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Miscellaneous - 65 BEVERLY STREET 4/30/2018
65�BE-•Y STREE� � 2101005 =0000.0 '\ I f r S.D. LEAD INSPECTIONS 756 Westford St. Lowell, Ma. 01851 978-458-3521 LETTER OF FULL DEL•LADING COMYLLANCE 1 Date. % Dear L `� This is to certify that I inyour property located atA spected(-tJ apartment no. and rel mmon areas ii the City or wn of for full deleading compliance on and on that dM those sufa cited in the initial inspection report�of k'- C l- : 17 l were found to be in full compliance with dental Laws, Chapter 111, Section 197, and 105 CMR 460.000: Regulations for Lead Poisoning Prevention and Control. Massachusetts law does not require the abater=or containment of aU residential lead paint. The residential premises or dwelling unit and relevant common areas shall remain in compliance only as long as there continues to be no peeling, chipping or flaking lead paint or other accessible leaded materials, as long as coverings and/or encapsulaats forming an effective barrier over such paint or Other leaded menials remain in place, and as long as surfaces reversed to correct lead hazards remain reversed and securely in place Seethe reverse side of this letter forthe location(s) of surfaces which were covered,encapsulated or reversed as an abet method to achieve compliance, if applicable. A complete reinspection report is attached to this letter. To the best of my knowledge, the cost of the legally required deleading is.$ P Sincerely, FEB - I rispector DPH License Number INSPECTION AND ABATEMENT HISTORY Name Lic06 Number of Inspector Who Performed Initial Inspection Date of Reoccupancy Reinspection Name and License Number of Inspector Who (If applicable) Performed Reoccupancy Reinspection Names) d License Number(s) of Department of Labor and Industries Authorized Deleading Contractors)Who Performed ent and/or Containment: Names) and Address(es) of Unlicensed Homeowner or Agents) Who Performed Low-Risk Abatement and/or Containment: k" 14 AREAS WHERE LEAD PAINT OR OTHER LEADED MATERIAL HAS BEEN COVERED, ENCAPSULATED OR REVERSED AS A LEAD ABATEMENT METHOD. INTERIOR Room# Side SurfaceTklure Type of COV/REWENC r 49 yi 1 h Z�d a, 71"), T 7, EXTERIOR Side Sr�e Type of COV/REV '35I � � 16 . ��GGYS ' !' ►moi ProScience Analytical Services, Inc. 22 Cummings Park - Woburn, MA 01801 - 781-935-3212 - FAX 781-932-4857 Laboratory Report Contact: Susan Desmarais - Batch# C205688 Client: Susan Desmarais Date received: 1/31/2000 Address: 756 Westford St., # 11 Date analyzed: 1/31/2000 Lowell, MA 01851 Date of report: 2/1/2000 Project# N/A P.O.# /A Project S' e: 65 Beverly St., 1st North Andover, Lead Analysis In Wipes Using SW846-7420 Results in ug/ft2 Sample Detection Lab ID Client ID date Description Result Limit Comments C 39274 1 1/30/2000 Rm 1 floor <10.0 10.0 C 39275 2 1/30/2000 Rm 1 sill <20.0 20.0 C 39276 3 1/30/2000 Rm 1 well <20.0 20.0 C 39277 4 1/30/2000 Rm 4 floor <10.0 10.0 C 39278 5 1/30/2000 Rm 4 sill <20.0 20.0 i C 39279 6 1/30/2000 Rm 4 well <20.0 20.0 C 39280 17 1/30/2000 Control blank <10.0 10.0 All blanks are reported in total micrograms. / �rY1 G( I Dorina Antonovici, Senior Analyst Adrian Stanca, Laboratory Director Page 1 Address 65 &ryr�� y ST Title of File Page of Date File Open: Date File closed: Doc Document/Action Tifile Date of Num. Btefer to Other Purpose of Docuand notes mEcnt/Action action Document/ document/ — Action De artment Board of Appeals — Board of Health — Planning Board — Conservation Commissi on — Building Departrrien,-- t � G� Mailing date : January 21, 2000 P1 JAN26 � Allison Conboy, Health Adm North Andover Board of Hea Town of North Andover North Andover, MA 01845 Northeast Housing Court 2 Appleton Street Lawrence, Massachusetts 01840 (978) 689-7833 Paul J. Burke David D. Kerman Clerk Magistrate Associate Justice Date : January 19, 2000 Re : North Andover Board of Hea Vs : Robert San Antonio No : 99-PC-01174 NOTICE OF RESCHEDULED SHOW CAUSE HEARING A request for criminal complaint naming you as the defendant has been filed in this Court, and a copy of the proposed complaint is enclosed. Before any criminal process issues, the Clerk of the Court will hold a show cause hearing to determine if there is sufficient evidence to require that you be charged with the offense alleged. A clerk' s hearing to determine whether criminal proceedings will be commenced against you will be held at the Clerk' s Office of the Northeast Housing Court, at 2 Appleton Street, Lawrence, MA 01840 at 09 : 30 o' clock, Tuesday, March 07, 2000 . At the hearing you may present your side of the matter, bring witnesses, and be represented by an attorney, if you so choose. Please note that this case has been rescheduled. Pau J. Burke Clerk Magistrate ELMS : RESCH-SCAUSE Town of North AndoverNpRT" * , OFFICE OF 3�c<< �° COMMUNITY DEVELOPMENT AND SERVICES p i 27 Charles Street North Andover, Massachusetts 01845 �9SSgcNU5�tt5 WILLIAM J. SCOTT Director (978)688-9531 Fax(978)688-9542 February 2, 2000 Robert San Antonio 65 Beverly Street North Andover,MA 01845 RE: Deleading Dear Mr. San Antonio, This letter is in regards to the Order to Correct that was issued on your property known as 65 Beverly Street on September 17, 1999. The Health Department has received the Letter of Full Deleading Compliance from your licensed Lead Inspector, DPH license number 11896 dated January 31, 2000. I have contacted the Lawrence Housing Court and have apprised them of the compliance to the Order. The scheduled hearing for March 7`h has been cancelled and this matter is considered closed. Thank you for your cooperation. If this office can be of any assistance in any future matters, please do not hesitate to call us. Sinceret _ ,r Sian Ford Health Inspector BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 Town of North Andover. NQRT►, OFFICE OF 3�Oy t t o 1�Q L COMMUNITY DEVELOPMENT AND SERVICES ° . A 27 Charles Street :10 North Andover, Massachusetts 01845 X94°•-1�° °"tty WILLIAM J. SCOTT SSAcwus� Director (978)688-9531 Fax (978)688-9542 February 2, 2000 Robert San Antonio 65 Beverly Street North Andover,MA 01845 RE: Deleading Dear Mr. San Antonio, This letter is in regards to the Order to Correct that was issued on your property known as 65 Beverly Street on September 17, 1999. The Health Department has received the Letter of Full Deleading Compliance from your licensed Lead Inspector, DPH license number 11896 dated January 31, 2000. I have contacted the Lawrence Housing Court and have apprised them of the compliance to the Order. The scheduled hearing for March 7`h has been cancelled and this matter is considered closed. Thank you for your cooperation. If this office can be of any assistance in any future matters, please do not hesitate to call us. Sinceret , Sdsan Ford Health Inspector BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 IF Lead Inspection/ Surface Assessment Form Inspeclo/Agency M & M •_ / LEAD INSPECTIONAL SERVICES, INC. page of `3 —Servicing all of Massachusetts— Method Used: License w - Phone(617)737-2514,(978)685.4172 a Fax(978)685.9062 C Na2S expiration date J* X-Ray uorescence Moder Serial#Ai Address Apt.# City 161sl j8jqjvjejkjHy1S r W W //-Atidl;7Ae4 Child's Name(Last,First,Init.) Birthdate(M/D/Y) Sex AiISI-t111161 la lis Parent/Guardian's Last Name Parent/Guardian's First Name single Family ❑ Multi-Family ja P R e- d Number of Unita Owner's Name: WCO Owner's Address: titij Alkdcvelt KEY: CAP rapped Remarks/Calibration: cov covered DIP d Aped ENC erlcapsuWted MI made imacl NA not accessible NEGnegative Scales:(scores of o or t pass.scores o12 0i is POS posltive PRE prepared sudaW subwalace N y paAf as paim iraad t=<t0%Palm na<a:t1 2=,IGK yorw awl rot:i REM removed substrate o.egad t=<lO.needs,epsa 2-10%needsrepall REP replacement Mat Tape Tesl 0-Ino paiaremoved 1.onrpantremoved 2=,1116'parol removed REV reversed SCR scraped to bare substrate X-cul Tape Iasi 0=no Pam:removed t= 1116'Wim removed 2=,1/16'pans removed Floor a J_ Floor p -7 ; f 1 I I'C; I I I I I 1 1 I I I 1 I I c 1 I 1 I -r-r -r - r-r-r- - T- T- T-1- 1- -r-r -r-r-r-r-r-r- r- T-T -T - 1-1 - I 1 1 1 1 I 1 1 1 I 1 1 1 I 1 1 1 I 1 I 1 1 I 1 I 1 -r -r -r- r - r- r - 1- -r-r-r-r-r-r-r -T -T - T - T -T- T -T - I I I I I I Q I I 1 I 1 1 1 I I I 1 I r I I I 1 -r -r-r- r- l - -r-'r-r-r-r-r- r-r-T- T-T - T -1-T- 1 I I I I 1tary�l`]1 •LI�p 1 1 1 1 1 I 1 1 1 I I 1 1 I 1 1 1 r- r- ' -T_I T _ _T_ T_ _r_r_r_r_r_ r_T_ T_T_T _T _T T'- 1 1 I I 1 I 1 I 1 1 1 I 1 I I 1 1 f I 1 1 1 1 1 1 r-r -r-r-r-r- r-r- r - I 1 1 I 1 1 1 I 1 1 1 I 1 1 1 I 1 1 I 1 1 1 1 61 I 1 1 1 i 1 1D B, I I I I I I I 1 1 1 I I D 1 1 1 I 1R 1 I I I 1 I I I 1 1 I 1 I 1 1 I i I I 1 I 1 1 I 1 }-F-}-}- -+ -4 - 1 1 1 1 1 1 I I I 1 I 1 I 1 I 1 I I I I 1 1 1 1 1 1 I I 1 I 1 I I 1 I 1 I I 1 1 I 1 1 1 1 1 1 I 1 1 _ F_L_♦•_ _L- - J- _6_F_4-L-L-L-4_L-L_1-i -J_J _J_ 1 I I 1 1 1 I 1 1 1 I 1 1 1 I I--4-_L-1-- -L-J- -J- -L-L-L-L-L-L 1 1 1 1 I 1 1 1 1 1 I 1 I 1 t I 1 I 1 I I I I 1 I I I I A(street side) A(street side) Pb(lead)more than 1.2 mg/=2 with x-ray fluorescence or positive with Na2S is Dangerous. Lead Hazards? 1.n comp4ance INSP.DATE (Y orWVj REINSvaP.DATE 2. *in Progmss ! 3.moccWancy hI i a.Io work dale VV ll�/ inspector 1.e, mW REINSP.DATE 2 M*ance REINSP.DATE 2.work nProO aas progress 3.I.oCQtpanty 3 reocugancy e,no work dale e m work dale t.n IbII1PYaf1(a REINSP.DATE 2.worklnprdg.as Full Compliance Date 3reowrpe" ..aw wak der Inspector Did you complete a sudace ame m cnt£orm S)r euealmlation? Y oto SURFACE I1ONES"-"" lam■■���■I■ 7 %�■� MEEMMM MR MOM . . -•'tel " if%I�L���■■ �■� .. ....cam, • ■���■i■■■ � � - � �■■� • L FM .•- • v� • .: •.. • • `.•- • LOCATION/ COMMENTS SURFACE 'rte■■■���■■ �■� . .Wil//-�i'i7���■■���■� � - . -. . moi■■■���■■ �■� • •• • • • , / • FA LOCATIONI SURFACE mcm ME•� 0- /I■■■ M■■ mm . ., v� • ME LOCATIOW SURFACE All ... .. . . . r cl®■!�t'i�i■■ i■� ill WIW■■��Mmwm am■� • •.•- l • ,L ill■■■���■� ■��'�"+��+■tel■■���■■ ■■� .r rim . . !�i1i■■��■■■■ ■■■■ [ilii■■■���■■ �■� M & M LEAD INSPECTIONAL SERVICES, INC. LEAD INSPECTION/ Pagez-?Of —Servicing all of Massachusetts— SURFACE ASSESSMENT FORM Phone(617)737-2514,(508) 5-4172 • Fax(508)682-9967 Address of Inspection: !E/�� Apt# City EXTERIOR SIDE LOCATION/ LEAD L OWR DLR SRF COMMENTS DELEAD DELEAD SURFACE ABT? PREP? DATE METHOD A0 COSiding 0.L Comerboards Lower trim VA % A /ONA C . Upper trim �Q H �► Door Doorcasing/Jamb .� Q Threshold Q Door Door casing/Jamb IThreshold Door I / Door casing/Jamb Threshold Q . Door Door casing/Jamb Threshold Window sillL Window casing /— Win sash/Mullions Window sill l_ Windowcasing }� Win sash/Mullions Window sill Window casing ,Z Win sash/Mullions ` n Window sill ►J Window casing Win sash/Mullions Cellar win units /r Cellar win units L All 43 Cellar win units Qr (e-e -A/ jj Cellar win units Foundation (/ Bulkhead Fences nor cis LICENSE# J/ DATE 10 TU Il 1 1 i a C'2 rj ���^-f �? .� �.� • -�: '�9rr s a� -�='v�'-�--..,�-� o,.i ��of ' f��-,,.� r71I�` 11�7 n�-?.i• cid LI-C Influenza HMO Medicare Risk (Senior) Reimbursement Project Adult Vaccine Administration Record (Influenza) The doctor or clinic may use this form for the written documentation required for every dose of vaccine, or they may record it in your medical record. They will record what vaccine was given, when the vaccine was given,the address where the vaccine was given, the name of the company that made the vaccine,t e vaccine's special lot num- ber,the name and title of the person who gave the vaccine, and the document number Info ation about the person to receive vaccine le e rin Name: (Last, First, MI) tirth date: Age: 1 Street address: C' State: Zip: Phone: Check the source of your healthcare from he following/ Medicare #: Blue Care 65 #: Fallon Senior Plan + #: First Seniority(Harvard Pilgrim) #: Secure Horizons (Tufts Health Plan for niors) #: United HealthCare/Medicare Complet Other #: Signature of person to receive vac/ine, or thatperson's guardian X Date: For Clinic/Office Use Vaccine name: Date vaccine administered: Injection site: Date VIS given: Date on VIS: Vaccine manufacturer: Vaccine lot number: Name and title of vaccine administrator: Clinic/office address: (8(14/99) M Town of North Andover a NCRTM OFFICE OF 3?0 4,0L COMMUNITY DEVELOPMENT AND SERVICES ° : A 27 Charles Street ° ". North Andover, Massachusetts 01845 *�° <y WILLIAM J. SCOTT 9SS4 USES Director (978)688-953'1 Fax(978)688-9542 January 20, 2000 Robert San Antonio 65 Beverly Street North Andover, MA 01845 RE: Deleading Dear Mr. San Antonio: This letter is in regards to the outstanding Order to Correct that has been issued on your property known as 65 Beverly Street. The Health Department has received a Notification of Deleading Work form concerning your property. According to the form, Nina's Deleading Co. will be performing the work between 1/21/2000 and 2/21/2000. In response to this action I contacted the Lawrence Housing Court. I am writing to inform you that you do NOT have to appear at the scheduled court date of February 1, 2000. The issue has-been continued until Tuesday, March 7, 2000, at 9:30AM. If the work is complete and a Letter of Compliance has been received at the Health Department before March 7d' you may not have to appear on that day either. If the Letter of Compliance is not received, you must appear before the court. In addition, if at any time, concern about the progress of this project is in question, it can be brought back into court immediately. Please notify this office of any significant changes to the proposed schedule so that we can continue the positive progress of this matter. Thank you for your anticipated cooperation Sincerely, Susan Ford Health Inspector BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 01-18-00 05:09 a 5080 R 6 001 Department of Public I ARI] and Department of Labor& Industries NOTIFICATI0N OF DELEADING WORK All sections of this form must be completed in order to comply with the notification requirements of M.G.L. c. 111 § 197 FILE NUMBER: � License A�.1,1-3--= U Contractor performing projec ' / _ .2 0c) / Exp. Date r /v • � License a Lead Paint Inspector Date of Inspection If low-risk deleading work is being performed, complete the following line: gents} Property Owner �.��e of Pra�t:ct Floor Building Name (if any) Street Address e Apt. No. Zip City City -ing Mclltod: W et/Dg Scrapin Heat Gun ncapsulant Covering Delitton Caustics a lacement Outer If-ower"-splecled,_piease explai Check One: dwelling is multi-family single-family — Start Date,L Completion Date When will workbe done; an� Pm- weekends? " (� /( l License It Project Supervisor's Name IL Property Owner I Address State Zip City Telephone In case of emergency contac Plione: day --- evening �-- (OVElt) 19 0 r l l 01-18-00 05:09 215080 R B 002 01-18-00 05:10 25060 R 0 003 Intccordanee with'Massaehusetts General laws c. 111 § 197. 454 CMR 22.00 and 105 CMR 460.000, notice of the date and tncdtod(s)of removal or covering of paint,plaster or other accessible materials containing dangerous levels of lead is to be provided and must be received'by the following persons,at least ten(10 days prior to the beginning of deteading. 1. Occupants of the dwelling unit 2. All other occupants of the residential premises, if any 3. Director, Childhood Lead Poisoning Prevention Program Fax(617)753-8436 Department of Public Health, 470 Atlantic Avenue, Boston, MA 02110 4. Director, Asbestos and jead Program Fax(617) 727.7568 Department of Labor and Industries Room 1106, 100 Cambridge Street, Boston, MA 02202 5. Local Board of Hcalth/Code Enforcement Agency 6. Miissachusetts,Historical Commission, (If premises is listed on the State Register of Historic Places, this notification 220 Morrissey Blvd must be made upon receipt of an Order To Correct Violations or at least 30 Boston, MA 01125 days prior initiating preventive deleading.) Fax(617) 727-5128 The undersigned hereby states, under the pains and penalties of perjury, that he/she has read and understood the Commonwealth of Massachusetts Deleading Regulations, 454 CMR 22.00, and Uad Poisoning Prevention and Control Regtrtations, ,105.CMR - .460.000,.-am that the..inf&ma6on contained-in this..notification.is irue.and.cor ect.to,the�bcst othislher knowled'e the Wief, Date �— �~ zoo 0 Signed: PTAIF Title: Q », Company Q C 41y P erty nwn�r(If owner or unlicensed owner's agent will be preforming low-risk deleding work) I certify that.I have complied with the training requirements of the Commonwealth of Massachusetts Lead Poisoning Prevention and Control 116gulations, 105 CMR 460.175, for owner/agent low-risk abatement and containment, I further certify that I or my agent will be perforating the following low-risk activities (I have circled all that apply): applying liquid encapsulant capping baseboards applying exterior vinyl siding covering surfaces removing doors, cabinet doors, shutters I certify that all the information contained in this notification is true and correct to the best of my knowledge and belief. Datc: Signed: C1WP30U.r:ninXJSV'ORMSV)61,NOTPRM Rev IOPJ.S Y c � Mailing date : December 16, 1999 P1 Allison Conboy, Health Adm North Andover Board of Hea Town of North Andover North Andover, MA 01845 Northeast Housing Court 2 Appleton Street Lawrence, Massachusetts 01840 (978) 689-7833 Paul J. Burke David D. Kerman Clerk Magistrate Associate Justice Date : December 10 , 1999 Re : North Andover Board of Hea Vs : Robert San Antonio No: 99-PC-01174 NOTICE OF SHOW CAUSE HEARING A request for criminal complaint naming you as the defendant has been filed in this Court, and a copy of the proposed complaint is enclosed. Before any criminal process issues, the Clerk of the Court will hold a show cause hearing to determine if there is sufficient evidence to require that you be charged with the offense alleged. A clerk' s hearing to determine whether criminal proceedings will be commenced against you will be held at the Clerk' s Office of the Northeast Housing Court, at 2 Appleton Street, Lawrence, MA 01840 at 10 :30 o' clock, Thursday, January 06, 2000 . At the hearing you may present your side of the matter, bring witnesses, and be represented by an attorney, if you so choose . Paul J. Vrke Clerk Magistrate i ECMS : SCH-SCAUSE 4 l REQUEST FOR CRIMINAL COMPLAINT FOR LEAD PAINT To any Justice or Clerk-Magistrate of the above-named Court: North Andover Health Dept , Town of North Andcver , on behalf of the Commonwealth, on oath complains that: Robert Sar Antonio GS was and is the owner of residential premises located at 65 Beverly Street,N. Andcver,MA 01845 wherein a child or children under the age of six resides; On September 16 , , 199 9 , a representative of the Childhood Lead Poisoning Prevention and Control Program inspected said premises and determined that paint, plaster or other materials accessible to children contained dangerous levels of lead equal to or in excess of 1 .2 milligrams lead per square centimeter or 0.5% lead by dry weight as defined by the Program' s regulations, 105 C.M.R. §460. 000 and the public health law, Gen.L. c. 111 §194; On Sept.eMbEir 22. , 199 9 , pursuant to § 410 . 750 (J) of the Program' s. regulations, and pursuant to §410.832-.833 of the State Sanitary Code, the defendant was served with a written order .to remove or cover such paint, plaster or other materials, thus to comply with §197 of the law. On Novenil,er 22 , 199 9 , and from day to day thereafter _the defendant has failed to comply with the order, each such day being a separate offense and a separate and distinct count ;of this complaint; all in violation of Program regulations, 105 C.M.R. § , the State Sanitary Code, §410.910-.920, and Gen.L. c. 111 §197-198; and did so willfully, intentionally, recklessly or repeatedly. Date plainant Sworn to before the undersigned Clerk-Magistrate of this Court. /c,14/1 � Date C1 -Magistrate f��41� ti (o 16 6 COMPLAINT To any Justice or C ►I� All' above-named Court: � North Andover He, _•th Andcver on behalf of the Coma, / ���' _ii complains that: Robert Sar AntonioSvcly —t. was and is the owner of .,:sidential premises located at 65 Beverly Street,N. Andcver,MA 01845 wherein a child or children under the age of six resides; On September 16 , , 199 9 , a representative of the Childhood Lead Poisoning Prevention and Control Program inspected said premises and determined that paint, plaster or other materials accessible to children contained dangerous levels of lead equal to or in excess of 1 . 2 milligrams lead per square centimeter or 0.5% lead by dry weight as defined by the Program's regulations, 105 C.M.R. §460 . 000 and the public health law, Gen.L. c. 111 §194; On Sept.erI)Er 22 , 199 9 , pursuant to § 410. 750 (J) of the Program' s, regulations, and pursuant to §410. 832-.833 of the State Sanitary Code, the defendant was served with a written order to remove or cover such paint, plaster or other materials, thus to comply with §197 of the law. On November 22 , 199 9 , and from day to day thereafter _the defendant has failed to comply with the order, each such day being a separate offense and a separate and distinct count ;of this complaint; .all in violation of Program regulations, 105 C.M.R. § , the State Sanitary Code, §410.910-.920, and Gen.L. c. 111 §197-198; and did so willfully, intentionally, recklessly or repeatedly. Date plainant Sworn to before the undersigned Clerk-Magistrate of this Court. /Cl//0X "4 Date Cl&rk-Magistrate r REQUEST FOR CRIMINAL COMPLAINT FOR LEAD PAINT To any Justice or Clerk-Magistrate of the above-named Court: North Andover Health Dept , Town of North Andcver , on behalf of the Commonwealth, on oath complains that: Robert Sar. Antonio was and is the owner of residential premises located at 65 Beverly Street,N. Andcver,MA 01845 wherein a child or children under the age of six resides; On September 16 , , 199 9 , a representative of the Childhood Lead Poisoning Prevention and Control Program inspected said premises and determined that paint, plaster or other materials accessible to children contained dangerous levels of lead equal to or in excess of 1 .2 milligrams lead per square centimeter or 0.5% lead by dry weight as defined by the Program' s regulations, 105 C.M.R. §460 .000 and the public health law, Gen.L. c. 111 §194; On September 22 , 199 9 , pursuant to § 410 . 750 (J) of the Program' s. regulations, and pursuant to §410.832-.833 of the State Sanitary Code, the defendant was served with a written order to remove or cover such paint, plaster or other materials, thus to comply with §197 of the law. On November 22 199 9 , and from day to day thereafter _the defendant has failed to comply with the order, each such day being a separate offense and a separate and distinct count ;of this complaint; .all in violation of Program regulations, 105 C.M.R. § , the State Sanitary Code, §410.910-.920, and Gen.L. c. 111 §197-198; and did so willfully, intentionally, recklessly or repeatedly. L _J Date plainant Sworn to before the undersigned Clerk-Magistrate of this Court. 174`r Date C1 -Magistrate • Z '370 627 500 US Postal Service Receipt for Certified Mail No Insurance Coverage Provided. Do not use for International Mail See reverse Sent to o6er�- o Street&Number 6 Post office,State ZIP e Ala R 69-Or Postage $ 9 9 Certified Fee C• lv Special Delivery Fee Restricted Delivery Fee LO Retum Receipt Stowing to *' Whom&Date Delivered "t o Retum Receipt Sfw*to Wham, Q Date,&addressee's Address TOTAL Postage&FeesCO $ n 0 Postmark or Date ri I a Stick postage stamps to article to cover First-Class postage,certified mail fee, and charges for any selected optional services(See front). 1. If you want this receipt postmarked, stick the gummed stub to the right of the return address leaving the receipt attached, and present the article at a post office service m window or hariiJ it to your rural carrier(no extra charge). 2. If you do not want this receipt postmarked,stick the gummed stub to the right of the Q) return address of the article,date,detach,and retain the receipt,and mail the article. LO 3. If you want a return receipt,write the certified mail number and your name and address on a return receipt card,Form 3811,and attach it to the front of the article by means of the gummed ends if space permits. Otherwise,affix to back of article. Endorse front of article n RETURN RECEIPT REQUESTED adjacent to the number. Q 4. If you want delivery restricted to the addressee, or to an authorized agent of the c addressee,endorse RESTRICTED DELIVERY on the front of the article. M 5. Enter fees for the services requested in the appropriate spaces on the front of this I_ receipt. If return receipt is requested,check the applicable blocks in item 1 of Form 3811. 6. Save this receipt and present it if you make an inquiry. 102595-99-M-0079 c2 r Town of North Andover t NORTk OFFICE OF r COMMUNITY DEVELOPMENT AND SERVICES 0 op 27 Charles Street WILLIAM J. SCOTT North Andover, Massachusetts 01845 �4Ssgc`►+usS��y Director (978)688-9531 Fax (978)688-9542 DATE:_ September 17 , 1999 ORDER TO CORRECT VZOLATION(S) Robert n Antonio 65 Beverly Street North Andover, MA 01845 Owner or agent of the property located at 65 Beverly Street, N. Andover, MA Be advised that an agent of the Board of Health has determined certain portions of the aforementioned residential property to- be in violation of the State Sanitary Code Chapter II, "Minimum Standards of Fitness for Human Habitation," 105 Code of Massachusetts Regulations (CMR) 410.750(1). This violation also constitutes a violation of the Lead Law, Nfassachusetts General Laws (MGL), Chapter 111, Section 197, and the Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. Conditions exist in this residence which may endanger and/or materially impair the health of the occupants of these premises. DECLARATION OF EMERGENCY The Director of the Childhood Lead poisoning Prevention Program and the Board of Health declare that the presence of the aforementioned violation of the Lead Law and the Regulations for Lead Poisoning Prevention and Control constitutes an emergency pursuant to the Lead Law, MGL Chapter 111, Section 198 and within the meaning of the Sanitary Code, Chapter I, 105 CIMR 400.200(13). BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 CORRECTION OF LEAD VIOLATIONS) The Lead Law, MGI,c. 111-, ss. 189 .-199B, and the Department of Public Health's Regulations for Lead Poisoning Prevention and Control, 105 CNIR 460.000, require that residential premises or dwelling units built before 1973 have lead paint lylolations either abated and contained for full compliance or brought under interim control when a child under the age of six lives in the residential premises or dwelling unit. If you are interested in interim control, then you must hire a licensed private risk assessor to perform a risk assessrlent and issue a "Lead Inspe---tion/Risk Assessment Recort" before you proceed. Ir you are inter er� in delea Lg for dull compliance, then you must hire a licensed private lead inst;e_or to perform a lead inspection and issue a "Lead Inspectien/Surface Assessment Report" before you proceed. The Lead Law, the Department of Labor and industries' Deleading Regulations, 454 CIMR 22.00, as well as the Regulations for Lead Poisoning Prevention and Control require that any high-risk residential lead abatement and containment activities, including making loose paint, plaster or putty intact, be performed by licensed deleading cor.tractors—whether in the context of achieving interim control or full compliance. An owner or owner's agent, after meeting the training requirements of 105 CIVa 460.175, may perform certain low-risk abatement and containment activities in accordance with these regulations without a deleader's license—again, whether in the context of achieving interim control or full compliance. These specific low-risk abatement and containment activities are the following: applying encapsulants; applying such coverings as carpet, vinvl, aiuminum, plywood, ple.1 iglass, and acrylic, to surfaces, including siding of exterior surfaces; removing doors, cabinet doors and shutters; and capping baseboards. In addition, an owner or owner's agent may perform structural repairs, as defined in 105 CMR 460.020, and cleaning of leaded dust, as may be required for interim coritrol, except that the final clean-up required after the completion of igh-risk abatement and cont al=i entwork by a licensed deleader must be performed by a licensed deleader. Violations of these requirements shall be punished by a tine of not less than 5500 nor more than 51,500 for each offense. ORDER You are hereby ordered to remedy all violations of NiGL c. 1 i 1, s. 197 and 105 CNiR 460.000, as identified by a licensed private lead inspector or, 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: tiz�`ithin sixty (60) days of your receipt of this Order, you must provide to this agency a copy of a sued contract with a licensed deleader, if any high-risk abatement and containment work, including malting leaded paint, putty or`plaster intact, is-required. If you or your agent is doing owner/agent low-risk abatement and containment and/or interim control work, you must also provide within sixty(60) days a signed and completed CLPPP form entitled "Documentation of Training to Perform Owner/Agent Low-Risk Abatement and Containment and Deadlines by Which Owner/Agent Low-Risk Work and/or Interim Control Work Will Be Completed." The contract must specify, and if you or your agent will be perfo=ng low-risk abatement and containment work or intenmA control work, then you or your agent will attest in the CLPPP fo , described above, that ti'-;e work will be completed according to ti,e following schedule: t (a) Violations of the arterior of the dwelling unit and interior common areas must be abated or contained-for full compliance, or as required for interim control, within ninety(90) days of your receipt of this Order. However, you have a total of one hundred and twenty(120) days from receiving the Order to complete the following activities: (i) any low-risk abatement and containment work you or your agent perform, as long as all dust-generating abatement or containment work, including surface preparation, required to be done by a licensed deleader, has been completed, and any doors removed have been replaced, within ninety(90) days of your receipt of this Order; (ii) application of encapsulants by licensed Level II deleaders, as long as all dust- generating abatement or containment work, including surface preparation required to be done by a licensed deleader, has been completed within ninety(90) days of your receipt of this Order, (iii) installation of replacement windows, as long as you can demonstrate that new windows have been ordered within ninety(90) days of your receipt this Order. (b) Violations on the exterior-of the residential premises and exterior common areas must be abated,and/or contained for full compliance or as required for interim control, within one hundred-and twenty(120) days of your receipt of this Order. Any contract with a deleading contractor must also specify,that the unit will meet acceptable lead dust levels, as determined by the results of sampling done by the licensed private lead inspector or risk assessor at the time of the reoccupancy reinspection, if one is necessary. Should any of the dust samples fail to meet acceptable standards, the contractor will be required to reclean the entire unit until all dust samples meet acceptable levels. In interim control cases in which no reoccupancy reinspection is necessary and no deleading contractor involved because no high-risk abatement and containment activities, including making leaded paint, plaster or putty intact, were necessary, then you or your agent who performed required work will be responsible for cleaning the unit to meet acceptable dust levels. In these cases, dust levels will be determined by the results of sampling done by the licensed private risk assessor at the time of the risk assessment reinspection. Any room or interior area in which one or more surfaces does not meet acceptable dust levels must be recleaned by you or your agent in its entirety. You must comply with all of the deadlines stipulated above, and with all applicable sections of 105 CMR 460.000, Compliance-with-this- O'r..der will-be determined by this agency's receipt of the appropriate documentation within the specified deadlines. The documentation consists of the following: a) if any high-risk abatement and containment work is necessary, including making lead-painted surfaces intact, a copy of a signed and dated deleading contract with a licensed deleader; b) if you or your agent will be doing low-risk deleading work or such other work as may be required for interim control, such as structural repairs and lead-dust cleaning for interim r f control, a completed and signed copy of the CLPPP form, 'Documentation of Training to Perform Owner/Agent Low-Risk Abatement and Containment and Deadlines by Which Owner/Agent Low-Risk Work and/or Interim Control Work Will be Completed"; c) a Letter of Lead Paint(Re)occupancy(Re)inspection Certification issued by a licensed private lead inspector or risk assessor, in cases in which high-risk abatement.and containment work, such as making loose lead paint, plaster or putty intact, is necessary, thus requiring occupants to be relocated from the unit for the duration of the work; d) copies of results of all dust samples taken by the licensed private lead inspector or risk assessor; e) a Letter of Full Deleading Compliance issued by a licensed private lead inspector or a Letter of Interim Control issued by a licensed private risk assessor. In addition, a copy of the deleading notification must be received by this agency at least ten (10) business days prior to any commencement of deleading, whether performed by a deleader or you or your agent, and whether in the context of full compliance or interim control. PENALTIES Failure to comply with this order will result in criminal prosecution. The law provides penalties of up to $500 for each day of non-compliance. In addition, you may become liable for civil punitive damages equal to three times,any actual damages for failure to comply with this order if a child becomes poisoned. CORRECTION OF VIOLATION BY CODE ENFORCEMENT AGENCY If within the time periods stipulated above the aforementioned residential property is not brought into full compliance or interim control, this agency.may contract with a licensed deleader to correct the violation(s) and obtain a Letter of Full Deleading Compliance or a Letter of Interim Control, and bill the owner, or initiate court action to reimburse itself. RIGHT TO A HEARING You may request a hearing pursuant to 105 CMR 460.900 of the Regulations for a Lead Poisoning Prevention and Control, in conjunction with the procedures of 105 CMR 400.200(B), the Sanitary Code provision for hearings in emergency public health matters. As already noted, the aforementioned violation constitutes an emergency. (See"Declaration of Emergency" section.) As such;`you may request a hearing only if you have complied with this Order. The hearing will be provided within ten days of your request. This agency shall issue a written decision within seven days after the hearing. asp ctor Director Certified Mail No. C:IWP50V-EAD1995%C4D ERAL%HOT09AWP6 I - Town of North Andover a NORTiy , OFFICE OF �2 `�"" �-c COMMUNITY DEVELOPMENT AND SERVICES ° p 27 Charles Street ^09 �^; North Andover, Massachusetts 01845 WILLIAM J. SCOTT SSAcmus Director (978)688-9531 Fax (978) 688-9542 LEADDE:'ERMINATION REPORT FOFcbi Dace of De:e.^.nination: Method used: Sodium Suifide Expiration date.-- X-Ray ate:X-Ray Fluoresccnce Mode!: Se.;al m: `J 9 .Z-7.0-7 Property Address: 1— S 3 e-✓ *-,13t Apt. Description of Prepe.Lv: Sinele iarruly _yt, _Multi-farniiy m units 21 Garaee F encs Other suuc-tures Age of Properrv: Pre 1978 Post-1978 Occupant: Occupants under six Vear Ot age: f DOB: 2— DOB: DOB: Occupant's T e!ephcae: — \ I Prooe:^y Own= j Owner's Address: S - r Owner's Telephone: _ _4y Lead Hazards found? Yes No An X-ray fluorescence.reading greater this 1.2 mz/cm2 or a gray or black reaction to sodiurri sulfide indicates a positive level of lead and constitutes a positive determination. Deieading of lead painted suriaccs as a result of this report or subsequent inspersion must be performed by a licensed de!eading contractor and/or by an owner/agent who is trained to perform specific wort: as required under the Lead Law. Contact the Childhood Poisoning Prevention Program for additional information regarding deleading and training. r.\w1,50L 1ZI995\LIr.FOftU�iuRE?r.'�PD BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 Y LOCATION SOURCE Pb l 1. I Child's bedroom I Window parting bead/e�cterior sill area 2. Child's bedroom ',;,u->.dow sill I 3. I Laving room I Window paling bead/ 4. I Kitchen Window pa,zing bea&e er.or sill area I ! 5. I Lntenor I Fla.-ing paint i i 6. Lx:e:icr I Flatting paint i7. I E.,Lerior I Cellar window units I i Q. I E.aerior I Window siils below 9 E: to for Main ent,,/ door casing 10. Interior Outside cone: or U-asebeard 11. Kitchen or Bates rccm C; air rail 12. Bads room I Window sill ! 13. I Ex prior I Threshold I 1=1. I Interior `railway(c;,mmon area) I Stair tread or su-irger 15. I Interior hailwav (common area) I Balusters 16. Interior hallwav (common area) Door ca sing 17. Porch I Stair tread or 1.ser ! I 18. Porch I Riling cap 19. ! Porch I Balusters 20. Porch Suppor columns(<o" diameter or souare) I I i 21. Porch I Staircase sty nger I ! I 22. I Extericr I BuLkhead 23. GarageiOutbuiiding I Door casing or Jamb i ! 24. Interior Closet door or baseboard (uncapped) 25. Interior Cabmet door, shelf, or wall EEE T u Town of North Andover Of AORTN r OFFICE OF COMMUNITY DEVELOPMENT AND SERVICES p 27 Charles Street WILLIAM J. SCOTT North Andover, Massachusetts 01845 �9S3gc,Hus�t�y Director (978)688-9531 Fax(978)688-9542 Date: September 17 , 1999 Robert San Antonio 65 Beverly Street N. Andover, MA 01845 Dear Mr. San Antonio A lead paint determination was made of the property owned by you at 65 Beverly St. by Susan Ford of'the Town of N. Andover Health Department on September 16 , 19 99 The determination revealed the presence of lead paint in violation of Massachusetts General Laws, Chapter 111, section 197. Please contact this ofice at 6 8 8—9 540 - as soon as possible to disc-ass your responsibilities in this case, and the material enclosed. The Massachusetts Department of Public Health (DPH)'s Lead Poisoning Prevention.Regulations require that you provide to this office, within sixty (60) days of your receipt of this letter, a contract with a licensed deleader, signed, by both you and the deleader, to abate and/or contain all lead violations existing in the dwelling unit, including interior and exterior common areas. You must provide the deleading contractor with a complete inspection report from a licensed private lead inspector, including an assessmentt for encapsulation if desired. Also, if you or your agent is planning to do any low-risk abatement and containinent worl, within sixty (60) days of your receipt of this letter you must provide this office with a signed and completed Childhood Lead Poisoning Prevention Program (CLPPP) form entitled, "Documentation of Training to Perform Owner/Agent Low-Risk Abatement and Containment and Deadlines By Which Owner/Agent Low-Risk Work Will Be Completed." This form is available from CLPPP in the Homeowners Abatement package. The contract with the-icensed deleader-must,specify,and ifyou-or your-agent will be performing low- risk work, then you or your agent will attest in the CLPPP owner/agent form described above, that the deleading will be completed by the deadlines described in this paragraph. All violations on the interior and interior common areas must be deleaded within ninety (90) days from your receipt of this letter. However, you have one hundred and twenty (120) days from your receipt of this letter to complete the following: any low-risk deleading work you or your agent perform, as long as all dust- generating abatement and containment work, including surface preparation, required to be done by BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 I I P a kcensed deleader has been completed, and any doors that were removed have been replaced, within ninety (90) days; application of encapsulants by Level II deleaders, as long as all dust-Venerating abatement or cont=ent work, including surface preparation, has been completed within ninety (90) days; and installation of replacement windows, as long as you can document that new windows have been ordered within n.inery (90) days. All exterior violations must be delead--d witrin one hundred and t,,venty (120) days. The contract must also specify that t'le unit will meet acceptable dust levels. as dete=ined by rise sampiinc- done by the iicensed private lead inspector; and that the deleader will be required to reclean the unit if necessary until it meets acceetable standards for dust. Theis Department is required by law to file a case against you in counnn 11- it has not received the rewired documents by the si-cty-firs, (hist) day, or if the time for rote or and ererior de!ead.n compitarce are net adhered to as de=emed by a private lead inspe-or. Ln a c:irninal case, you may be fined by the coon up to 5500 for each day of nor:-compliance. Under the law, only deleadinQ contractors licensed by the Department of Labor and Industries (DLI) may engage in the abatement or containment of known lead hazards, with the exception of certain low-risk work that may be performed by an owner or owner's agent without a deleader's license. Before such an owner or owner's agent may perform low-risk abatement and containment work, he or she mus read the Childhood Lead Poisoning PreventionPro=.m (CLPPP)'s educational booklet, view the CLPPP encapsulation videc, and take a self-corrected exam that mus be submitted to CLPPP. To receive a-copy of the Homeowner Abatement package, call the CLPPP Central OEce at 1-800-532-95-1. Also available from CLPPP, at the phone number above, is the booklet, "Deciding Whether to Encapsulate." If after reading it you decide you would like to have an assessment for encapsulation perforr:ed, you must hire a licensed private lead inspector to per-fern this assessment. Results of the assessment shall be recorded on the initial "Lead Inspection/ Surface Assessment form".and a copy should be sent to me. Only those surfaces approved by the licensed ins—pec—tor—Will be eligible for encapsulation, no matter who actually applies the encapsulant — a licensed Level II_deleader or you or your agent. Irave enclosed a list of licensed private lead inspectors. If you would like information about financial resources available for deleading, a pamphlet entitled "Deleading? Grants & Loans for Property Owners 1995 Resource Directory" is also available from CLPPP. At least 10 business days before any deleading work begins, the deleader must provide written notification to DLI, all residential occupants, the Board of Health and CLPPP. It is vour resconsfoilirv, as the owner of the premises, to make sure the contractor sends the completed forms to all parties. If you or your a--ent will-be peTfb,rFn 2-low-risk abatement and containment work, YOU are responsible for providing the written notice of deleading to DLI, the residential occupants, the Board of Health and CLPPP, and also for writing on the form which low-risk abatement and containment activities you or your agent will be performing. All occupants and nets must be out of the dwelling unit for the entire time that rote for deleadinV work performed by the licensed deleader is in progress. Occupants and pets may remain in the unit while ybu or your agent perform low-risk abatement and containment work, as long as they stay out of the work area. Also, occupants and pets must be out of the unit entirely while you or your agent apply coverings to a surfacewith peeling, chipping or cracking lead paint or plaster. Occupants and pets who-leave been out of the unit may not return until a licensed private lead in approves reoccupancy by conducting an on-site reinspection of the unit, including taking dust samples to assure that lead dust levels meet approved standards. This reinspection will be done at least 25 hours after deleading work is done: the inspector must wait at least one hour after the deleader performs a final clean-up, and the deleader must wait at least 24 hours after the completion of deleading work to perform that final clean-up. Deleaded surfaces are not to be repainted until the inspector performs the reinspection and ves approval All work is to be done in a workmanlike manner, and-the dwelling must be returned to a condition that meets the requirements of Chapter U of the State Sanitary Code. Scraped surfaces must be feathered and made smooth by the deleader prior to repainting. (Repaint only after reinspection). Deleaded windows and doors must have all panes of glass intact and must be weather tight. You are required to provide-written notice of the presence of lead paint to all other occupants of the building. "Notice to Tenants of Lead Paint Hazards" is enclosed for that purpose. You are required to send a copy of the inspection report and the enclosed order to all mortgagees and lienholders of record. Questions regarding Department of Labor Industries regulations should be addressed to the DLI office (617-727-1932). Questions!regarding the Department of Public Health regulations should be addressed to the CLPPP central office (800-532-9571) or this Department (6 8 8-9 5 4 0 ), Spector Director CAwp50Uead 19951gencral\bhcov3 95.wp6 ` - The Commonwealth of Massachusetts Executive Office of Health and Human Services Department of Public Health Childhood Lead Poisoning Prevention Program 470 Atlantic Avenue, Second Floor WILLIAM F. WELD Governor Boston, MA 02210 ARGEO PAUL CELLUCCI 617-753-8400 1 800-532-9571 Lieutenant Governor GERALD WHITSURN Secretary DAVID H. MULLIGAN Commissioner DISCLAIMER CONCERNING LEAD DETERMINATION REPORT The information contained in this report concerning the presence of lead paint does not constitute a comprehensive lead inspection. The surfaces tested represent only a portion of those surfaces that would be tested to determine whether the premises are in compliance with the Massachusetts Lead Poisoning Prevention Law(Massachusetts General Laws, chapter 111, sections 189A through 199B). . i Serious lead poisoning hazards are created when materials containing lead paint are disturbed, unless proper safety guidelines are followed. Therefore, Massachusetts law requires that: All lead paint removal, and in general, most of the work required to abate and contain lead paint violations, must be done by a licensed deleader. However, property owners and their unlicensed agents may perform certain low-risk abatement and containment activities without a deleader's license. Before they do'so,ethough, owners and their agents must obtain and review educational materials produced by the Childhood Lead Poisoning Prevention Program, and complete and send back to CLPPP a self-corrected exam. The low-risk abatement and containment activities are the following: applying encapsulants; covering surfaces; capping baseboards; removing doors, cabinet doors and shutters; and applying exterior vinyl siding. Letters of Full Compliance will be withheld if unauthorized deleading has occurred. Any renovating or rehabilitation of,premises containing dangerous levels of lead paint must be done in compliance with the procedures set forth in=the Deleading Regulations issued by the Department of Labor and Industries (454 Code of Massachusetts Regulations 22.11), including sealing off the work area from adjacent.areas, and using a HEPA vacuum and tri-sodium phosphate (TSP) detergent for final clean-up. Any deleading work done on the basis of this report will not qualify the property owner for a state income tax credit, nor will the cost of such deleading be reimbursable under any state loan or grant program. In order to qualify for such programs, the premises must first be subject to a comprehensive lead paint inspection. e IF child under six resides in this dwelling, the property,owner.may, face criminal or civil liabilities unless all lead paint violations have been corrected. This lead report cannot assure that the property owner has met his or her obligations under the law. It is unlawful for rental property owners to use the presence of lead as the basis for discrimination against tenants or potential tenants with young children. C.\WP50V.EAD 1995\GENERAL\DISCLAIM WPD Rev. 11/95 r - -The Commonwealth of Massachusetts Executive Office of Health and Human Services Department of Public Health Childhood Lead Poisoning Prevention Program 470 Atlantic Avenue, Second Floor WILD!, F. WELD Boston, MA 02210 Governor ARGEO PAUL CELLUCCI 617-753-8400 / 800-532-9571 Lieutenant Governor GERALD WHITBURN Secretary DAVID H. MULLIGAN Commissioner RESIDENTIAL DELEADING ADVISORY The process of abating or containing lead paint (commonly called deleading) can be very dangerous, whether it is done for full compliance or as part of bringing a unit under interim control. For this reason, the Lead Law(Massachusetts General Laws chapter 111, sections 189A_ through 199B), the.Regulations for Lead Poisoning Prevention and Control (105 Code of Massachusetts Regulations 460.000) and the Deleading Regulations(454 CMR 22.00) require- that a licensed deleading contractor remove lead paint, and in general, perform all deleading work necessary to correct lead violatigns that is not low-risk. The Lead Law, as well as the Regulations for Lead Poisoning Prevention and Control, allow property owners and their agents to perform certain low-risk deleading activities without a deleader's license, whether the work is done for full compliance or interim control. Before they do so, though, owners and their agents must obtain and review educational materials produced by the Childhood Lead Poisoning Prevention Program, and complete and send back to CLPPP a self-corrected exam. The educational materials include information for owners and their agents about safety precautions and cleanup requirements. The low-risk abatement and containment activities are the following specific activities: applying encapsulants; covering surfaces; capping baseboards;'removing doors, cabinet doors and shutters; and applying exterior vinyl siding. Property owners and their agents may also perform other work that may be necessary for interim control, such as structural repairs and lead'-dust cleaning. The Lead Law and the Regulations for Lead Poisoning Prevention and Control have additional requirements to make sure that occupants of a dwelling unit are not exposed to lead hazards. The most important requirement is that any occupants be relocated from the dwelling unit while a deleader is performing any deleading work that is not defined as low-risk on interior surfaces. Property owners and occupants%should refer to "Notice to Property Owners and Tenants: tenants' rights, "Responsibilities and Remedies" for move information on alternative housing arrangements. Occupants may continue to live in a unit while an owner or agent is performing specified low-risk deleading activities, or other work that may be necessary for interim control, such as structural repairs or lead-dust cleaning, as long as they stay out of the area in which these kinds of activities are taking place. However,occupants must be out of the unit for the day while an owner or owner's agent applies coverings to a surface with peeling, chipping or cracking lead paint or plaster, and during spray application of enc4psulants, and may return at the end of the workday, after the owner or owner's agenf has cleaned up, but need not be out of the unit overnight. It is very important that occupants think carefully about what their daily needs will be during the time they areaway from home, and take along all that they will need. No one should return to a dwelling unit while a deleader is still working or while an owner or agent is covering a surface with peeling, chipping or cracking lead paint or plaster, or applying encapsulant by airless .sprayer. Both property owners and occupants must take their responsibilities seriously and cooperate fully to assure the protection of all concerned. No one should interfere with the work being completed safely. Occupants of the unit in which any kind of deleading work is taking place, whether for full compliance or as part of interim control, and other residents of the building, if any, must receive written notification at least 10 business days prior to the beginning of any lead paint abatement and containment work. Before a deleader begins work, all furnishings and possessions of every type should be removed or stored in plastic bags in non-work areas. This includes all children's clothing, toys, stuffed animals, bedding, etc. Everything should be removed and closets must be emptied. Possessions not removed from the work area should be put in plastic bags and left in the center of the room only as a last resort. The reason for these.extensive precautionary measures is to protect every household article from lead dust contamination. Very fine dust is extremely- hazardous and especially difficult to remove..Belongings must also be protected before an owner or agent performs low-risk abatement and containment work, or other work that may be required for interim control, but the precautions are not as extensive for this type of work. In general, it is recommended that furniture and belongings be moved outside the work area, or covered.with thick plastic and sealed with duct tape, before low-risk abatement and,containment begins. A very thorough final cleanup will be conducted by the deleader no sooner than 24 hours after the completion of the deleadees interior work. This delay ensures that fine airborne particulate will settle out and be removed in the final clean-up. Occupants can return only after a lead inspector or risk assessor determines that a residential premises or dwelling unit is safe through the reoccupancy reinspection, which will include an analysis of lead dust levels within the home. Occupants should leave a.phone number where they can be reached so that the inspector or risk assessor can notify them when it is safe to return home. Occupants cannot be permitted to reoccupy the home unit until the dust sampler.are found to indicate acceptable lead dust levels. If the property owner or agent is going to be performing low-risk.deleading work or other work that may be required for interim control after the occupants return home, they will be taking some precautions as instructed in the CLPPP educational materials. They will also be responsible for cleaning up when they are done(and.need not wait 24 hours after completion to do so). An inspector or risk assessor will return at that point and perform a reinspection to check the owner's or agent's work. While there is no substitute for correcting lead hazards through full compliance, or bringing a unit under interim control, and then performing a thorough clean-up to protect children from lead exposure, there are some important steps that can be taken even before work for full compliance or interim control begins. Your lead inspector's or risk.assessor's advice and counsel should be carefully followed because of his/her personal knowledge of your child's home environment. As part of their normal behavior, young children place things in their mouths, especially toys and their own fingers. If there are leaded paint chips and dust in your home, they may end up in Your child's mouth. Children's fingers pick up lead dust, as do fogs, food and candy that fall on the hoor,,It is especially important to wash your child's toys and-to try to keep your child's hands clean, particularly at meal time. Areas of peeling, chipping or flaking lead paint and dust should be cleaned. Wet sponging and mopping with detergents containing phosphate, such as TSP (tri-sodium phosphate), sold in most hardware stores, or automatic dishwasher detergents, such as Cascade or Sunlight, or other lead- specific detergents, are best for this kind of cleaning. Windows and window sills in particular are often a major source of lead exposure. Sills should be cleaned regularly if paint dust or flakes collect there. If windows are in poor condition, the best thing to do may be to keep the lower sash closed and open only the upper sash for ventilation. (This has the added benefit of protecting your child from accidental falls from'the window.) Contact paper may be applied to areas of peeling paint on window sills, walls or other surfaces as a temporary measure. Do not use your household vacuum cleaner to clean up paint chips, because it will disperse fine particulate into the air. Sometimes furniture can be moved to form a child-protective barrier to cover deteriorating paint or plaster. If deteriorating paint or plaster is in the child's bedroom, use another room as the child's room, if possible. Think of those parts of the home where your child spends most of his or her time, and:try to keep them as clean as you can before your home's lead paint hazards are addressed through full compliance or interim control. Lead paint can contaminate soil. If the exterior surfaces of your home have chipping, peeling or flaking paint; do not allow your child to play in the soil around the house, and be careful not to track soil from these areas into the house. Follow the advice of your lead inspector or risk assessor about soil on your property. C:1WP50\IFAD 1995\SHARON\ADVISORY. Rev.9/95 Fund=mv.9/95 The Commonwealth of Massachusetts Executive Office of Health and Human Services Department of Public Health Childhood Lead Poisoning Prevention Program 470 Atlantic Avenue, Second Floor WILLIAM F. WELD Boston, MA 02210 Governor ARGEO PAUL CELLUCCI 617-753-8400 / 800-532-9571 Lieutenant Governor GERALD WHITBURN Secretary DAVID H. MULLIGAN Commissioner NOTICE TO PROPERTY OWNERS AND TENANTS: TENANTS' RIGHTS. RESPONSIBILITIES AND REMEDIES VIOLATION - It has been determined that the residential.premises-or dwelling unit and/or common areas at the address cited on the accompanying documents contain dangerous levels of lead in paint or other coating, in violation of portions of the Lead Law, Mass. General Laws chapter 111, sections 196 and 197, and 105 Code of Mass. Regulations 460.000, Regulations for Lead Poisoning Prevention and Control. This violation may endanger or materially impair the health, safety or well-being of persons occupying the premises or unit: It is the responsibility of the owner of the residential premises or dwelling unit, under M.G.L. c. 111, s. 197, to abate and/or contain lead violations for full compliance, or bring the unit under interim control, whenever a child under six years of age resides in the premises or unit, or in special cases when directed by local or state authorities. TENANTS'RIGHTS, RESPONSIBILITIES AND REMEDIES In order for the above violation(s) to be corrected as quickly and effectively as possible, it benefits both the property owner and the tenant to cooperate with each other and make responsible accommodations to each others' reasonable needs. Should good-faith efforts at cooperation fail, tenants may, depending on the circumstances, be able to avail themselves of certain statutory rights and remedies. Since property owners have common law as well as statutory rights and remedies, too, and most of the remedies available to both tenants and property owners are somewhat complex, tenants are advised to obtain legal assistance and/or legal-advice before seeking to use the rights summarized below. (1) Alternative Housing. M.G.L. c. 111;,\s. 197 and 105 CMR 460.160(A) require that tenants be relocated from the dwelling unit or residential premises for'the entire time that interior deleading work(other than that defined as low-risk) is being performed by a licensed deleader. Tenants may remain in the unit while a property owner or owner's agent without a deleader's license performs low-risk deleading work or other work that may be required for interim control, such as structural repairs or lead dust cleaning, as long as the tenants stay out of the work area. However, tenants must be out of the unit for the day if an owner or owner's agent uses an airless sprayer to apply encapsulants, or applies coverings _ t 1 - to a surface with peeling, chipping or cracking lead paint or plaster. In these two cases, tenants may return at the end of the workday, after the owner or owner's agent has cleaned up, but need not be out of the unit overnight. Tenants who have been relocated from the unit may not return until the deleader's interior work is completed, the unit is cleaned up and a licensed lead inspector or licensed risk assessor finds that it meets the conditions of a reoccupancy reinspection specified in 105 CMR 460.760(A).. It is the responsibility of the property owner and tenant to work out an acceptable plan for alternative housing when it is necessary. Whenever possible, tenants should find temporary housing with family-or friends. M.G.L. c. 111, s. 197(h) requires that owners pay for the tenant's reasonable moving expenses and any charges for occupancy of the alternative housing unit the owner offers, and that tenants continue to pay their full normal rent during the period they are moved out to alternative housing. The alternative housing unit must be one that does-not cause undue_economic or personal hardship to the tenant. If the alternative housing.unit chosen by the owner does not pose a hardship, and the tenant still refuses.to accept it,then the tenant is responsible for finding and arranging for his or her own temporary housing during deleading. In such a case, the tenant is not responsible for paying rent during the period he or she is out of the unit, but is responsible for paying.the cost of the temporary housing he or she has chosen. The owner remains responsible for paying the-tenant any reasonable moving expenses, plus any amount by which the cast of the alternative housing unit originally chosen by the owner exceeds the rent for that period. Tenants under lease.and tenants at will have applicable legal rights and are advised to seek legal assistance in the event an agreement cannot be reached. (2) Protection from Retaliatory Rent Increase or Eviction. Under M.G.L. c. 186, s. 18, the property owner may not increase rent or evict tenants in reprisal for their having reported a violation or suspected violation of the Lead Law. If rent is increased or the tenants evicted within six months of the tenants' taking any action with respect to the Lead Law issue, the property owner would have to show clear evidence that he or she had other reasons for the rent increase or eviction, and that he or she would have raised the rent or evicted the tenants at that point in time, regardless of the tenants' actions with respect to the Lead Law. Property owners who are found to have threatened or taken.reprisals against tenants for exercising rights under the Lead Law are liable for damages under M.G.L. c. 186, s. 18 and M.G.L. c. 93A- (3) 3A(3) Rent Withholding. Tenants have a basic obligation to pay rent to the owner of a unit they occupy. M.G.L. c. 239, s. 8A creates an exception to this when there are local or state law violations, including Lead Law violations, existing in the unit, by allowing tenants who qualify to withhold rent as long as•.such violations remain uncorrected. Tenants may take this step only if they were up to date in their rent payments at'the time the owner was notified of the lead paint violations, and they did not begin withholding until this point. Property owners are entitled to bring a court action to evict tenants for nonpayment of rent. To fully protect themselves against attempted evictions, tenants withholding rent for Lead Law violations may need to place withheld monies in an escrow(separated savings) account, or may be ordered to do so by the court. If these conditions are met, tenants may not be evicted for nonpayment of rent or for any other violation which is not the fault of the tenants. Property owners have the right to enter the tenants' premises, if possible by appointment, but in any case in emergencies, to inspect for violations and to have them repaired, and this includes the lead inspection and deleading or interim control process. Tenants have a responsibility to cooperate with owners and allow all necessary access to their unit for repairs. Tenants who interfere with this right of entry may be subject to eviction. As soon as the lead paint violation is certified as having been corrected, all or part of the withheld monies may have to be paid to the owner, based on the court's judgment. (4) "Rent Receivership'". M.G.L. c. 111, ss. 127C through 127J allows the tenants, the Massachusetts Department of Public Health's Childhood Lead Poisoning Prevention Program or the local Board of Health to petition the court to find that Lead Law violations exist, and to allow rent to be paid into court rather than to the property owner, to pay for the repairs necessary. As under the rent withholding statute, this law allows tenants to take this step only if they were up to date in rent payments at the time they begin paying rent.to the court. The court may then appoint a "receiver" who may spend as much of the rent money as is needed to correct the violations. Any remaining rent money after repairs have been made are paid to the owner. (5) Abatement of Rent or Damages. A tenant may have rent reduced or recovered as damages for a unit with Lead Law violations through a court action for breach of implied warranty of habitability, in accordance with the Massachusetts Supreme Judicial Court decision in Boston Housing Authority v. Hemingway, 363 Mass. 184, 293 NE2d 831 (1973) and M.G.L. c. 93A. In such an action, brought by the tenant independently or as a counterclaim to a property owner's court action seeking eviction for nonpayment of rent, the court determines the value of the premises or unit with violations, and reduces the amount of rent due. (6) Owner Liability: Compensatory and Punitive Damages. Under M.G.L. c. 111, s. 199, the owner of a residential premises or dwelling unit built before 1978 is financially liable for all damages to a child under age six who becomes lead poisoned as defined by the Regulations for Lead Poisoning Prevention and Control as a result of the owner's failure to:-comply with the Lead Law and Regulations either through full compliance or interim control. The owner of such a residential premises or dwelling unit who is notified through an Order to Correct Violations or Order to Restore Interim Control Measures of a dangerous level of lead in paint, plaster or other material present upon the surfaces and building components of his or her premises, and who willfully fails to correct or remove the violations for full compliance, or bring the unit into interim control, in accordance with the Lead Law and Regulations, is also, in addition to actual damages, subject to punitive damages, which are triple the actual damages found. A property owner found to be financially liable under the Lead Law can seek contribution against the parent or guardian of the child after damages have been awarded to the child. REPAINTING Violations-of the Lead Law constitute violations of the State Sanitary Code. Although repainting of surfaces from which lead paint or other coatings have been removed is not required for compliance with the Regulations for Lead Poisoning Prevention and Control, repainting such surfaces is required under 105 CMR 410.021 of the State Sanitary Code. It is important that deleaded surfaces be sealed and can be easily cleaned. Repainting of deleaded surfaces may not occur until after the surfaces have been reinspected while bare and approved for repainting by a licensed lead inspector or a licensed risk assessor. Repainting of deleaded surfaces on the interior of the dwelling unit and interior common areas must be completed within 30 days of the reoccupancy reinspection, if there is one, or if not, the deleading reinspection or the risk assessment reinspection. Exterior surfaces must be repainted within 30 days of the deleading reinspection or risk assessment reinspection. This repainting requirement does not apply to surfaces where lead paint has been covered or a new fixture or:surface installed to replace a leaded one. However, such surfaces must also be reinspected by a licensed lead inspector or risk assessor before they are repainted. Tenants are advised to contact their property owners if the required repainting is not completed as stipulated above. If the property owner does not respond, then tenants may wish to call the local board of health. CUP9S.19 — Aeuised 3/95: - Further reuised 5/95 and 9/95 ,t r AORTH q 011 SSIFD i°,ti° ° BOARD OF HEALTH O o * x 120 MAIN STREET • TEL: 682-6483 CHusEt`y NORTH ANDOVER, MASS. 01845 Ext. 32 or 33 April 61 1990 Flathery Bay Realty 101 Butternut Ln. Methuen, MA. 01844 RE: 65 Beverly rl St. Mr. Russ Uuarteroni : At a housing inspection that was done at 65 Beverly St. on 4/6/909 the following housing violations were found: - The handrails of the stairway leading down from the second are loose and must be repaired for safety purposes. (105 CMR 410. 503 A - The owner shall provide a safe handrail for every stairway that is used or intended for use by the occupants. ) Repair the window over the sink and replace the screen with All windows in the apartment must one that is tight fitting. A 1 p 9 9 have screens. (105 CMR 410. 353) - All windows in the apartment must be able to be locked. (105 CMR 410. 551) Replace the broken smoke detector in that ba%ament. (015 CMR 410. 48?) •- Any utilities should be kept as a separate if the tenants are required to pay the utilities themselves(hot water,, telephone & electric) . (105 CMR 410. 500) There is Asbestos covering the pipes in the basement that is in poor repair. You must repair the asbestos material, enclose the asbestos material or remove the asbestos material. Please contact the Board of Health with the method in which you plan to correct this problem. (105 CMR 41U. 353) All of the above violation must be corrected with - in 10 business days of this letter. A reinspection will be scheduled for the 10th day to make sure that the violations have been corrected. If you have any questions, please contact this office at 682- 6483. Sincerely, Stephanie J. L. Foley Health Sanitarian KERMAN, KERMAN & KERMAN ATTORNEYS AND COUNSELORS AT LAW NORMAN KERMAN 290 BROADWAY,SUITE 5 SHIRLEY M.KERMAN METHUEN,MASSACHUSETTS 01844 BRYAN J.KERMAN (MASS.&N.H.) TEL. (508) 689-2033 (508) 685-5066 OF COUNSEL FAX. (508) 975-4395 LESLIE J. KERMAN May 1 , 1990 WASHINGTON,D.C. Ms . Stephanie J. L. Foley Health Sanitarian Board of Health 120 Main Street North Andover, Mass. 01845 RE: 65 Beverly Street , North Andover , Mass. Dear Ms. Foley: Pursuant to our telephone conversation of April 30, 1990 , kindly find enclosed a copy of a letter dated April 27 , 1990 to Winne L. Thyne, a tenant of 65 Beverly Street , North Andover , Massachuseetts . Please note that Flather Bay Realty Trust has entered into an agreement with East Coast Environmental Inc. of Atkinson, New Hampshire for the removal of any asbestos which is present in the cellar of 65 Beverly Street . This office has been informed that East Coast Environmental Inc. is licensed for asbestos removal in the Commonwealth of Massachusetts and that on April 27, 1990, said company provided appropriate notification of the anticipated asbestos related work to the Commonwealth of Massachusetts. Said company has further informed this office that the asbestos related work is expected to begin and be completed on May 16, 1990. If you have any question regarding this matter , please do not hesitate to contact this office. Very truly yours , Kerman, Kerman, & Kerman By C. ryan J. an, sq. BJK/tl CC. Flather Bay Realty Trust r May 3, 1990 Flather Bay Realty 102 Butternut Ln. Methuen, MA. 01844 RE: 65 Beverly St. Mr. Russ Quarteroni/Sam Perruccio: Because of the condition of the asbestos in the basement of 65 Beverly St. , and the fact that the is no door to the basement, you should secure a piece of polyethylene film over the entrance of the basement stairway. This is important in protecting the people who live in the building by putting a barrier between them and any loose asbestos particles that could affect their health. Please complete this request as soon as possible. Please contact me •if you have any questions regarding this request. Sincerely, Stephanie J. L. Foley Health Sanitarian SJLF/pd `4 KERMAN, KERMAN & KERMAN ATTORNEYS AND COUNSELORS AT LAW NORMAN KERMAN 290 BROADWAY,SUITE 5 SHIRLEY M.KERMAN METHUEN.MASSACHUSETTS 01844 BRYAN J.KERMAN IMASS.&N.H.) TEL. (508) 689-2033 (508) 685-5066 OF COUNSEL FAX. (508) 975-4395 LESLIE J.KERMAN April 27 , 1990 WASHINGTON.D.C. Ms . Winnie L. Thyne 65 Beverly Street , 2nd Floor North Andover , Mass . 01845 RE: Notice of Nonrenewal of Lease Notice of Noncompliance with Lease Property Location - 65 Beverly Street , 2nd Floor North Andover , Mass . Dear Ms . Thyne: Kindly be advised that this office represents Flather Bay Realty Trust owner of and landlord for your rental unit at 65 Beverly Street , 2nd Floor , North Andover , Massachusetts . Pursuant to your lease with Flather Bay Realty Trust (hereinafter Landlord) dated September 27 , 1989 (a copy of said lease being attached hereto) , Landlord hereby notifies you that your lease shall terminate on October 31 , 1990 and that the Landlord shall not renew or extend this lease. Accordingly, kindly be advised that it is the intent o; the Landlord to have prospective new tenants view your rental unit at reasonable times subsequent to September 1 , 1990 . Landlord will make all reasonable efforts to minimize any inconvenience to you. Further , it has come to the attention of the Landlord that you are keeping a dog and a cat within the rental unit in violation of the terms of your lease. As you are aware, your lease specifically states : "No dogs , cats , pets or animals to be kept on the premises" . Landlord therefore requires that you forthwith remove said animals from the Premises . -1- Finally, during the last several days , the Landlord, through its Trustees , has made repeated efforts to contact ,you in order to arrange a suitable time for the Landlord to complete certain repairs within your rental unit . The Landlord, however , has informed this office that you have neglected to return their telephone calls . The Landlord requests that you immediately contact one of the Trustees in order to arrange a suitable time for these repairs to be completed. If you have any questions regarding the contents of this letter , please do riot hesitatc to contact this office. Very truly yours , Kerman, Kerman-,_....&-:!x n yan. - Ke`rm sq. BJK/tl CC. Flather Bay Realty Trust Certified Mail - April 27 , 1990 Regular Mail - May 1 , 1990 -2- ,LAV 10 D's 40� . Sts Q0d /L*m LEASE AND AGREEMENT DATE: i� 19W . The undersigned Landlord hereby leases to the undersigned Tenant the PREMISES: 5�5'(,WID Fc)at" /�cT at# ✓ESL St., lvivez Aly-oV . /T.- 114, FOR 4JE YESinnin be g VF�j� S i: �� 19 ,for which Tenant agrees to pay $ Co..00—of which$ 640 have been paid, and the balance to be paid monthly at$ _ �;Wc. , said payments to be delivered or mailed to Lessor so as to reach him on or before the EICSS 1 Da'1/ of each month beginning J4ll,E�+-1A�C 19&.This lease shall automatically renew and continue thereafter from year to year until either party shall give written notice on or before the first day of (f�7D66e /�?y (mo.)in any year,terminating this lease as of the last day of &1h111141 /We (mo.). Landlord acknowledges the receipt of$ 6s c'c'+ as SECURITY DEPOSIT.Security Deposit to be returned,with interest as required by law, less damages and other lawful deductions to be itemized on a list and submitted by Landlord, within thirty (30) days after termination of the tenancy. Said sum IN NO CASE TO BE APPLIED BY TENANT AS RENT. The primary use of the premises by Tenant to be that of: P4.CSt)A14 L>INA//E Others to occupy(and ages of minor children): 77VVNL 64ILa464) t�N�lld 15 ��Sni?�IiSL/�cf�, ' f,IE.0 !�uy✓ /✓ <' /�ri/y GEC` �C A 0 ,¢1v_i CC. / tit- r#A 44W04.eCD cm Z5%4 PC - 7-0Ll4 7-0 P�'D✓ r-C C iL� f _ o The parties hereby covenant and agree: NO PART of the premises shall be sublet, or underlet, without written permission of L NO ARTICLE OR SUBSTANCE shall be kept on thcpramiceS__nnLan-y eatiTi or occupation conducted, which is illegal, noisy, or dangerous, or which might increase the insurance premiums of the building. ALL RUBBISH to be properly separated by TENANT and placed in proper receptacles.No paper,cans,or bottles to be placed in GARBAGE containers. NO DOGS, CATS, pets or animals to be kept on the premises. ALL DRAINS AND WASTE PIPES ON plumbing are accepted as clear by TENANT, and any partial or complete stoppage occurring during the tenancy shall be repaired by TENANT. NO RADIO,TELEVISION,PHONOGRAPH,TAPE RECORDER,OR SOUND SYSTEM to be played after p.m. NO BABY CARRIAGES, TOYS, SPORTING EQUIPMENT, or other articles to be left in halls or stairways. NO LOCKS to be installed ortchanged, except with written permission of LANDLORD. LANDLORD is to have key to the premises at all times, and he or his agents may, without liability,enter at reasonable times to inspect, repair,or show the premises to a prospective Tenant or Purchaser, and may post To-Let signs. PARKING on the premises IS/ allowed: -r* 4�ILVV64Z,44 Parking for U/VL automobile(s) is provided: LEAKS IN PIPES OR OVERFLOWS, unless caused by negligence of TENANT, his guests or invitees, are to be repaired by LANDLORD,within a reasonable time after notice; but LANDLORD shall not be liable or responsible for any damages resulting from any such leaks or overflows occurring for reasons beyond his control. TENANT ASSUMES THE RISK of damage, theft, or destruction of his personal property and that of his guests and invitees on the premises, unless directly caused by the negligence of LANDLORD. TENANT HAS INSPECTED THE PREMISES and accepts them AS IS. LANDLORD shall be under no obligation to improve the premises, or make decorations, except as provided by law. TENANT SHALL HAVE A DUTY to notify LANDLORD of dangerous conditions or need for repairs on the premises, and shall guard against loss or risk to himself and others until LANDLORD shall have e-portunity to inspect and rectify, if necessary, the said conditions or need. THE WAIVER of any term of this contract at any time shall not'be deemed a waiver on any other occasion nor of any other term. LEGAL NOTICES from either party shall be deemed prgperly.delivered.if mailed by ordinary mail to the premises or address of LANDLORD. SHOULD THE RENT BECOME OVERDUE, and LANDLORD,sue for same,or sue for possession for non-payment of rent after thirty (30) days, TENANT shall pay all Court costs and I reasonable attorney's fees. NAMES, ADDRESSES&TELEPHONE NUMBERS _ ���4eS Tenant (Owncr) /0j All CL (Per)n.4..pon,ible for care,mainttnaneefand repair of propcny) Tenant: elA 111 (Peron authorized to receive notice,of violationsof lam and to � accept service of process for o.ner) andlord: a. FORM RLA. ORDER THESE FORMS DIRECT FROM ar / REALFORMS.BOX X,ANDOVER,%4 ASS 01110 r �� ��9�90 >2�m9� � 6� �w.w aS+< 5N5 � I/ � fr jwa NORTH 04 ? ` = ' -°0 BOARD OF HEALTH 120 MAIN STREET �9ss�c►+u 'NORTH ANDOVER, MASS. 01845 TEL. 682-6400 COMPLAINT FORt1 DATE 111Y13& Made by �L _—Pe Address Tel . Nature of complaintAV /1 tlAf Location Occupant Owner or Agent Address DO NOT WRITE BELOW THIS LINE Referred to Date of Investigation 1119A Result of investigation Recommendations Action taken THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH CITY/TOW N IT r' DE ARTMENT ADDRESS GIM , e TELEPHONE Address --Occupant Floor _ Apartme No. _ No. Occupants _ a - - -- - -- No. of Habitable Rooms __ No. Sleeping Rooms _ No. dwelling or rooming units _ No. Stories Name and address of owner_Rleu —_ -- Au SS V4�t�.e r 0 vv� Q pRemarks Reg. Vio. YARD Out Bldgs.: Fences: Garbage and Rubbish: Containers: Drainage Infestation Rats or other: STRUCTURE EXT. Steps, Stairs, Porches: Dual Egress: and Obst'n.: ❑ B ❑ F OM Doors, Windows: IWIMAL M4A SI Roof Gutters, Drains: h, Walls: Foundation: h A Z410 Sq Chimne BASEMENT Gen. Sanitation: Dampness: Stairs: ' _ Lighting: STRUCTURE INT. Hall, Stairway: , Obst'n.: Hall, Floor,Wall, Ceiling: Hall Lighting: Hall Windows: PEZ-jza "Ar oz HEATING Chimneys: Z Central ❑ Y ❑ N Equip. Repair 2 TYPE: Stacks, Flues,Vents: a PLUMBING: Supply Line: ❑ MS ❑ ST ❑ P Waste Line: m H.W.Tank(s) Safety and Vent(s)co _ ELECTRICAL Panels, Meters, Cir.: 0 ❑ 110 ❑ 220 Fusing, Grnd.: AMP: Gen. Cond. Distrib. Box: 0 Gen Basement iring: 5tj WELLING UNIT ok*e Ventil. Lgtng. Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen _ Bathroom Pantry Den _ Living Room _ Bedroom (1) Bedroom (2) as, Oil, Elect.: s Vents Safeties: 6 O's / � � .� —y�-Z ��., Sanit'n.: i, Shower or Tub: Roaches or Other: )bst'n: :)sted: loors: ONE OR MORE ur- THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSPECTOR. (See Over) "THIS INSPECTION REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES OF PERJURY." INSPECTO - - - - TITLE qCJ'- DATE --_-. _ .._!_Q._ _. _ TIME -_1Ov - -- P.M. A.M. THE NEXT SCHEDULED REINSPECTION _ _—__— _ __� _ _ P.M. 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions, when found to exist in residential premises, shall be deemed conditions which may endanger or impair the health, or safety and well-being of a person or persons occupying the premises. This listing is composed of these items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter II, 105 CMR 410.000 through 410.499 state minimum requirements of fitness for human habitation, any violation has the potential to fall within this category in any given situation but may not do so in every case and therefore cannot be included in this listing. Failure to include shall in no way be construed as.a determination that other violations may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of the violation(s) pursuant to 410 CMR, 410.830 through 410.833 nor shall it affect the legal obligation of the person to whom the order is issued to comply with such order. (A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B) and 410.202. (C) Shut-off and/or failure to restore electr}city or gas. (D) Failure 'to supply the electrical facilities required by 105 CMR 410.250(B), 410.251(A) , 410.253(A), 410.253(B) and the lighting in common area required by 105 CMR 410.254. (E) Failure to provide a safe supply of water. (F) Failure to provide a toilet and maintain a sewage system in operable condition as required by 105 CMR 410.150(A)(1) and 410.300. (G). Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by an object, including garbage or trash, which prevents egress in case of an emergency 105 CMR 410.450 and 410.451. (H) Failure to comply with the security requirements of 105 CMR 410.480(D). (I) Failure to comply with any provisions of 105 CMR 410.600 through 410.602 which results in any accumulation of garbage, rubbish, filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. (J) The presence of lead-based paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public Health Regualtions for Lead Poisoning Prevention and Control 105 CMR 460.000. (K) Roof, foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or other dangers or impairment to health or dafety. (L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating, gas-fitting and electrical wiring standards or failure to maintain such facilities as are required by 105 CMR 410.351 and 410.352 so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety. (M) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or knowledge of the owner of said condition or conditions: (1) lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven or any defect that renders either operable. (2) failure to provide a washbasin and a shower or bathtub as required in 105 CMR 410.150(A)(2) and 410.150(A)(3) and any defect which renders them inoperable. (3) any defect in the electrical, plumbing, or heating system which makes such system or any part thereof in violation of generally accepted plumbing heating, gas-fitting, or electrical wiring standards that do not create an immediate hazard. (w) failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as required by 105 CMR 410.503(A) and 410.503(B). (5) failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550. (N) Amy other violation of Chapter II not enumerated in 105 CMR 410.750(A) through (M) shall be deemed to be a condition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner to remedy said condition within the time so ordered by the board of health. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH —�— - CITY/TOWN - - --- ---- - - W - -- i� DEhlReT�MENT o ADDRESS _ ----- - - - - 1 TEL PHONE Address _,a XK St - --- Occupant _. _Wi Floor Apartmeg No ___ No. Occupants No. of Habitable Rooms No. Sleeping Rooms -- No. dwelling or rooming units -- No. Stories ---L Name and address of owner_ K, 14 '. (�U SS 90.1' r 0 vx 1 - --01W y Remarks Reg Vio. YARD Out Bldgs.: Fences: , Garbage and Rubbish: Containers: Drainage Infestation Rats or other: STRUCTURE EXT. Steps, Stairs, Porches: Dual Egress: and Obst'n.: ❑ B ❑ F ❑ M Doors,Windows: M&hr M4A Sl Roof Gutters, Drains: ►,,q Walls: Foundation: c � cx� trj0 Chimne BASEMENT Gen. Sanitation: Dampness: 44 Stairs: _ Lighting: NJ STRUCTURE INT. Hall, Stairway: Obst'n.:co - 03 Hall, Floor,Wall, Ceiling: Hall Lighting: Hall Windows: oz HEATING Chimneys: Z Central ❑ Y ❑ N Equip. Repair LU TYPE: Stacks, Flues,Vents: a PLUMBING: Supply Line: ❑ MS ❑ ST ❑ P Waste Line: m H.W.Tank(s) Safety and Vent(s) o ELECTRICAL Panels, Meters, Cir.: _ ❑ 110 ❑ 220 Fusing, Grnd.: AMP: Gen.Cond. Distrib. Box: o Gen Basement iring: �a WELLING UNIT ovErAvor (Lc! Ventil. Lgtng. Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen _ Bathroom Pantry Den Living Room _ Bedroom (1) Bedroom (2) Bedroom (3) Bedroom (4) Hot Water Facil. Sup.Ten., Gas,Oil, Elect.: _ Stacks Flues Vents Safeties: Kitchen Facilities Sink Stove Bathing, Toilet Facil. Vent., Plumb., Sanit'n.: Wash Basin, Shower or Tub: _ Infestation Rats, Mice, Roaches or Other: Egress Dual and Obst'n: General Building Posted: Locks on doors: ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSPECTOR. (See Over) "THIS INSPECTION REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES OF PERJURY." F INSPECTO TITLE DATE TIME _� i Ov_ P.M. A.M. THE NEXT SCHEDULED REINSPECTION _ - P.M. 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions, when found to exist in residential premises, shall be deemed conditions which may endanger or impair the health, or safety and well-being of a person or persons occupying the premises. This listing is composed of these items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter II, 105 CMR 410.000 through 410.499 state minimum requirements of fitness for human habitation, any violation has the potential to fall within this category in any given situation but may not do so in every case and therefore cannot be included in this listing. Failure to include shall in no way be construed as.a determination that other violations may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of the violation(s) pursuant to 410 CMR, 410.830 through 410.833 nor shall it affect the legal obligation of the .person to whom the order is issued to comply with such order. (A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B) and 410.202. (C) Shut-off and/or failure to restore electr#city or gas. (D) Failure 'to supply the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253(A), 410.253(B) and the lighting in common area required by 105 CMR 410.254. (E) Failure to provide a safe supply of water. (F) Failure to provide a toilet and maintain a sewage system in operable condition as required by 105 CMR 410.150(A)(1) and 410.300. (G)• Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by an object, including garbage or trash, which prevents egress in case of an emergency 105 CMR 410.450 and 410.451. (H) Failure to comply with the security requirements of 105 CMR 410.480(D). (I) Failure to comply with any provisions of 105 CMR 410.600 through 410.602 which results in any accumulation of garbage, rubbish, filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. (J) The presence of lead-based paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public Health Regualtions for Lead Poisoning Prevention and Control 105 CMR 460.000. (K) Roof, foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or other dangers or impairment to health or dafety. (L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating, gas-fitting and electrical wiring standards or failure to maintain such facilities as are required by 105 CMR 410.351 and 410.352 so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety. (M) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or knowledge of the owner of said condition or conditions: (1) lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven or any defect that renders either operable. (2) failure to provide a washbasin and a shower or bathtub as required in 105 CMR 410.150(A)(2) and 410.150(A)(3) and any defect which renders them inoperable. (3) any defect in the electrical, plumbing, or heating system which makes such system or any part thereof in violation of generally accepted plumbing heating, gas-fitting, or electrical wiring standards that do not create an immediate hazard. (K) failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as required by 105 CMR 410.503(A) and 410.503(B). (5) failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550. (N) Amy other violation of Chapter II not enumerated in 105 CMR 410.750(A) through (M) shall be deemed to be a condition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner to remedy said condition within the time so ordered by the board of health. As B IL ST-6 S TO: Board of Health FROM: Stephanie J. L. Foley RE: 65 Beverly St. - Flather Bay Realty DATE: April 26, 1990 ---------------------------------------------------------------- On April 19th, I spoke to Russ Quaterone, a owner of 65 Beverly St. Regarding the removal of the asbestos that was present in the basement. He informed me that he planned taking the route of encapsulation the asbestos rather that removal of it. I told him that that would be fine as long as he had a licensed asbestos take care of it. April 61 1990 Flathe4 Bay Realty 101 Butternut Ln. Methuen, MA. 01844 RE: 65 Beverly St. Mr. Russ Quarteronia At a housing inspection that was done -at 65 Beverly St. on 4/6/901 the following housing violations were found: - The handrails of the stairway leading down from the second are loose and must be repaired for safety purposes. (105 CMR 410. 503 A - The owner shall provide a safe handrail for every stairway that is used or intended for use by the occupants. ) - Repair the window over the sink and replace the screen with one that is tight fitting. All windows in the apartment must have screens. (105 CMR 410. 353) - All windows in the apartment must be able to be locked. (105 CMR 410. 551) - Replace the broken smoke detector in the •basement. (015 CMR 410. 488) - Any utilities should be kept as a separate if the tenants are required to pay the utilities themsolves(hot water, telephone & electric) . (105 CMR 410. 500) - There is Asbestos covering the pipes in the basement that is in poor repair. You must repair the asbestos material, enclose the asbestos material or remove the asbestos material. Please contact the Board of Health with the method in which you plan to correct this problem. (105 CMR 410. 353) All of the above violation must be corrected with in 10 business days of this letter. A reinspection will be scheduled for the 10th day to make sure that the violations have boon corrected. If you have any questions, please contact this office at 682- 6483. Sincerely, \ Stephanie J. L. Foley t Health Sanitarian b� i � r vY -, Ln. C)1;114 t 4'i l.y Jt.. 1 fir`• �,•-� � i�llc.lr'i;�:l'r.,iYl i��i�,fn 1�1)r'Y'ta�:t`�u , m i'L:,111,>L yJi til:. t:(Jlit: iteLilt .�� til:' �1 i.,.� , �.il Lhc: U,..`.�(:f11R7nt U1' GJ t"•,:vG rl iw . "ticJ tali i,ti t L Y � th t til.: :,:, rl�.� dear• the you tluuld jaaf' PalYL" ;iyl. ..OL2 i ilAl UVLt' thL Untl•,:rm: V i tt t.: i1..i�,�.t11�'ilt .�t,llr't4C1y. I fll', l:, if, pur'i:,mt in pr otu t irig tl,L, NUL,Plc.' l ivy in thu building by Nu'-�; my o b4ir^r,iur, butwoon thuni ,.Ind ony 11+�� �; ,(1R '„jtit!� �latl't1C'lR."_• th-L R:-!ilii their ho,.;lth. uclfoP t h it, t^r:Ci lli t ,.1L „C ti:i i �U'�:,1 iJ lFt ")rtt�1Ct 100 "1 You h...VL ,'any quL':.itio1)'- r':,."L]atl'djj-.0 i,i1iL, 1'L gL.IR:':,t. S i nUC i-L I Y, stf.-Ph ri ( J. i.. f-Uluy Hooltil :i�.,rlit,tt, ;ctrl 5,1 Lt-/1-id April G, Va',K) F14rthury D iy Rv ilty 141 Uut LLi-nut Ln. ML:LIYu.:n, Mf;. 4181; '; RL DLA VLr'ly at. Mr'. n'4 .., ,ILII-iny in,;pcction ;;teat d,lrlt: at G5 Buvur'ly St. on 4/G/40, Lhu ---ol l...,winy huU:Any viL,l,.L iun., wc:ru found : T:iL, of the s.tcii,'w4iy lu.aLlino down from the second 41r'L' IQQG ;L.' C.i"Id MU''Ut i.7E i 4+:' purpuL.2.a. ( 145 CMR /: 14. 343 A - Thu ownLr l,.ill pi'uviJL� :,oft., handr�iil for jvl.ry uta i r w4y 1741 iu. Ltc L+d Gi' lilt L:�"Id L:C� i Car' Ll:.� �.7y thL' 1.1CCI.tp41 r'It:,• ) H pa> r LhL window uv-,r- tht. t,ir.'c ,.nc' .:placsr th:2 t-c:ruurl with that i-; tiLPub f'iLtirly, All windl.jw- in thu aprartmunt muut ( IOU CMR - All window., in thL ap4irtm-nt I.ILI:,L bc: ab1L bL: lockud. ( 10"i CMR 410. UU 1 ) - RL:+placc: Lhu broken -mukc. dutc:cLur• in 'W-hu Ja:.iurnunt . (41�i CMR fmy ut i 1 i L iLm: -licluld bc: kupt r'L:yuit-Cd LU pc:y Lhv uL i 1 i L iL:- Ll�: ril:... lv. :, (17�:1t w�.rtur', 111-..1uphunc: (11 L:luctr'ic) . ( 14U Cri^ 1; 10. L,C�0) cov: r=r-IrJ thi- pap;: in thu ba,.;c:mL:nt that iu 1n PQLJI' rop,lir'. Y,--u r+lu`..L rup..++.r' ill:.: ti. ,bc ALL+ i rnAtori al, �1nCll1',L+ Ll7c: �l:jb.+:�tc.�:.+ tl.atur'iill ...:• T'.'r.i.�V.: Lhc: a'..ibE::,L�.r°.. maLuri,.il. '1c..4, ;c.+ contac tt th:.+ with thu mcrthod irr which y,_1Lr p1,rn to cur•roct this, p;'cibli rI. ( 145 CMR 410. 3J3) hl l Llf Lhc .tbovu vic.+laL iun mu:;L b(.: with in 10 day,: wf' Ll7iu lutLur. A r::in,pucti�-.11 will bL "chuuulud fur- 'LhW 14th day tl. mcakz.' i.�ui`u th..iL t:iL' vio1c.;L iurl. h Avu bL.L:n corrucGud. If' you have any cyuuti un r, i71c.'ouu this, Q f it:C., at 032,-. M-+s 3. S i r7curu 1 y, SLuph;miu J. L. FulLy 4 TO: Board of Health FROM: Stephanie J. L. Foley RE: 65 Boverly St. - Flathor Bay Realty DATE: January 23, 1991 -------------------------------------------------------------------- On April 19th, I spoke to Ruus Quaterono, a owner of 65 Beverly St. Regarding the removal of tho nubpaton that was present in the Womont. He informed mo that he plannod taking the route of QW1001440 Ike 100480 raWY Wh IDIOV91 Of At I told him that that would be fine an long an he had a licensed asbestos take care of it. East Coast Environmental, Inc. -D c)q-e- M f9AI MAY 1( N 9 n �6s-r C.D.Y z- \3 t 2 0f M511)T*L- rJ C_ , S Tr4-rL�-E r� A-rJ Jos a r=:sTO S R EWIO v A-t- P 20 J C L✓T Al- (06- P 5,j N o,-'ri+ A ,j,'oof v?-- j M A . vJ c Vj aa-5- 1+1 2IFD a F-L_A--r4 rz-7,zi3 kY 2E►��`ry r 2v s-F � �-,� fL� 56010- - 0w0&f� IZ t Wto40 i-IFe r O F aq-52Es7ns Pi�E /NSUI.-0-rjOA1 'TO i AL .vg-LO/✓ Tt4w4i �U14Tz onr c�J� 1gd9 S�l1� E N i" 45 5 0 m c- P/P C- /.0 5 L) -rI"A/ f4 L,L e-C,Cg 0 L.�� B G-E5 tj 2C-'vut o 0'--b G0 AY -EC-F L y . J08 WRS camPI,-FTEI) vn7 01ttY 6g 1.1 iTp D ENN 15©,V E1J0t R01J M f:-lJ T)4t / �,U�- `'�00, Fou R6- \)IsL)14 M6,5, P4UI,- -P G7R Caw FAD M T 14 E � 'D t to, v� (idhf3o2 i�N0 1N1)0 SIT X)VS II AD A CEta)SC AijD VaSiS-r- 0 P',>U - -r)-t6- 6 AFM r.,W•t 1'I L 17- (FLo.)'rk4-,M i,v i4-Tt b R6 V6 2Te�-9 3 L-rO(P—67 rf nZ16 A-*P f`b—a v J/2, w0Ale- vow COMPLe�-ri5;D ANI-D io45 5&T/Sr/ C-0 01 ' -14' W/-r4T 1 E 5k.0 6 0-01 -rl M CS - i.r- yoO �. 6OLr n)S GW 15 71+1r- •ro C A t_L, w e . S1 1J LL•-ALC L L� /i'I(- 37B 37B Academy Avenue - Atkinson, New Hampshire 0311 - Telephone (603) 362-4929 Dennison Environmental, Inc. DATE: May 23, 1990 TO: JOB NO. 22000102 . 00 F --I AUTHORIZATIONverbal East Coast Environmental 37B Academy Avenue Atkinson, NH 03811 L REPORT OF ANALYSIS Facility: 65 Beverly Street, North Andover SAMPLE DATE NUMBER SAMPLE LOCATION/IDENTIFICATION TAKEN RESULT Inside Containment, By Stairway to First Floor 2 Passive Final 05/18/90 0 . 003 Inside Containment, By Rear Entrance, Passive 3 Final 05/18/90 0 . 003 NOTES: All results are expressed in fibers/cubic centimeter air. MA DLI Certification Number AA000007 PAT Laboratory Identification Number 01801-001 Project Monitor: G. Hanes PM00146 Analyst: G. Hanes Lir• i-- Gregory J. Hanes Laboratory Supervisor <- less than ND-not detected <.ND-parameter is less than the value given and not detected by the technique employed >-greater than &WWvim. 0 ot4ea6ma c/.l doo and A Sao 4.4+A.4 st w mai NOTIFICATION OF ASBESTOS WORK (In accordance with the provisions of M.C.L. c. 149, §6-6F and 453 CMR 6.12) All sections of this form must be completed in order to comply with the notification requirements of 453 CMR 6.12 TEN DAY PRIOR NOTIFICATION IS REQUIRED OF ANY ABATEMENT PROJECT GREATER THAN THREE (3) LINEAR OR SQUARE FEET DLI FILE NUMBER Contractor performing project,el j -License # L,'__1VC'l%� Do prevailing rates of wages apply to this project as required under M.G.L c. 149, §26, 27 or 27F? (circle one) YES NO Address of Project Building Name (if any) Street. Address City /t/6"IAV ��'l/!!'!%<!� Zip Project type (circle one): DEMOLITION RENOVATIOI_' REPAIR'' OTHER If *Other* selected, please explain s Asbestos Activity: (circle one): ENCAPSULATION ASSOCIATED PROJECT ENCLOSURE ( REMOVAL Indicate amount of: asbestos surface on pipes or ducts LINEAR FEET OR asbestos surface on structures other than pipes or ducts to be removed, enclosed or encapsulated SQUARE FEET Start date `���'�� /� am K' pm weekends? �T Completion Date_ `'2y%_ ( Project Supervisor Name Certificate p Asbestos Analytical Lab Namej;;iu� l'�:- L�lb•«dc� Certificate / Nags d Address of disposal s)site( lLri"// .4'Cf /�'tcicsfl' iYf:"t:ii .fes:(, ei Z. 00-f')1/1 is asbestos contract written or verbal? Contractor's Workers' Compensation rnsurer f��L�`:G� l/�f'.��i�, .; , ��• % 7s�s , ��� . Policy Number Facility Owner Address City ij ,41 ��� /,%ice' State_ Zip G1_5e),� Description, of work practices to be followed: z2 e Description of decontamination system(s) to be used `1;��,/• 54 lf�«r;, 7- Description of handling/disposal methods/ to comply with 453 CHR 6.14(2) (g) � JJ , � t"li�954[ l.t Sr't 1 _ tt. c"<< �,., « � << Name and address of transporters) if other than the asbestos contractor: The undersigned hereby states, under the penalties of perjury, that he/she has read and understood the Commonwealth of Massachusetts Regulations for the Removal, Containment or Encapsulation of Asbestos, 453 CMR 6.00, and that the Information contained in this notification is true and correct to the best of his/her knowledge and belief. Date t�`' �% iL' Signed: /c �.- it :�4'le A_ - Title: Company: Please return this form to: Asbestos Control Technical Services Department of Labor and Industries Division of Industrial Safety 100 Cambridge Street, Room 1101 Boston, MA 02202 0049x/2 COMMONWEALTH OF MASSACHUSETTS It DEPARTMENT OF ENVIRONMENTAL PROTECTION C ASBESTOS REMOVAL DESCRIPTION DIVISION OF AIR QUALITY CONTROL 1. ASBESTOS CONTRACTOR [SEE LAST PAGE FOR OFFICE LOCATIONS] Name:,61f' ,'osT MJF'/C'1.ftd� I 1 Telephone: 5Z_1- 111;2,5: NOTIFICATION FORM FOR Street Address: '%•Y .�4u�=.rye City/Town: ASBESTOS REMOVAL AND GENERAL DEMOLITION/RENOVATION Department of Labor and Industries License 4 f;7 Z 2. ON-SITE SUPERVISOR A APPLICABILITY Name: Department of Labor and Industries Certification /i- Demolition/Renovation operations involving asbestos-containing material (ACM) and 3. HYGIENIST / 'i G; . .-•e e general Demolition/Renovation operations are regulated by the Department of Environmental 4. SPECIFIC WORKSITE LOCATIONS(S) (i.e.Building name,number,wino, floor, Protection (DEP), Division of Air Quality Control, under Regulations 310 CMR 7.00, 7.09 and 7.15.Notification to the REGIONAL OFFICE of general demolition/renovation operations and room, tunnel. IS the job indoor or outdoor?) ci demolition/renovation operations involving ACM is required under 310 CMR 7.09 (2) and 310 CMR 7.15 (1)(b) twenty (20) days prior to any work performed. The followinq information is 5. ESTIMATED AMOUNT OF EACH TYPE OF ACM TO BE HANDLED (in linear required pursuant to 310 CMR 7.15. and/or Square feet): Copies of "Regulations for the Control of Air Pollution", 310 CMR 6.00 to 8.00 may be purchased from the State Bookstore, State House, Room 116, Boston, Massachusetts. 02133. boiler, breeching, duct, tank surface coatings Telephone number(617) 727-2834. Please Print. thermal, solid core pipe insulation 31-' corrugated or layered paper pipe insulation insulating cement spray-on fireproofing FBTGENERAL PROJECT DESCRIPTION trowel/sprayer coatings cloths, woven fabric 1. FACILITY transite board, wall board other-please describe Name: Telephone: ( ) Street Address: vv� ��'����� v City/Town: /t! f�croc%o��' TOTAL IN LINEAR FEET Size of Facility: in square feet: 3c, TOTAL IN SQUARE FEET 6. DESCRIPTION OF TECHNIQUES USED FOR ESTIMATION in number of floors: _ Q� Was the Facility built prior to 1980?Yes Z- No Current or Prior use of Facility: 7. ASBESTOS REMOVAL START DATE: END DATE:HOURS OF 'DAYS OF 2'-T Is the Facility Occupied? Yes ✓ No OPERATION: ' daytime OPERATION: Mon.-Fri. 2. FACILITY OWNER evening Sat.-Sun. f1af ./ J./� /��G�rl" T?._�J7�/ night Name: Telephone: (6-' 7) (Note:Any changes in these dates must be reported to the appropriate regional Street Address: i''-d ��� -'-�'G' City/Town: _/L'. office. If a removal is postponed for more than thirty (30) calendar days, separate notification will be required.) 3. ON-SITE MANAGER 8. DESCRIPTION OF ASBESTOS REMOVAL PROCEDURES TO BE USED Name: �I=�l�� ="a�t>�� Telephone: (Ga;} :R? glove bag enclosure /�.�,�x✓ra�/xl full containment Street Address: City/Town: ��Gi������t ;�%� cleanup encapsulation disposal only 4. GENERAL CONTRACTOR other-please describe Name: �/'S/ L�-.r�i iv.,:rx�-�/Telephone: (Goj) �C�-y`� 9. TRANSPORTER OFASBESTOS-CONTAINING WASTE MATERIAL FROM SITE Street Address: -:,"e A1101 City/Town: a'��-���� i>l!�. TO TEMPORARY STORAGE SITE(IF NECESS,,.RY)TO FINAL DISPOSAL SITE %-asi r`.,.:i .t r Does this project involve the removal and/or alteration of any Asbestos Containing Name: Telephone: (6a� - Material (ACM)as defined and applied in 310 CMR 7.00 and 7.15? Yes V' No_ Street Address: mak-- City/Town: 10. TRANSPORTER OF ASBESTOS-CONTAINING WASTE MATERIAL FROM IF YES, you must supply in full the information requested in sections C through E REMOVAL/TEMPORARY STORAGE SITE TO FINAL DISPOSAL SITE below. If NO, you must supply in full the information in sections D and E. Name: %"3/ "FTelephone: ( ) Street Address: City/Town: 11. REFUSE t HANSrER STATION FACILITY AND OWNER (IF APPLICABLE) Name: Telephone: ( ) Street Address: City/Town: Owner's Name: (NOTE:Transfer Stations must comply with the Division of Solid Waste Regulations E I PREPARER OF FORM 310 CMR 18.00.) 12. FINAL DISPOSAL SITE THIS FORM MUST BE SIGNED BY THE OWNER OR BY THE RESPONSIBLE Name: i���,L Telephone:1 OPERATOR OF THE PROPOSED PROJECT. Street Address: 91o,Ple-544- LkI K t -r City/Town: CERTIFICATION: 1 CERTIFY THAT I HAVE EXAMINED THE ABOVE AND THAT Owner's Name: TO THE BEST OF MY KNOWLEDGE IT IS TRUE AND COMPLETE. SIGNATURE ;::.:'TE:C1:, 0sal of ACM must complywith the Division of Solid Waste Regulations SUBJECTS SIGNER TO THE PROVISIONS OF THE GENERAL STATUTES 31U CMR 19.00.) REGARDING FALSE AND MISLEADING STATEMENT(S). 13. FOR EMERGENCY ASBESTOS REMOVAL OPERATIONS, NAME AND TITLE L'1 / , Z`Z j� -yp� OF DEP OFFICIAL WHO EVALUATED THE EMERGENCY Name: �.��: -- Telephone: (��3) Street'Address: - "� "`�y�l<�' City/Town: - Name: Title: Date of Authorization: � /�� Y✓!s`"*�` (SIGNATURE) (TITLE) D. GENERAL DEMOLITION/RENOVATION DESCRIPTION y (REPRESENTING) (DATE) 1. DEMOLITION/RENOVATION CONTRACTOR Name: Telephone: ( ) Street Address: City/Town: 2. ON-SITE SUPERVISOR F REGIONAL OFFICE LOCATIONS Name: 3. SPECIFIC WORKSITE LOCATION(S): AIR QUALITY SECTION CHIEF AIR QUALITY SECTION CHIEF DIVISION OF AIR QUALITY CONTROL DIVISION OF AIR QUALITY CONTROL MET BOSTON/NORTHEAST REGION SOUTHEAST REGION LAKEVILLE 5 COMMONWEALTH AVENUE HOSPITAL 4. WAS THE FACILITY SURVEYED FOR THE PRESENCE OF ASBESTOS WOBURN, MA 01801 MAIN STREET CONTAINING MATERIAL (ACM)? Yes No TELEPHONE: (617) 935-2160 LAKEVILLE, MA 02347 WHO CONDUCTED THE SURVEY? OR 727-5194 TELEPHONE: (508) 946-2770 Name: Department of Labor and Industries Certification #: AIR QUALITY SECTION CHIEF AIR QUALITY SECTION CHIEF 5. DEMOLITION/RENOVATION START DATE: END DATE: DIVISION OF AIR QUALITY CONTROL DIVISION OF AIR QUALITY CONTROL 6. DESCRIPTION OF DEMOLITION/RENOVATION PROCEDURES TO BE USED WESTERN REGION STATE HOUSE-WEST CENTRAL REGION 436 DWIGHT STREET-4th FLOOR 75 GROVE STREET SPRINGFIELD, MA 01103 WORCESTER, MA 01605 MAIL TO: P.O. BOX 2410 TELEPHONE: (508) 792-7693 TELEPHONE: (413) 784-1100 (NOTE: Demolition/Renovation Operations must comply with 310 CMR 7.09 to control emissions to prevent a condition of air pollution.) i 7. FOR EMERGENCY DEMOLITION/RENOVATION OPERATIONS,NAME,TITLE AND AUTHORITY OF STATE OR LOCAL OFFICIAL WHO EVALUATED THE j For official use only: EMERGENCY file no. Name: Title: i original resubmittal Authority: Date of Authorization: (GENERAL STATEMENT: If Asbestos-Containing Material is unexpectedly found or j notification incomplete/returned _ damaged during a Demolition/Renovation operation, all responsible parties must i date cert. mail # comply with 310 CNIIR 7.00, 7.09, 7.15 and Chapter 21 E of the General Laws of the Commonwealth. This would include but would not be limited to filing an asbestos removal notification with the Department and/or a notice of a release/threat of release - - -