HomeMy WebLinkAboutMiscellaneous - 594 CHICKERING ROAD 4/30/2018 594 CHICKERING ROAD
210/070.0-0017-0000.0
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Title of File
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Date file closed:
Doc Document/Action Tifile
action Date of Refer to other Purpose of Docume ct of nand notes
Num. Document/ document/ --
Action De artment
Board of Appeals — Board of Heal h Plann�%ng Board
Conseruat.0n Commission — B�iVdin pe
partrnent �— ----I
I
Town of North Andover NORTH
,
OFFICE OF 3?oy
COMMUNITY DEVELOPMENT AND SERVICES p
27 Charles Street Z '
North Andover, Massachusetts 01845 9Q(9ro.PP �S
WILLIAM J. SCOTT 9SSncHusEt
Director
(978)688-9531 Fax(978)688-9542
Establishment:
Address :
Telephone: Date: —
Person Scakenl With:ith: p '
Owner•
On this day an inspection was made of your/waste receptacle area.
Your waste receptacle area was found Mclean dirty and the
cover of your waste yr-e eptacle was found _�� in good repair _
in poor repair and � kept closed not kept closed.
Other Comments:
410 . 600 Storage of Garbage and Rubbish - Garbage/Rubbish
shall be stored in watertight receptacles with
tight-fitting covers. Said receptacles and covers
shall be of metal or other durable, rodent-proof
material .
410 . 601 Collection of Garbage and Rubbish - The owner of
any dwelling shall be responsible for the final
collection or ultimate disposal or incineration of
garbage and rubbish by means of a regular
collection system approved by the Board of Health.
410 . 602 Maintenance of areas free from Garbage and Rubbish
(A) - The owner of any parcel of land, vacant or
otherwise, shall be responsible for maintaining
such parcel of land in a clean and sanitary
condition and free from garbage, rubbish or other
refuse. The owner of such parcel of land shall
~correct any condition caused by or on such parcel
or its appurtenance which affects the health or
safety, and well-being of the occupants of and
dwelling or of the general public.
Person in Charge Inspector
BOARD Or A2PEALS 638-9541 KTILO NG 683-95.15 CONSERVATTON 633-9530 HE !TH 683-9510 PL::NNTNG 638-9535
Ci
U' M 7 IONS
Environmental Services, inc.
March 28, 1994
Re£#9403426
Mr. Kyle MacAfee
Emergency Response Branch
Mass DEP Northeast Region Office
10 Commerce Way
Woburn, MA 01805
Re: Imminent Hazard Determination
ECLC North Andover
Dear Mr. MacAfee:
Simmons Environmental Services (SEVIMONS) has completed its
initial investigation of the odors detected at the Early Childhood Learning
Center (SCLC) which is located adjacent to Haffner's Gasoline Station at 594
Chickering Road, North Andover, MA. We believe that we have identified a
potential cause of these odors. We also believe that we have obtained
sufficient analytical data to demonstrate to the Department that the
situation encountered does not pose what the Department would define as an
"imminent hazard" under the Massachusetts Contingency Plan (MCP) or by
other applicable health standards or guidelines.
This letter describes the actions taken since Wednesday, March 16,
1994 when we met with you and others at the ECLC. Our objectives have
been twofold. First, we wanted to determine what immediate actions, if any,
were necessary to protect the health and safety of the occupants of the ECLC.
Once this was accomplished, our second objective was to identify the source
of the odors.
Since the odors were strongest in the floor drains located in the ladies
room and in the boys room, plumber's plugs were installed in these drains
immediately (by ECLC's plumber). SIMMONS then proceeded to collect
water samples from the sewer line at manholes located beneath the sidewalk
25 Kenoza Avenue
Haverhill, NIA 01830
—elephone 508-521-3333
Fax 508-521.3322
i
SIMMONS
Environmental Services.Inc.
in front of Haffner's (MH-1) and in front of the ECLC (MH-2) to determine if
the odors were attributable to the presence of gasoline in the sewer line.
The following day, March 17,1994, arrangements were finalized with
Covino Environmental Consultants, Inc. (CEC) to perform an air sampling
study inside the ladies room and at a background location selected to be
upgradient of the gasoline station. Because of information concerning the
frequency of odors as supplied by the ECLC staff, it was agreed to sample on
Saturday morning, March 19, 1994. A decision to sample on a Saturday
morning was based upon a prolonged period with no air exchanges between
Friday evening and Saturday morning. This was thought to be
representative of a worse case exposure scenario. In preparation for this
activity, Mr. William Sarro of SIMMONS visited ECLC on Friday evening
around 6 P.M. and removed the plumbers plug from the ladies room floor
drain where air samples were to be collected.
On Saturday, March 19, 1994, Mr. Sarro met with Mr. William Wessel
of CEC at the ECLC at 8:30 A.M. Mr. Wessel set up personal air monitoring
pumps connected to tubes containing an adsorption media at two sampling
locations: 1, in the ladies room and 2, outdoors to the Northwest of the main
entrance to ECLC. The wind direction was observed to be from the
West/Northwest. The gasoline station and other potential sources of volatile
organic compounds were situated downgradient of this location based upon
the apparent wind direction as noted. Samples were collected for
approximately two hours at each location and sent to a laboratory for
analysis of the parameters of concern which were benzene, ethyl benzene,
toluene, and xylenes (BTEX compounds). The purpose of the sampling was
to identify and quantify any possible health hazards associated with the
short term inhalation of these compounds.
Concurrent with these measures Mr. Sarro collected several additional
pieces of data relative to indoor air quality. These measurements utilized a
Gas Tech Trace-Techtor monitor with a methane response switch which will
measure hydrocarbons with or without the contribution of methane. This
option allows the user to screen for non-methane compounds such as
benzene, toluene, xylene, etc. without interference from the methane. The
difference of the two readings can be caused by compounds other than
ZZ
SIMMONS
Environmental Services.Inc.
methane, and by the difference in sensitivity of the instrument in the two
different modes, and is not necessarily indicative of the presence of methane.
The following table summarizes sample location and observations made.
TABLE 1 -TRACE-TECHTOR READINGS (PPM)
LOCATION FULL NO
GAS METHANE
Background 0 0
Lobby 180 30
Boiler room 280 40
drain
Ladies room 640 210
drain
Boys room 300 50
drain
Ladies room 250 62
sink
Double 1180 600
Action
in sink 1180 640
after 430 92
flush
Pentapine 2400 2000
in sink 2000 1000
after 420 200
flush
From the above table of results, it is noted that several commercial
cleaning compounds used at the ECLC facility produce a strong response in
both the "full gas" and "no methane" modes. It is therefore difficult to
separate the contribution of the residues of these compounds from the total
measurement of hydrocarbons in some locations (such as the ladies room).
I
SIMMONS
Environmental Services.Inc.
Analytical results for water and air samples collected were received by
SIMMONS on Friday, March 18 and Wednesday, March 23, respectively.
Tables 2 and 3 below show a summary of the results with comparisons to
MCP Clean up Standards for drinking water quality and acceptable ambient
levels for indoor air as established by the Department's Office of Research
and Standards.
TABLE 2 -WATER ANALYSES (UG/L)
CONSTITUENT MH-1 MH-2 Reference
WATER WATER Standards
benzene. 95 76 5
ethyl benzene 44 34 700
toluene 220 140 1,000
x lene 350 240 10,000
1- Reference Standard is based on Method 1 Clean up goals for water classified as GW 1
under the new MCP.
TABLE 3 -AIR ANALYSES (PPB)
CONSTITUENT LADIES OUTSIDE Reference
ROOM Standard!
benzene 0.64 0.40 3.0
ethyl benzene 0.10 0.08 NA
toluene 5.32 0.93 50
xylene 1.20 0.20 200
2-butoxy ethanol 61.80 0.66 NA
2- Reference Standard is based on MDEP Office of Research and Standards' most stringent
levels for short term re-occupancy of an area that was previously evacuated. Where a
standard has not been established, the NIOSH TLV for occupational exposures is typically
used.
In terms of health risk, our main concern was with the potential for
high levels of BTEX compounds common to gasoline in the air. Our results
show that, even in the worst location (i.e., the ladies room), under the worst
conditions (morning, no ventilation, floor drain open), these levels were less
SIMMONS
Environmental Services.Inc.
than the present guidelines established by the Office of Research and
Standards.
In addition to using the reference standards cited above, we have also
calculated the health risk based upon indoor air quality results recorded
above. This was done using MCP risk assessment criteria, for benzene,
which is a suspected carcinogen. The result of this risk screen is 2.7 x10-9
which compares favorably to the Department's level for an imminent hazard
of 1x10-5 This calculation is based on determination of the average daily dose
(ADDinh) and use of literature data for the cancer potency factor (CPF).
Additionally, a risk screen was also run for benzene assuming that there was
a direct exposure pathway to ambient air from the gases in the sanitary
sewer. The results of this screen showed a risk of 1 X 10-6 which also
compares favorably to DEP's quantitative imminent hazard criteria.
Complete calculations are contained in Attachment 1.
After receipt of the analytical data, personnel from CEC informed us of
one contaminant which dominated the air sample. This compound was 2-
butoxyl ethanol, also referred to as butyl cellosolve or ethylene glycol
monobutyl ether. It is an ingredient in cleaning chemicals used at ECLC.
This includes First StepTM and AquasolTM-
On Thursday, March 24, 1994, SIMMONS enlisted the services of a
licensed Master plumber, Richard D. Bonin to investigate the floor drainage
system and to determine if the floor drains were properly trapped. He
determined that the floor drains were properly trapped. Because of this
effective trap seal,.sewer gases cannot enter the building via the floor drain.
Mr. Bonin also pointed out to us "weep holes" in the upper sections of the
floor drains which are designed to drain groundwater into the drain pipe
should it rise to floor level beneath the building. With the plumber's plugs
still in each floor drain pipe, we filled the floor drain inlets with water in
both the ladies room and the boys room. Over time, the water in each inlet
percolated down the outside of each drain pipe. The water in the ladies room
i
I
I
SIMMONS
Environmental Services,Inc.
inlet fell to below the level of the weep holes in less than 15 minutes. The
water in the boys room inlet remained in the inlet much longer and was not
observed to be below the level of the weep holes until the following day.
CONCLUSIONS
Based on the results of our investigation, we believe that the primary
cause of the odors in the ECLC is from gases emanating from the void space
surrounding the drain pipes in both the ladies room and the boys room. The
odors are much stronger in the ladies room than in the boys room. This
seems to be consistent with our finding that the water percolates down the
outside of that drain pipe much more quickly than it does in the boys room.
The only constituent detected in the air at significant levels was 2-butoxy
ethanol. According to the ECLC's janitorial service, the floors were stripped
approximately two weeks ago. First StepTM wax stripper which contains 2-
butoxy ethanol was used.
It is possible that the odor may be from groundwater in the void space
surrounding the drain pipe or from soil in the vadose zone between the floor
and the water table. If this were the case, and if the contaminants were
petroleum products migrating from Haffner's Service Station, then the air
samples collected clearly should have contained significantly higher
concentrations of BTEX compounds. Since our main concern at the time of
sampling was the health risks associated with inhalation of the BTEX
compounds, we have only been able to conclude that there is no health risk
from these constituents and that Haffner's is not creating an imminent
hazard at the ECLC.
SIMMONS
Environmental Services,Inc.
Based on this information, we request that the Department withdraw
its imminent hazard determination as cited in the Notice of Responsibility
issued to Haffner's on March 16, 1994. If you have any questions, please
contact either of the undersigned at (508) 521-3333.
Very truly yours,
William F. Sarro
Environmental Engineer
r i
William A. Simmons, LSP
Principal
SIMMONS
Environmental Services.Inc.
ATTACHMENT 1
RISK CHARACTERIZATION
SCREEN CALCULATIONS
ADD;nh = jOHM]oi, xVRxBAF xDixD2xFxC
BWavg x AP
ELCR =ADDinh x CPF
where:
[OHM]» = air concentration of the compound mg/m3
ADDinh = average daily dose for inhalation route mg /kg/day
VR = daily respired volume = 10 m3/day
BAF = bioavailability factor = 1 (worst case)
Di = average duration of each exposure event = 0.33 days (8 hours)
D2 = duration of the exposure period = 4 years
F = conversion factor to account for average duration of each exposure event
= 8hrs/day, 5 days/week, 52 weeks/year for 4 years (Age 1 -5) = 0.05
C = units conversion factor = 1
BWavg = average body weight of child = 20 kg
AP = averaging period
(70 years carcinogenic effects; 5 years non-carcinogenic effects)
ELCR = excess lifetime cancer risk.
CPF = cancer potency factor (.029 for benzene)
' I
SIMMONS
Environmental Services.Inc.
RISK CHARACTERIZATION
SCREEN CALCULATIONS
Benzene in air
[OHM] = 0.00064 ppm/3.25 = 0.000197 mg/m3
ADD;nh = 0.000197x 10x 1 x 0.33 x 4 x 0.05 x 1
20 x 70
= 9.29 x 10-8
ELCR = 9.29 x 10.8 x 0.029 = 2.69 x 10.9
Benzene in water (assuming that 1 mg/liter will partition into
0.001 mg/cubic meter of air).
[OHM].i, = 0.076 mg/liter x 0.001 liter/m3 = 0.000076 mg/m3
ADDirth = 0.000076 x 10 x 1 x 0.33 x 4 x 0.05 x 1
20x70
= 3.58 x 10-5
ELCR = 3.58 x 10-5 x 0.029 = 1.04 x 10-6
CEC
�Mxv.....
300 Wildwood Avenue,Woburn,MA 01801
(617) 933-2555 FAX (617) 932-9402
March 28, 1994
Mr. William Sarro
Simmons Environmental Services, I11C.
25 Kenoza Avenue
Haverhill, Massachusetts 01830
Ref: CEC Project 94.00358
Educational Learning Center
594 Chickering Road
North Andover, Massachusetts
Dear Mr. Sarro:
The purpose of this letter is to present the results of air monitoring performed by
Covino Environmental Consultants, Inc. (CEC) at the above referenced facility on March
19, 1994. The air samples were collected onto thermal desorption tubes (TDT) and
were analyzed to determine airborne concentration levels of benzene, toluene, ethyl
benzene and xylene (BTEX) vapors. TDT sampling was performed in order to evaluate
very low concentrations of airborne BTEX vapors.
METHODOLOGY
The thermal desorption tube (TILT) air samples were collected using Carbotrap 300
tubes (Supelco CAT. No. 2-0379). Duplicate samples were collected to provide a back-
up since there is a risk of losing the sample on the analytical instrumentation during
sample analysis. Air was drawn through the tubes at now rates ranging from 0.050
to 0.0775 liters per minute (lpm) using Gilian Model HFS 513A sampling pumps. The
air sampling flow rates were determined at the beginning and end of each sampling
period using a Gilian Instrument Corporation HFS Pump calibrater. An air sample was
collected in the Women's Room where an open floor drain was located. In addition,
as a control, an air sample was collected outdoors upwind on the north side of the
building. A field blank was not prepared, as the outdoor sample served as the control.
Following sample collection, the TDT air samples were hand-delivered to ESA
Laboratories, Inc., an American Industrial Hygiene Association (AIHA) accredited
laboratory located in Bedford, Massachusetts. The MT samples were desorbed in a
ii
94.00356
Page 2
METHODOLOGY (CONT.)
thermal desorption chamber and were analyzed by Gas Chromatography/Mass
Spectroscopy (GC/MS) methods, Quantitative identification of the solvent vapors
collected on the air samples was performed by comparison�s spectra fthe oair resample
o
chromatogramsstandards. Thess SESA�,in�laboratoryth report is attached.
laboratory
RESULTS
The airborne concentration levels of BTEX vapors for both of the TDT samples are
presented in the attached tables as parts of contaminant billion parts of theair (ppb).
In addition, based on information provided by laboratory
of a targe 2-butoxyethanol (EGMBE) peak for the indoor sample, this substance was
quantified on the air samples at the client's request. EGMBE was identified on the
Material Safety Data Sheets for floor stripper and detergent reportedly used in the
Educational Learning Center by a cleaning Contractor approximately two weeks prior
to the air sampling date.
Reference values for STEX vapors included on the table are
Office es established
Research and
the Massachusetts Department of Environmental Protection
Standards (DEP-ORS) related to emergency oil and petroleum spills. The Indoor Action
Level is the airborne concentration at which the airborne vapors released from a
petroleum spill present an imminent health hazard, and which may require building
evacuation. The Short Term Occupancy Limit is the airborne concentration level at
which the building may be reoccupied during the course of spill remediation. The
Indoor Action Level and Short Term Occupancy Limit address the immediate potential
hazard and do not address the evaluation of long-term environmental risks due to site
contamination.
The observed indoor BTEX vapor concentrations were below the Shortform Indoor Air
Background Concentrations shown in Table 6-4 of the DEP-ORS Risk Assessment
Shortform, Residential Scenario Policy #WSC/ORS-142-92. Thus, the observed BTEX
vapor concentrations were within the range which could be attributed to indoor sources
of these vapors (e.g. construction materials, furnishings, consumer products). The
sampling performed during this survey, however, is not sufficient to determine whether
or not the observed BTEX vapor concentrations were due to indoor sources or to site
contamination.
CEC
awamillaryFAX(6i 93Z 9402
300 Wildwood Avenue,Woburn,MA 01801,(617)933-2555
94.00356
Page 3
Enclosed please find the table presenting the air monitoring results asESA
h loon,
Laboratory data sheets. If you should have any questions regarding
please do not hesitate to call.
Sincerely,
Prepared by. .
William C. Wessel
Project Manager
Reviewed by: Ll�
Ann D. Eckmann, CIH
Industrial Hygiene Manager
WCW\jj
w+194-00356
300 Wildwood Avenue,Woburn,MA 01801,(617)933.2555,F.AX(617)932-9402
94.00356
Page 4
A4:bome Benzene. Toluene, Ethyl Berme and Xylene (W E .) 'Vapor Measurements
Educational Reaming Center
594 chiduxkg Road
North Andover, Massadwsetts
March 19, 1994
Samnl�e No.
t,ocatinn Sam a Period Sam led Air Voitune in Air [ppb
031994-02 Women's restroom, 9:24 am 6.40 0.64 (benzine)
on edge of sink to 0.1 (ethyl benzene)
above floor drain, 11:18 am 5.32 (toluene)
2.5 above floor level 1.2 (Xylene ail isomers)
031994-04 Outdoors, sidewalk 9:59 am 5.97 0-4 (bye)
north of building, to <0.08 (ethyl benzene)
sample placed on 11:21 am 0.93 (toluene)
chair --2' above 02 (xylene-all isomers)
ground level (up
wind on survey date)
D Note- The laboratory report indicates that 0.004 micrograms benzene was detected on the Method Blank. The laboratory reported verballj
i that a large peak attributable to 2-but"y ethanol (EGMBE) was observed on the mass spectra for Sample 031994-02- An EGMBI
concentration of 61.8 ppb was observed for Sample 031994-02- An EGMBE of 0.66 ppb was observed for sample 031994
U 04.
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RlSi"!S[lGlRal:VALVE
Conunonwealth of Massachusetts, Department of Environmental Protection, office of Research and Standards
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COMPLAINT NUMBER DATE:
#16 MARCH 15, 1994
COMPLAINTANT:ANONYMOUS CLOSE DATE:
ADDRESS:594 CHICKERING ROAD PHONE:
OWNER:ECLC PHONE #: 685-8111
ADDRESS:594 CHICKERING ROAD
INSPECTION DATE: MARCH 16, 1994 ORDER L DATE:
COMPLAINT:ODOR COMING FROM DRAINS. HAFFNER GAS STATION? CAUSING HEADACHES.
ACTION: INSPECTED WITH DEP EMPLOYEE, KYLE MACAFEE. GOT POSITIVE READINGS AT
1 DRAINS IN STAFF REST ROOM AND BOYS REST ROOM. MET WITH WILLIAM
RJI) SIMMONDS, ENVIRONMENTAL CONSULTANT FOR HAFFNERS, AND GLSD. N.O.R.
ISSUED TO HAFFNERS BY DEP. TESTING FOR CHEMICAL COMPONENTS IN SCHOOL
BUILDING TO BEGIN IMMEDIATELY.
CHRONOLOGY REPORT - 594 CHICKERING ROAD
3/15/94 - Conservation receives call from Fire Department about
odor and fumes at E.C.L.C.
3/15/94 - Anonymous complaint made to B.O.H. about odor and
resulting headaches.
3/16/94 - Fire Department called D.E.P.
Inspected site with D.E.P. inspector, Kyle Macafee.
- Drains in staff rest room and boys room showed
positive.
- Joined by William Simmons, environmental consultant and
personnel from G.L.S.D. because positive readings found
in sewer manholes.
- N.O.R. issued by D.E.P. to Haffners.
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COMPLAINT NUMBER DATE:
#3 - APRIL 24, 1992
COMPLAINTANT:ECLC LEARNING CENTER CLOSE DATE:
ADDRESS:594 CHICKERING ROAD PHONE:
OWNER:IRENE ROCHWARG PHONE #:
ADDRESS:594 CHICKERING ROAD
i
INSPECTION DATE: ORDER L DATE:
COMPLAINT: GROUND WATER OOZING OUT OF SLOPE OF HILL, POSSIBLE HAZARDOUS
WASTE.
ACTION:
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_- =-_- TOWN OF NORTH At NDOVER
—_ ;;
M r Board of Health
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June 23, 1998
To whom it may concern,
I hereby certify that Stephanie A. Green has successfully
completed a level C (Health Care Provider/Professional Rescuer) CPR
course on :lune 23, 1998. She will be receiving her certification card within
the next few weeks. If you have any questions please feel free to contact me
at (508) 616-9349.
3
Thank You,
Kyla B. McClure. .
BLS Instructor
y
s
i
C to This recognizes that
a N STEPHANIE GREEN
.` o has completed the requirements for
m Lifeguard Training 10
a OC
conducted by
NORTH PROVIDENCE REC DEPT
Date completed 06/26/1998
The American Red Cross recognizes this certificate
as,.slid for 3 year(s)from completion date.
HThis recognizes that
V Q STEPHANIE GREEN
has completed the requirements for
L
Community First Aid and
ESafety
conducted by
NORTH PROVIDENCE REC DEPT
Date completed 06/26/1998
The American Red Cross recognizes this certificate
as valid for 3 year(s)from completion date.
'i
�4s Chairman. Ame�dCrO55
P4�
Instructor's Signature 1
4CLapter�
a
RHODE ISLAND CHARTER
Holder's Signature
32100 ®, Cert.653999(June 1997)
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C:hainnan. .Vnc �n Rat Cross
Instructof s Si atnrC
Chaptcrr
RHODE ISLAND CHAPTER
• Holder's Signature
32100 •®m =m 6539W Oune 1997)
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ACMN-KNG ENIRPRI]SILS, NC.
COMMONWEALTH OF MASSACHUSETTS 26 Livingston Stroot
TOWN OF: NORTH ANDOVER
Low.8!41 m oios.42
SYSTEM PUMPING REPORT
ACTION KING ENTERPRISES, INC REPORT FOR THE MONTH OF:SEPTEMBER 2009
CONTENTS CONDITION OF
DATE ----.--NAME ADDRESS GAL I TYPE TRANSFERRED TO SYSTEM
9/21/2009 MERRIMACK COLLEGE 315 TURNPIKE R-OADD 2,500 SEPTIC 'FIT HBURGWWTP
_9i/2_4/2009 IKINDER- CARE 594 CHICKERING ROA 1,5001SEPTIC.,!FITCHBURG WWTP
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THE COMMONWEALTH OFMASSACHUSETTS
TOWN OF NORTH ANDOVER
BOARD OFHEALTH
Date: DECEMBER 30,1996
Permit#: 0011-7
This is to certify that:KINDERCARE,594 CHICKERING ROAD,NORTH ANDOVER,MA 01845
IS HEREBY GRANTED A DUMPSTER PERMIT
This permit is granted in conformity with the statues and ordinances relating thereto, and expires
DECEMBER 31,1997 unless sooner suspended or revoked. —4,
Gayton Osgood;•Chaifinan
vL
t,a: c.(, i
JVrancis,P:�IacMi11 ,` A"-Member
t !' �
John`S:~Rzza;�.fVI.3�;`iVIeinbe�
,f �
`G
TOWN OF NORTH ANDOVER
BOARD OF HEALTH
TOWN HALL ANNEX
146 MAIN STREET n
NORTH ANDOVER, MASSACHUSETTS !�
TELEPHONE# (508) 688-9540
APPLICATION FOR DUMPSTER PERMIT
PURSUANT TO SECTION 31A AND 31B OF CHAPTER III
OF THE GENERAL LAWS, AND RULES AND
REGULATIONS OF THE
NORTH ANDOVER BOARD OF HEALTH
DATE: 0 (O
Application is hereby made for a permit maintain a dumpster (s)
on property located at c) ( WAU d0 e�--
in accordance with the rules and re ulations of the Board of
Health.
Number of Dumpsters:
Check use: ✓
( ) Residential use Commercial use
( ) 30 day temporary11 (�) Annual
Name of applicant: KIfxhc or, r P
Owner of property: it
Telephone#: 0E ' - ►1
Dumpster Comp"any:- Q.
Telephone#:
Pick-Up Schedule:
Trash Contractor:
Frequency of Pick-Up: I1P P u
On the bottom half of this rm, please sketch an outline of
property, showing the proposed location of the dumpster (s) . Give.
distance from dumpster to other buildings and lot lines or
boundaries. Use back side if additional space is needed.
Please return this application with a fee of $25.00 per
establishment ($10.00 for temporary permit) to Town of North
Andover, Board of Health Office, Town Hall Annex, 146 Main Street,
North Andover, M A 01845.
� _QR_ IC1 Off
Commonwealth of Massachusetts
�IS ,ECTO,R(AGENCY � -
�_1A (= CHILDHOOD LEAD POISONING
1 '/tA . 01) /46/ 19 PREVENTION PROGRAM
M
,A)r�'�,r, p 305 SOUTH ST.,,JAMAICA PLAIN,MA �r1I'do
INSPECTION FORM �/SF
CASE CODE
Address(include Apt.#)
v �J
LAST NAME OF CHILD FIRSTNAME CITY-' Birth Date /
I. MM DD YY Sex
Parent/Guardian's Last Name Parent/Guardian's First Name
1. DWELL OWNS
2. DAYCAREOWNE
OCC.R 5
SCHOOL UNITS
3. OTHER YORN EYORN
Parent/Guardian's Telephone# 1. SINGLE NO.OF ROOMS
2. 2-4APTS. B INCLUDE BATHROOMS
3. 5 OR MORE BUT NOT HALLS
OWNER'S NAME: MORTGAGOR NAME:
OWNER'S ADDRESS: MORTGAGOR ADD.:
CITY: CITY
TEL.#:.
Book No. REMARKS:
Page #
Probate
8 1. VICTIM 4. REPAIR 7. OTHER REQ.DATE (NSftDATE,�2. PAR.REQ. 5. VACANCY VIOLATION
3. HIGH INC. 6. INSTITUTION I IT 3 Y OR N
FLOOR# FLOO1#-
C
#C C
B D B D
?41 '1
A (STREET SIDE) A (STREET SIDE)
Pb MORE THAN 0.5% OR 1.2 mglcm 2 IS ILLEGAL
SERVICE DATE I REINSP.DATE 1.
SREHABTE
B 2. TARD
3. NO WORK �-
INSPECTOR
REINSP.DATE 3. ST WORK REINSP.DATE 3. NO WORK REINSP.DATE 3. NO WORK
T-
DATE DATE INITIAL DATE .a
REINSP.DATE 1. REHAB COMPLAINT SOUGHT SHOW CAUSE ARRAIGN
2 STARTED
3. NO WORK
DATE
ACTUAL DATE PRETRIAL INITIAL DATE FINAL DATE
1. DISMISSED VACANT
ARRAIGN TRIAL TRIAL DISMISSED REBED
4. DAB
5. ORDERED REHAB.
AND COURT'COSTS
APPEAL
6. ORDERED REHAB
APPEAL TRIAL DATE 2 UPHELD 8 RIGHT TO RENT WITHHOLD 8 AND FINE
V OR N F1 2. MODIFIED REPAIR
3. OVERTURNED Y OR N Y OR N
8 REHAB DONE BY 1. OWNER
REHAB DATE KNOWN CASH COST
2. CONTRACTOR
3. TENANT
INSPECTOR 4. VOLUNTEER
5. CITYISTATE # INSPECTIONS
5M-11/82-170874
INSPECTOR/AGENCY Commonwealth of Massachusetts
CHILDHOOD LEAD POISONING PREVENTION PROGRAM •
305 South St.,Jamaica Plain,MA 02130 f
1 p��l�� -- 'INSPECTION FORM p" Of/1
PRINT ONLY— PRESS DOWN
CASECODE
ADDRESS OF INSPECTION(Intrude Apt.#or Floor) OWNER'S NAME&ADDRESS City// Code
w / City
ROOM SIDE SOURCE Pb Loose R ROOM SIDE SOURCE Pb Loos R
,j_ Upper Walls �� \ � 16 4 Window Sill/Apron
Room Lower Walls Window Casing/Header/Stops
Chair rail Window Sash/Mullions
Baseboard ExteriorSill/Parting bead
t/ Door t Window Sill/Apron
Door Casing-Jamb {'l� �# Window Casing/Header/Stops
Door Window Sash/Mullions
Door Casing-Jamb Exterior Sill/Parting bead
Door Closet Walls
Door Casing-Jamb Closet Door-Interior
Window Sill/Apron Closet Casing-Jamb
Window Casing/Heade�lpfz ps r Closet Baseboards
Window Sash/Mullions t Closet Shelves
ExteriorSill/Parting bead Floor
Window Sill/Apron Ceiling
Window Casing/Header/Stops i
'..GIC•E�'�. � f:....
Window Sash/Mullions % .�;, �j •`j f f cy,r
ExteriorSill/Parting bead ,A
Window Sill/Apron
Window Casing/Header/Stops
Window Sash/Mullions -U-per Walls 42
ExteriorSill/Parting bead Room j Lower Walls
Window Sill/Apron Chair rail
Window Casing/Header/Stops Baseboard
Window Sash/Mullions Door
ExteriorSill/Parting bead Door Casing-Jamb / f `
Closet Walls Door
Closet Door-Interior Door Casing-Jamb
Closet Casing-Jamb Door
Closet Baseboards Door Casing-Jamb
Closet Shelves Window Sill/Apron
Floor Window Casing/Header/Stops
Ceiling Window Sash/Mullions
rY`l! iftllw- ExteriorSill/Parting bead
Window Sill/Apron
rri ,1 // '�!f -�✓ll+ Window Casing/Header/Stops
Window Sash/Mullions
ExteriorSill/Parting bead
H.UWFWalls -/ , Window Sill/Apron
Room Lower Walls ,/ Window Casing/Header/Stops
Chair rail Window Sash/Mullions
/ r Baseboard Exterior Sill/Parting bead
Door Window Sill/Apron
Door Casing-Jamb /j j / /JyO Window Casing/Header/Stops
Door ,1 7 7 Window Sash/Mullions
Door Casing-Jamb/ Exterior Sill/Parting bead
Door Closet Walls
Door Casing-Jamb Closet Door-Interior
Window Sill/Apron Closet Casing-Jamb
Window Casing/Headef/Stops ' J Closet Baseboards
Window Sash/Mullions `, Closet Shelves
Exterior Sill/Parting bead Floor `
Window Sill/Apron Ceiling
Window Casing/Header/Stops �z,,- ;"A* ' -' -�� /j�•[
Window Sash/Mullions r I/fir
ExteriorSilllParting bead
Pb MORE THAN 0.5% OR 1.2 Mg/CM-2 IS ILLEGAL
REMARKS
INSPECTOR
Inspection Date
A
1OM-11182-170874 /
INSPECTOR/AGENCY Commonwealth of Massachusetts
j?�� / �r CHILDHOOD LEAD POISONING PREVENTION PROGRAM •
e 305 South St.,Jamaica Plain,MA 02130
*INSPECTION FORM
PRINT ONLY— PRESS DOWN
CASE CODE
r
ADDRESS OF INSPECTION(Include Apt.N or Floor) OWNER'S NAME&ADDRESS City
r/ Code
r I - City
ROOM SIDE SOURCE Pb Loose R ROOM SIDE SOURCE Pb Loose R
Upper Walls Window Sill/Apron
Room # Lower Walls ✓ Window Casing/Header/Stops
Chair rail Window Sash/Mullions
Baseboard Exterior Sill/Parting bead
'f Door , / f/ G Window Sill/Apron
Door Casing-Jamb, # Window Casing/Header/Stops
Door I Window Sash/Mullions
Door Casing-Jamb Exterior Sill/Parting bead
Door Closet Walls
Door Casing-Jamb Closet Door-Interior
Window Sill/Apron g Closet Casing-Jamb
Window Casing/Header/Stops Closet Baseboards
Window Sash/Mullions �, Closet Shelves
Exterior Sill/Parting bead Floor
Window Sill/Apron Ceiling
Window Casing/Header/Stops
Window Sash/Mullions
Exterior Sill/Parting bead
Window Sill/Apron i�f�/ , `f 1 I'.t
Window Casing/Header/Stops
Window Sash/Mullions Upper Walls A1.1 410
Exterior Sill/Parting bead Room Lower Walls
Window Sill/Apron Chair rail
Window Casing/Header/Stops Baseboard
Window Sash/Mullions . Door
Exterior Sill/Parting bead �f' Door Casing-Jamb`
Closet Walls Door
Closet Door-Interior Door Casing-Jamb
Closet Casing-Jamb Door
Closet Baseboards DoorCasingJamb
Closet Shelves Window Sill/Apron
Floor Window Casing/Header/Stops
Ceiling Window Sash/Mullions
a., J. /v Exterior Sill/Parting bead
d/ �1 ( ` Window Sill/Apron
n .dnl /� , ✓ Window Casing/Header/Stops
Window Sash/Mullions
Exterior Sill/Parting bead
Upper Walls / 4 Window Sill/Apron
Room , Lower Walls `/ Window Casing/Header/Stops
Chair rail ! Gj Window Sash/Mullions
Baseboard Exterior Sill/Parting bead
Door 1 ( �p C1 Window Sill/Apron
Door Casing-Jamb { 1 f Window Casing/Header/Stops
Door i Window Sash/Mullions
Door Casing-Jamb Exterior Sill/Parting bead
Door Closet Walls
Door Casing-Jamb Closet Door-Interior
Window Sill/Apron r ` / Closet Casing-Jamb
Window Casing/Header/Stops Closet Baseboards
Window Sash/Mullions Closet Shelves
Exterior Sill/Parting bead Floor `
Window Sill/Apron Ceiling
Window Casing/Header/Stops
Window Sash/Mullions �% ✓
Exterior Sill/Parting bead
Pb MORE THAN 0.5% OR 1.2M&M 2 IS ILLEGAL
i�
REMARKS
v - INSPECTOR
p Inspection Date
J
IOM-11/82-170874
INSPECTOR/AGENCY Commonwealth of Massachusetts
✓=f��,�,�^ CHILDHOOD LEAD POISONING PREVENTION PROGRAM •
305 South St.,Jamaica Plain,MA 02130
'INSPECTION FORM r)��
PRINT ONLY— PRESS DOWN
CASECODE
OWNER'S NAME 8 ADDRESS City
ADDRESS OF INSPECTION(Include Apt.p or Floor) Code
01
City
ROOM SIDE SOURCE Pb Loose R ROOM SIDE SOURCE Pb Loose R
Upper Walls / /f y j. Window Sill/Apron jig
RoomLower Walls / /
/f / / Window CasinglHtsade"r/Stops
Chair rail Window Sash/Mullions
Baseboard Exterior Sill/Parting bead
Door /1// ASp , Window Sill/Apron
j Door Casing-Jar6b J Window Casing/Header/Stops
! Door Window Sash/Mullions
Door Casing-Jamb Exterior Sill/Parting bead
Door Closet Walls
Door Casing-Jamb Closet Door-Interior
Window Sill/Apron !f / Closet Casing-Jamb
Window Casing/Heade`r/Stops " ,/ Closet Baseboards
Window Sash/Mullions Closet Shelves
Exterior Sill/Parting bead Floor
Window Sill/Apron Ceiling
Window Casing/Header/Stops 41 F' --_—_-�F- -�-4- .'o- 1
Window Sash/Mullions
Exterior Sill/Parting bead /'�� f7
Window Sill/Apron ,f"��r'.�C( `
Window Casing/Header/Stops �// %/J/a �" .�l /,-'ri
Window Sash/Mullions UpperWalls-/ 1 i
Exterior Sill/Parting bead Room f Lower Walls
Window Sill/Apron Chair rail
Window Casing/Header/Stops i, Baseboard
Window Sash/Mullions G Door
Exterior Sill/Parting bead / DoorCasing-Jamb /f'C
Closet Walls Door ( /
Closet Door-Interior Door Casing-Jamb`
Closet Casing-Jamb Door
Closet Baseboards Door Casing-Jamb
Closet Shelves Window Sill/Apron 0 H f.
Floor Window Casing/Header/Stops ' 1
Ceiling Window Sash/Mullions
Exterior Sill/Parting bead
s f? Window Sill/Apron
Window Casing/Header/Stops
Window Sash/Mullions
Exterior Sill/Parting bead
Upper Walls // (� Window Sill/Apron
Room r! Lower Walls ` / Window Casing/Header/Stops
Chair rail Window Sash/Mullions
Baseboard Exterior Sill/Parting bead
l� Door F rU Window Sill/Apron
/ ) Door Casing-Jamb'/ f` ~` Window Casing/Header/Stops
Door Window Sash/Mullions
Door Casing-Jamb Exterior Sill/Parting bead
Door Closet Walls
Door Casing-Jamb Closet Door-Interior
Window Sill/Apron Closet Casing-Jamb
Window Casing/Header/Stops Closet Baseboards
Window Sash/Mullions Closet Shelves
Exterior Sill/Parting bead Floor
Window Sill/Apron Ceiling
Window CasinglHeader/Stops �r r:fL 1 r�f r O r i
Window Sash/Mullions
rlr'.
Exterior Sill/Parting bead
Pb MORE THAN 0.5% OR 1.2 mglcm 2 IS ILLEGAL
/
REMARKS
INSPECTOR
Inspection Date_ I
l J' o ..
1OM-11/82-170874
INSPECTOR/AGENCY Commonwealth of Massachusetts
CHILDHOOD LEAD POISONING PREVENTION PROGRAM
305 South St.,Jamaica Plain,MA 02130
'INSPECTION FORM 14
f�R, �'r''.�r lr ._ ,/�i/ /• �, d t Pg Of
CASE CODE
PRINT ONLY— PRESS,DOWN
ty
ADDRESS OF INSPECTION(Include Apt.q or Floor) OWNER'S NAME&ADDRESS Code
J-
City
ROOM SIDE SOURCE Pb Loose R ROOM SIDE SOURCE Pb Loos R
Upper Walls , , vr C , Window Sill/Apron
Room Lower Walls f f ( / Window Casing/Header/Stops
�-� Chair rail Window Sash/Mullions
Baseboard Exterior Sill/Parting bead
Door _ / )FC„ Window Sill/Apron
Door Casing-Jamb #I ! ' Window Casing/Header/Stops
Door ` Window Sash/Mullions
Door Casing-Jamb Exterior Sill/Parting bead
Door Closet Walls
Door Casing-Jamb Closet Door-Interior
Window Sill/Apron yc_ Closet Casing-Jamb
Window Casing/Helder/Stops• ` Closet Baseboards
Window Sash/Mullions Closet Shelves
Exterior Sill/Parting bead Floor
Window Sill/Apron Ceiling
Window Casing/Header/Stops
Window Sash/Mullions
Exterior Sill/Parting bead
Window Sill/Apron
Window Casing/Header/Stops
Window Sash/Mullions Upper Walls
Exterior Sill/Parting bead Room Lower Walls
Window Sill/Apron Chair rail
Window Casing/Header/Stops Baseboard
Window Sash/Mullions Door
Exterior Sill/Parting bead Door Casing-Jamb
Closet Walls Door
Closet Door-Interior DoorCasingJamb
Closet Casing-Jamb Door
Closet Baseboards Door Casing-Jamb
Closet Shelves Window Sill/Apron
Floor Window Casing/Header/Stops
Ceiling Window Sash/Mullions
. r 1, r ,,✓�y"., ^04 Exterior Sill/Parting bead
t r ✓, j / ,:, Window Sill/Apron
11" Window Casing/Header/Stops
Window Sash/Mullions
17-7 4 • Exterior Sill/Parting bead
Upper Walls Window Sill/Apron
Room Lower Walls Window Casing/Header/Stops
Chair rail Window Sash/Mullions
Baseboard Exterior Sill/Parting bead
Door Window Sill/Apron
Door Casing-Jamb Window Casing/Header/Stops
Door Window Sash/Mullions
Door Casing-Jamb Exterior Sill/Parting bead
Door Closet Walls
Door Casing-Jamb Closet Door-Interior
Window Sill/Apron Closet Casing-Jamb
Window Casing/Header/Stops Closet Baseboards
Window Sash/Mullions Closet Shelves
Exterior Sill/Parting bead Floor
Window Sill/Apron Ceiling
Window Casing/Header/Stops
Window Sash/Mullions
Exterior Sill/Parting bead
Pb MORE THAN 0.5% OR 1.2 mglcm 2 IS ILLEGAL f
REMARKS I
r / ,
/� � INSPEGTOA
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1 OM-1 118 2-1 70874
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