this work consists of a copy of a reinspection report from a licensed lead inspector or risk assessor, copies of passing dust wipe results, and a copy of a compliance document of these documents must be provided to this agency by the 120a . Copies opies PROSECUTION AND CIVIL PUNITIVE DAMAGES Failure to comply with any of the deadlines set out above will require this agency to initiate criminal or civil proceedings against you within seven (7) business days. Compliance with this Order to Correct will be determined by this agency's receipt of the appropriate documents within the specified deadlines. Documents should be sent to your code enforcement lead inspector n (provide inspector name and business address). p Inspection documents required by the 60th day deadline. One of the following: ❑ Comprehensive Initial Lead Inspection report by a licensed private lead inspector; ❑ Comprehensive Initial Lead Inspection report and Risk Assessment report by a licensed Private risk assessor if pursuing interim control; ❑ Post-Compliance Assessment Determination(PCAD) done by a code enforcement lead inspector. Documents required by the 60th day deadline.At least one of the following, although may be a combination of documents: there ❑ A contract with a licensed Deleading Contractor,licensed moderate risk deleader, Lead- Safe Renovators who have completed the 8 hour Lead-Safe Renovator training plus an Revised 3/2016 5 additional 4 hour#), training on moderate risk deleading whose license or low/moderate risk authorized Owner/agent; begins with an ❑ A copy of an enta on agent authorization letter from CLPPp "Documentation of Training to be an Authorized Owner/A With the Order to Correct"form; and a completed gent And Intention to Comply ❑ If you or your agent will only be doing structural repairs an interim control, a signed written statement attesting that t d lead dust cleaning for accordance with the required timelines. his work will be completed in Documents required by the 90th day deadline: ❑ A Letter of Lead Paint (Re)occupancy( ) lead inspector or risk assessor, in cases where hi Re inspection Certification issued b y a occurred, requiring occupants to be relocated from the unigh-Or t for the deleadinglwo licensed ❑ Copies of results of all dust samples taken b the he duration of the work; and copies of all reinspection reports)issued by a licensed lad inspector peecto or risk assessor; lead inspector or risk ❑ Copies of any invoices documenting that all work to-date was conducted b lead dust. lamed invoice for structural repair work and appropriately Documents required by the 120th day deadline; ❑ Copies of any invoices documenting authorized people, including a signed that all work was conducted b lead dust; invoice for structural repair work p and cleanup of AND one of the following; ❑ A Letter of Full Deleading Compliance issued by a licen ❑ A Letter of Interim Control issued by a licensedlicensed private lead inspector; private risk assessor; ❑ For previously deleaded Properties,a Certification the original Letter of Compliance)issued of Restored Compliance y a code enforcement lead inspector. addendum to In all cases, the owner must ensure that a co inspector. agency at least ten (10) days before the start of n the deleadin the work, and whether it is for full coin g nOhfication is sent to this y deleading,no matter who is performing pliance or.interim control. The law provides Penalties of up to $500 for each day of may become liable for civil Y noncom failure to coin I Punitive damages equal to three times ac In addition you P Y with this Order to Correct if a child becomes poisoned. g for Revised 3/2U16 6 CORRECTION OF VIOLATION BY CODE ENFORCEME NT AGENCY If within the time Periods stipulated above this residential property is not brought into full compliance or interim control slls agency may contract with an authorized Persons to correct the violation m ( ) and obtain a Letter of Full Deleading o Compliance or a Lettrson Or er of Interim Control, and bill the owner, or initiate court action to reim Cburse itself.RIGHT TO A HEARING You may request a hearing Prevention and Control, in con scant to 105 CMR 460.900 of the Regulations for Lead Poison' Sanit pjunction with the procedures of 105 CMR 400.200 B Poisoning aforementioned violationfconsti hearings in emergency public health matters. � )'the As such totes an emergency. As already noted, the YOU may request a hearing only if you have complied with this Or See "Declaration of Emergency"section.) hearing will be provided within ten days of your request. This decision within seven days after the hearing, der to Correct. The agency shall issue a written FEDERAL REGULATIONS Some federal financial assistance programs require addition You are planning on or have a �environmental investigation. If additional r pplied for a federal loan program, please contact discuss these requirements with the program administering the loan or grant, e t 'an - , AC g Health A Tel ephonel - _1 ® Board of Health Revised 3/2016 7 If your property already has a Letter of Compliance Your code enforcement lead inspector within 14 days. Please include You mustfill t this form related paperwork for this address. �d return it to copies of ALL your lead- Your code enforcement lead inspector will review the YOU to schedule a post compliance assessment determination paperwork for site visit, this address and contact you may be eligible for a 30-day �naeri (, during Upon this review and a to fix the hazards yourself and your Letter of Compliancnance period, s em d �g which you may be able Failure to re arcs valid. turn this form to your code enforcement lead inspector within 14 disqualify you from this option,requiring this Order to Correct. Only q g you to follow all of the rules days may y a code enforcement lead inspector can do the require timelines outlined in work for previously complied ro p for free.Please complete and return his form immediate) �u�ed inspection The inspection and reinspection services are provided this 30-day maintenance period y to order to take full advantage of Please print clearly: NAME: -- - - - ---�- - ---� DATE: ADDRESS: _ ZIP CODE: TELEPHONE NUMBER: ADDRESS OF THE PROPERTY CITED: S N ZIP CODE: OCCUPANT O NAME: OCCUPANT'S TELEPHONE NUMBER: (_) Please check off which documents you have attached to this form: ❑ Lead Inspection Report ❑ Risk Assessment Report ❑ Letter of Full Initial Inspection Compliance ❑ Letter of Abatement Compliance ❑ Letter of Full Deleading Compliance ❑ Letter of Interim Control ❑ Certificate of Maintained Compliance ❑ Certificate of Restored Other: Compliance Revised 3/2016 8 This is an lrnporzanr Hoar cc. Please.havc-ir translated. Estee urn aviso zm Este p° �Ce. Quelra manda-Io �aduzir. es un aviso irnpotta�� Sirvase rnand ,CAI' LA MOT B ado rraducir. TH6NG CAO QUAN T XIN vUI LQNG CHO DI RONG Ceci est ' .CH �.AI '�'H�NG CA �41' tmporran� WWII= faire traduire. w � a o d -* . -t IIPDX OXH, AYTO EYNAI IHMA1V'TIKO, Questo a un 'awiso i �AKAAa METAc�pAIM mportante. Si pregadi farlo tradurre Revised 3/2016 9 >>UPLOAD LETTERHEAD IN THIS SPgCE« { t St.# LEAD DETERMINATION Street Name NATION REPORT FORM Ci _ - --- - - - -- Street T e Unit -------�--—� � Zi Code Date of Determination:jg/29/.Zcj Sodium Sulfide expiration date �$ X-Ray Fluorescence: Model: Owners Name; _ -- Serial#: - Number of Rooms in Unit Owner Address:2. Pw _ Property Type: Contact Information: - ------ ❑single Family Multi Family #of Units_ Home built before 1978? �— Ncondominium LEAD HAZARDS? 9 Yes No #of Units Yes No O ❑Day Care Other FloOI# 2 (level within buildin of C unit being inspected) Property Diagram/Unit Labels I B r r+r D r Vn r'f 2 Un i 41 17 ---__v9�.__ — r`fl A(Street Side) Start Here A gray or black reaction to sodium sulfide or an X-ray.fluorescence readingA(Street side) indicates a dangerous level of lead and constitutes a positive determination and equal to or greater than 1.0 mg/cm2 identify ng must not be undertaken based on this report.A licensed lead inspector identifying all lead hazards in order for you to qualify for a Compliance Letter. viol m n of the Lead Law. p for must do a full inspection t B Dq2a7-- Inspector's: ame License# i Sgnature 4-- Date Inspector .rint) Lic# / Signature dd Date Aress of Pro ert # SIDE LOCH (circle one c SOURCE (circle one) circle one) Pb Hazard B C D Child's bedroom Rm# (circle one) (circle) indow si A B C D Child's bedroom Rm# POS INC M L Window Int sash Ext sash Exterior sill POS NEG INC M/I L Door edge Door jam B C D Child's bedroom Rm# A B C D Child's bedroom Rm# POS G INC F L C D Child's bedroom Rm# Baseboard indow casing Door casing POS INC Baseboard Win casing Door casing POS M A B C D Kitchen Bath Room# v INC Window sill Handrail Railing cap POS NEG INC A/M L A B C D Kitchen Bath Room# Windowsill Handrail Railin cap POS NEG INC A B C D Kitchen Bath Room# g A/M L Window Int sash Ext sash Exterior sill POS NEG INC M/I L A B C D Kitchen Bath Room# Window Int sash Ext sash Exterior sill POS NEG INC A B C D Door e Kitchen Bath Room# M/I L edge Doorjamb A B C D Kitchen Bath Room# POS NEG INC F L Door edge Doorjamb A B C D Interior hallwa POS NEG INC F L y Stair tread Door edge Doorjamb POS NEG INC A B C D Interior hallway F L (common area) Window Int sash Ext sash Exterior sill A B C D Interior hallway POS NEG WC M/I L (common area) Stair tread Door edge Doorjamb POS NEG INC A B C D Interior hallway F L (common area) Window sill Handrail Railing cap POS NEG INC A/M L A B C D Interior stairway (common area) Stair tread Door edge Doorjamb POS NEG INC A B C D Porch F L Stair tread Door edge Doorjamb POS NEG INC A B C D Porch A/M L A B C D Exterior Railing cap Handrail Windowsill below 5 POS NEG INC A/M L Cellar window sill A B C D Exterior POS NEG INC A/M L Window sills below 5' A B C D Exterior—Main En POS NEG INC A/M L A �3' Stair tread Door edge Doorjamb POS NEG INC F L B C D Exterior Main entry door casing A B C D Exterior POS NEG INC L Siding Window casings Door casings POS NEG INC L A B C D Garage/Outbuilding Siding Window casings Door casings POS NEG IN A B C D Garage/Outbuilding Wind C L Window sills below 5' A B C POS NEG INC A/M L v 2 A B CS f 'fir POS G NC Q• 3 e POS -G INC A B C!� �- A B C® r POS 10 INC B NEG INC Key for Hazard type; A/M=Accessible/Mouthable L=Loose F=Friction M/I=Moveable/Impact Address of Pr en DID IMER CONCERNING LE AD The information contained in this report conceInin DETERMINATION RETORT comprehensive lead inspection tested to determine whether the premises are in tested represent presence of lead paint does not constitute a epresent only a portion of those s Law(Massachusetts General Laws,chapter 111,sections 8 ith the maces that would be Massachusetts Lead Poisoning Prevention Serious lead poisoning hazards are created when through 199B). Proper safety guidelines are followed. materials containing lead Therefore,Massachusetts's law pant are disturbed Before deleadin and regulations re 'unless lead hazards g work begins, a comprehensive intial inspection must be quire that: and qualifies approrpiate deleadin o by an appropriately authorized g options.Deleading of lead hazards which identifies renovator with moderate-risk deleadin must be person including a licensed deleadin to perform specific work as required under the Lead Law. C g contractor, a licensed lead-safe ed g certification, and anowner/agent who is trained Prevention Program for additional info Contact the Childhood Lead Pand Boni authorized 800-532-9571 or visit:w information re renovators certifed to doww*mass.gov/dph/cI regarding deleading and authorization. ng Pingpp. To find a list of licensed deleaders or lead safeoll ee moderate-risk deleading visit the De www•mass.gov/deleading-and-lead-safe unauthorized deleadin ty the of Full Comment of Labor Standards g has occurred. Pliance will be withheld if(DLS)at Deleading requirements include up requirements, rules regarding notification,containment, a state income tax crediit lnoamg work done on nment, occu will the cost of such hede ead n this report will not upancy restrictions, and clean program. hi order to qua li g be reimbursable qualify the ro Paint inspection. f Y for such programs,the premises must first be subject a co p perty owner for y state loan or grant mprehensive lead Because a child under six resides in this dwelling, unless all lead paint violations have been corrected.This lead re rh'°per may face criminal or civil liabilities has met his or her obligations under the law, port cannot assure that the property owner It is unlawful for rental property or potential tenants with young children. discrimination owners to use the presence of lead as the basis for against tenants a"A 1110 VV"11'1V11VVVC11L11 VI 11PIICI, IU*CLL, Executive Office of Health and Human Services Department of Public Health ' Bureau of Environmental Health 250 Washington Street, Boston, MA 02108-4619 CHARLES D. MARYLOU SUDDERS BAKER Secretary Governor MONICA BHAREL,MD,MPH POLIT O E. Commissioner OLIT Lieutenant Tel:617-624.6000 Governor www.mass.govldph REQUEST FOR DETERMINATION OF LEAD HAZARDS AND ENFORCEMENT OF THE LEAD LAW Date:A* I 2p ll? Sn f s�9h. request the Childhood Lead Poisonin Prevention rint name ofPccupant Pr-ogam to inspect my residence or dwelling unit for lead paint: The address of this residence or unit:_ 7 DOW S f Street and Apt&n-it N umber ~ City or Town - -- ' MA 0 1 The telephone Zip Code number to reach me there is: _ y _G-7g _ S - C4 L j0$ Phone Number ------The child (ren)under the age of six (6) years who reside(s) in this household is/are: --6.-k 1 0-P, D' Name Birth ate Name -- Birth date Name - --- —- Birth date Name Birth date Was the residence built before 1978? Yes No The Commonwealth of Massachusetts k L l�w�j Executive Office of Health and HumHumanService service Department.of Public Health s IRPIBureau of Environmental Health 250 Washington Street, Boston, MA 02108-4 CHARLES D.BAKER Phone: 617-624-5757 F 619 Governor TTY: 617-624 5286 7-624-5777 KARYN E.POLITO MARYLOU SUDDERS Lieutenant Governor Secretary MONICA BHAREL,MD,MPH Commissioner Tel:617-624.6000 www.mass.gov/dph RESIDENTLAL DELEADING ADVIISORY The process of removing or covering lead dangerous if it is not done properly. That's g l the Lead paint hazards commonly hus called deleading, c Y g, an be Massachusetts Regulations 460.000)and the Deleadin (Massachusetts General Laws chapter 111, deleading is done in homes and apartments. These rules a rang prevention and Control(105 Code of o have to be taken while the work is done,how t g Regulations(454 CMR 22.00)have rules for how explain t who can do the work, safety steps that approved. These rules are enforced by the De to up after the work, and how the work is finally Prevention Program(CLppp)� the Department of Public Health's Childhood Lead Poisoning partment of Labor Standards(DLS), and local boards of health. Who can do deleading work Under these laws, only a licensed deleading contractor can do high-risk work, stripping lead paint,repairing large areas of chi demolishing lead-pamted buildin ppmg°r peeling lead paint so it can be rep such as d g or g parts.Besides deleawork, s ers,ch property owners and their agents who take a one-day course can do moderate-risk deleading work,such as removin wui about any Other surface of a house,as well as re so it can be re g dO�'s, woodwork,and just painted.Lead-Safe Renovators withds mall am hour n Department of Labor Standardsbeginning ppmgd pee�g lead paint risk deleading work.Finally,low�'sk deleading ork the be done o and license issued er the moderate-risk deleading work,as well as owners and the' p ��may also be hired to do moderate- the CLPPP low-risk authorization booklet(and/or enca su ne by all the people who can do high_or it agents,including contractors, who complete covering surfaces,applying encapsulants,removin p lant booklet . exterior siding.Property owners and their agents may also do ) Low-nsk deleading includes g doors, cabinet doors and shutters, and applying interim control. structural repairs and lead-dust cleaning for Staying out of the home or parts of the home during deleading To protect the people who live in the home or a about making sure they stay out of the home or apartment, or the area be' apartment being deleaded,the law also has rules • All people and pets must be tem oraril moved from the home or a artme high-or moderate-risk deleading work is taking place inside the mg worked on: Provide tenants with a reasonable alternative place to live ethe apartment for the whole time that tenants should refer to the CLPPP document, "Notice i home or apartment. The owner must Rights, Responsibilities"for more information on alternative during s tune Property owners and Property Owners and Tenants: Tenants' • People and pets must stay ousing ut of the work area while most low-risk deleading g deleading. Residential Deleadin work, 2017 g Advisory Page 1 structural repairs, or cleaning of lead dust is taking place. They also must stay out of the work area when deleading work of any kind is taking place in common areas outside of the home or apartment as long as they have another regular way(not a fire escape)to go in and out of the building.In these cases,people and pets can use the area once cleanup is completed after all the work in the area is ' done. • People and pets must stay out of the home or apartment for the da areas when they do not have ano during deleading of common ther regular way to go in and out of the building. When people pets are out of their home or apartment for the day,it means they can come back to the home or and apartment after cleanup at the end of the workday, and don't have to be out overnig ht. It is very important that people whose home or apartment is being deleaded think carefully about what they will need during the time they are away from home,and take it with them. No one can to a home or apartment while deleading that requires them to be out is still taking place, and has not be Properly cleaned up.Property owners and tenants must take deleadin safety cooperate fully to make sure everyone is protected.No one should interfere with the work b been g ety rules seriously and safely. being done Getting ready for deleading to begin People who live in a home or apartment in which an y kind of deleading work is tang place must receive written notice at least 10 days before he start of this work. This also to blie other tenants of a building,if any deleading work will take place in common areas.Before deleading work begins,all household possessions of every type should be removed or stored in plastic bags s to work areas. Closets and cabinets to be deleaded must be emptied.As a last resort large belongings not removed from the work area should be put in plastic bags and left in p ags h non- , furniture and room, where they will be covered with heavythe center of the deleading. The reason for his is to protect everything and sealed with duct tape by the person doing the contamination.Belongings must also be protected beforetan owner home o r agent performs 1 w dust work,or other work that may be required for interim control,but he precautions are not as extensive for this type of work.In general, it is recommended that furniture and bepr s be low-risk deleading area, or covered with thick plastic and sealed with duct tape,before low-risk deleading begins.e he work Cleanup after deleading and returning home A final cleanup will be done at least two hours after all the interior high-or moderate-risk deleading work is done. This delay is to make sure that fine lead dust will settle out of the air an removed in the final cleanup.People and pets who were temporarily moved to alternative housing return o�afte1 a licensed lead inspector or risk assessor says that the home is s an afe.The licensed lead inspector decides this after doing a reoccupancy reinspection, which includes an analysis of lead dust levels within the home. Tenants should leave a phone number where they can be reached so that the licensed lead inspector or risk assessor can call them and let them know when it is the property owner or agent is going to be doing low-risk deleading work or other work for safe to return interim home. control after the tenants return home,they will be taking some safety steps for this,ask for If CLPPP low-risk authorization booklet.They will also be doing a cleanup when they are done with the low-risk work.A licensed lead inspector or risk assessor will return at the completionbed in the do a reinspection to check the owner's or agent's work. of all the work and Residential Deleading Advisory 2017 Page 2 Temporary ways to protect children from lead poisoning Children exposed to lead paint hazards are at risk of becoming lead poisoned. This disease affect every part of a young child's developing body, and in particular,can seriously and can hurt the brain,kidneys, and nervous system.Even at lower levels of exposure,lead can have le Y Permanently learning and behavioral problems. cause children to The best and only permanent way to protect children from lead poisoning is deleadin .B before that process begins,there are some important steps that can be taken to protect youngchildren from lead poisoning. Your licensed lead inspector's risk assessor's advice should Protect c g ut even because he or she knows your child's home. carefully followed As part of their normal behavior,young children place things in their mouths, especiallyt their own fingers.If there are lead paint chips and dust in your home, they may be picked child's fingers, as well as by toys, foods, and pacifiers that fall on the floor,and end u in ur YO toys and mouth.It is especially important to wash your child's toys and to the our,child's , P d your r hill Particularly before meals and at bedtime. P Your child's P Y luld s hands clean, Areas of peeling or chipping lead paint and dust should be cleaned. Wet wiping with paper and a general household detergent is best. Do not use your household vacuum cleaner to clean chips, because this will only send fine lead dust into the air.InP P towels floors under windows are often areas where children can be exposed to lead. Window sills up paint cleaned regularly if paint dust or flakes collect there. c Particular,windows,window sills, and the do may be to keep the lower sash closed and open only the upper sash for ven should be windows are in poor condition,the best thing to Your child from accidentally falling from the window. Contact paper may be applied t This also protects paint on window sills, walls,or other surfaces as a temporary measure. areas of peeling Sometimes furniture can be moved to block children from deteriorating deteriorating paint or plaster is in the child's bedroom,use another room as the child's hild's paint room,ifr.if Think of those parts of the home where your child spends most of his or her time,and clean as you can before your home is deleaded. m,if possible. try to keep them as Lead paint can also get into soil.If the outside of your home has chipping or peeling paint let your child play in the soil closest to the house.Be careful to wipe your shoes off on a walking into your house, so you don't track in soil from these areas.Follow the advice g P 'do not lead inspector or risk assessor about soil on theproperty. mat before of your licensed For from lead poimore in r 1 the tolmation l out free ow he del �a g process works,and how to Protect your children information line, at 1-800-532-9571. Residential Deleading Advisory 2017 Page 3 The Commonwealth of Executive Office of Health and Human Service Massachusetts Department of Public Health s V, Bureau of Environmental Heal th 250 Washington Street, Boston, MA 021 CHARLES D.BAKER Phone: 617-624-5757 F 08-4619 Governor TTY: 617-624.528g 7 624-5777 KARYN E.POLITO MARYLOU SUDDERS Lieutenant Governor Secretary MONICA BHAREL,MD,MPH Commissioner Tel:617-B24-6000 NOTICE TO PROPERTY O �•mass.gov/dph TENANT'S RIGHTS AVID ERS AND TENANTS: RESPONSIBILITIES Hazards Lead paint hazards under the Lead Law and or apartment listed in the attached documentstliTheste tan'Code have been found in the home people living in the home or apartment. hazards may be a danger to the health of the of being lead poisoned. Lead pi ent. Children younger anger than six years old are at the most risk Even small amounts of lead can h amage a child's growing brain and other arm a child. parts of the body. The owner of this home or apartment is responsible for removin o (deleading)if a child under six lives in the home. g r covering the lead hazards Legal Rights and Responsibilities For these lead hazards to be deleaded as quickly and safely as oss' and the tenant cooperate with each other. It is important that tenants rights under state law. Because the laws are notten p i and ble, it helps if both the owner and/or legal advice before simple, tenants may need to get leowners gal h their trying to use the rights found below. p (1) Tem ora Housin . (Massachusetts General Laws chapter 111, section 197) Tenants and their pets must be temporarily moved out of the home whole time that high-risk or moderate-risk deleading work is taking home or apartment. or apartment for the a licensed Seed Sent. They finds that tcannot he until that work is done, the unit is cleaned e home or apartment is safe, up and The owner and tenants have to agree on a plan for temporary housing.choose to move in with family or friends they do not have a re while they are out w their home. If the tenants d ary ng If the tenants owner must find the temporary pay rent to their landlord o not stay with family L friends, the owners a p �'Y housing and offers it to the tenant. Pay any charges for the temporary housingthe owner off The Law requires that continue to pay their full normal rent during the time they live in the end that tenants The temporary housing must be one that"does not cause undue Sec temporary housing. onomic or personal Tenant Rights 2017 Page 1 hardship to the tenant."If the temporary hardship, and the tenant still refuses to a cept it then the he ow n caner would not cause a for his or her own still ant has to find have to pay rent for the days he or hedis nogg home, and arrange g In this case, the tenant doesn't temporary housing he or she has chosen. In this the has to pay the cost of the amount by which the cost of the tem or has to than the rent for that period. No matter w e e°the terian t a°San b pay the tenant any reasonable movingcosts. T Y the owner is more Tenants are advised to get legal help e owner must pay the owner on a plan. Y cannot agree with (2) Protection from Retaliato A property owner ma Rent Increase or Eviction. y not evict a tenant, or increase the rent or refuse to renew the lease of a tenant in retaliation(getting even) for the tenant reporting violation to a code enforcement a raised, or tenants get an eviction notice or their lease ' g a suspected lead paint agency such as the local board of health. If the rent is after the tenants called the board of health or got their home del wed , automatically find that the owner took this action in retaliationwithin six months show clear evidence that he or she had other reaso ended, a court can eviction based en on not a elaeunless the owner can found to have threatened oaken arena s not retaliato elated to the violations.An against tenants forexercising ers who are Lead Law are liable for damages under M.G.L. c. ena s. 18 an rights under the A tenant who believes that the owner has retaliatednstd M.G.L. c. 93A. violations may also file a complaint with the Massachusetts Comhim mission Against (3) Rent lftoldin=. (Massachusetts General Laws chapter Tenants have a basic obligation to pay rent for their home or apartment But, if lead violations are not n toein ay r 239' section to rent payments. Tenants may take this step t aded tenants may have o the oback time the owner was notified of the lead paint viol they were up to date intheirdrent at he withholding until this point. Owners have the right o go oc court did not begin e Paying rent. To fully protect themselves against attempted ecourt to evict tenants for not rent for Lead Law violations may need to place withheld rent move ' (separate savings)account, or may be ordered to do so ns, tenants withholding are met, tenants may not be evicted for not paying y in an escrow y or the court. If these conditions not the tenants' fault. p Yl g rent or for any other violation that is Owners have the right to enter the tenants' home or apartment ' appointment, but in any case in emernspgencies, �if Possible by ect them repaired. Tenants have a responsibility to cooperate with lead violations and to have necessary access to their home or a owners and allow all With this right of entryapartment for repairs. Tenants who do not cooperate may be subject to eviction. If rent was withheld, the court may Tenant Rights 2017 Page 2 order that all or part of the withheld rent be paid to deleaded, the owner after the violat' (4) AbatementIons are of Rent or Dama r tenants may able to have es. Even when the rent withholding their home ore able t apartment has Lead Law educed or statute does not aid get back rent they have apply, Provide housing that meets basic housing stanviolatidards he ell already breach of this "implied Word always has a dutypaid o d'if mplied warranty,,. A tenant c an big a court action for (5) "Rent Receivershi " This law allows tenants(Massachusetts General Laws, chapter 111 local board of health to' the state Childhood Lead Poisonin ' sections 127C_ rent to be ask the court to find that Lead Law g Prevention Pro 12he Paid into court rather than to the owner, a for violations exist, °r the (6) Owner Liabilit to Pay necessary and to allow Corn to � ar1'repairs. chapter 111, section 199) and Punitive D The owner of a home or a ama es' (Massachusetts General Laws under age six who beco pent built before 1978 is liable for With the Lead Law mes lead poisoned as a result of the o damages to a child With and regulations. own failure to compl through an Order to Correct Violations or wner°f such home or a y lead violations Order to Restore Inte 'partment who is notified Lead Law and who will fullY fails to correct the rim Control and Regulations, is also subject to violations, in accordance with the of actual damages found. Punitive d with the damages, which are triple the NOTE: All the . information presented above is onl decide to withhold Y a summary that you consult an Your rent or take. Ifany other le °f the law.Before you on should contact the nearest Le al Se cannot afford to consult t i auto sable YouLegal Services office, rney,you Repainting Violations of the Lead Law are also lead paint or other coatings have been violations Of f the state t or the state Sanitary Code. Sanitary Code. Deleaded s have to be repainted under 105 Caces from which surfaces can only be r maces have to be sealed CMR 410.020 of by a licensed lead inspector. after the surfaces have been reinse made easy to clean. Deleaded Tenants may while bare and approved Y want to not respond, contact the owner if the required repainting is not done. If the owner does tenants should call the local board of heal th. Tenant Rights 2017 Page 3 � / 9 2 co CD OD CD M d E D a E / 7 J » 5' C / $ CD ƒ CD 2 CD / \ E ƒ 0 �. # � r � � / k a) ° ƒ F $ co E ƒ k CL k k k O • 2 � ' M \ � cr < a CO 0 � k ƒ CD k ƒ ƒ y ° 7 ■ �r ,mE C� ) \CL / \ (D / 2 E £ $/ w E E i a o n ( n % o « i A \ƒ ƒ r a g $ E 2 2 .m & / E ¢ E � k / / 2 g E E / E a i $ ) a ( m C « & CL 7 2 Z ƒ \ CD ( § g \ f CD a E ca 0 ƒI (ƒ m ƒE E £/ >g £I � � a » 2 / s ( 2 � §k $ ■� (D« ' « £� £� _ ° � m a k §) /k / SD « m k ƒ $ƒ § } KE A ( ( oo s0 ¥ f 7 ( Q 0 k f f % $ � / / m co / 2 k _K § i ° ~ C & t / ■ CO 2 e § M e e o § Ri ° « » o $ 2 2 0 0 § § \ 2 (0QD e § CA) & 14 � 0 2 § e e S w % a Q / / $ - y \ \ f f a ) A $ ° co & $ o @ G OD 14 k k k \ § 7 \ k k , � R # $ ƒ 2 z It" a) \ / 7 ƒ I # ƒ ' / ƒ ( J 0 z /. 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Cl 'O N 9 co N tD N CD (DO N d y N N y y D 3 D� N• o c o 0 (aCDy m H m y y o vyi ai ai y V! N 7• O 0 0 O N .0.. y N y y (D 'O N o CA N y N N A A 'A ' ' y :(1 O O N n CD CD CD(gyp [yD N n Al - x ; CA 0 0 CA p C p� G O y A A A ca y A Z1 1 'O h N tp 0 N C4 A x O �•`� -s O O CJ W O 0) + + V 0 co O 0) CA co Ci Cb O +O N OD co W W O � -O ON (D —co CO co CD CO —O _O N N N N C" V OVD G CO ODfa CO OD O O O N O O O O N CNO to CA)N co co O & Crl) , V O V (� t0 G1 1a IV V T N V o CA W � O O V O A tlo CA) O CA N L1 w O ("' w C ti CJ1 Ch Ch Cb cn 9 i� Cp OD V (0 CO N w co .� Cn V V N A O O O w $ �A A a T THE COMMONWEALTH OF MASSACHUSETTS ECUtI E OFFICE OF RAM WORKFORCE DEVELOPMENT DEPARTMENT OF LABOR STANDARDS Cur entl L c sed[]eiea in Contr ctors AS OF 11/5/2018 This List is Ordered by Town and Company Name DC001205 Expires: 7/26/2019 DC500131 Expires: 6/20/2019 ROGER H.MATTHEWS,III,President DC001068 Expires: 9/7/2019 PARAGON GLOBAL PARTNERS, INC. MAGUFFIN MICROWAVE,LLC LAMONT O.COLLINS,Supervisor 7 HEARTHSTONE PLACE 100 NANO STREET SUITE 10 ANDOVER,MA 01810 HAMMOND DELEADING AND 978-470-0562Employees: CONSTRUCTION,INC. ALLSTON,MA 02134 Has Emp toy ees: 90 CUTTER HILL ROAD 617-254-2800 Has Employees: Yes ARLINGTON,MA 02474 DC500060 Expires: 5/18/2019 DC001740 Expires: 11 781-643-1582 Has Employees: Yes /3/2019 JAMES A.BROOKS DC001899 Expires: 2/2/2019 BROOKS ENVIRONMENTAL SERVICES PETER ATSIKNOUDAS PETER ATSIKNOUDAS DAVID FOSS,Owner 179 WEST ST 125 BELMONT ST DAVID FOSS&SONS LLC AUBURN,MA 01501 BELMONT,MA 02478 9 BELLFLOWERRD 508-733� 01179 Has Employees: No BILLERICA,MA 01821 617-489-2100 Has Employees: No 508-361-2737 Has Employees: No DC500127 Expires: 4/30/2019 pC500016 Expires: 12/16/2018 360 ENVIRONMENTAL CORPORATION DC500128 Expires: 5/30/2019 22 BOSTON WHARF ROAD CHEVASSE WHITE BOSTON DELEADING COMPANY 7TH FLOOR A M ENVIRONMENTAL 91 LANDSEER STREET BOSTON,MA 02210 108 SOUTHERN AVE 833-936-8476 Has Employees: BOSTON,MA 02124 APT 2 BOSTON,MA 02132 857-258-8371 Has Employees: 857-615-1483 Has Employees: DC001699 Expires: 6/20l2019 4/ DC003129 Expires: 24/2019 NOEL G.C.LAING DC500134 Expires: 7/11/2019 LAING ENTERPRISES,INC. RICARDO A.REYES-PEPIN,President PAUL BOYLE D/B/A ENVISION PAINTING 32 MELBOURNE ST RICARDO REYES PEPIN 216 BOWDOIN STREET 67 OLD COACH RD APT 1 B BOSTON,MA 02124 #2 RAINTREE,MA 02184 BOSTON,MA 02122 781-843-8639 Has Employees: 617-287-8800 Has Employees: Yes 617-834-4540 Has Employees: No DC000574 Expires: 9/15/2019 DC500133 Expires: 6/28/2019 DC500021 Expires: 10/23/2019 ERROL W.WgLSHE COMMONWEALTH CONTRACTING INC. MANUEL S.DASILVA FREDRICK L.MCCONAGA O COMMONWEALTH RD DASILVA DELEADING CONTRACTOR 103 WALNUT STREET FREDRICK MCCONAGA BRIGHTON,MA 02135 45 MULBERRY STREET Has Employees: Yes 617-312-1694 BROCKTON,MA 02401 BROCKTON,MA 02302 508-583-8485 Has Employees: Yes 508-405-5731 Has Employees: DC001807 Expires: 1211/2018 BODURIN OLOWU DC001809 Expires: 9/30/2019 DC001750 Expires: 11/30/2018 LONGWAY REMODEL CONTRACTOR STEVEN SMALL SMALL WORLD ENVIRONMENTAL NATHANIEL DUBLIN 55 PRINCE STREET SERVICES LEEDER MANAGEMENT COMPANY,LLC BROCKTON,MA 02302 857-991-2742 Has Employees: 10 TYLER STREET 318 HARVARD STREET s Em to ees: No BROCKTON,MA 02302 RM 23 617-792-2729 BROOKLINE, MA 02446 Has Employees: Yes 617-232-8700 Has Employees: Yes The licensing information of the above-listed contractors is updated monthly. While most contractors renew their licenses on or before the expiration date of the license,DLS recommends that you call our ofFce at(617)626-6960 to verify a contractor's licensing status prior to the contractor beginning any Deleading work. Generated On: 11/5/2018 Page 1 of 7 This List is Ordered by Town and Company Name DC001842 Expires: 9/15/2019 PETER J.ARIGONI DC500085 LITTLE BROOK BUILDERS Expires: 11/17/2018 DELUXE PAINTING INC., DC500121 116 MOHAWK TRAIL 37 LITTLE FARMS RD Expires: 11/17/2018 FLORIDA,MA 01247 FRAMINGHAM, DELUXE PAINTING INC., FLORIDA,M MA 01701 37 LITTLE FARMS RD Has Employees.. 508-877-6380 Has Employees: FRAMINGHAM No ployees: Yes MA 01701 508-877-6380 Has Employees: Yes DC000229 Expires: 1/19/2019 MARK MINASALLI,Su DC500113 Supervisor Expires: 5/3/2019 ENVIRONMENTAL RESTORATIONS,INC. GARY P. DC500072 25 SPAULDING O'NEILL Expires: 12/8/2018 ROAD GARY P.ONEILL DEREK RODRIGUES, SUITE 17-2 97 SAND STREET Owner FREMONT,NH 03044 GLOBAL COMPASS INC. GARDNER,MA 01440 750 MAIN STREET 603-895-0400 Has Employees: Yes 978-549-2200 Has Employees: No SUITE 100 DC000322 HARTFORD,CT 06103 Expires: 9/5/2019 413-244-9624 ROBERT N.MADDEN,President DC001491 Has Employees: Yes ALL AMERICAN D Expires: 5/9/2019 ELEADING,INC. DEAN CARLOS MALCOLM DC001812 136 NOKOMIS RD DURABLE&DEPEND Expires: 7/24/2019 HINGHAM,MA CONTRACTING LLC ABLE ROBBIN D.JONES 781-953-1673 02043 21 DEVEAU STREET 27 READVILLE STREET INDIAN ORCHARD, Has Employees: No HYDE PARK Mq p2136 413-575-347g MA 01151 617-390-6537 Has Employees: No Has Employees: DC001709 Expires: 5N/2019 ANDREW SIMPSON,Owner DC001910 A&S CONSTUCTION AND DEMOLITION Expires. 2/1/2019 LLC RICHARD A.ROBILLARp DC001867 A.A.ASBESTOS ABATEMENT CO., Expires; 12/7/2018 3152 WASHINGTON CHRISTIAN A.PgLMA S 3152 WA P STREET R-1307 HARTFORD AVE. INC' DADS Supervisor LAIN,MA 02130 JOHNSTON,R ABATEMENT LLC 617-322-1751 I 02919 49 BLANCHARD ST Has Employees: Yes 401-351-1188 SUITE 209 Has Employees: Yes DC001838 LAWRENCE,MA 01843 Expires: 6/17/2019 978-691-5151 LEOCADIO PAULINO DC500130 Expires: Has Employees: Yes L.A.CONSTRUCTION LLC 6/15/2019 MERRIMACK VALLEY GENERAL DC001924 41 BOURQUE ST CONTRACTORS INC Expires: 9/29/2019 LAWRENCE,M LUIS MIGUEL TEJEDq,President 01843 49 BLANCHARD STREET MIGUELIN CONTRACTING 978-885-7794 Has Employees: SUITE 207-2 RACET INC No LAWRENCE, 289-291 ESSEX STREET LAWRENCE,MA 01843 LAWRENCE, 978-794-1182 MA 01841 DC500089 Has Employees: Yes Expires: 12/28/2018 Has Employees: Yes MPJ REMEDIATION SERVICES CORP 00001794 Expires: 3/7/2019 25 ENDICOTT STREET NOLBERTO GALICIA,Owner DC500129 AL LAWRENCE,MA 01841 NG ENVIRONMENTAL CONTRACTORS,' Expires: 5/30/2019 978-590-0366 LLC RACTORS, EJANDRO NIN Has Employees: NIN-CONTRACTOR LLC 49 BLANCHARD ST 49 BLgNCHARD STREET LAWRENCE,MA 01843 978-794-7922 SUITE 202-1 DC500105 Has Employees: Yes LAWRENCE,MA 01843 Expires: 9/14/2019 978-390.6965 Yakaira Inoa,Principal 00500077 Has Employees: RAY SERVICES,INC Expires: 4/3/2019 P Yees: No OLIVER CONCEPCION,P DC500050 530 BROgpWAY S.E.C. resident Expires: 8/20/2019 2ND530 F CONSTRUCTION CORP. MATTHEW SOEP, FLOOR 85 WACHUSETT AVE SOEP P Owner LAWRENCE,MA 01841 LAWRENCE,MA PAINTING ROAD CORP. 978-686-3680 01841 16 BALLgRD ROgD Has Employees: Yes 978-655-4021 Has Employees: Yes LAWRENCE,MA 01843 781-322-7800 Has Employees: Yes the licensing information of the above-listed contractors is u rxpiration date of the license,DLS recommends that ontractor beg/nn/n y Adated monthly. While most contractors renew their licenses on or before the g an Deleading tyo You cal/our office at(617)626-6960 to veri Generated On: 11/5/2018 fY a contractors licensing status prior to the Page 3 of 7 This List is Ordered by Town and Company Name DC000635 Expires: 8/18/2019 DC100857 Expires: 1/17/2019 ROBERT P.RIVET,President DC500019 Expires: 2/14/2019 NORTHEAST EMEDIATION RMR ASSOCIATES,INC. 25 STOREY AVE ANTONIO C.ARO,Owner 637 CHURCH STREET #256 ARO PAINTING AND REMODELING-DBA NEW BEDFORD,MA 02745 NEWBURYPORT,MA 01950 37 PHILMORE ROAD 508-998-2473 Has Employees: Yes 617-389-9188 NEWTON,MA 02458 Has Employees: Yes 978-398-3101 Has Employees: No DC500094 Expires: 3/10/2019 DC500056 Expires: 3/29/2019 DC500126 Expires: 4/3/2019 KUNEVICH&LAU CONSTRUCTION AND DEVELOPMENT,INC. TRAVIS KACZOWSKI,Supervisor DR.NASKO 268 CENTRE STREET GEM ENVIRONMENTAL,INC. 75 EDGELAWN AVE NEWTON,MA 02458 69 UNION STREET � 617-487-4868 NORTH ADAMS,MA 01247 Has Employees: No NORTH ANDOVER,MA 01845413-663-9884 Has Employees: Yes 978-208-9969 Has Employees: DC500116 Expires: 7/7/2019 DC000764 Expires: 8/14/2019 MACE CONTRACTING,INC. DC001542 Expires: 4/72/2019 1404 BASSWOOD CIRCLE JEAN J.INNOCENT DAVID GRANT DAMON,Contractor ACT MODELING NORTH ANDOVER,MA 01845 CONSTRUCTION R CTION LLC D ALL SAFE DELEADING 617-777-2908 Has Employees: 30 SERENADE PARK MAIN ST NORTH EASTON,MA 02356 NOO RTH EASTON,MA 02356 781-254-2212 508-238-5136 Has Employees: No Has Employees: No DC500124 Expires: 2/1/2019 DC000801 Expires: 9/29/2019 CORNERSTONE ENVIRONMENTAL LLC DC500100 Expires: 8/19/2020 RONALD C. LEADIN T JEFF PAINTING&GENERAL SERVICE, 12 PLEASANT HEIGHTS DRIVE OXFORD DEEADING,INC. INC. NORTH EASTON,MA 02356 8 LIND STREET 16 SILVER LEAF WAY 508-944-0166 Has Employees: No OXFORD,MA 01540 1628 508-987-0092 Has Employees: Yes PEABODY,MA 01960 781-602-0070 Has Employees: DC001480 Expires: 5/20/2019 DC500110 Expires: 3/21/2019 SCOTT AULSON dba SCOTT AULSON DC001849 Expires: 5/7/2019 14 CURWEN RD 91 A HOME IMPROVEMENT NINA INCHARDI,President W W..UNION STREET PEABODY,MA 01960 PITTSFIELD,MA 01201 ULTIMATE ABATEMENT COMPANY,INC.978 34 MOUNTAIN STREET �23-3472 Has Employees: No 413-841-7504 Has Employees: PLAINFIELD,MA 01070 413-246-0472 Has Employees: Yes DC001607 Expires: 317/2019 DC000244 Expires: 3/19/2019 MONY S.NONG ERNEST DC500102 Expires: 7/13/2019 R ERNEST MS NONG CORPORATION HODE RHODES CRANE CARPENTRY INC STREET 114 THORNTON ST 9-5JACKSON STREET #3 50 ELMORE STREET UNIT 2 ROXBURY,MA 02119 SALEM,MA 01970 REVERE,MA 02151 910-876-5494 781-589-6184 Has Employees: 781-941-0695 Has Employees: No Has Employees: DC500136 Expires: 10/1/2019 DC001879 Expires: 5/21/2019 NRC EAST ENVIRONMENTAL DC500122 Expires: 12l7/2018 SERVICES, INC. ANDREW MIRKIN BIG CITY BUILDERS INC. 114 BRIDGE ROAD BAYSTATE CONTRACTING SERVICES, 42 ARBUTUS STREET SALISBURY,MA 01952 352 ALBANY STREET SPRINGFIELD,MA 01109 978-465-1595 Has Employees: Yes SPRINGFIELD,MA 01105 413-284-2048 Has Employees: 413-732-3179 Has Employees: Yes The licensing information of the above4isted contractors is updated monthly. While most contractors renew their licenses on or before the expiration date of the license,DLS recommends that you call our office at(617)626-6960 to ve contractor beginning any Deleading work. rify a contractors licensing status prior to the Generated On: 11/5/2018 Page 5 of 7 This List is Ordered by Town and Company Name DC500042 Expires: 4/9/2019 CHRISTOPHER LOUD DC001253 Expires: 9/30/2019 CHRISTOPHER LOUD LEONARDO RABELLO DC001960 Expires: 2/27/2019 192 BARTLETT ROAD LR CONTRACTING LUIZ A.VIEIRA,Owner WINTHROP,MA 02152 271 WASHINGTON STREET VIEIRA CONSTRUCTION 617-224-3919 Has Employees: WOBURN,MA 01801 5 WASHINGTON AVE 617-501-0559 Has Employees: No WOBURN,MA 01801 DC001737 Expires: 9/19/2079 617-429-2622 Has Employees: No JAMES A.BOYNTON OCS00103 Expires: 8/24/2019 ALL AMERICAN ENVIRONMENTAL ROBERT BRACKETT,Owner DC001926 Expires: 4/20/2019 33 SHELBY STREET BRACKETT CONTRACTING ENIO BARBOSA,Owner #1 17 HANCOCK STREET HOMEPROMASS CONTRACTING LLC WORCESTER,MA 01905 WORCESTER,MA 01610 11 ELLIE WAY 857-222-8055 Has Employees: 508-371-0318 Has Employees: WORCESTER,MA 01610 DC500125 Expires: 2/6/2019 508-667-3150 Has Employees: No MUNOZ CONSTRUCTION,INC. 18 HUNTINGTON AVE WORCESTER,MA 01606 774-232-0126 Has Employees: The licensing information of the above-listed contractors is updated month/ expiration date of the license,DLS recommends that ou call our office at 617 contractor beginning any Deleading work, Y Y While most contractors renew their licenses on or before the ( )626-6960 to verify a contractor's licensing status prior to the Generated On: 11/5/2018 Page 7 of 7 The Commonwealth of Executive Office of Health an Massachusetts Human Department of Public Health Services Bureau of Environmental Health 250 Washington Street, Boston, MA CHARLES D.BAKER Phone: 617-624-5757 02108-4619 Governor Fax: 617-624-5777 KARYN E.POLITO TTY. 617-624-5286 Lieutenant Governor MARYLOU SUDDERS Secretary MONICA BHAREL,MD,MPH Commissioner Tel:617-624-6000 *W*-mass.gov/dph NOTICE TO TENANTS OF LEAD p Lead hazards have been found AINT HAZARDS lead hazards are at risk vbeen d in apartment child's developing becoming lead poisoned. --' In this building. children exposed P g body, and in This disease can affect all to and nervous system. Even at lower levels of n sur seriously and Parts of a your and behavioral problems. Permanently hurt the brain g lead can cause children to have leeys, arming If you have a child less than six years old, it is important for lead Poisoning, as the law requires. If Your child's doctor as health care Your child has no benites tested at he°recent y,r she be re provider to test him or her. If you don' early tested care provider, you can call your local board of health, or Y, You should ask Prevention Program (CLPPP t have a regular health for lead for free. )at 1-800-532-9571, to the state Childhood Lead Poisoning Lead Poisoning find out where You c g can only be detected by such testinan g, an get Your child tested Since lead hazards have been found that your unit may have lead hazards too. fn u apartment in this building ask the owner of your building about haulm you have a childless than s- 'it is quite possible call your local board of health to check for led ur( a Years old, you should apartment inspected for lead 1-800-532-9571 for further advice. It is a pit• you can against tenants with children beta (ask for a lead dete against state law forproperty nation), or call CLppp at use of lead paint hazards in theia owners to discriminate If deleadingapartment. common areas, staircases, � will also include deleading of co notice 10 days before any'porch and/or the exterior of your building, moron hallways, must keep out of the areas beingding will begin g, you will get a Written fin• �1e the deleading is being done, everyone of your building Forked on.aparyou may as a co during this time. If Y have to use another wa moron area in which deleading beintr g is on the s y to go in and out work will protect o g done, the ame floor and is in the work area Plastic sheeting Y apartment. They will be temporarilyperson or persons doing the deleading around or g and taping it down with maskin covering your doorway under your door. If the g tape, so that fine lead dust c Y with thick dust and debris from the deleadin Y have not Properly ane be blown in P perl covered areas to Department of Labor Standards D work, tell the owner of Protect them from lead ( LS) at 1-617-626-6975,o°CLppP t or call the state at 1-800-532-9571. If you Notice to Tenants of Lead Paint hazards 2017 1 don't have an alternative way of getting in and out of your building, building, or the person or People doingthe deleading, talk to the owner of your Check your window sills and doorways s for aii and coordinate the work. can be cleaned up with paper towels and a mixture of regular householer d e dust aft deleading. Lead dust You notice lead dust from deleading in your apartment, tell the person doing the owner of your building, detergent and water. If Deleading work that is done the right way should n g the deleading, acid building. However, if you notice any lead paint dust or debris thatresult not lead contamination of your up at the end of the workday, tell the owner of your building. You can also been properly cleaned 626-6975 or CLPPP at 1-800-532-9571 or the local health de call DLS at 1-617- Parhnent. Notice to Tenants of Lead Paint hazards 2017 2 North Shore Lead Paint Testing Service P.O. Box 734 Beverly, MA 01915 (978) 927-8152 LETTER OF FULL DELEADING COMPLIANCE 57-59 Dow St et L C 2 Penn i Lane Bever!t 01915 Joh C v nau h Dear 57-59 Dow Street LLC This letter is to certify that on 0�/19 Unit 2 _ I re-inspected your Property and relevant interior and exterior common areas !the city/Town f ocated at 57 Salem On that date,those surfaces cited in the initial inspection report b conducted on 12/27 /18 as being - -Regulations for Lead Poisoning prevention and Control,were determs Ge DOWd - g in violation Control, Massachusetts General Laws,Chapter 111,1S Section on 197 1 were taken and found to be within acceptable limits. ned to be in current compliance with those same laws.DusR 4 and 105 CMR 460.000: Massachusetts law does not require the abatement or containment of all reside t smnples dwell'n unit and relevant common areas shall remain in com Hance with t above only as on as there continues to be no residential lead paint. The residential remises or materials, as ton as coverin s and/or enca sutantseformin i effective bar ' e re uirements of the Lead Laws referenced chi in or flalcintr lead remain in lace and as ton as surfaces reversed to correct lead hazards remain aunt or other accessible leaded grants you a 30-day Tier over such aint or other leaded y maintenance period to repair deteriorated lead paint or detached coverings over such materials which time this Letter remains valid. reversed and securely in lace. The law The second page or reverse side of this letter identifies the authorized persons who Paint,and to clean up, during summary of the methods used to achieve compliance with the Lead Laws. A complete Rein ral specifies how and on what date each surface was brought into compliance. ) performed deleading on the property spection Report is attached o this letter,which To the best of my knowledge,the cost of the legally required deleading is$ 6 500 The CLPPP authorized serial number for this Letter of Full Deleading Compliance i This number is tracked and unique to this address and unit. 4� s 67061170031219-2_ DO NOT LOSE THESE DOCUMENTS. If the documents are to services that may cost you significant amounts of money This Letter of Full Deleadi ng lost, you will l required to have additional private inspector above.If you change the street address,unit number or an this Letter of Full Deleadin Y other identifying information Pertainingnce is to the residential address and unit noted Health and/or a municipal health office.Compliance this this Compliance Letter may be considered null and void b premises referred to in Do not alter this document in an Y the Department of Public y way.Altering this document is fraudulent and may endanger the health and safe of a result in significant legal consequences. In addition to an Letter of Compliance, the Massachusetts Department peek criminal prosecution of an Y Potential civil liability which may safety child which may P rthis d u Public Health's Childhood Lead�Poi Poisoning preventionresult of programnma of this Y person who alters this document after it is originally issued. Sincerely, y Thomas Dowd n Inspector(print name) M'1� �t A ,..1/ License# ((vff�'��'"'�� 03/ 12 /19 ignature Questions?Call the Department of Public Health at 1-800-532-9571. Date LOFDC—rev 06/17 DO NOT LOSE THESE DOCUMENTS P•.10a 1-C, Address:57 Dow St. Serial Number: 67061170031219.2 unit#: 2 City/Town:Salem Deleadin r Historti Deleading Contractor Samnan Sar --- - License#:❑✓ DC 500�Exp Date 01/ Deleading Methods: ❑✓ DS 004 E❑✓ Scraping 0 Making Intact(Exterior) ❑ l ❑✓ Sanding Heat Gun Power Making Intact(interior) ❑ Caustics ❑ ❑ Demolition ❑ Removal Replacement � El Liquid Encapsulation ❑ Covering Work was done in the following rooms: ❑ Other m Ex rior Work was done on the follo g win Rm te types of components: Start Date: 03/ 08 /19 Finish Date: 03/ 10 /19 Cost: $ 6 500 RRP w/additional Moderate Risk Training An zation# MR_ xpiration Date: Moderate Risk Deleader(owner/agent) Authorization# Deleading Methods: Issuance Date: OM `�M ❑ Replacement ❑ Covering ❑ g Intact(Interior) Making Intact(Exterior) ❑ Liquid Encapsulation ❑ Removal Work was done in the following rooms: Other Work was done on oolowing types of components: Sta ate: / / Finish Date: Cost:$ Low Risk Deleader(owneriagent) ~~~ Authorization# OL AL Deleading Methods: Issuance / / OE AE ❑ Covering OB AB ❑ Replacement (ONLY doors,cabinet doors,s squid Eric on s,shelves not affixed,drawers,windows on hinges) Work was done in the following rooms: Work was done on the following types of c nents: Start Date: Finish Date: Cost:$ DELEADING INVOICE Please completely and clearly fill out appropriate information: Name(print) Samnang Sar —Telephone 781 367- 1667 Company: Precision Lead Paint Solutions Address: 710A Summer St,L nn MA Work/Cell 781 367- 1667 —i Zip Code 01905 - Address of Deleading Work T pW 4. Zip code I hereby attest that all deleading activities and clean up were done in accordance with the Department of Labor and Workforce Development's Regulations,454 CMR 22.00 the Childhood Lead Poisoning Prevention Program's Regulations, 105 CMR 460.000. Signature_ ?? Dater J / Jp/ 'G� Only complete section reflecting your authorization/license status Deleading Contractor Sampan Sar License#: ®DC 500074 Exp.Date 01/ 15 /z o ®DS 004189 Deleading Methods: ❑ Scraping ❑ Demolition ❑ Power Sanding ❑ Caustics ❑ Heat Gun ❑ Replacement ❑ Covering [I Liquid Encapsulation ❑ Making Intact ❑ Other Work was done in the following rooms: Sc� �.7 Work was done on the following es of com onents: Start Date: 3 / � Finish Date: `3 / /• /1 Cost: (d RRP w/additional Moderate Risk Training r uthorization# MR- Issuance Date: Moderate Risk Deleader(owner/agent) Authorization# _❑OM❑AM Issuance Date: Deleading Methods: ❑ Replacement ❑ Making Intact(interior) ❑ Capping Baseboards Work was done in the folio ❑ Covering ❑ Making Intact(exterior) ❑ Liquid Encapsulation �' rooms: Work was on the following types of components: St ate: / / Finish Date: Cost: _ Doesn't Include owner's Labor Low Risk Deleader(owner/agent) Authorization# - ❑OL❑AL Iss ate: / / ❑OE❑AE Deleading Methods: ElOB DAB ❑ Covering ❑ Liquid 3psulation ❑ Capping Baseboards ❑ Replacement (ONLY doors,cab�-doors,shutters,shelves not affixed,drawers,windows on hinges) Work was done in the following rooms.- Work �- / types of components: Start D / Finish Date: / / Cost: (Doesn't Include owner's Labor) Questions?Call the Dennrfmn..♦sus :_■�__... s �1 Environmental Hazards Services, L.L.C. Lead Dust Wine 7469 Whitepine Rd Analysis Report Richmond,VA 23237 Telephone:800.347.4010 Client: North Shore Lead Paint Testing Report Number; 19-03-01237 71 Cabot Street d Receive Date: Beverly, MA 01915 03/11/2019 Analyzed Date: 03/11/2019 ProlecttTest Address: 57 Dow St Apt 2; Salem Reported Date: 03/11/2019 Collection Date: 03/08/2019 Client Number; 22-3980 Laboratory Results Faxes Lab Sample Client Sample Collection Location 978-927-8152 y Number Number Surtace - - - . _ _ . Total Pb Wipe Area Concentration Narrative 19-03-01237- 1 Jug) (ft=) 001 RM 1 (ug�ft__� ID 19-03-01237- FL <5 00 - 2 1.00 <5.00 002 RM 1 SL 19-03-01237- <5.00 0.500 003 3 RM 1 <10.0 19-03-01237- 4 WV1/ <5.00 0.500 <10.0 004 KITCHEN FL 19-03-01237- 15.1 1.00 005 5 KITCHEN 15.1 19-03-01237- SL 47.5 0.500 006 6 KITCHEN 94.9 19-03-01237- WVN 19.0 0.500 007 7 BLANK 38.1 <5.00 Page 1 of 2 Client Number: 22-3980 Environmental Hazards Services, L.L.0 Project/Test Address: 57 Dow St Apt 2; Salem Report Number: 19-03-01237 Lab Sample Client Sample Collection Location Surface Total Pb Wipe Area Concentration Narrative Number Number — - - (ug) (ft2) (ug/ft2) ID Method: ASTM E-1979-17/EPA SW846 7000B Accreditation#: Reviewed By Authorized Signatory: c K0-w-,or—le— Missy Kanode QA/QC Clerk The Federal lead guidelines for dust clearance levels by wipe sampling: Floors(FL)-40 ug/ftz, Interior Window Sills (SL)-250 ug/ftz, Window Wells(WW)-400 ug/ftz. Effective April 1, 2017 all existing Office of Lead Hazard Contol and Healthy Homes (OLHCHH), Lead Based Paint Hazard Control(LBPHC), and Lead Hazard Reduction (LHRD) grantees will use the following dust-lead action levels and clearance action levels (or lower levels if required by local, state or tribal authorities having jurisdictions): Dust-Lead Action Levels: Floors(FL)- : 10 ug/ftz Window Sills (SL)- : 100 ug/ftz Lead Clearance Action Levels: Interior Floors (FL)-< 10 ug/ftz Porch Floors(PFL)-<40 ug/ftz Window Sills(SL)- < 100 ug/ftz, Window Troughs (WW) -< 100 ug/ftz The Reporting Limit(RL) is 5.00 ug Total Pb. Reported results are not corrected for field blanks. Dust wipe area and results are calculated based on area measurements determined by the client. All internal quality control requirements associated with this batch were met, unless otherwise noted. The condition of the samples analyzed was acceptable upon receipt per laboratory protocol unless otherv�ise noted on this report vided by the client. Results .Results represent the analysis of samples submitted by the client.Sample location,description,area,etc.,was pro reported above in ug/ft2 are calculated based on area supplied by the client. If the report does not contain the result for field blank,it is due to the fact that the client did not include a field blank with their samples. EHS sample results do not reflect blank correction. This report shall not be reproduced except in full,without the written consent of the Environmental Hazards Services,L.L.C. ELLAP Accredtitation through AIHA-LAP,LLC(100420), NY ELAP#11714. Legend ug=microgram ug/ftz=micrograms per square foot - — Pb=lead mL=milliliter _ — ftz= uare foot Page 2 of 2 WiN MEN cm) co 5 vi ^r•a'n=l �` Ft �; ; }{ yF I rto Al j 12 • Y.' � ,{�� .L'i� � •� } � w _ L t Fri•1, } ]1 ? `� r F {y`,ksh_:• � ti/ '' it •- •'. f t 1 f �. F .x ... �=".� '`•tit rt � _ c� �; •� � .� �; � ;^• '� t= •.�..,, a...,,,� � � �ti_, , tz . zs 4 Gt7 tr11 F.S r f �y`� z + ? �(]0� ;b0I j j L Vjv 00 - .,:;' l;: �` ii ,� �; ;• "�j �. ?.� � �; t: � ., ,,. sM•Na I^VA'yfirMf r .. ,,� y ? ? ! 4 iz i t , +f1, • 771 ~ f, L.'4' J D. •` }^3 •z`I (�� ! •(y 7 tf} p I 1 ' i ' ):1, � I - - - - -- Pagel of I 1 North Shore Lead Paint Testing Service P.O. Box 734 Beverly, MA 01915 (978) 927-8152 St,# Lead Inspection I Risk Assessment 57 _____ _Street Name__Dow w-�'-�`--�-- City Salem - -------- Type-_Street T St. ----- -- --� -- ---�__ZipCode-01970 ---------Unit 2 Owner Name: 57-59 pow Street LLC 4 4 4 Owner Address: Penn Number of Rooms in Unit: Contact Information: L ne Beverly. MA 01915 Property Type; Client Name(if ditl'erentfrom onCavanaU h ❑ Single Family Client Address: ❑✓ Multi Family _ Y #of Units: 4 ❑ Condominium #of Units: Key Leader ❑ Day Care ❑ COV Covered Kev Delead/IC Method Column ge Other: DC Drop Ceiling COV Covered llelead/IC Method Column Latin MET DIP REM dry in Basement? Yes ❑ Metal Dipped Removed Finished Space in Basement? No MR Metal Rep. ENC Encapsulated REP Replaced NA s Window INS SCR Yes ❑✓No Not Accessible Intact Scraped Possible Pb NC No Coating MI Made Intact SFR Storm F Water Service Line Tile Frame Removed ❑Yes ❑✓ No Tile(testing suggested) PRE Prepared for Enc. SLD Sealed ❑ Not Tested VB Vinyl Baseboard Component Does Not Exist V� Stripped Testing Method Used VR Vinyl Rep. RIMR Vinyl/Metal Re Na2S Expiration Date: p Window p Window Comments/Notes: —---- -— X-Ray Fluorescence ---- _ Model: LPA-1 Serial# 2137 � ❑ Demarcation Lines Floor# 2 ElSubmitted for Compliance Evaluation (level within building of uni C t being inspected) Floor#~ �y p C Property Dragram/Unit Labels -- - - -- - , --- �--;---�---'---;---�- , Street _ w , - ` - - - ;- r- ;-- B --- - - - D It - - -- - , ID B - - � - -- r -- - ; -_ - - - � - p #2 -r--;- ------ ' ' 7A t r ; 9 Apt#2 ' r___r__i___ r•-� , .........A(Street Side) -� � , , , ,---F--,---T --- 57 Apt59 1 Start Here #� Apt# Pb lead equalA(Street Side) XRF Calibration Recorded in r eater than 1.0 mg/cmz with x-ra Start Here - - g Book Y fluorescence or positive with Na2S is Dangerous.A(S Side) Address Verified through USPS Research on Lead Related History for Address ❑ -Check off when complete -Check off when comple}� �r10n18 ww'w.state.ma.us/dph/clppp or 800-532-9571 j� w ❑✓ ✓- �xnppf_-)..�� _ �9 Check off w�fei\cr,mntdF,,l Address: 57 Dow St. - - - -— - Apt#-.-2 - - city Salem INSPECTION HISTORY -- -- -- -- - - -- - ___ Page 2 of FL.ad rmination -- INTERIM CONTROL 2 8 1 8 Inspector Name: Bar08 - Lic#4227 Vises` N Signature- Risk Assessment R.A.Name: Hazards? - M ----- -- _- . Lic#Signature Comprehensive U ant Pb.Hazards? ---- Initialo Ins.ection Inspector Name:Oscar Be in 4 -- - 0 7 2 7 Y ust a en or Q 1 Lic#1063 Risk Assessment R.A.Name:_ N Signature y -- - -- -: Lic# Lead Hazards? -- Urgent Ph.Hazards? N Signature_ Comp Initial , - ------ - - -- ----- W/Partial PCAD Inspector Name; Visual Portion of y Lic# Reinspection for P R•A.Name:_ Interim Control --- ----- -= LIC# Lead Hazards? N Signature-_ - F Signature --- - Addendum(add-on ~ to Initial Ins ectiod Dust Taken for Risk y Inspector Name:_ Assessment Reins - P R.A.Name:_ Lic# Lic# N Signature___ F Signature Lead Hazards? Addendum as Full Visual Portion of Ins ection Inspector N e:Thomas Do Reinspection for 1 2 2 7 1 $ y U #1170 Interim Control P R.A.Name:_ - y--y Lic# N Signature_ uM��-j F Signature Lead Hazards? -- -- ---- --- -- _ Walk Through for Dust Taken for Risk g Inspector Name: Assessment Reins . P R.A.Name:- Ed/Consultation Lic# --- -- - -- - _,Lic# Signature_ EF Signature — Risk HISTORY Risk Assessment Recertification y R.A.Name: Visual Portion of Lic# TTIV P Inspector Name:_ N --- - - - -— -- --��Lic# Signature_ F Signatures Ur ent Ph.Hazards? Visual Portion of Inspector Name:!�VI Dust Taken for Reocc.Reins ection RA Recertification P R.A.Name:— ------- ----Lic#__ a 3 fj j f Signature__ *10*1 LU Signature Dust Taken for P Inspector Name: POST COMPLIANCE ASSESSMENT DETERMINATIONS Reocc.Reins ection LiC# RMINATIONS F Signature_ --- ---- PCAD y Inspector Name: Dust Taken for Inspector Name: - - -- - - - Lic# Reocc.Reins ection � N Lead Hazards? Signature_ 3 19 F Signature e NVl I"1 ------- - -- --- --- Full Inspection Visual Portion of P e �, ^!WL7 Actin as PCAD y Inspector Name: _ Final Reins ection p Inspector v',1 - oqt _ Lic# d 0 t ( F Signature N Signature_ Lead Hazards? Visual Portion of Fina(Reins rction N Inspector Name: Visual Portion of Inspector Name: F LiC# PCAD Reins ection P Signature_ _ F Signature__ _ Dust Taken for Final - --- - -- Reins .{iVo Reocc P Inspector Name: _ Dust Taken for -�Lic# PCAD Reins ection [nInspector Name:_Signature Uc#Signature____ Dust Taken for Final P -- -- --- --- Rffft7l Inspector Name:. _ Dust Taken for - Lic# pC,yD Reins ection �Inspector Name:_ F Signature_ - - - - —__ Lic# Address: 57 Dow St, - _ Apt#__2 - - - - -- -- - - -- City Salem REOCCUPANCY CERTIFICATE HISTORY `�- - - - - - - - - Page 3 of Certificate of COMPLIANCE HISTORY(CONY.) Reoccu ancv Certificate of Inspector Name: Lic# Mamtamed Only after Com liance Inspector Name: High/Mod Risk Signature -- - ---__ -,Lic# i#rooms rule]4 No Work=No Dust Signature— Work=7 Dust -- Certificate of Reoccu ane" Inspector Name: Certificate of - - --��Lic# Restored Only after Signature.-_ Com liance High/Mod Risk _ _ _ _ _ - Inspector Name:— --y-4 Lic# (#rooms rule) Dust wipes and auth. Signature- Certificate of Peo le --- -- ----- Reoccu ancv Inspector Name:_ Certificate of - ---—�, LIC# Maintained Only after Signature_ Com liance Inspector Name:_ High/Mod Risk - -- - - _- -- -- _._ LiC# {#rooms�llei- -1 Signature No Work=No Dust - COMPLIANCE HISTORY Work=7 Dust -- - Letter of Full Initial Com liance Certificate of Inspector Name:_ Restored Lic# Com fiance Inspector Name:. No prior history/ Signature _ Lic# No si ns of UD Signature_ Dust wipes and auth. - -- eo le - -- Letter of Interim Control Inspector Name: _ OTHER HISTORY:WAIVERS/UD Lic# Signature- APProved No prior Comp. 9 ture--__ _ --_ CLPPP Waiver Ex ices in 1 rr. - Inspector Name:_ -- - - ---__,Lic# Attach to Comp Signature Recertification of Docs Interim Control inspector Name: - - - - - --- Lic# Approved Expires 2 yrs from Signature. _ _ CLPPP Waiver Inspector Name: original Interim - - - ------__ _ Llc# Control Attach to Comp Signature- Letter _ - ----- - -- - - --- Letter of Full - omDel li ing Inspector N m :� 0 ftV1 pp d Com liance '1']O UD/DES Visual 030 1 Signature -'`(- Reins ection p Inspector Name: Dust wipes if No -- __ F - - - -- - __ _ Lic# Reocc. Signature No LOC Issued - Certificate of Maintained UD/DES Dust Com liance Inspector Name:_ Taken Lic# Inspector Name: _ Signature_ F _:Lic# No Work=No Dust - Signature Work=7 Dust No LOC Issued - --- -- - Certificate of UD/DES Dust Restored Taken p Inspector Name: Lic# __ -_ Com liance Inspector Name:_ F Signature- - - - - - - - _ Lic# - -� Signature No LOC _ Issued - - -- - - - Dust wipes and auth. - --- _ _ __ - --- - - - eo le UD/DES Final Reins ection p Inspector Name: F Lic# ,,_, Signature EXPLANATION OF LEAD INSPECTION/RISK ASSESSMENT REPO This page provides general information needed to understand the lead inspection/ ' RT FORM COLUMNS with the inspector/risk assessor before needed start to do an y inspection/risk assessment report.However,you should speak y work on your home. SIDE Refers to A B building or room is the side facing buildtreet that gives in or room. the a diagram on the cover sheet.The"A"side of the building).Keeping your back to this street,from the" property its address(usually,it is the front of the side opposite you,and the"D"side to the right. Numbering side move clockwise to the"B" g umbering is from left to right. side on your left,the LOCATION/ Refers to the building component(s)being tested.Some surfaces ma be SURFACE example,"Baseboard"may refer to four separate pieces of wood one o Y made up of more than one part.For LEAD The actual lead result.Each surface tested must have a result recordedn each wall),but is still considered one surface. • A number shows that the surface was tested with an m the"Lead"column. is a dangerous level of lead. XRF analyzer.A number equal to or A«pos„or"neg"shows that the surface was tested with sodium sulfide."Pos"means thateater than 1.0 mg/cmz level of lead. • "N/A"means that the inspector was not able to test the surface.The inspector must ass there is a dangerous and require it to be deleaded. Speak to the inspector about possible alternative must options."MET or assume the surface contains lead • "MR" that a metal surface was not tested.Metal handrails,metal window sills,railing caps need to be deleaded if they test equal to or greater than 1.0 mg/cmz,or are mar ns. "N/A".All other metal surfaces must be intact. lls,and metal • For key to abbreviations like kid"MET"or «COv",«Vg„ « « , VR or MR" "NC"�"Tile","DC",see the cover page. is TYPE OF Not all lead paint must be deleaded. HAZARD standards below may not apply for Interim Cocolntrols.tells You IF o and dizr risk as wi'a surface needs deleading. The deleading ' "M/I"circled means that the surface is a moveable/impacted part of a window and must b assessor for more information. • "SF"circled indicates that there is a storm frame present which requires the blind stop an deleaded as interior moveable/impacted surfaces. a deleaded in its entirety. • "A/W circled means that the surface is"accessible mouthable"and must be deleaded to d exterior sill be high, four inches in from the edge or corner. • "F"circled means that the surface is a" a minimum of five feet • friction"surface and must be deleaded at all points of friction. "L"circled means that the surface is loose and must,at a minim sealed with paint or similar coatinust um,be made intact.Loose leaded floors must be • If more than one choice is circled,the rules for deleading deleading you choose. Speak to the inspector for more information. "N/A"means the inspector was unable to determine if the f change depending upon what method of deleading must check this surface and follow all the rules for deleading. Speak to the ins ace was a lead hazard.The person doing the information. • If nothing is circled in the column,then it is likely the surface does not need deleading- Sector for more for more information. Remember,this does not mean the entire surface is lead free it just deleading in its current condition. tpeak to the inspector � st does not require URG HAZ? This column is completed du ring wring a risk assessment,which is an evaluation of a home's suitability for Interim Control. Only a licensed risk assessor can do a risk assessment. If"Y"is circled,then ' an"Urgent Lead Hazard"and deleading is required to qualify for Interim Control. this surface is considered IC DATE The date the licensed risk assessor determines the surface meets the stand IC METH The deleading method or structural repair done to qualify the surface for ands for Interim Control. codes key on the cover page. Interim Control.Refer to the deleading DELEAD DATE The date that the lead inspector reinspects the surface and finds that it is DELEAD METH The method used to brie g a surfac in compliance. e into full compliance.Refer to codes in the Key on the report's cover page. EXCLUDED The amount of loose paint on a surface as measured by the lead inspector.` SURFACES able to measure the loose paint,but has determined it is more than the c - `N/'`1 means that the inspector was not RULED OUT Encapsulants on inspector sees than only work well if the paint is in good condition.If the ins cut-Off for moderate risk making intact. BOX are adhesion problems with eligible surfarP.;,, ..______ , . 'Thomas Dowd M-1170 pector Ins (print) Lic# Signature 12 27 18 Page 5 of Date Risk Assessor(print) Address of Pro rt : 57 Dow St Lic# Signature ROOM# A t.# 2 Date !It : Salem SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEA DELEAD SIDE A B LOCATION/ LEAD SURFACE HAZARD HAZ? DATE METH DATE METH TYPE OF Up Waits C,d L N/A Y SURFACE HAZARD URG IC IC DELEA DELEAD A ,B Low Walls HAZ• DATE METH DATE METH L N/A Y A Window Sill M/1 AIM L NIA Y A e Baseboards 0, L NIA Y B Win Apron 4 3 L N/A y A e Chair Rail L NIA Y C Win Casing Q�� L N/A Y AB f7k! D Header Stop M/I r r Radiator L N/A y t•� L N/A Y Floor 1. L[](dust)N/A y Int Stops ,,D Ceiling t L N/A Y 1 Win Int Sash M!I L N/A y L N/A y Door C�f N/A Y 2 Exterior Sill M/I SF L N/A Y C D Door Edge i N/A Y 'S = 3 Part Bead M/I L NIA Y 12 Door Casing Q� L NIA Y 4 Blind Stop n71i SF L N/A y 3 4 poor Jamb 1 F L N/A Y Win Ext Sash M/i L N/A Y Threshold Oil L N/A y A Window Sill &VI A/M L N/A Y A 6 Door r0 L N/A y B Win Apron L N/A Y D Door Edge 01 F L N/A Y C 'ruin Casing L NIA y 12 Door Casing 0 L N/A Y D Header Stop M/I L N/A Y 34 Door Jamb Qt F L N/A Y Int Stops M/I L NIA y Threshold (f L N/A y 1 Win Int Sash M!I L N/A Y A B Door L NIA y 2 Exterior Sill M/I SF L NIA Y C D Door Edge F L N/A Y 3 Part Bead M/I L NIA Y 12 Door Casing L N/A y 4 Blind Stop M/l SF L N/A Y 34 Door Jamb F L N/A Y Win Ext Sash M/I L N/A Y Threshold L NIA y A 'Window Sill M/I A/M L N/A Closet Door B Win Apron Y �� L NIA Y L N/A Y A Cl Door Edge 01 F L N/A Y C Win Casing L N/A Y Cl Casing L NIA Y D Header Stop M/i L N/A Y C Closet Jamb + F L N/A Y Int Stops M/I L N/A y D Closet Walls B L NIA Y 1 Win Int Sash M/I L NIA Y Cf Baseboard L / Y 2 Exterior Sill MA SF 1 Closet Pole d} L N/A Y �IVI 3 Fart Bead L N!A Y M/l L NIA y 2 Closet Shelf R L N/A y 4 ai1nd Stop M/I SF L NIA y 3 cd Supports L N/A Y Win Ext Sash MN L NIA y 4 Closet Floor L❑(dust) NIA Y A B R replace C D Mange L N/A y Closet Ceiling L / y )VT cAB p Win Above 5' L N/A Y COMMENTS/STRUCTURAL DEFECTS: Qt' L N/A Y Ceiling Moldin• d� L NIA Y EXCLUDED F M/1 A/M L N/A Y SURFACES:Surfaces listed in these boxes can only be made intact F M11 A/M L N/A y by a Deleader(MORE THAN 288 So.IN.) F M/I AIM L N/A Y SIDE LOCATION MEASURE:LOOSE PAINT IC IC F M/I A/M L N/A Y DATE METHOD F M/1 A/M L N/A y • F M/I AIM L N/A y ❑ Check the box if this ROOM is RULED OUT for encapsulation because there are 3 or more AIM surfaces with adhesion problems Thomas Dowd M-1170 /� 'b�Inspector(print) Lic# 12 27 18 Page Of /_�Signature Date Risk Assessor(print) Lic# Address of Pro : 57 Dow St. Signature Date ROOM# Ar.# 2 CT : Salem SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD SIDE LOCATION/ LEAD SURFACE HAZARD HAZ? DATE METH DATE METH TYPE OF URG IC IC DELEAD DELEAD A B SURFACE HAZARD HAZ. DATE METH DATE METH Up Walls � L /A Y 3-2; MJ. Window Sill 011 M/I A/M L N/A Y A s Low Walls L N/A Y A 6 Baseboards r 6 L - Y B Win Apron 0,.j L N/A Y L N/A Y A B Chair Rail 3-f C Win Casing 0,0 L N/A Y • AS Radiator +.6 L NIA Y D Header StopQ1MnL N/A Y Floor ( L Q(dust) N/A Y Int Stops Q�.� M/I L N/A Y Ceiling L N/A Y Win Int Sash J . WI L N/A Y AB Door L N Y 2 Exterior Sill M/I SF L N/A Y IA Door Edge F L N/A Y 3 Part Bead M/I L NIA Y 12 Door Casing : I +'A Y 4 611nd Stop ?.NI SF L N/A Y 34 Door Jamb r F L N/A Y 34 T Win Ext Sash MP L N/A Y Threshold 3— m� vV!ndo M/l w Sill r d!f 17 L NIA Y N/A Y L NIA Y 3_ S A B Door Vy Win Apron gr L N/A Y 3'� INT C D Door Edge F C VVin Casing `�. L N/A Y L NIA Y D Header Stop r M/I - 1 2 Door Casing L N/A Y L N/A Y 34 Door Jamb F L NIA Y Int Stops �,. M/I L N/A Y Threshold 1 Win Int Sash • L N/A Y r'� M/I L NIA Y A B Door ®L N/A Y Exterior Sill r/ M/I SF L NIA Y C D Door Edge F L N/A Y 3 Part Bead °t I L N/A Y 12 Door Casing L N/A Y 4 Blind Stop M/I SF L N/A Y 34 Door Jamb F L N/A Y Win Ext Sash M/I L N/A Y Threshold L NIA Y '4'indow Sill hP I L N/A Y B Win Apron �b Closet Door L NIA Y 6•� SCA L NIA Y 3^ A Cl Door Edge F L N/A Y C Win Casing , L N/A Y tr Z INr B Cl Casing L N/A Y D Header Stop , M/1 L N/A Y 3_V C Closet Jamb Int Stops 3 Z k F L N/A Y / I'A/I L NIA Y 3_ �. D Closet Walls 1 Win Int Sash M/I L N/A Y L N/A Y C1 Baseboard 2 Exterior Sill M/I SF L L N/A Y 3 Part Bead N/A Y 2 Closet Pole L N/A Y L NIA Y M/I L N/A Y 2 Closet Shelf 4 E!md Stop M/I SF L N/A Y 3 CI Supports L N/A Y Win Ext Sash M/I L N/A Y 4 Closet Floor A B Fireplace L NIA Y • L❑(dust) N/A Y C D Mantle Closet Ceiling L N/A Y AS L N/A Y dpp COMMENTS/STRUCTURAL DEFECTS: CD Win Above 5' L N/A Y Ceiling Mold! L N/A Y F M/1 AIM L N/A Y EXCLUDED SURFACES:Surfaces listed in these boxes can only be made intact F M/I AIM L NIA Y by a Deleader MORE THAN 288 SO.IN.) 1 F M/1 A/M L N/A Y SIDE LOCATION F M/1 A/M L N/A Y MEASURE:LOOSE PAINT IC IC DATE METHOD F MJI AIM L N/A Y F M/1 AIM L N/A Y ElCheck the box if this ROOM is RULED OUT for encapsulation because there are 3 or more A/M surfaces with adhesion problems Thomas Dowd Inspector(print) M-1170 Lic# Signature 12 t Date 27 18 Page�Of Risk Assessor(print) Address of Pro ert : 57 Dow St ROOM#_j _ Lic# Signature A t.# 2 Date SIDE LOCATION/ LEAD Cit : Salem TYPE OF URG IC IC DELEAD DELEAD SURFACE HAZARD SIDE LOCATION/ LEAD HAZ. DATE METH DATE TYPE OF A e Up Walls METH SURFACE URG IC IC DELEAD DELEAI A B L LA Y HAZARD HAZ. r Low Walls DATE METH DATE METH • L N/A y _� N� A Window Sill i WI AIM L N/A y n a Baseboards d , B Win Apron L N/A Y L N/A y A 9 Chair Rail Win Casing A L N/A y e L N/A y r , Radiator L N/A Y D Header Stop Q M/l � f L NIA y Floor } L[](dust) N/A y IntStops Qt Ceiling DI, L NIA y L N/A y 1 Win Int Sash WI L N/A y Door �1 L N/A y 2 Exterior Sill C D Door Ed a M/I SF L N/A y g I F L N/A y 3 Part Bead V /I 12 Door Casing t L N/A y L NIA y 4 Blind Stop 3 4 Door Jamb F L N/A SF L N/A y y Mein Ext Sash Ulf Threshold L NIA Y A Window Sill Mrl L N/A Y Door MII A/M L N/A B B Wry Apron y � L N/A Y 1 L N/A C D Door Edge F L N/A Y y'+"+m Casing 12 DnorCasing t L N/A y D Header Stop L NIA y 3 4 Door Jamb % F M!I L N/A y L N/A Y Int Stops Threshold 11 L N/A y 1 Win Int Sash ! M/I L N/A y A B Door ® Exterior Sill M!1 L NIA Y C D Door Edge L NIA y M/I SF L NIA y F L N/A y 3 Part Bead J M/I 12 Door Casing L NIA Y L N/A y 4 Blind Stop M/I SF L N/A y 3 4 Door Jamb F L N/A y Win Ext Sash I Threshold A Window Sill y L N/A y L NIA Y M/l A/M L N/A Closet Door 0 L N/A B Win Apron y L N/A A Cl Door Edge Q F L N/A y + y C Win Casing (; Cl Casing y L NIA y D Header Stop L N/A y F Closet Jamb M/I L NIA y D Closet Walls A L N/A y Int Stops M/I S� 1 Win Int Sash L N/A y Cl Baseboard L NIA Y M/I 2 Exterior Sill L NIA y 1 Closet Pole 0%� N," Y M/l SF L N/A Y L NIA y �� 3 Part Bead 2 Closet Shelf 0 •) L N/A y L N/A Y 4 Blind Stop 3 o Supports 0 1.1 M/l SF L N/A y 4 Closet Floor L N/A y Mein Ext Sash • dr{ L❑(dust) N!A Y A I3 Fireplace M/I L N/A Y Closet Ceiling N C D Mantle COMMENTS/STRUCTURAL DEFECTS: y L N/A y 3-$ SNJ AB c D Win Above 5' ©FZ L N/A y Ceiling Moldin ' L N/A y EXCLUDED SURFACES:Surfaces listed in these boxes can only be made intact F M/I A/M L N/A y by a Deleader(MORE THAN 288 SQ.IN,) F M/I A/M L N/A y F M/I AIM L WA Y SIDE LOCATION AIM L NIA MEASURE:LOOSE PAINT IC IC F M/l y DATE METHOD F WI A/M L N/A y F M/I AIM L NIA y ❑ Check the box if this ROOM is RULED OUT for encapsulation because there are 3 or more A/M surfaces with adhesion problems i�l�Ren7nt7n__ Thomas Dowd M-1170 ;�,*Uc �—e- 12/ 27/ 18 Page 9 — — Inspector(print) Lic# Signature Date Risk Assessor(print) Lic# Signature Date Address of Pra rt : 57 Dow St. A t.# 2 Cit : Salem KITCHEN SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD SURFACE HAZARD HAZ7 DATE METH DATE METH SURFACE HAZARD HAZ. DATE METH DATE METH n a Up Walls Sal N/A Y 3'$ A Window Sill >> Mil AIM L NIA Y A B Low Walls L N/A Y ( Win Apron L NIA Y A B F Baseboards d7eZ L N/A Y C Win Casing2 f��. L NIA Y A e Chair Rail L NIA Y D Header Stop ��0 M/I L NIA Y AB CD Radiator 01 j L NIA Y I Int Stops 0A1 M/I L N/A Y Floor 40#1 L (dust) NIA Y © Win Int Sash / M/I L NIA Y Ceiling 1010 L NIA Y 2 Exterior Sill M/I SF L N/A Y Door L N/A Y 3 Part Bead n M/I L N/A Y C D Door Edge F L N/A Y 4 Blind Stop Mll SF L N/A—Y 12 Door Casing O J z L N/A Y Win Ext Sash NVI L N/A Y 34 Door Jamb r F L NIA Y A Window Sill M/I AIM L N/A Y T hreshold 0,T L N/A Y Win Apron L N/A Y A B Door L NIA Y C win Casing 01 1L NIA Y D Door Edge F L N/A Y D Header Stop Q�� M/I L N/A Y 12 Door Casing +� L NIA Y Int Stops M/I —L N/A Y 34 Doorjamb F L N/A Y 1 Win Int Sash TV I I L N/A Y Threshold L N/A Y Exterior Sill V Mll SF L NIA Y A Door L NIA Y 3 Part Bead M/I L N/A Y Door Edge F L N/A Y 4 Blind Stop M11 SF L N/A Y 2 Door Casing FIN L N/A Y Win Ext Sash JA-- MII L N/A Y 34 Doorjamb 0 t F L N/A Y A Up Cab Frame . L N/A Y Threshold Q L N/A Y D Up Cab Door Q 1 L NIA Y Closet Door L NIA Y Up Cab Walls �. L N/A Y A CI Door Edge F L N/A Y 1 2 Up Cab Shlvs Q L NIA Y B Cl Casing L NIA Y 3 4 Supports Q t L NIA Y C Closet Jamb F L NIA Y Low Cab Fram ` L N/A Y D Closet Walls L N/A Y A Low Cab Door 10, L NIA Y Cl Baseboard L N/A Y Low Cab Wall ► L NIA Y 1 Closet Pole L NIA Y Low Cab ShN L NIA Y 2 Closet Shelf L N/A Y 1 2 Supports L N/A Y 3 Cl Supports L N/A Y 3 4 Drawers Q� L NIA Y 4 Closet Floor L❑(dust) NIA Y As CID Win Above 5' d I. L N/A Y Closet Ceiling L NIA Y Ceiling Moldini 40l.0 L N/A Y COMMENTS/STRUCTURAL DEFECTS: Ci rtJ 0,11 F M/I AIM L NIA Y Q AL F M/1 AIM L WA Y F ee, t0 FM/I A/MLN/A Y F Mil AIM L N/A Y EXCLUDED SURFACES:Surfaces listed in these boxes can only be made intact F MII AIM L NIA Y by a Deleader(MORE THAN 288 SQ.IN.) F MII AIM L NIA Y SIDE LOCATION MEASURE:LOOSE PAINT IC IC F M/1 A/M L N/A Y DATE METHOD F Mll AIM L NIA Y Check the box if this ROOM is RULED OUT for encapsulation because there are 3 or more A/M surfaces with adhesion problems Thomas Dowd M-1170i/y�,, Inspector(print) Lic# Signature 12/ 2' / 18 p Date Page f Of Risk Assessor(print) Address of Prorert : 57 Dory S Signature PANTRY A t.# 2 Date SIDE LOCATION/ LEAD IC DELEAD DELEAD Citv: Salem TYPE OF URG IC SURFACE HAZARD HAZ. DATE METH DATE SIDE LOCATION/ LEAD A B METH TYPE OF URG IC Up Walls SURFACE IC DELEAD DELEAE L N/A Y HAZARD HAZ? DATE METH DATE A B Low Walls A B Up Cab F METH rame A B L N/A Y L N/A y Baseboards Lilt L N/A y C D UP Cab Door L NIA y A B AB Chair Rail L N/A y UP Cab Walls L N/A y CD Radiator L N/A y 12 UP Cab Shlvs L N/A y Floor Q L❑(dust) N/A y 34 Supports L N/A y .,; g 00 L N/A y A B UP Cab Fra y B Door C D Up Cab Door L N/A C D Door Edge F L N/A Y L N/A Y L N/A Y Up Cab Walls 1 2 Door Casing 12 U,o Cab Shlvs L N/A Y A L N/A Y 34 Door Jamb r F 34 supports L N/A y L NIA y L N/A Y Threshold 411 L N/A Y Low Cab Frain A B Door A B Low Cab Door L N/A Y C D Door Edge F L NIA Y L N/A y L N/A Y C D Low Cab Wall 12 Door Casing L N/A y L N/A Y Low Cab Shl 34 Door Jamb 12 Supports L N/A y • F L N/A Y Threshold L N/A y 34 Drawers L N/A y Closet Door L N/A Y L N/A Y Low Cab Frain Q� A CI Door Edge F L N/A y L N/A Y B Low Cab Door t B Cl Casing L N/A y C Low Cab Wall L NIA Y C Closet Jamb L Y Low Cab Shl 3' �►�r D Closet Walls F L N/A Y L / Y L N/A y 12 Supports CI Baseboard 34 Drawers y 1 Closet Pole L NIA Y L y L NIA y Low Cab Fram — �- 2 Closet Shelf A B Low Cab Door L N/A y 3 CI Supports L N/A Y L N/A y L N/A Y C D Low Cab Wall 4 Closet Floor L N/A y L[](dust) NIA Y Low Cab Shl Closet Ceiling L N/A y L N/A y 12 Support L NIA y A B Up Cab Frame 34 Drawers L N/A Y L N/A y C D UP Cab Door L N/A Y Window Sill a M/l AIM L NIA Up Cab Walls L N/A Y Wdn Apron y 12 Up Cab Shlvs L N/A Y C vk'in Casing L NIA y 34 Supports L N/A y L N/A y D Header stop (t M/I L N/A y F M/l A/M L NIA Y Int Stops Q! M/I L N/A y COMMENTS/STRUCTURAL DEFECTS: 1 Win Int Sash 14 M/I L N/A y 2 Exterior Sill M/1 SF L N/A y 3 Part Bead M/I 4 Blind Stop L N/A y EXCLUDED SURFACES:Surface Win Ext Sash s listed in these boxes can only be made intact M/I SF L N/A y iI L N/A y by a Deleader(MORE THAN 288 SQ.IN.) F Wi A/M L NIA Y SIDE LOCATION V Q f F WI AIM L N/A y MEASURE:LOOSE PAINT IC IC DATE METHOD F M/i AIM L NIA y F M/I A/M L NIA y �/� ❑ Check the box if this ROOM is RULED OUT for encapsulation �T R-7n 1^1 n_._, because tha.ire o____ ..__ -Thomas Dowd M-1170 +�u�I Inspector(print) Lic# Si 12 /27 / 18 10 )d 1 gnature Page—Of_ Date Risk Assessor (print) Lic# Address of pro rl ; 57 DOW St. Signature Date BATHROOM# Apt.# 2 Cil : Salem SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD SIDE LOCATION/ LEAD SURFACE HAZARD HAZ. DATE METH DATE METH TYPE OF A e SURFACE HAZARD URG IC IC DELEA DELEAD I. Up Walls a L NIA Y HAZ? DATE METH DATE METH A B Low Walls ' L N/A Y A B Up Cab Frame L N/A Y A B C D UP Cab Door r, Baseboards 046 L N/A Y L NIA Y A B Chair Rail L N/A Y Up Cab Walls L N/A Y AB 12 Up Cab Shlvs co Radiator L N/A Y L N/A Y Floor L Q(dust) NIA y 3 4 Supports L N/A Y Ceiling 0� L N/A Y Low Cab Fram al L N/A Y B Door 61 L NIA Y Low Cab Door Q 1 L NIA y D Door Edge ds2. F L N/A Y C D Low Cab Wall Q�0 L N/A Y 12 Door Casing #,% L N/A Y Low Cab Shl 11A L N/A Y 34 Door Jamb 0,1 F L N/A y 1 2 Supports ��) L N/A Y Threshold Qa L N/A y 34 Drawers y), L N/A Y A Door L NIA Y A WirdowSill ��.� M/I A/M L N/A Y boor Edge F L NIA Y Win Apron f L N/A Y Door Casing Q L N/A Y Win Casing Q� L N/A Y 34 Door Jamb F L N/A y Header Stop G M/1 L N/A y Threshold L NIA Y Int Stops i M/I L N/A Y A B Door L N/A Y t Win Int Sash WI L N/A Y • C D Door Edge F L NIA y 2 Exterior Sill M/I SF L N/A Y 12 Door Casing L N/A y 3 Part Bead ,IL N/A Y 34 Door Jamb F L NIA y 4 Blind Stop M/I SF L N!A Y Threshol L N/A a B Win Ext Sash M/I L N/A y d Y Closet Door L N/A Y CD Win Above 5' 1 L NA y A Cl Door Edge F L N/A Y AB Ceiling Moldi L NA Y B Cl Casing 17, L NIA Y C[) Medicine Cab L NA y Closet Jamb b a F L N/A Y F MII AIM L NIA Y Closet Walls t L N/A Y F MA A/M L N/A y Cl Baseboard A&0 L NIA y F MII AIM L NIA Y 1 Closet Pole L N/A Y F WI AIM L NIA Y 2 Closet Shelf L N/A Y F MI AIM L N/A y 3 CI Supports r: L N/A Y F WI AIM L NIA Y 4 Closet Floor Qr. L ](dust) y F WI A/M L N/A Y Closet Ceiling L V/ y F WI A/M L N/A y F NI AIM L N/A Y F WI A/M L N/A y F WI A/M L N/A Y F MII AIM L N/A Y F WI AIM EXCLUDED SURFACES:Surfaces listed in these boxes can only be made intact COMMENTS/STRUCTURAL DEFEC S L NIA Y by a Deleader(MORE THAN 288 SQ.IN.) SIDE LOCATION MEASURE:LOOSE PAINT IC IC DATE METHOD Check the box if this ROOM is RULED OUT for encapsulation El because there are 3 or more A/M surfaces with adhesion problems -Thomas Dowd M-1170 ignature / 27/ 18 Inspector(print) Lic# 12 Page Lt Of`9 Date Risk Assessor(print) Lic# Signature / Address of Pro rt., 57 Dow St. Date HALLWAY:Interior # A 1.# 2 Cit : Salem or Common Hallway: Front Rear Floor SURFACE H RD # SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD SIDE LOCATION/ LEAD TYPE OF URG IC IC AZA HAZ DATE METH DATE METH DELEAD DELEAD Up all L �A Y A B SURFACE HAZARD HAZ. DATE METH DATE METH Ws t A B Low Walls Closet Door L N/A Y L NIA Y A B A Cl Door Edge F L N/A Y -, Baseboards 0.1 L N/A Y A B Chair Rail L NIA Y B Cl Casing L N/A Y AB C Closet Jamb F L NIA Y Radiator L N/A Y Floor D Closet Walls � L Q(dust) N/A Y L N/A Y Ceiling t L N/A y Cl Baseboard L N/A Y i3 Door L NIA Y 1 Closet Pole L NIA Y •� C D Door Edge F L NIA Y 2 Closet Shelf L N/A Y 12 Door Casing OF l L N/A Y 3 Cl Supports L N/A Y 34 Door Jamb Ot) F L N/A Y 4 Closet Floor L0(dust) N/A Y Threshold L m NIA Y Closet Ceiling L NIA Y � Door L N/A Y A Window Sill M/I A/M L N/A Y C D CoorEdge F L N/A Y B *in Apron L N/A Y 12 Door Casing L NIA Y C 'Vi'in Casing L NIA Y 34 Door Jamb J't} F L N1A Y D Header Stop M/I L N/A Y Threshold fi L N/A Y Int Stops M/1 L N/A Y t A B Door P L NIA Y 1 Win Int Sash W L N/A Y D Door Edge 0� F L N/A y 2 Exterior Sill M/I SF L N/A Y 12 Door Casing S L N/A Y 3 Part Bead M/I L NIA Y 3 4 Door Jamb t F L N/A Y 4 Blind Stop M/I SF L N/A Y Threshold L NIA Y Win Ext Sash W L N/A Y ({t A Window Sill A B Door of L NIA Y M/I A/M L N/A Y Door Edge ❑t F L N/A Y B Win Apron L N!A y 12 Door Casing L N/A Y C Win Casing L N/A Y 34 Door Jamb F L NIA Y D Header Stop M/I L N/A Y { 17 !,it Door 0.1 IA Y Int Stops M/I L NIA Y L N I Door Edge ,`1 NAA Y 1 Win Int Sash MD L NIA Y s 2 Exterior Sill Wi SF L N/A Y Q .I Casing (►j L N/A Y n Jamb ►j F LN/A Y 3 Part Bead M/1 L NIA Y D Closet Walls L N/A Y 4 Blind Stop Pall SF L N/A Y Win EA Sash M/I L NIA Y Cl Baseboard L NIA Y AB 1 Closet Pole L NIA Y CD Win Above 5' L N/A Y 2 Closet Shelf L N/A Y Ceiling Moldin L N/A Y 3 CI Supports L N/A Y •—— F►wI AIM L N/A Y 4 Closet Floor L[](dust) N!A Y _ --- AIM L N/A Y Closet CeilingI I i L NIA Y F M/I AIM L N/A y EXCLUDED SU ACES:Surfaces listed in these boxes can only be made intact COMMENTS/S CTURAL DEFECTS: by a Deleader(MORE THAN 288 SQ.IN.) SIDE LOCATION MEASURE:LOOSE PAINT IC DATE IC METHOD ❑ Check the box if this ROOM is RULED OUT for encapsulation because there are 3 or more AIM surfaces with adhesion problems Thomas Dowd Inspector(print) M-1170 �00101Lic# S nature 12/27 / 18 / Date Page0 Of Risk Assessor{print) Address of Pronert : 57 Lic# Signature HALLWAY:Interior # ow St Date or At.# 2 SIDE LOCATION/ LEAD Common Hallway: Front Rear Floor# Ctr : Salem TYPE OF URG IC IC DELEAD DELEAD SURFACE HAZARD HAZ. DATE METH SIDE LOCATION/ LEAD A B O DATE METH TYPE OF URG IC IC DELEAD DELEAI UP Walls i L N/A Y SURFACE HAZARD A B Low Walls HAZ• DATE METH DATE METH • L N/A Y Closet Door e Q,� Door Edge F L N/A Y L N/A y Baseboards A Cl D L N/A Y A B Chair Rail L N/A y B Cl Casing A B L N/A y Radiator L N/A y C Closet Jamb F L N/A Y Floor O,1*. L D Closet Walls Ceiling ❑(dust N/A Y L N/A L N/A y CI Baseboard y B Door 1 Closet Pole L N/A y C D Door Edge L N/A Y L N/A y F L N/A y 2 Closet Shelf 12 Door Casing 3 L N/A Y L NIA y ClSupports 3 4 Door Jamb O t F L N/A y L NIA y 4 Gioset Floor Threshold Closet Ceiling L 0(dusQ N/A Y A B Door L N/A Y L N/A y 95 Do L /A y A Window Sill or Edge 2 hA'I A!M L N/A y �� F L N/A Y B 'a`In Apron 12 Door Casing i• —� L N/A y 3 4 Door Jamb L N/A Y C Win Casing F L N/A Y D Header Stop M/l L N/A y Threshold L N/A y Int Stops L NIA YM/I A B Door L NIA Y M/I 1 Win Int Sash L N/A y C D Door Edge L N/A F L N/A Y 2 Exterior Sill Y 12 Door Casing M/I SF L N/A Y 34 Door Jamb L NIA Y 3 Part Bead M/I F L N/A Y 4 Blind Stop L N/A y Threshold M/I SF L N/A y L N/A y Win Ext Sash A B door M/l L N/A Y A Window Sill C D Door Edge L N/A Y M/I A/M L NIA y F L N/A Y B Win Apron 12 Door Casing L N/A y 34 Door Jamb L N/A y C Win Casing F L NIA y D Header Stop M/l L NIA y Closet Door L N/A y L N/A y Int Stops A CI Door Edge M/I L NIA Y F L N/A y 1 Win Int Sash B CI Casing �l L N/A y L N/A y 2 Exterior Sill MII SF C Closet Jam F L N/A'e y 3 Part Bead L N/A y D Closet Walls Mli L N/A y L N/A y 4 Blind Stop N Cl Baseboard Win Ext Sash anli SF L /A y M/I 1 Closet Pole L N/A Y AB L N/A Y L N/A y c D Win Above 5' 2 Closet Shelf L N/A Y 3 Cl Supports L N/A Y Ceiling Moldi L NIA y 4 Closet Floor L NIA Y L F WI A/M L N/A • Q(dust) N/A Y Y Closet Ceiling F MA AIM L N/A y L N/A Y F WI A/M L N/A y EXCLUDED SURFACES:Surfaces listed in these boxes can only be made intact COMMENTS/STRUCTURAL DEFECTS: TIDE LOCATION by a Deleader(MORE THAN 288 SQ.IN.) MEASURE:LOOSE PAINT IC DATE IC METHOD ❑ Check the box if this ROOM is RULED OUT for encapsulation because there are 3 or more A/M surfaces with adhesion problems URA Rep 201714.11 -Thomas Dowd M-1170 j�/�iytyt• ea� l Inspector(print) Lic# Signature 12 / 27 / 18 Page r+3 Of 1 Date Risk Assessor(print) Lic# Signature Address of Pro rt : 57 Dow St Date STAIRCASE#- DA/V ALA.# 2 Cit : Salem SIDE LOCATION/ LEAD TYPE OF I URG IC IC DELEAD DELEAD SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DREADSURFACE HAZARD HAZ. DATE METH DATE METH A B SURFACE HAZARD HAZ DATE METH DATE METH Up Walls � NIA Y 3- 1 A Window Sill M/I AIM L NIA Y A B Low Walls �, L NIA Y A B 3^ 'T tX B Win Apron L NIA Y Baseboards 0, L NIA Y C Win Casing L N/A Y A B Chair Rail Q L NIA Y B D Header Stop Mill L NIA Y A c o Radiator L NIA Y Int Stops M/I L N/A Y Floor �'} L[(dust} N/A Y Ceiling 1.1 L N/A Y 1 Win Int Sash M/I L NIA Y B Doo d N/A Y 2 ExteriorSill M/1 SF L N/A Y r C D Door Edge y F L /A Y 1 lytt 3 Part Bead M/1 L N/A Y 12 Door Casing t L N/A Y 3` 4 Blind Stop AAA SF L NIA Y 3 4 Door Jamb F Win Ext Sash MII L N/A Y L N/A Y A V�=ndow Sill nrtrl Threshold L N/A Y AM L N/A Y t B W'in Apron L N/A Y A B Door L N/A Y C Win Casing L N/A Y Door Edge 0 F L NIA Y D Header Stop MII L NIA Y 2 Door Casin 41, N/A Y 3 Int Stops M/I L NIA Y 4 Door Jamb F L N/A Y 1 Win Int Sash Threshold L NIA Y WI L NIA Y 2 Exterior Sill M/1 SF L N/A Y A B Door 4 L N/A Y C Door Edge 3 Part Bead M/l L NIA Y t• F L N/A Y 4 Blind Stop MII SF L N/A Y 2 Door Casing � L N/A Y 3 4 Door Jamb F L N/A Y Win Ext Sash M/1 L N/A Y ,• Threshold l L N/A Y Newel Post s L NIA Y A B Door L NIA Y Railing Cap A/M L N/A Y C Handrail D Door Edge F L NIA Y f AIM L N/A Y 12 Door Casing L NIA Y Balusters L N/A Y 34 Doorjamb F L NIA Y Lower rail L N/A Y Closet Door L N/A Y Treads L1,1 F L N/A Y • A GI Door Edge F L N/A Y Risers L NIA Y Stinger .(] L N/A Y B Cl Casing L N/A Y C Closet Jamb F L N/A Y Tread edge>5 r L WA Y D Closet Walls L NIA Y Landing floor r L El(dust) N/A Y Cl Baseboard L N/A Y moor Edge L N/A Y 1 Closet Pole L NIA Y Floor Casing L N/A Y 2 Closet Shelf L NIA Y F Mill AIM L N/A Y 3 CI Supports L N/A Y F WI AIM L NIA Y 4 Closet Floor F M/I AIM L N/A Y Closet Ceiling L N/A Y F M/l AIM L NIA Y F M/I A/M L WA Y EXCLUDED SURFACES:Surfaces listed in these boxes can only be made intact COMMENTS/STRUCTURAL DEFECTS: by a Deleader(MORE THAN 288 SQ.IN.) SIDE LOCATION MEASURE:LOOSE PAINT IC IC DATE METHOD Check the box if this ROOM is RULED OUT for encapsulation ❑ because there are 3 or more A/M surfaces with adhesion problems Thomas Dowd M-1170 /�� J/ C 12 27 1 Inspector not 8 Page!/Of� Pe (print) Lic# Signa ure Date Risk Assessor(print) Lic# Signature Date Address of Pro t 57 Dow St. ADt. 2 Cit : Salem STAIRCASE# iV SIDE LOCATION/ I LEAD TYPE OF URG IC IC DELEAD DELEAD SIDEJ LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD SURFACE HAZARD HAZ? DATE METH DATE METH SURFACE HAZARD HAZ DATE METH DATE METH A4B - AUp Walls L /A Y m A Window Sill 4 0 M1I A/M L NIA Y Low Walls L N/A Y B Win Apron Q�l tE L N/A Y Baseboards QY L NIA Y Win Casing Qr A B Chair Rail L N/A Y D Header Stop L N/A Y AB P Aq�r M/I L N/A Y CD Radiator L N/A Y Int Stops V r,l M/I L N/A Y Floor �*� L 0(dust) N/A Y 1 Win Int SashRM; Ceiling r� L N/A Y Y 2 Exterior Sill YDoor O L NIA Y 3 Part Bead D Door Edge Z F L N/A Y 54 Blind Stop12 Door Casing L N/A YinExtSash 3 4 Door Jamb , F L NIA 7;7Y A vv ndow Sill I W AIM L NIA Y Threshold dr O L N/A Y Door B Win Apron L N/A Y t L NIA Y C Win Casing L N/A Y C D Door Edge F L N/A Y D Header Stop M11 L NIA Y 12 Door Casing O t L N1A Y Int Stops P M!I L N/A Y 34 Door Jamb F L N/A Y 1 /inlntSash MA L N/A Y Threshold L NIA Y 2 Exterior Sill M/I SF L N/A Y A B Door N►� /A Y 3— S C,,01, 3 Part Bead Mil L N/A Y C D Door Edge F L N/A Y 4 Blind Stop M/I SF L N/A Y 2 Door Casing L9 ` L N/A Y T Win Ext Sash M/I 34 Door Jamb Q. F L N/A Y L NIA Y Newel Post 13 t 1 L N/A Y Threshold 0 L N/A Y Railing Cap 1 A/M L NIA Y A B Door L NIA Y C D Door Edge F L N/A Y Handrailof A/M L N/A Y Qt 12 Door Casing L NIA Y Balusters L N/A YLower rail 34 Door Jamb F L NIA Y L N/A Y Closet Door L NIA Y Treads j k l F L NIA Y A C I Door Edge F L N/A Y Risers to L N/A Y 5lnnger Qt( L N/A Y B CIICasing L N/A Y Tread edge>5 6 L N/A Y C C oset Jamb F L NIA Y D Doset Walls g floor Q l L [](dust) N/A Y L N/A Y LandinFloor Edge atl L N/A Y CI Baseboard L N/A Y Floor Casing L N/A Y 1 Closet Pole L N/A Y 2 Closet Shelf L NIA Y F W1 AIM L N/A Y 3 CI Supports L NIA Y F MA A/M L N/A Y 4 Closet Floor -L[]-(dust) N/A Y F MII AIM L N/A Y Closet Ceiling L N/A Y F M11 AIM L NIA Y F M/I A/M L NIA Y EXCLUDED SUR CES:Surfaces listed in these boxes can only be made intact COMMENTS/STRUCTURAL DEFECTS: by a Deleader(MORE THAN 288 SQ.IN.) SIDE LOCATION MEASURE:LOOSE PAINT IC IC DATE METHOD ❑ Check the box if this ROOM is RULED OUT for encapsulation because there are 3 or more A/M surfaces with adhesion problems Thomas Dowd M-1170 12127118 Page 15 Of Inspectorr(print) Lic# Sign ure Date / I Risk Assessor(print) Lie# Signature Date Address of Property: 57 Dow St. Ant.# 2 City: Salem BASEMENT/LAUNDRY AREA SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD ISIDE LOCATION/ LEADI TYPE OF URG IC IC DELEAD DELEAD SURFACE HAZARD HAZ? DATE METH DATE METH SURFACE HAZARD HAZ. DATE METH DATE METH A s Walls 0% L N/A Y A s Servieeboard cl,: L N/A Y A B Walls ` I'S L !A Y A B Shelves L N/A Y AB Walls 9,v L NIA Y IC D Supports L N/A Y A 9 Walls L N/A Y n A B Shelves L N/A Y Baseboards L NIA Y c o C D Supports L N/A Y CID Chair rails L N/A Y A B Shelves L N/A Y Floor LEI(dust) NIA Y C D Supports L N/A Y Ceiling L NIA Y A B Window frame M/I L NIA Y A a Chimney L N/A Y C D Window Sash M/I L N/A Y A B Support ColurT 0 ! L N/A Y 1 2 Exterior Sill M/I L N/A Y Door IA Y — y"1 34 Parr Bead Mll L N/A Y Door Edge F L ?R Y — cA, Win Ext Sash M/I -L N/A Y 12 (Door Casing IA Y — 1G A B Window frame M/I L N/A Y 34 Door Jamb Ui F A Y G^ C D Window Sash M/I L N/A Y Threshold L NIA Y 1 2 Exterior Sill M/1 L N/A Y A oor /A Y &A, 34 Part Bead M/I L NIA Y oor Edge F L N/A Y Win Ext Sash M/l L N/A Y 1 2 Door Casing L N/A I Y A B Window frame M/I L NIA Y 34 Door Jamb %VL F L NIA Y C D Window Sash M/I L NIA Y Threshold L N/A Y 12 Exteror Sill W L N/A Y Closet Door L N/A Y 34 Part Bead M/I L N/A Y A a Door Edge F L N/A Y Win Ext Sash M11 L N/A Y B Cl Casing L NIA Y Newel Posts Q t L NIA Y C Closet Jamb F L NIA Y A B Handrail a AIM L N/A Y D Closet Walls L N/A Y C D Balusters L NIA Y Cl Baseboard L N/A Y 12 Lower rail L N/A Y 1 Closet Pole L N/A Y 34 Treads F L N/A Y 2 Closet Shelf L N/A Y Risers �]� L N/A Y 3 CII Supports L NIA Y S ringer L NIA Y 4 Closet Floor L❑(dust) N/A Y iTfead Edge L N/A Y Closet Ceiling L N/A Y Landing floor L ❑(dust) N/A Y n e Cabinets L NIA Y A B Oil Tank L N/A Y A B Benches L N/A Y A e Win Above S L L NIA Y C D Supports L N/A Y F WI A/M L N/A Y a o Pipes 0�� L NIA Y F M/I AIM L NIA Y A e Sink L NIA Y F M/I AIM L N/A Y A s D.LLrainpipe L NIA Y F M11 AIM L N/A Y EXCLUDED SURFACES:Surfaces listed in these boxes can only be made intact Comments/Structural Defects by a Deleader(MORE THAN 288 SQ.IN.) SIDE LOCATION MEASURE:LOOSE PAINT IC DATE IC METHOD Check the box if this ROOM is RULED OUT for encapsulation El because there are 3 or more A/M surfaces with adhesion problems Thomas Dowd M-1170 UeM1 12 / 27 118 Page Of Inspector(print) Lic# Signature Date Risk Assessor (print) Lic# Signature Date Address of Property: 57 Dow St. Aot # 2 City: Salem EXTERIOR A Side SIDE LOCATION/ LEAJ TYPE OF URG IC IC DELEAD DELEAD SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD A SURFACE HAZARD HAZ? DATE METH DATE METH A SURFACE HAZARD HAZ. DATE METH DATE METH Siding O. L N/A Y Window Sill Cp A/M L N/A Y Comer Boards L N/A Y A Win Casing L N/A Y A Lower Trim p.0 L N/A Y # I Window Sash Co L N/A Y Upper Trim JO N/A Y 3— M x Cellar Win Sill A/M L N/A Y Win Above 5' O N/A Y 3- A Cel Win FrameL N/A Y Porch Above 5' f� L /A Y GG✓ # Cal Win Sash L N!A Y Storm Door L N/A Y Screen Frame L N/A I Y Strm Door Edge 7 F L N/A Y Cellar Win Sill (, A/M L N/A Y Door $.1 NIA Y A Cal Win Fram L N/A Y 2 Door Edge j ,q F L N/A Y h!dSC A # 3 Cel Win Sash W.1 L N/A Y 3 4 Door Casing L N/A Y Screen Frame L N/A Y Door JambjF NIA Y / Cellar Win Sill AAA L N/A Y �i� Threshold L N!A Y A Cel Win Fram L NIA Y Kickplate L N/A Y # Cal Win Sash L N/A Y Storm Door L N/A Y Screen Frame L N/A Y Strm Door Edge F L N/A Y Foundation m L N/A I Y Door L N/A Y — {�i A Bulkhead L N/A Y 1 Door Edge F L N/A Y Fences N/A Y Q r- 3 4 Door Casing L N/A Y Shutters L NIA Y 51 Doorjamb F L '!A Y Newel post 0.1 L N/A I Y Threshold Q r� L N/A Y Railing Cap O,0 A/M L NIA Y Kickplate L NIA Y Handrail L N/A Y Door L N/A Y A Balusters 00 L N/A Y A Door Edge F L N/A Y Lower Rail 07 L NIA Y 1 2 Door Casing L N/A Y Treads Q r F L NIA Y 3 4 DoorJamb F L N/A Y Risers C, L N/A Y Threshold L N/A Y LTread edge , L N/A Y Kickplate L N/A Y Landing floor Di 1 L N/A Y Window Sill 4I Al I L N/A Y Stri per Q� L N/A Y A Win Casing G L N1A Y Lattice L NIA YPF-1 #1 Window Sash IL- L N/A Y Drain Pipes p,) L N/A Y Nin Ow Sill AIM L NIA Y A Elec Conduit Q L NIA Y A ';fi,in Casing L NIA Y Oil Fill Pipe L NIA Y # Window Sash L N!A Y Overhang Tri. L N/A Y COMMENTS I STR CTURAL DEFECTS: A Lamp Post L N/A Y A F M!I A!M L NIA Y A F M/I AIM L WA Y EXCLUDED SURFACES:Surfaces listed in these boxes can only be made Soil Test Results(Must be less than 400 ppm for play area/1200 ppm for bare soil) intact by a Deleader(MORE THAN 2880 SQ.IN.) LOCATION I AREA MEASUREMENT RESUL REMED REMED SIDE LOCATION MEASURE:LOOSE PAINT IC DATE I IC METHOD (Square Feet) (PPM) DATE METH A Play Area A Bare Soil A Comments: A T T/DA D-'IAI Thomas Dowd M-11702io�tw_ Po�wg.. 12/ 27/ 18 Page '7of L' Inspector(print) Lic# Signature Date Risk Assessor (print) Lic# Signature Date Address of Proaerty: 57 Dow St. AD,,.#2 City: Salem _ EXTERIOR B Side SIDE LOCATION/ LEA• TYPE OF URG IC IC DELEAJ DELEAD SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD B SURFACE HAZARD HAZ. DATE METH DATE METH B SURFACE HAZARD HAZ. DATE METH DATE METH Siding 67,Y L N/A Y Window Sill A/M L NIA Y Comer Boards L N/A Y B Win Casing L NIA Y B Lower Trim L N/A Y #3 lWindowSash L N/A Y Upper Trim L NIA Y — =/J i Cellar Win Sill 77 A/M L N/A Y Win Above 5' L N/A Y B Cel Win Fram L N/A Y Porch Above T L N/A Y #/1 Cal Win Sash L NIA Y Storm Door Q�� L N/A Y Screen Frame tj L N/A Y Strm Door Edge Q.I F L NIA Y Cellar Win Sill A/M L NIA Y B Door 0, L N/A Y B Cal Win Frame Od L N/A Y 1 2 Door Edge O,. F L NIA Y #Z Cal Win Sash L N/A Y 3 4 Door Casing CI&V L N/A Y Screen Frame CjV L N/A Y Door Jamb g,,'(I F L NIA Y 3- '- Cellar Win Sill AFC) L N/A Y Threshold 061 L NIA Y B Sel Win Frame L N/A Y Kickplate CIA L N/A Y 4 Cal Win Sash L N/A Y Storm Door L N/A Y Screen Frame) L NIA Y Strm Door Edge F L N/A Y Foundation . L N/A Y B Door L N/A Y B Bulkhead L N/A Y 1 2 Door Edge F L NIA Y Fences Q r L N/A Y 3 4 Door Casing L N/A Y Shutters L NIA Y Door Jamb F L NIA Y Newel post to j L NIA Y Threshold L N!A Y Railing Cap 0,a A/M L NIA Y Kickplate L NIA Y Handrail 0,9 A/M L NIA Y Door L N/A Y B Balusters L N/A Y B i Door Edge F L NIA Y Lower Rail L N/A Y 1 2 Door Casing L NIA Y Treads F L N/A Y 3 4 Door Jamb F L N/A Y Risers IV& L NIA Y Threshold L N/A Y Tread edge AJ& L NIA Y Kickplate L N/A Y Landing floor Ij G L N/A Y Window Sill L A'M L NIA Y Stringer f V& L N/A Y B Win Casing CrIl L NIA Y Lattice z L N/A Y # Window Sash L NIA Y Drain Pipes Q.) L NIA Y Window Sill A!M L N/A Y B Elec Conduit (Di L N/A Y B `-,Vin Casing L N/A Y Oil Fill Pipe L N/A Y #7/Window Sash L N/A Y Overhang Trim L N/A Y COMMENTS I STRUCTURAL DEFECTS: B Support Clmn- L NIA Y B F WI A/M L NIA Y B F WI A/M L N/A Y EXCLUDED SURFACES:Surfaces listed in these boxes can only be made Soil Test Results(Must be less than 400 ppm for play area 11200 ppm for are soil) intact by a Deleader(MORE THAN 2880 SQ.IN.) LOCATION AREA MEASUREMENT RESULT REMED REMED SIDE LOCATION MEASURE:LOOSE PAINT IC DATE IC METHOD (Square Feet) (PPM) DATE METH B Play Area B Bare Soil B Comments: B 'Thomas Dowd M-1170 J00'e`L 121 271 18 Page Of Inspector(print) Lic# Signature Date Risk Assessor (print) Lid Signature Date Address of Proper!V: 57 Dow St. _ Apt.#2 City: Salem EXTERIOR C Side SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD C SURFACE HAZARD HAZ? DATE METH DATE METH C SURFACE HAZARD HAZ. DATE METH DATE METH Siding Q, L N/A Y Window Sill A!M L N/A Y Comer Boards L N/A Y C Win Casing Cdl L N/A Y C Lower Trim L N/A Y # 9 Window Sash L NIA Y Upper Trim NIA Y Cellar Win Sill rn L NIA Y Win Above 5' L N/A Y C Cal Win Frame N/A Y 3 •� Porch Above 67 L N/A Y Cel Win Sash d.1 L N/A Y Storm Door (),.I L N/A Y Screen Frame 1.1 N N/A Y —61 Strm Door Edge T.1F L NIA Y Cellar Win Sill civ. w't.q L NIA Y Door 5,. N/A Y 3^ C Cel Win Frame L N/A Y 1 2 Door Edge 111 O NIA Y Ifrly # Cel Win Sash L N/A Y 3 4 Doo(Casing C11, Y Screen Frame 1 t°� N/A Y Door Jamb r F N/A Y S Cellar Win Sill A M L N/A Y Threshold A L NIA Y C Gel Win Frame L NIA Y Kickplate L N/A Y Cal Win Sash L N/A Y Storm Door �� L N/A Y Screen Frame GJV L N/A Y Stm Door Edge 0•U F L N/A Y Foundation 6,kV L NIA Y Door & N/A Y C Bulkhead 07, L N/A Y 1 Door Edge L N/A Y S Fences o, L N/A Y 3 4 Door Casing C.OV L N/A Y Shutters L N/A Y Door Jamb 317FF 61 N/A Y Newel post 0. L NIA Y Threshold 6 L N/A Y Railing Cap . A/M L N/A Y Kickplate L N/A Y Handrail 0 ! A/M L N/A Y Door ! L N/A Y Balusters L NIA Y C Door Edge F L N/A Y Lower Rail oil L N/A Y 1 2 Door Casing L NIA Y Treads G F L NIA Y 3 4 Door Jamb F L N/A Y Risers /n L NIA Y Threshold L N/A Y Tread edge NG L N/A Y Kickplate L NIA Y Landing floor ^/.G L N/A Y Window Sill A/M L N/A Y IStfInger L NIA Y C win Casing L N/A Y Lattice L NIA Y # Window Sash VIL L NIA Y Drain Pipes 0► L NIA Y Window Sill 7M L NIA Y C Elec Conduit L N/A Y C Win Casing L N/A Y Oil Fill Pipe L N/A Y # indow Sash L NIA Y Overhang Trim L N/A Y COMMENTS I STRUCTURAL DEFECTS: C Support Clmns I L N/A Y C Shed 10,01 F M/I AIM L N/A Y C F M/I AIM L N/A Y EXCLUDED SURFACES:Surfaces listed in these boxes can only be made Soil Test Results(Must be less than 400 ppm for play area!1200 ppm for bare soil) intact by a Deleader(MORE THAN 2880 SQ.IN.) LOCATION AREA MEASUREMENT RESULT REMED REMED SIDE LOCATION MEASURE:LOOSE PAINT IC DATE IC METHOD (Square Feet) (PPM) DATE METH C Play Area C Bare Soil C Comments: C Thomas Dowd M-1170 12 127 118 Page-Lj Of `9 Inspector(print) Lic# Signature Date Risk Assessor (print) Lic# Signature Date Address of Property: 57 Dow St, 62t.# 2 ci : Salem EXTERIOR D Side SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD D SURFACE HAZARD HAZ7 DATE METH DATE METH D SURFACE HAZARD HAZ DATE METH DATE METH Siding L NIA Y Window Sill 77A!M L N/A Y Comer Boards L N/A Y D Win Casing 57 L N/A Y D Lower Trim L N/A Y #I Window Sash V L N/A Y Upper Trim Q N/A Y T Cellar Win Sill A/M L N/A Y Win Above 5' &V L NIA Y D Cel Win Frame' L NIA Y Porch Above 5 L N/A Y #I Cel Win Sash L N/A Y Storm Door 0.,) L N/A Y Screen Frame L NIA Y Strm Door Edge 010 F L N/A Y Cellar Win Sill A/M L N/A Y D Door 6.0 L N/A Y D Cel Win Frame 1 N/A Y _ 1 2 Door Edge J,O F L N/A Y #2,Cal Win Sash CJV L N/A Y 3 4 Door Casing CA L NIA Y Screen Frame (, L N/A Y Door Jamb . F NIA Y 4h) — Cellar Win Sill AIM L N/A Y Threshold 01-1 L NIA Y D Cel Win Frain L N/A Y Kickplate L NIA Y # Cel Win Sash L N/A Y Storm Door L NIA Y Screen Frame L NIA Y Strm Door Edge F L NIA Y Foundation L NIA Y D Door L NIA Y D Bulkhead L NIA Y 1 2 Door Edge F L N/A Y Fences L N/A Y 3 4 Door Casing L N/A Y Shutters L N/A Y Door Jamb F L N/A Y Newel post 60 L N/A Y Threshold L N/A Y I Railing Cap p r l A/M L NIA Y Kickplate L N/A Y Handrail �,( AIM L N/A Y Door L N/A Y D Balusters J..1 L N/A Y D Door Edge F L N/A Y Lower Rail 0,4 L NIA Y 1 2 Door Casing L NIA Y Treads F L N/A Y 3 4 Door Jamb F L NIA Y Risers L N/A Y Threshold L N/A Y Tread edge N. L N/A Y Kickplate L N/A Y Landing Floor L N/A Y VVEndcw Sill CAvel A/M L NIA Y Stringer L N/A Y D Win Casing UV L N/A Y Lattice L NIA Y # Window Sash L N/A Y Drain Pipes 77 L N/A Y Window Sill CIV A1M L N/A Y D Elec Conduit J L N/A Y D 'Nin Casing L N/A Y Oil Fill Pipe L NIA Y # Window Sash I L N/A Y Overhang Trim L NIA Y COMMENTS I STRUCTURAL DEFECTS: D Support Clmn L N/A Y D F M11 A/M L WA Y D FM/1 AIM L N/A Y EXCLUDED SURFACES:Surfaces listed in these boxes can only be made Soil Test Results(Must be less than 400 ppm for play area/1200 ppm for bare soil) intact by a Deleader(MORE THAN 2880 SQ.IN.) LOCATION AREA MEASUREMENT RESULT REMED REMED SIDE LOCATION MEASURE:LOOSE PAINT IC DATE IC METHOD (Square Feet) (PPM) DATE METH D Play Area D Bare Soil D Comments: D TW Envtronm 0 ntol Services,Inc. P.0.Sox 180306.Boston,MA O2118 TO:6117.471:2888 Fax;617.471..3880- www.twenviro@aol.com www;twenviro.com LETTER OF ML DE EAI R]Nf C4MPLL_Q DATE: 1 B':11. Ralrtond L Yoatzg 87 Federal St. Salem:MAP 70 Dear Sir/Madanz This letter is to certify that.Y re-inspected your property located at;5' tz ..apartmeipt rioo 1,, and relevant common areas,in:the City.or Town of for fu11eleading compliance onl ` 'j atfd on that date those surfaces cited in the initial inspection report of ;were found to be in-hR compliance with, Massachusetts'.General,IAWS, Chapter%'Ill. 'Section 197, and 105 CMR 4460.0001. Regulations for Uad Poisoning Prevention and Control. Dust samples were taken.and`fpund to be'witlun acceptable,limits. Massachusetts law does ;not require the abatement or containment of all residential`lead'paint The residentiah.premises or dwelling unit and relevax t comxuan areas shaU._r=M='in complhance only as long as, there continues to be no peeling,chipping or flakittg.lead paint or other accessible leaded materials;as long as coverings and/or encapsulants.forming an effective.barrier over. such,paint or other.leaded materials remain in place, and as long as surfaces reversed to correct.lead'lxazards remain zevOrsed'and securely in place, The.law grants you,a ,30-day maintenance period to,-repair. deteriorated lead paint :or detached coverings over-such paint,;and to clean up,during which time this Vetter remains.valid.. The reverse side of this letter indicates the authorized'person(s) wfiq performed deluding on the properly and°a general.summary of the methods used: A complete reirtspection report is attached to this letter,which specifies'how-and on what date each surface was brought into'compliance..Do,not lose Ibese documents. To the best of my lmgwledge,the cost of the legally required deluding is°$1 Ste,____ Sincerely,, Wubishet.Tilahun linspectax ---- DPI License Number prwataL me Page 1 of 2 Rev 9J08 'nv6M�m�rk.lamiaypx..S�aAUwastcv!Fbw *BWMAba rdWW.o2iie.dtTeAa3 9.biilpS3db8�xwr.Mrnu�aoom• dwm ADDRESS 1 Dow St.Ant.02'� Insoectiou and Deieadij&History Initial inspection done on;07/27&I by Oscar Bcgb License#11f 6,____ Reoccupancy reinspection,if needed,.done on NIAA by r,�cense Final Deleadingreinspection clone on:I WWII by'WUbishet Tiiahun License# Deleading ant&General Repair CO.Jlcense#;l7MOD14S. Delead ng methods: hCir va bg Demolition Power sanding Caustics Heat gun Reoiacmmem Cnverinr< Liquid encapsulation Other , Work was done in the following rooms:As specified in tbpju%Mflon reports Work was done on the following types of Components As-specified in the igU!tction re Llp rt Start Date: 31119/11 _Finish Date:_11I3D111 Costi $1s5 QQ Load-safe renovator. KLA ModerateAsk ownerlagentr ---- -- ^_.Authorization# Deleading Methods: Replacement. Making-intact,(interior): Making intact(exterior) Covering Liquid encapsulation. Work was done in the following rooms; Work:was done on,the following types of components Starts Date:_ -._Finish Date; Cost: ( ?t include ow"I'I:aW) Low-risk owner/agent:_i A; -� Authod ution Deleading.methods: Cohering Liquid encapsulation Gapping baseboards Replacement torn,toms,cdntnd dons;dh,utew;; cs sot am:ca,dmwala,w;vdo„s on hinWt Work was_dono in the foIlowing7roorns: Work was-done on the following types of components; Start.Date Ebish Date:_,1,./ Cost:$ (l omit include owners Labor) Should you have any questions about this letter,cell the Department ofp bUeRcalth at 1-800.532:9571., Pdvalcumc Page Z off, Rev,91C18 �xrEm+rorn.rra.►kssMc.s�s��emrstwRoor::.a»bn,wr :otlte*.arra4saaaa.an