HomeMy WebLinkAboutMiscellaneous - 78 JEFFERSON STREET 4/30/2018 (6)0 r a ml �vy�On l/ r=-� Old fit �� sO Ob(, 8Cb Im""ll �10 (2; June 11, 2010 I Victor Abramson delivered a letter to Ms. Sweeney's room today June 11, 2010. The letter was handed to my by Debra Rillahan. Victor Abramson MOVED General M nager JUN I I Zulu TOWN OF NORTH ANDOVER HEALTH DEPARTMENT . « t < m § 0 2§ 0 m (D& ■ 0 E « LL 2 R m ' 2 § @ E© 0 \ C = % ■ 0 § m E / 0 � k M: / $ 0 k 0 CD. k ■ CL @ a § « 2 » . @ 3 § . . @ @ a U b c m % % t k a m k 9 § 2 ■ E E 2 $ q_ 2 . 0 M;Q E /. t la . k § E E k %t 0 m « M r_ & m m IT U- f - 0 :r a m k m -1)8 E m -js 2 2_ U % ¢ § k > � c � § t. , ¥ � a E � 00 8 � M E .@ 8 CL k E t� c co � 04 x ce) � n o o $_ q. '_ - ¥ q 2 q q o $ 7 9 9 pr I 7 7 q % ¥� G A A v¥ & & LO M¥ o n ¥ % L6 CN �% � $ C? 19$ 17 $ 9 9 9 0? 9 17 OD 00¥ 00 ¥ 00¥ ¥ q 00 ¥ � t- o— 000 00 00 1- 00 w n 00 o � ¥ ¢ ¥ T- @ o o c 0 o o 0 0� ¥ @ @ o » m § 0 2§ 0 m (D& ■ 0 E « LL 2 R m ' 2 § @ E© 0 \ C = % ■ 0 § m E / 0 � k M: / $ 0 k 0 CD. k ■ CL @ a § « 2 » . @ 3 § . . @ @ a U b c m % % t k a m k 9 § 2 ■ E E 2 $ q_ 2 . 0 M;Q E /. t la . k § E E %t 0 m « M r_ & m m IT U- f - 0 :r a m k m -1)8 E m -js 2 2_ U % . 2 c k > G COMMONWEALTH OF MASSACHUSETTS NORTHEAST HOUSING COURT NO.03-CV.00167 NORTH ANDOVER BOARD OF HEALTH, PLAINTIFF VS. HELEN C. SWEENEY, DEFENDANT STIPULATION It is hereby stipulated and agreed as follows: 1. The Defendant, Helen C. Sweeney, shall not allow or maintain pets, particularly but not limited to any dog(s) or cat(s) on or in her dwelling located at 78B Jefferson Street, No. Andover, MA, Village Green Condominiums. 2. This Stipulation and Order of the Court shall not prevent either party from applying to the Court for additional Orders or from agreeing to a modification of this Stipulation and Order, subject to the approval of the Court. 3. The Defendant, Helen C. Sweeney, represents that she has been advised of her right to a hearing on this matter before the Court; voluntarily waives such hearing and chooses to enter into this Stipulation. 4. This Stipulation shall be entered as an Order of the Court and shall be binding on the parties hereto as of the date signed by the parties or their duly authorized representatives. Dated this 17th day of June,.2010. "Ie' /P Plai f , Susan er D to on alf of Town of No. Andover, MA Board of Health Chief Hearing Specialist Date K Helen C. Sweeney, Defendant Date Date Defenda t Is Attorney 36 Webb Brook Road, Ste. 2 Billerica, MA 01821 978 663-2170 BBO #635988 Judge David D. KEiiEZ Date `1� TRANSMISSION VERIFICATION REPORT TIME 06114/2010 14:04 NAME HEALTH FAX 9786888476 TEL 9786888476 SER.# 0004J120960 DATE,TIME 06114 14:02 FAX NO./NAME 19786632596 DURATION 00:02:52 PAGE{S} 09 RESULT OK MODE STANDARD ECM Sawyer, Susan From: Sent: To: Subject: Dear Ms. Sawyer, attyjmckenna@comcast.net Friday, ,lune 11, 2010 5:27 PM Sawyer, Susan 78 Jefferson Street, North Andover, MA I I have been advised that an Order condeming the above referenced property has been issued by the Board of Health. The owner of the property is Helen Catherine Sweeney. I have been contacted by her brother Thomas Sweeney, Esq. requesting that I obtain a copy of the order. Her family is willing to assist her and the Town to remedy this matter. Please email or fax me the order so I may assist the family in taking corrective measures to address this situation. You may also call me on my cell phone at 978-939-1275 . Thank you, John J. McKenna, Esq. Lava Office of John J. McKenna 38 Webb Brook Road, Suite 2 Billerica, MA 01821 978-663-2170 fax 978-663-2596 COMMONWEALTH OF MASSACHUSETTS NORTHEAST HOUSING COURT Plaintiff G0--, r, - v. - Defendant No. r,,3-L-V-bL,i(= % MOTION WITH HEARING AT LAWRENCE SESSION The undersigned>_<,�_;,__,� �-,- hereby moves this Court [_] to continue this case until [_] to amend [_] to dismiss this case [_] to remove default or dismissal and for relief from judgment and set the case for trial on [_] to stay execution until [ ] to issue execution [ ] other for the following reasons: Z This motion will be heard by the Northeast Housing Court at Courtroom 3, Northeast Housing Court, 2 Appleton Street, Lawrence, at 9:00 o'clock a.m. Thursday, '),G., 4-1 I 200 . to I (gave) (mailed) a copy of this motion on ignature and dat Name Address �- 31 `f' 7 9 L- 9 s` rfi'S j- t Telephone U f P f ,x COMMONWEALTH OF MASSACHUSETTS NORTHEAST HOUSING COURT i V. endant STIPULATION No. 03 -C -V- 00 /e The undersigned parties hereby stipulate and agree as follows: 1�- C =� ONCE APPROVED BY THE ;JUDGE, THIS AGREEMENT BECOMES A COURT ORDER AND BOTH PARTIES ARE LEGALLY REQUIRED TO FOLLOW IT If questions arise, please, consult the housing specialist I I UNDERSTAND THAT I HAVE THE RIGHT TO A HEARING ON MY CASE BEFORE A JUDGE, BUT INSTEAD I CHOOSE TO SIGN THIS AGREEMENT i S' ned and da d by Signed "and 4ed y Tenant P1 's Defendants Attorney Chief Hous ng Special ' ,� Patrick J . McDonough �. Judge David D. Kerman COP (GI� ILED) TO PARTIES ON 01/22/09 10:13 FAX 978 689 7838 Dear Ms. Sweeney, N.E. HOUSING CT. Northeast Housing Court Tenancy Preservation Program 2 Appleton Street Lawrence, MA 01840 (978) 687-7184 x2328 [a 002 Thursday January 22, 2009 I tried to call you both earlier this week and today, as we agreed after we met last week. I have not been able to reach you. I understand from the Health Department that the cleaners from My Maids did not come on Monday and Tuesday of this week as you called to reschedule them I also understand that you asked Ms. Rillahan for another week lo work on your bedroom and bathroom areas, which have not been inspected recently. It has now been a week and the Health Department has not been able to re -inspect your home. You are still under a court order and at this point are not in coi6pliance with it. The court may recommend the appointment of a Receiver for your case. This is someone the court appoints to take over and manage the problems until they are resolved. This costs money which you will be responsible for paying. The Receiver will have the authority to do whatever it takes to clean out your apartment and bring it back to health code compliance. This will mean cleaning out your apartment where you may not have much say over what stays and what goes. I am sure this is not a pleasing thought to you, but it is getting Bose to that point. I had hoped that you would be able to stick to a regular schedule with My Maids, particularly in the beginning when a lot of heavy work needs to be done. My Maids cannot operate their business when you make so many cancellations and reschedule requests. I am not confident that they will be willing to continue to work with you. Please call me at your earliest convenience. At this point, you are scheduled to return to Housing Court on 2/5/09. However, the Health Department may bring you in earlier if necessary, possibly next Thursday, 1/29/09. My office number is 978 687-7184 x2328. I hope to hear from you soon, Helen. Sincerely, Heather Abrams, LICSW TPP Director A 02/04/2009 11:38 7815656344 _PAGE 01/02 TERMS AND CONDITIONS Betwean My Maids and CATHERINE SWEENEY MY Maids has been hired to perform the cleaning service chart for CATHERINE SWEENEY at i8 services ST APT, specified in the SCOREBOARD My Maids will supply 13, NORTH ANDOVER, MA. Pp Y necessary cleaning chemicals and equipment to perform this s CATHERINE is responsible to provide trashcan liners. ervic SWEENEY e. ➢ If either party feels that this Agreement does not suit their terminated without notice. If the client terminates without a 5 da billed for the entire week of service. iyf needs, the Agreement can be lack of Y Maids can terminate the orntract atitten notfany tifine dull Payment from the client. Payment Terms: DUE UPON RE=CEIPT Cleaning price: S40/HR PER PERSON. contract will be reviewed and clientbe no tfied n wriricels trnthrou h 2009. g dj that time the Additional services requested that are not included on g of any price adjustments. the weekly invoice as a separate line item. Additional services May incl the Specifications list will be added to window washing, etc. Y ude carpet cleaning, Quoted By: Jose Bobadilla and/or Christina Nault Date: MY Maids ACCEPTANCE OF PROPOSAL jAuthorized mer: CATHERINE SWEENEY Com an Maids ,. ' r? Authorised '��l.� ture• SI na tures Title: C) � V.,P �^ Title: Date: - — D 0 °i Date: L COMMONWEALTH OF MASSACHUSETTS NORTHEAST HOUSING COURT %laintiff fendant O C,v - b 01 (4 MOTION WITH HEARING AT LAWRENCE SESSION The undersigned hereby moves this Court [ J to continue this case until [_] to amend [ J to dismiss this case [_J to remove default or dismissal and for relief from judgment and set the case for trial on [ J to stay execution until [ J to issue execution to ord� )aYme of the judgmen within 13 ays [ J [V_J, other - -I ► . ii O This motion will be heard by the Northeast Housing Court at Courtroom 3, Northeast Housing Court, 2 Appleton Street, Lawrence, at 9:00 o'clock a.m. Thursday, Lz 20�j I (gave) (mailed) a copy of this motion on to 5�tRr dtg r 0 InIrT 17*1 Telephone North Andover Police Department 566 Main Street North Andover, Ma. 01845-4099 (978) 683-3168 Incident Report Narratives for Incident Number 2010000012402 ? Yes Other Narratives not authorized for print? None Narratives this user authorized to print: Narrative by: Patrolman Stephen Diminico Division: Patrol Officers Incident Number: 2010000012402 File No: N/A Dispatch Incident Number: 2010000013244 Print Date: June 10, 2010 Printed By: pgallagh Date & Time Narrative Description Entered by Status Reviewed by Last Edit Date 06/04/2010 16:38 Patrolman Stephen Open 06/04/2010 Diminico I Ofc. Diminico was dispatched to 78 Jefferson to meet the NA board of Health for a well being check and report the following. When I arrived I was met out front by Deb from the Board of Health. She stated the neighbors have been complaining of the bad odor coming from the unit and no one has seen the resident at 78B a Helen Sweeney for at least a week. One neighbor stated her car was not in the parking lot. I knocked on the front door in an attempt to raise someone but there was no answer. A strong odor of cat urine could be smelled coming from inside the unit. Inside the front window I could see a golden retriever dog that was barking at me and jumping on the window sill. The floor in the living room was full of urine stains as well as massive amounts of dog feces. In order to check the well being of Helen Sweeney the NAFD was called to the scene and forced entry to the front door of 78B Jefferson Street. I checked the inside of the unit and there was no person found inside. The entire unit was full of trash everywhere. There was dog and cat waste everywhere you looked. Trash was stack up on itself and was ceiling high in places. While assess the scene the Board of Health 'determined the unit condemned and in no condition for human or animal inhabitants. While the dog was being removed from the unit and placed in the back of 321 for transport, Helen came home. Helen was advised that she couldn't go into her unit and the dog was being taken by the NAPD. Helen became very upset and stated, "I should just die." The NAFD ambulance was then called to the scene and Helen was transported to LGH for a mental health evaluation. The dog was taken in 321 by myself to the Andover Animal Hospital for boarding and the Board of Health stood by on scene to secure the unit. Signature - Reporting Officer Signature - Reviewing Officer Incident Notes: Create User ID: Date & Time No Incident Notes Listed Incident Dispatcher Remarks: Create User ID: system Date & Time 06/04/2010 16:33:42 2010/06/04 13:51 Lundquist, Joan 546: HEALTH DEPARTMENT REQUESTS A WELL BEING CHECK, OFFICER DIMINICO IS RESPONDING. 2010/06/04 14:37 Lundquist, Joan 546: OFFICER DIMINICO REPORTS NO ONE HOME AT THIS TIME, WAYNE NADER WILL BE ASSISTING WITH THE DOG AND CATS,. 2010/06/04 15:26 Bonanno, Jonathan 554: A-2 RESPONDING FOR A 60 Y/O FEMALE MENTAL EVAL. RUN# 1076 2010/06/04 15:38 Lundquist, Joan 546: ENROUTE MILEAGE TO HFH 43623. OFFICER DIMINICO REPORTS HE WILL BE TRANSPORTING THE DOG TO THE ANDOVER ANIMAL HOPITAL. 2010/06/04 16:09 Vieira, Brighid 556: A2 ENDING MILE TO HFH 43631 ------- -- ..----------------------------------------------------------------------------------------------------------------------- Incident Number: 2010000012402 Page 2 of 3 PlFormSingle 12/01/09 North Andover Police Department Incident Number: 2010000012402 666 Main Street File No: N/A North Andover, Ma. 01845-4099 Dispatch Incident Number: 2010000013244 (978) 683-3168 Print Date: June 10, 2010 Incident Report Printed By: pgallagh Incident Information Occurred Day of Date Time Occurred Day of Date Time Reported Date Time On/From Week Officer Title Officer Name To Week Patrolman William H Brush III On Patrol Officers Patrolman Stephen M,Diminico Fri 06/04/2010 1:50:02PM Stephen M Diminico Fri 06/04/2010 1:50:02PM --4 6/4/2010 1:50:02PM Reported As Incident Type - Primary Arresting Officer Well Being Check Well Being Check Incident Address Reporting Officer 78 Jefferson Street, North Andover, MA 01845 Patrolman Stephen Diminico Sector Stat. Area j ISubStat. Area Census Tract Landmark Business Name Incident Types - Other N/A Associated Persons Summary Type Name(Last, First, MI) Date of Birth I Sex I Home Phone # I Cell Phone # I Work Phone # Involved SWEENEY, HELEN C, 8/4/1949 F N/A N/A N/A ---------------- ---- ------ -----...-----------........... ------------... --- -- ......---......----------...... ......-- Address. 78 Jefferson Street, North Andover, MA 01845 Associated Businesses Summary Type I Name Primary Phone # I Secondary Phone # No Associated Businesses reported for Incident M 2010000012402 Involved Officers Officer Title Officer Name Officer Type Division Patrolman William H Brush III Responding Officer Patrol Officers Patrolman Stephen M,Diminico Reporting Officer Patrol Officers Patrolman Stephen M Diminico Responding Officer Patrol Officers IBR/UCR Offenses Offense Number IBR Type Chapter Section Statute ID / IBR Type Description No Incident Offenses Recorded for Incident #: 2010000012402 Complaint Charges r Seq # Chapter Section Name(Last, First, MI) Description of Offense No Complaint Offenses Recorded for Incident #: 2010000012402 Vehicle Info Vehicle No. Vehicle Make I Vehicle Model I Vehicle Year VIN Primary Color I Secondary Color I Plate No. I State No Vehicle Info Recorded for Incident M 2010000012402 (Property INo Property Info reported for Incident #: 2010000012402 Citations Citation No Code Date Status Statute Description No Citations reported for Incident #: 2010000012402 Incident Number: 2010000012402 Page 1 of 3 PIFormSingle 12/01/09 Sawyer, Susan From: attyjmckenna@comcast.net Sent: Friday, June 11, 2010 5:27 PM To: Sawyer, Susan Subject: 78 Jefferson Street, North Andover, MA Dear Ms. Sawyer, I have been advised that an Order condeming the above referenced property has been issued by the Board of Health. The owner of the property is Helen Catherine Sweeney. I have been contacted by her brother Thomas Sweeney, Esq. requesting that I obtain a copy of the order. Her family is willing to assist her and the Town to remedy this matter. Please email or fax me the order so I may assist the family in taking corrective measures to address this situation. You may also call me on my cell phone at 978-930-1275. Thank you, John J. McKenna, Esq. Law Office of John J. McKenna 36 Webb Brook Road, Suite 2 Billerica, MA 01821 978-663-2170 fax 978-663-2596 -°DelleChiaie, Pamela From: Sawyer, Susan Sent: Monday, June 07, 2010 2:35 PM To: Rillahan, Deb Cc: DelleChiaie, Pamela; Grant, Michele Subject: FW: My Maids. From: JOSE BOBADILLA [mailto:josemb@msn.com] Sent: Saturday, June 05, 2010 10:31 PM To: Sawyer, Susan Subject: RE: My Maids. Susan, 7�7-�sa� moi` I just rec'd a call from Catherine today at roughly 7 AM. I am not sure as to what is going on, I simply have the details from our brief conversation. She said she said many times that she was sorry and simply hung up. From our. conversation, there is obviously something that she is and was hiding and it was exposed. She has never been truthful from the beginning and since the new cleaner has been taking care of her, I thought she was just being more consistent due to finding a cleaner that she was "comfortable with". She has had the new cleaner since Jan, since her request was placed and honored. She would never let anyone else into her place, only this scheduled cleaner, so we always ensured that this was the woman that performed her "service". With that being said, I have asked Catherine to no longer contact My Maids as I cannot believe a word that she says or even determine what she was allowing the cleaner to perform on the Saturday scheduled mornings at 9 AM. Looking back, I wish that I have got into the apartment sooner. I even had an appt to see the place this Saturday and advised her that I was reporting back to you with pictures as the testimony of the cleaner was not suffice. I never heard that there were any challenges, not even one! I just hope that no one was hurt and that the animals are in a safer place. Hopefully Catherine in the meantime will receive the assistance that she so desperately needs. Thank you. Christina From: josemb@msn.com To: ssawyer@townofnorthandover.com Subject: RE: My Maids. Date: Thu, 3 Jun 2010 13:50:26 -0400 Hi, I just spoke with her, the cleaner. From what I understand, she still has the dog and the has been in and out of the hospital and I am not sure if the dog is being walked. The cleaner said that the friend is walking the dog. She said that the dog pees on the kitchen floor and on ocassion we are asked to stay away from the kitchen to protect the doog, which is not really acceptable and I will addresss moving forward. The cleaner is calling Catherine and telling her that we need to do a deep clean in the kitchen. She believes that Me urine is seeping into the floors. I am going to take a look as well, I will suprise her on Saturday. It is well overdue. Thanks and let me know what else should be done. Christina From: ssawyer@townofnorthandover.com To: josemb@msn.com Date: Thu, 3 Jun 2010 13:39:15 -0400 Subject: RE: My Maids. That is good to hear. As a matter of fact we could use your expert assistance. We had a complaint this week concerning a strong odor coming from the apartment. Have'you been there personally? Before we have to do an inspection, would it be possible for you to visit at the next cleaning date and send us a report of your findings? Maybe take a few pictures if you have a phone camera if you think she wouldn't mind. I am wondering if she still has the dog walker. Maybe that could be the problem. I will try to contact that person as well. Susan Sawyer 978 688-9540 if you have any thoughts you would like to share. From: JOSE BOBADILLA [mailto:josemb@msn.com] Sent: Thursday, June 03, 2010 9:47 AM To: Sawyer, Susan Subject: RE: My Maids. Hi Susan, Hope all is well! She has been excellent, no rescheduling, no cancelling, etc. We have been taking care of her five rooms for some time now. Let me know what else you require. Thanks! Christina Nault My Maids, Inc. 978.416.0602 From: ssawyer@townofnorthandover.com To: josemb@msn.com Date: Wed, 2 Jun 2010 16:42:43 -0400 Subject: RE: My Maids. Hello Christina, I haven't heard from your company in awhile regarding this issue. Could you tell me if you are still under contract with Helen Sweeney, 78 Jefferson, North Andover, MA? If not, can you tell me when you stopped providing her service. If you are, may we plan a time to speak about the property. ThanVyou for your help as in the past. `Susan Sawyer Public Health Director From: JOSE BOBADILLA [mailto:josemb@msn.com] Sent: Wednesday, February 04, 2009 10:42 AM To: Sawyer, Susan Subject: My Maids. in Sorry, I am traveling today so sending from a personal account. I just had my office send you the contract as it was signed last night. Please confirm. Thanks and speak wiht you soon. Let me know what else you require. Question: Were you happy with the condition? Thank you!! Christina i Windows Live TM: Keep your life in sync. See how it works. Hotmail is redefining busy with tools for the New Busy. Get more from your inbox. See how. Hotmail has tools for the New Busy. Search; chat and e-mail from your inbox. Learn more. The New Busy is not the too busy. Combine all your e-mail accounts with Hotmail. Get busy. 3 COMMONWEALTH OF MASSACHUSETTS NORTHEAST HOUSING COURT laintiff rfndant No. MOTION WITH HEARING AT LAWRENCESESSION The undersigned hereby moves this Court [_] to continue this case until [_] to amend [_] to dismiss this case [_] to remove default or dismissal and for relief from judgment and set the case for trial on [_] to stay execution until [ ] to issue execution [ to order p�aymen, of the� j �zdgmen within [ 3 a s [ ) [1/ J , other `� r\ 1 L � 1 CN 0 /-� X� N Eli This This motion will be heard by the Northeast Housing Court at Courtroom 3, Northeast Housing Court, 2 Appleton Street, Lawrence, at 9:00 o' clock a.m. Thursday, , 20�02. I (gave) (mailed) a copy of thi motion on to n turerdi dat , TO - l D' Telephone �EjqDl �) 16 COMMONWEALTH OF MASSACHUSETTS NORTHEAST HOUSING COURT �Ct laintiff - v.- Nor� fendant MOTION WITH HEARING AT LAWRENCE SESSION The undersigned hereby moves this Court [_] to continue this case until [_] to amend [_] to dismiss this case [_] to remove default or dismissal and for relief from judgment and set the case for trial on [_) to stay execution until [ ] to issue execution to ord� pa e of tY}� j�dgmen within [3 a' other 'l r\mtr(Isn \ 1 /-V CN 0 r` i� � `�X This motion will be heard by the Northeast Housing Court at Courtroom 3, Northeast Housing Court, 2 Appleton Street, Lawrence, at 9:00 o'clock a.m. Thursday, 20�j I (gave) (mailed) a copy of this motion on to ,.t tAORTy ; 6 OL O " it V PUBLIC HEALTH DEPARTMENT Community Development Division Helen Sweeney 78B Jefferson Street North Andover, MA 01845 January 28, 2008 Dear Ms. Sweeney, This letter is a follow-up to the inspection conducted by the Public Health Nurse, Debra Rillahan on January 28, 2008. Ms. Rillahan's report regarding the inspection was of great concern. She reported that the condition of the condo unit appears to be deteriorating. In addition, due to circumstances over her last few visits, she has been unable to conduct a complete inspection of the premises. In particular, the bedroom apparently has been unavailable for viewing due to family illness. The Health Department has worked with you for many years in the hope that past sanitation problems would not reoccur. On February 22, 2005 a letter was sent to you spelling out an agreement between you and the Health Department, (see attached) Debbie has been very liberal in accepting your need to postpone and reschedule many appointments, but if the end result is that you have been unable to maintain your home in a sanitary manner than this flexibility cannot continue. Debbie has told me that she made an appointment for February l la' at 10:00 AM. I will be accompanying her on this inspection. If we are unable to view the entire apartment to confirm that the home is in a sanitary condition, or if no one is present at the time of inspection a complaint will be filed the following Thursday at the Lawrence Housing Court. It is important that this issue be remedied so that you can maintain compliance to the court's requirements. Please note that our records currently show BJ's Pet Sitting and Anna and Rosa's house cleaning in your employ. Please supply this office with current phone numbers of these employees by the next meeting. Thank you for your anticipated cooperation in this important matter of public health. Sinc e , san Sawye , Si PZ;X� ublic Health Director Cc Debra Rillahan, Public Health Nurse Michele Grant, Public Health Inspector 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.towoofnorthandover.com NORTFj 4yy � eye yy� `T O 11�M! T/ Q_ CO[M1[Nl WK• 7' PUBLIC HEALTH DEPARTMENT Community Development Division Helen Sweeney 78B Jefferson Street North Andover, MA 01845 January 28, 2008 Dear Ms. Sweeney, This letter is a follow-up to the inspection conducted by the Public Health Nurse, Debra Rillahan on January 28, 2008. Ms. Rillahan's report regarding the inspection was of great concern. She reported that the condition of the condo unit appears to be deteriorating. In addition, due to circumstances over her last few visits, she has been unable to conduct a complete inspection of the premises. In particular, the bedroom apparently has been unavailable for viewing due to family illness. The Health Department has worked with you for many years in the hope that past sanitation problems would not reoccur. On February 22, 2005 a letter was sent to you spelling out an agreement between you and the Health Department. (see attached) Debbie has been very liberal in accepting your need to postpone and reschedule many appointments, but if the end result is that you have been unable to maintain your home in a sanitary manner than this flexibility cannot continue. Debbie has told me that she made an appointment for February 1 It' at 10:00 AM. I will be accompanying her on this inspection. If we are unable to view the entire apartment to confirm that the home is in a sanitary condition, or if no one is present at the time of inspection a complaint will be filed the following Thursday at the Lawrence Housing Court. It is important that this issue be remedied so that you can maintain compliance to the court's requirements. Please note that our records currently show BJ's Pet Sitting and Anna and Rosa's house cleaning in your employ. Please supply this office with current phone numbers of these employees by the next meeting. Thank you for your anticipated cooperation in this important matter of public health. Sin�e, san Sawye , fSIVR Public Health Director Cc Debra Rillahan, Public Health Nurse Michele Grant, Public Health Inspector 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com Q " S�Vdl ( Csw-e c &,-, ■ Complete items 1, 2, and 3. Also complete A.TL item 4 if Restricted Delivery is desired. 1:1Agent ■ Print your name and address on the reverse X ❑ Addressee so that we can return the card to you. B. R ceived by ( Printed Name C. Da of Delivery ■ Attach this card to the back of the mailpiece, a _ U or on the front if space permits. D. Is delivery address different from item 1? ❑ Yes 1. Article Addressed to: If YES, enter delivery address below: ❑ No 3. Service Type ❑ Certified Mail ❑ Express Mail ❑ Registered ❑ Return Receipt for Merchandise ❑ Insured Mail ❑ C.O.D. 4. Restricted Delivery? (Extra Fee) ❑ Yes 2. Article Number 7003 1680 0004 9915 8650 2�S-2 (transfer from service label) �, � ■ PS Form 3811, August 2001 Domestic Return Receipt 102595-02-M-1540 UNITED STATES POSTAL SERVICE First -Class Mail 111111 Postage & Fees Paid USPS Permit No. G-10 • Sender: Please print your name, address, and ZIP+4 in this box • Health Department 400 OSGOOD STREET North Andover, MA 01845 5c41, v A bn d 45 ca Ke 15 (1-0 5 G��'y Page 1 Off DelleChiaie Pamela From: dkobrenski@ilyd.com [dkobrenski@ilyd.com] Sent: Thu 11/13/2008 9:47 AM To: DelleChiaie, Pamela Cc: Subject: RE: Odor in hallway Attachments: It is in the Village Green Condo Complex. Thanks, Dan Kobrenski "DelleChiaie, Pamela" <pdellech@townofnortha ndove r.com> 11/13/2008 09:14 AM Which complex is this? Pamela DelleChiaie To <dkobrenski@ilyd.com> cc' Subject RE: Odor in hallway From: dkobrenski@ilyd.com [mailto:dkobrenski@ilyd.com] Sent: Wed 11/12/2008 9:01 PM To: DelleChiaie, Pamela Subject: Odor in hallway Hello, I live in a garden style condo in North Andover with a hallway shared with three other neighbors. There is a foul odor in the hallway that has been lingering for at least 1 week. I believe the smell is coming from one of the other units. I would appreciate it if this matter is investigated at your earliest convenience. My Address: 78C Jefferson St North Andover, MA 978-835-0840 Thank you for your help, Dan Kobrenski http://exchange2003.town.north-andover.ma.uslexchange1pdellechiaiellnboxlRE:%20Od... 11/13/2008 NORTH ANDOVER HEALTH DEPARTMENT 27 Charles Street • North Andover, MA 01845 Tel. 978 688-9540 • Fax: 978 688-9542 email: healthdept@townofnorthandover.com Complaint Investigation/Inspection Report r-- g�Zo2 Rev. 6/04 INSPECTOR i NORTH ANDOVER HEALTH DEPARTMENT 27 Charles Street • North Andover, MA 01845 Tel. 978 688-9540 • Fax: 978 688-9542 email: healthdept@townofnorthandover.com Complaint Investigation/Inspection Report Rev. 6/04 INSPECTOR r� I --I ;0D --f vill REyg®,1 NOV 17 2008 TOWN OF NORTH ANDOVER , _qo HEALTH DEPARTMENT �N )-cG,� je �' Fly`/- '� � i � _.ti al : `•i i �� C , l �• (.��r,, !� - `J, f' �'. f. 4 1 It - - •V -- 1 ic, /Vl4- I.,- KI COMMONWEALTH OF MASSACHUSETTS NORTHEAST HOUSING COURT I Defendant AGREEMENT TO CONTINUE The undersigned parties hereby agree to continue the above case to 7., .� 200q at ®•'��,H, o'clock. Sign an d ed by Plaintiff Signed and dated by Def dant Defendant's Attorney Date COPI (VEN) (MAILED) TO PARTIES ON a-�� DelleChiaie, Pamela From: Sawyer, Susan Sent: Monday, January 12, 2009 4:27 PM To: DelleChiaie, Pamela; Rillahan, Deb Subject: Helen Heather cell phone (978) 790-0519 Heather will be at Helen's 10 AM, Wed. Jan 14th Deb is going to meet her there. Pam, Deb doesn't know what time so please let her know when she comes in on Wed. thx :-. 0 i.i f0 w A n a d m CL 0 7 A) A 0 3 3 0 m Q m w 7 ° C (.7 C rA Er t�D d C t O y m Z0/Z0 39Vd oDVo�cnAwN�d _ COC -n C Z O p C• ID O O 74 40 O j 4 E oUS 0 IV E W O LL 0 (h C O Vi tD .� mm 0m a X 4 3 m CL Q- y H a CL N 0 o c ((Np_ a N LL 9 a i i � tpGo-.iQ�tttiAWN�►,�,+ CT AWN ••+ O ' L; N 7c�Qp y %;.o C q0 0 O QeD fD 0 O lD f]. y td O awl �i 4 O O 0 w d d N p Oji m N eb JU :r cc ul O msD R, l CL 00 0— v i=o'° =c � o m ID n- a» -3 on fp CL LL 3• -1 y to C N pOj O N 0 '00 CL o c tyD fo0 _ 3 cfl A m N a (D Q � a Cc 0 o �. n O Q mon. m ee A) 23 a !D CL a 50 00 q m u, A cw :016 "v° Q7CQ m (D o y�N'aa q5 3n. ma.P'�°�' c� p a 3 9 il0 2L -c3 (n a a 5 7d 0. C i R C OL r X •fOm Vd>P:lb, f7 ' ft -n�TfCiC7�m-Ica' -.5 m o 0 ycc30te -0 Ora ED o o ° obi m, 3 {� E aQw w a�pyaoN fwD � w W inmm¢w3QQe70w3o 3 n•Ig:y a m OL c CD CL 'mo.3� CL tD a B. CL 9 1111113 IIIIIIIIII' ODvOfC7�AwN :.•t/j Tl -n - 03 -a C7 -4 FA"E4 (fi o Cn tD' f7 c O �v`y 7 N N M 3 QD 3fD��Q,aw 3 CL tl a m a m m o 3 y CL e`Ce N CL C N m Q wW-4M0 AwNT- tu 0' Cc) v N p C x a y cr O � C-) ° N 4o�w O w 7 O =to 0 o 7 N CLL 0 ui O fDa_=Nwm.-9„fo4Dw0 %agawn* CL nycODcoms-a3 mNo- c a cy a n 3 y FL c n. cn m F 3 o c m f1 C m S N d m a a llllli~ w � HIM OVE999918L 8E:ll 600Z/00/Z0 DelleChiaie, Pamela From: Sawyer, Susan Sent: Wednesday, February 04, 2009 9:56 AM To: Sawyer, Susan; Rillahan, Deb; DelleChiaie, Pamela Cc: Grant, Michele Subject: RE: helen I have a call into My Maids. We need that contract before I call off tomorrows court date. I gave Christina our fax again. Please look out for it and remind me to get a hold of Jay as soon as I confirm it exists. Thx From: Sawyer, Susan Sent: Tuesday, February 03, 2009 2:16 PM To: Rillahan, Deb Cc: Sawyer, Susan Subject: helen The insp. went well. I will fill you in. If we get the contract from the cleaner I will call Jay tomorrow about continuing. Please remind me. DelleChiaie, Pamela From: Sent: To: Subject: You are very welcome! JOSE BOBADILLA gosemb@msn.com] Friday, February 20, 2009 4:02 PM Sawyer, Susan; Rillahan, Deb; DelleChiaie, Pamela RE: My Maids. 60.%/ '/s' n%ii'ersa2 Ler2 S'usemrre(/ So, we saw her not this past Wed, the one prior and the girls were there a total of four hours. Then she was "tied" up this week so we will be there tomorrow, Saturday. We plan to be there about 4-5 hours. The standard amount of hours weekly should be about 3-4, depending on how well she maintains it. Rest assured, you will be the first to know if and when she starts acting up :) Talk with you soon. Regards, Christina Nault My Maids Info(abmymaidsnewengland. com Subject: RE: My Maids. Date: Fri, 20 Feb 2009 14:55:12 -0500 From: ssawyer(a)townofnorthandover.com To: josemb(abmsn.com CC: pdellech(5)townofnorthandover.com; drillaha(a)townofnorthandover.com Thanks for the update on Helen. You can just tell me the dates and hours spent. If she cancels or is causing other problems please let me know as well. I will place your emails in the file. Thank you Susan From: JOSE BOBADILLA [mailto:josemb@msn.com] Sent: Wednesday, February 18, 2009 2:31 PM To: Sawyer, Susan Subject: RE: My Maids. Hi Susan, Everything is going just as planned. She is letting us into the house and we are doing what is necessary to ensure that we maintain the cleanliness. What other data can I provide you with? Thank you again. Christina Nault 1 My Maids Subject: RE: My Maids. Date: Tue, 17 Feb 2009 16:10:44 -0500 From: ssawyer(atownofnorthandover.com To: josemb@msn.com Hi Christina, How is it going with Helen Sweeney? Can you send me an update? Susan From: JOSE BOBADILLA [mailto:josemb@msn.com] Sent: Wednesday, February 04, 2009 2:54 PM To: Sawyer, Susan Subject: RE: My Maids. Hello! Loving the sheet over the pile. Did she accumulate this is the short time since we where there? Too funny. So there is still an odor. I will ask the girls to do more with uncovering that smell. Not sure how where that is coming from. That is strange. So let me know how the cancellation of the court date is going.; Let me know what I can do to assist you. Thanks! Christina Subject: RE: My Maids. Date: Wed, 4 Feb 2009 12:23:33 -0500 From: ssawyer(abtownofnorthandover. com To: josemb@msn.com Hi Christina, Yes, I received the fax. I am trying to cancel the court date for tomorrow. The cleaning results were excellent at Helen's. She obviously had a lot of help. She did remove a lot of furniture and stuff as well. I love the sheet hanging over the stuff in the corner. Hey, it looked good enough. I too still wonder about the odor. I could smell it in the hallway. I hope with a few weeks of steady cleaning, painting the walls, washing her clothes, cleaning her fabric furniture etc. it will disappear. I had no idea what is exactly. It is very unusual. Susan From: JOSE BOBADILLA [mailto:josemb@msn.com] Sent: Wednesday, February 04, 2009 10:42 AM To, Sawyer, Susan Subject: My Maids. Hi, Sorry•, I am traveling today so sending from a personal account. I just had my office send you the contract as it was signed last night. Please confirm. Thanks and speak wiht you soon. Let me know what else you require. Question: Were you happy with the condition? Thank youth Christina Windows Live TM: Keep your life in sync. See how it works. Windows Live TM: Keep your life in sync. See how it works. Want to do more with Windows Live? Learn "10 hidden secrets" from Jamie. Learn Now Windows Live TM: Keep your life in sync. Check it out. 3 DelleChiaie, Pamela From: Sawyer, Susan Sent: Friday, February 20, 2009 2:55 PM To: JOSE BOBADILLA Cc: DelleChiaie, Pamela; Rillahan, Deb Subject: RE: My Maids. Thanks for the update on Helen. You can just tell me the dates and hours spent. If she cancels or is causing other problems please let me know as well. I will place your emails in the file. Thank you Susan From: JOSE BOBADILLA [mailto:josemb@msn.com] Sent: Wednesday, February 18, 2009 2:31 PM To: Sawyer, Susan Subject: RE: My Maids. Hi Susan, Everything is going just as planned. She is letting us into the house and we are doing what is necessary to ensure that we maintain the cleanliness. What other data can I provide you with? Thank you again. Christina Nault My Maids Subject: RE: My Maids. Date: Tue, 17 Feb 2009 16:10:44 -0500 From: ssawyer(aOtownofnorthandover.com To: josemb@msn.com . Hi Christina, How is it going with Helen Sweeney? Can you send me an update? Susan From: JOSE BOBADILLA [mailto:josemb@msn.com] Sent: Wednesday, February 04, 2009 2:54 PM To: Sawyer, Susan Subject: RE: My Maids. Hello! Loving the sheet over the pile. Did she accumulate this is the short time since we where there? Too funny. So there is still an odor. I will ask the girls to do more with uncovering that smell. Not sure how where that is coming from. That is strange. So let me know how the cancellation of the court date is going. Let me know what I can do to assist you. `Thanks! Christina Subject: RE: My Maids. Date: Wed, 4 Feb 2009 12:23:33 -0500 From: ssawyer(&townofnorthandover.com To: josemb@msn.com Hi Christina, Yes, I received the fax. I am trying to cancel the court date for tomorrow. The cleaning results were excellent at Helen's. She obviously had a lot of help. She did remove a lot of furniture and stuff as well. I love the sheet hanging over the stuff in the corner. Hey, it looked good enough. I too still wonder about the odor. I could smell it in the hallway. I hope with a few weeks of steady cleaning, painting the walls, washing her clothes, cleaning her fabric furniture etc. it will disappear. I had no idea what is exactly. It is very unusual. Susan From: JOSE BOBADILLA [mailto:josemb@msn.com] Sent: Wednesday, February 04, 2009 10:42 AM To: Sawyer, Susan Subject: My Maids. Hi, Sorry, I am traveling today so sending from a personal account. I just had my office send you the contract as it was signed last night. Please confirm. Thanks and speak wiht you soon. Let me know what else you require. Question: Were you happy with the condition? Thank you!! Christina Windows Live TM: Keep your life in sync. See how it works. Windows Live TM: Keep your life in sync. See how it works. Want to do more with Windows Live? Learn "10 hidden secrets" from Jamie. Learn Now z 'DelleChiaie, Pamela From: Tymon, Judy Sent: Friday, February 20, 2009 11:46 AM To: Ippolito, Mary; Curran, Bernadette; Glennon, Michel; McEvoy, Jeannine; Brown, Gerald; DelleChiaie, Pamela Subject: MIMAP Good morning - I know that all of you have been waiting with bated breath for the appearance of MIMAP - well, here is our first prototype! Just in time for FRIDAY! Click on this link, enter an address and have fun! http://mns.mvpc. org/northandovelpropeLtyselector/default. aspx?town=north+andover Judy DelleChiaie, Pamela From: Sawyer, Susan Sent: Monday, February 23, 2009 11:26 AM To: DelleChiaie, Pamela Subject: FW: My Maids. Pam, can you print this and put in Helen's file. They will let us know if she denies entry for cleaning going forward. At this point, Deb nor I will be going on a monthly basis. We go once or twice a year randomly but no regular. S From: JOSE BOBADILLA [mailto:josemb@msn.com] Sent: Sunday, February 22, 2009 8:44 AM To: Sawyer, Susan Subject: RE: My Maids. You are very welcome! 1. 2-06-09 Four hours total. 2. 1-29-09 Four hours total. 3. 02-11-09 Three hours total. 4. 02-21-09 Four hours total. I will absolutely let you know. Thanks for everything. Regards, Christina Subject: RE: My Maids. Date: Fri, 20 Feb 2009 14:55:12 -0500 From: ssawyer@townofnorthandover.com To: josemb@msn.com CC: gdellech(a townofnorthandover.com; drillaha(&townofnorthandover.com Thanks for the update on Helen. You can just tell me the dates and hours spent. If she cancels or is causing other problems please let me know as well. I will place your emails in the file. Thank you Susan From: JOSE BOBADILLA [mailto:josemb@msn.com] Sent: Wednesday, February 18, 2009 2:31 PM To: Sawyer, Susan Subject: RE: My Maids. Hi Susan, Everything is going just as planned. She is letting us into the house and we are doing what is necessary to ensure that we maintain the cleanliness. What other data can I provide you with? p0 h y� Thank you again. Christina Nault My Maids Subject: RE: My Maids. Date: Tue, 17 Feb 2009 16:10:44 -0500 From: ssawyerCaltownofnorthandover. com To: iosemb@msn.com Hi Christina, How is it going with Helen Sweeney? Can you send me an update? Susan From: JOSE BOBADILLA [mailto:josemb@msn.com] Sent: Wednesday, February 04, 2009 2:54. PM To: Sawyer, Susan Subject: RE: My Maids. Hello! Loving the sheet over the pile. Did she accumulate this is the short time since we where there? Too funny. So there is still an odor. I will ask the girls to do more with uncovering that smell. Not sure how where that is coming from. That is strange. So let me know how the cancellation of the court date is going. Let me know what I can do to assist you. Thanks! Christina Subject: RE: My Maids. Date: Wed, 4 Feb 2009 12:23:33 -0500 From: ssawyerCabtownofnorthandover.com To: josemb@msn.com Hi Christina, Yes, I received the fax. I am trying to cancel the court date for tomorrow. The cleaning results were excellent at Helen's. She obviously had a lot of help. She did remove a lot of furniture and stuff as well. I love the sheet hanging over the stuff in the corner. Hey, it looked good enough. I too still wonder about the odor. I could smell it in the hallway. I hope with a few weeks of steady cleaning, painting the walls, washing her clothes, cleaning her fabric furniture etc. it will disappear. I had no idea what is exactly. It is very unusual. Susan From: JOSE BOBADILLA [mailto:josemb@msn.com] Sent: Wednesday, February 04, 2009 10:42 AM 2 North Andover Board of Assessors Public Access Page 1 of 1 j%0RTjf North Andover Board of Assessors Of 4•�ae .e'�.y0 SS"CH°ge iz�roperty Record Card Click Seal To Return Parcel ID :210%046.0-0096-0049.E FY:2010 Community : North Andover SKETCH PHOTO Search for Parcels o ketch No r 1 cu re Search for Sales Available v n l l f ) f u J Summary Residence Detached Structure Location: 78 JEFFERSON STREET Condo Owner Name: SWEENEY, HELEN C C/O UPTON FINANCIAL Commercial Owner Address: P O BOX 1411 City: ARLINGTON State: MA Zip: 02174 Neighborhood: 0 Land Area: 0.00 acres Use Code: 102 -CONDOMINIUM Total Finished Area: 650 soft ASSESSMENTS :al Value: Iding Value: id Value: rket Land Value: ipter Land Value: CURRENT YEAR 104,000 104,000 0 0 PREVIOUS YEAR 117,300 117,300 0 http://csc-ma.us/PROPAPP/display.do?linkId=1514128&town=NandoverPubAcc 6/2/2010 4 North Andover Board of Assessors Public Access NORTN SACHUS t� Click Seal To Return Search for Parcels Search for Sales Page 1 of 1 is > r+; ' '!. '�, •... : �� ,-r ' �.`�+ .'.� .. ;�, v ;._:. MATCHING PARCELS Click on a column title to sort data by that column 4 items found, displaying all items.1 Fiscal Year Parcel ID St.No. I Street Owner Name 2010 210/046.070096-0049.G 78 JEFFERSON SWEENEY, HELEN C, C/O UPTON STREET FINANCIAL 2010 210/046.0-0096-0050.G 78 JEFFERSON SAMBUCO REALTY TRUST, FRANK J & STREET MARY F SAMBUCO, TRUSTEES 2010 210/046.0-6096-0051.G 78 JEFFERSON WALKER, JUDITH D, STREET 2010 210/046.0-0096-0052.G 78 JEFFERSON KOBRENSKI, DANIEL, C/O HURD, STREET 1ALLISON 4 items found, displaying all items.1 http://csc-ma.us/PROPAPP/newSearch.do?town=NandoverPubAcc&from=NewSearch 6/2/2010 Q N c v 3 � O z w W �00zx � w tion � O � W Q H ad R = •= an +- o s 3 ro F. 75> �M ° ,N D s F F E ai to m Y — Q F L F- L• Vi O O $ r ° U 3 c � o c cs 000 0 0 3 0-4 o w =Y O o ai c ° o ° F aci P -I y U R }1 003 .^A O 181L o w ti Q V s ry d m c O U C rc 3 ti W y ai 5 0 w .a° ro x Lmy o W o, •, .d o � u a 3 ooID oC.Lv0 0 Cd oo 0- o C4 U u p W O y 00 C L C -rAa� bay �d U A U C7 G U E ti V a u ad F F E a c 00 M O M r o � U c N 0 0 S 0 can �U cc J N O O N 0 0 N EMERGENCY CONDEMNATION AND ORDER TO VACATE Finding of Unfitness for Human Habitation and Determination of Immediate Danger In accordance- with M.G.L. c. 111, §§ 127A and 127B, 105 CMR 400.000: State Sanitary Code, Chapter I: General Administrative Procedures and 105 CMR 410.000: State Sanitary Code, Chapter II: Minimum Standards of Fitness for Human Habitation, Susan Sawyer, Health Agent and Debra Rillahan, Health Nurse for the North Andover Board of Health, on June 4, 2010 date conducted an inspection of a dwelling located at 78B Jefferson Street, Massachusetts. A copy of the inspection report is annexed hereto. Based on the results of that inspection, the Board of Health ("Board") finds that the dwelling is unfit for human habitation. Pursuant to M.G.L. c. 127 B and 105 CMR 410.831 (D), the Board further finds that the conditions within the dwelling are such that the danger to the life or health of the occupants of the subject dwelling is so immediate that no delay may be permitted in making this finding. Conditions found within the dwelling, which give rise to the emergency finding of unfitness and determination of immediate danger, include: Acting on multiple odor complaints in the past two days at 78 Jefferson Street, the N. Andover Health Department personnel went to the condominium to confirm the complaint. This building has four units. A neighbor allowed entry to the joint hallway and an immediate stench prompted a call to the North Andover Police Department over concern for the owner of the condo and the animals that were known to be present. The dog could be seen from the window and was extremely agitated. The NAPD gained access to the one bedroom unit. The stench was from the filth and feces strewn throughout the premise. . It appeared to the NAPD that the animals have been abandoned and the dog was dehydrated and needed care. The Andover Animal Control was contacted. The dog was transported to the Andover Animal Hospital. It is believed that there are two cats as well, but they have not been located. The NAPD checked with the owner's place of work and she has not been seen for a week. The other building occupants have not seen the owner for a few days. The owner's current location is not known at this time. The Health personnel on site, in concurrence with the NAPD, have determined that this property is uninhabitable and must be secured from entry until such time the Health Department confirms that it is cleaned up. I - Based upon these findings any, and all occupants are hereby ordered to vacate and the landlord/owner is ordered to secure the subject dwelling within 48 hours of receipt of this order. If any person refuses to leave a dwelling or portion thereof, which was ordered condemned and vacated s/he may be forcibly removed by the local board of health (MGL. c. 111, §127B), or by' local police authorities at request of the board of health. Furthermore, anyone who fails to comply with any order of the board of health may be subject to fines ranging from $10-$500. Each day's failure to comply with an order shall constitute a separate violation. Once vacated this building may not be occupied and the placard removed without the written approval of the board of health. Note: This is an important legal document It may affect your rights. You should have it translated. Signed ' Local Boaof Health Cc: Gerald Brown, Insp of Buildings Fire Department EMERGENCY CONDEMNATION AND ORDER TO VACATE Finding of Unfitness for Human Habitation and Determination of Immediate Danger In accordance with M.G.L. c. 111, §§ 127A and 127B, 105 CMR 400.000: State Sanitary Code, Chapter 1: General Administrative Procedures and 105 CMR 410.000: State Sanitary Code, Chapter II: Minimum Standards of Fitness for Human Habitation, Susan Sawyer, Health Agent and Debra Rillahan, Health Nurse for the North Andover Board of Health, on June 4, 2010 date conducted an inspection of a dwelling located at 78B Jefferson Street, Massachusetts. A copy of the inspection report is annexed hereto. Based on the results of that inspection, the Board of Health ("Board") finds that the dwelling is unfit for human habitation. Pursuant to M.G.L. c. 127 B and 105 CMR 410.831 (D), the Board further finds that the conditions within the dwelling are such that the danger to the life or health of the occupants of the subject dwelling is so immediate that no delay may be permitted in making this finding. Conditions found within the dwelling, which give rise to the emergency finding of . unfitness and determination of immediate danger, include: Acting on multiple odor complaints in the past two days at 78 Jefferson Street, the N. Andover Health Department personnel went to the condominium to confirm the complaint. This building has four units. A neighbor allowed entry to the joint hallway and an immediate stench prompted a call to the North Andover Police Department over concern for the owner of the condo. and the animals'that were known to be present. The dog could be seen from the window and was extremely agitated. The NAPD gained access to the one bedroom unit. The stench was from the filth and feces strewn throughout the premise. It appeared to the NAPD that the animals have been abandoned and the dog was dehydrated and needed care. The Andover Animal Control was contacted. The dog was transported to the Andover Animal Hospital. It is believed that there are two cats as well, but they have not been located. The NAPD checked with the owner's place of work and she has not been seen for a week. The other building occupants have not seen the owner for a few days. The owner's current location is not known at this time. The Health personnel on site, in concurrence with the NAPD, have determined that this property is uninhabitable.and must be secured from entry until such time the Health Department confirms that it is cleaned up. Based upon these findings any and all occupants are hereby ordered to vacate and the landlord/owner is ordered to secure the subject dwelling within 48 hours of receipt of this order. If any person refuses to leave a dwelling or portion thereof, which was ordered condemned and vacated s/he may be forcibly removed by the local board of health (MGL. c. 111; §127B), or by local police authorities at request of the board of health. Furthermore, anyone who fails to comply with any order of the board of health may be subject to fines ranging from $10-$500. Each day's failure to comply with an order shall constitute a separate violation. Once vacated this building may not be occupied and the placard removed without the written approval of the board of health. Note: This is an important legal document It may affect your rights. You should have it translated. Signed Local Boar of Health Cc: Gerald Brown, Insp of Buildings Fire Department EMERGENCY CONDEMNATION AND ORDER TO VACATE Finding of Unfitness for Human Habitation and Determination of Immediate Danger In accordance with M.G.L. c. 111, §§ 127A and 127B, 105 CMR 400.000: State Sanitary Code, Chapter I: General Administrative Procedures and 105 CMR 410.000: State Sanitary Code, Chapter II: Minimum Standards of Fitness for Human Habitation, Susan Sawyer, Health Agent and Debra Rillahan, Health Nurse for the North Andover Board of Health, on June 4, 2010 date conducted an inspection of a dwelling located at 78B Jefferson Street, Massachusetts. A copy of the inspection report is annexed hereto. Based on the results of that inspection, the Board of Health ("Board") finds that the dwelling is unfit for human habitation. Pursuant to M.G.L. c. 127 B and 105 CMR 410.831 (D), the Board further finds that the conditions within the dwelling are such that the danger to the life or health of the occupants of the subject dwelling is so immediate that no delay may be permitted in making this finding. Conditions found within the dwelling, which give rise to the emergency finding of unfitness and determination of immediate danger, include: Acting on multiple odor complaints in the past two days at 78 Jefferson Street, the N. Andover Health Department personnel went to the condominium to confirm the complaint. This building has four units. A neighbor allowed entry to the joint hallway and an immediate stench prompted a call to the North Andover Police Department over concern for the owner of the condo and the animals that were known to be present. The dog could be seen from the window and was extremely agitated. The NAPD gained access to the one bedroom unit. The stench was from the filth and feces strewn throughout the premise. It appeared to the NAPD that the animals have been abandoned and the dog was dehydrated and needed care. The Andover Animal Control was contacted. The dog was transported to the Andover Animal Hospital. It is believed that there are two cats as well, but they have not been located. The NAPD checked with the owner's place of work and she has not been seen for a week. The other building occupants have not seen the owner for a few days. The owner's current location is not known at this time. The Health personnel on site, in concurrence with the NAPD, have determined that this property is uninhabitable and must be secured from entry until such time the Health Department confirms that it is cleaned up. Based upon these findings any and all occupants are hereby ordered to vacate and the landlord/owner is ordered to secure the subject dwelling within 48 hours of receipt of this order. If any person refuses to leave a dwelling or portion thereof, which was ordered condemned and vacated s/he may be forcibly removed by the local board of health (MGL. c. 111, §127B), or by local police authorities at request of the board of health. Furthermore, anyone who fails to comply with any order of the board of health may be subject to fines ranging from $10-$500. Each day's failure to comply with an order shall constitute a separate violation. Once vacated this building may not be occupied and the placard removed without the written approval of the board of health. Note: This is an important legal document It may affect your rights. You should have it translated. Signed Local Boa of Health Cc: Gerald Brown, Insp of Buildings Fire Department From: ssawyer@townofnorthandover.com To: josemb@msn.com Date: Thu, 3 Jun 2010 13:39:15 -0400 Subject: RE: My Maids. That is good to hear. As a matter of fact we could use your expert assistance. We had a complaint this week concerning a strong odor coming from the apartment. Have you been there personally? Before we have to do an inspection, would it be possible for you to visit at the next cleaning date and send us a report of your findings? Maybe take a few pictures if you have a phone camera if you think she wouldn't mind. I am wondering if she still has the dog walker. Maybe that could be the problem. I will try to contact that person as well. Susan Sawyer 978 688-9540 if you have any thoughts you would like to share. From: JOSE BOBADILLA [mailto:josemb@msn.com] Sent: Thursday, June 03, 2010 9:47 AM To: Sawyer, Susan Subject: RE: My Maids. Hi Susan, Hope all is well! She has been excellent, no rescheduling, no cancelling, etc. We have been taking care of her five rooms for some time now. Let me know what else you require. Thanks! Christina Nault My Maids, Inc. 978.416.0602 From: ssawyer@townofnorthandover.com To: josemb@msn.com Date: Wed, 2 Jun 2010 16:42:43 -0400 Subject: RE: My Maids. Hello Christina, I haven't heard from your company in awhile regarding this issue. Could you tell me if you are still under contract with Helen Sweeney, 78 Jefferson, North Andover, MA? If not, can you tell me when you stopped providing her service. If you are, may we plan a time to speak about the property. Thank you for your help as in the past. Susan Sawyer Public Health Director From: JOSE BOBADILLA [mailto:josemb@msn.com] Sent: Wednesday, February 04, 2009 10:42 AM To: Sawyer, Susan Subject: My Maids. Hi, Sorry, I am traveling today so sending from a personal account. I just had my office send you the contract as it was signed last night. Please confirm. Thanks and speak wiht you soon. Let me know what else you require. Question: Were you happy with the condition? Thank youth Christina Windows Live TM: Keep your life in sync. See how, it works. Hotmail is redefining busy with tools for the New'Busy. Get more from your inbox. See how. Hotmail has tools for the New Busy. Search, chat and e-mail from your inbox. Learn more. The New Busy is not the too busy. Combine all your e-mail accounts with Hotmail. Get busy. 3 Sawyer, Susan From: JOSE BOBADILLA Uosemb@msn.com] Sent: Saturday, June 05, 2010 10:31 PM To: Sawyer, Susan Subject: RE: My Maids. Susan, I just rec'd a call from Catherine today at roughly 7 AM. I am not sure as to what is going on, I simply have the details from our brief conversation. She said she said many times that she was sorry and simply hung up. From our conversation, there is obviously something that she is and was hiding and it was exposed. She has never been truthful from the beginning and since the new cleaner has been taking care of her, I thought she was just being more consistent due to finding a cleaner that she was "comfortable with". She has had the new cleaner since Jan, since her request was placed and honored. She would never let anyone else into her place, only this scheduled cleaner, so we always ensured that this was the woman that performed her "service". With that being said, I have asked Catherine to no longer contact My Maids as I cannot believe a word that she says or even determine what she was,allowing the cleaner to perform on the Saturday scheduled mornings at 9 AM. Looking back, I wish that I have got into the apartment sooner. I even had an appt to see the place this Saturday and advised her that I was reporting back to you with pictures as the testimony of the cleaner was not suffice. I never heard that there were any challenges, not even one! I just hope that no one was hurt and that the animals are in a safer place. Hopefully Catherine in the meantime will receive the assistance that she so desperately needs. Thank you. Christina From: josemb@msn.com To: ssawyer@townofnorthandover.com ` Subject: RE: My Maids. Date: Thu, 3 Jun 2010 13:50:26 -0400 Hi, I just spoke with her, the cleaner. From what I understand, she still has the dog and the has been in and out of the hospital and I am not sure if the dog is being walked. The cleaner said that the friend is walking the dog. She said that the dog pees on the kitchen floor and on ocassion we are asked to stay away from the kitchen to protect the doog, which is not really acceptable and I will addresss moving forward. The cleaner is calling Catherine and telling her that we need to do a deep clean in the kitchen. She believes that the urine is seeping into the floors. I am going to take a look as well, I will suprise her on Saturday. It is well overdue. Thanks and let me know what else should be done. Christina /.+.t.! L. ld •* i� t� I� f / � f •'" ♦ • /♦/id/ I/r ,.. ♦ it iI///Isx � • i i1/ir/t�/�/ w�♦ i t♦ r r I r r s +1C,+".°♦kif kp•�.§I.��Sr ! f*v,♦ rM F j } ii�r�� is �.tp..s l•M''i •r rr f,��r r ,li 'Ir,♦ ii i.e s:r�rr „:r+!i•. i ! ♦ M'. o � L r �. r A �' t> NORTH ANDOVER HEALTH DEPARTMENT 27 Charles Street a North Andover, MA 01845 Tel. 978 688-9540 • Fax: 978 688-9542 email: healthdept@townofnorthandover.com Complaint Investigation/Inspection Report 9 1'ro ( L. -A> & r" (<-c-4-S r'_l r-- -& T3 v-'� . L,', , e -I --s Rev. 6104 NORTH ANDOVER HEALTH DEPARTMENT 27 Charles Street • North Andover, MA 01845 Tel. 978 688-9540 • Fax: 978 688-9542 email: healthdept@townofnorthandover.com Complaint Investigation/Inspection Report Rev. 6/04 S, C--&-L,-L- %,rI3���z cs� �l� Kai A- X y F' M T _ y u= x � r £ QTS fq k M ff � op NORTH ANDOVER HEALTH DEPARTMENT 27 Charles Street North Andover, MA 01845 Tel. 978 688-9540 • Fax: 978 688-9542 email: h6althdept@townofnorthandover.com Complaint Investigation/inspection Report OWNER ADDRESS '7 08 DATE 7 0/ Ir Rev. 6/04 INSPECTOR Korth �asl Ai'mal mei te�2 97F 7qS-qW l �! y tiZ✓ S � y ��/;nom �w/ends 6 03 8932q�3 X03 8qq 2 q � a MA ,rr�✓� l 1 i 1,41-a l� OWNER ADDRESS NORTH ANDOVER HEALTH DEPARTMENT 27 Charles Street • North Andover, MA 01845 Tel. 978 688-9540 • Fax: 978 688-9542 email: healthdept@townofnorthandover.com Complaint Investigation/Inspection Report t- Is,, �5,,,a DATE e - Rev. 6/04 INSPECTOR NORTH ANDOVER HEALTH DEPARTMENT 27 Charles Street • North Andover, MA 01845 Tel. 978 688-9540 9 Fax: 978 688-9542 email: healthdept@townofnorthandover.com Complaint Investigation/inspection Report V�Y a ttl OWNER ADDRESS ,.- DATE —T7 Rev. 6104 INSPECTOR NC)JITH ANDOVER HEALTH DEPARTMENT 2 i' Charles Street o Noith Andover, MA 01845 Tel. 978 688.9540 4, Fax: 978 688-95/42 email: heaandept@tlyw wfnorthandover.com o IC-1i11t Investigation/inspection 111 OWNER � ADDRESS _ t:�:��—�-• 01 DATE _ -- - -------- _ .� d` -z., i',�,..c ' _� .yam �—,��.ti f�.8.t...—��•- � _. - r .- . ^, �h+i � mom• ....- a � '6n'-^ ^ ',�,�C� u7e52ECr f 4iR Rev. 6M4 NORTH ANDOVER HEALTH DEPARTMENT 27 Charles Street • North Andover, MA 01845 Tel. 978 688-9540 • Fax: 978 688-9542 email: healthdept@townofnorthandover.com Complaint Investigation/Inspection Report J� OWNER Z `i h, t ILL, Lvv �11L-> r— ADDRESS ` C DATE �_ / 12 Rev. 6/04 INSPECTOR NORTH ANDOVER HEALTH DEPARTMENT 27 Charles Street • North Andover, MA 01845 Tel. 978 688-9540 • Fax: 978 688-9542 email: healthdept@townofnorthandover.com Complaint Investigation/Inspection Report OWNER k 2,-1-4 �5— 11t->Gu-►-.�-. ADDRESS DATE Rev. 6/04 INSPECTOR NORTH ANDOVER HEALTH DEPARTMENT 27 Charles Street • North Andover, MA 01845 Tel. 978 688-9540 • Fax: 978 688-9542 email: healthdept@townofnorthandover.com Complaint Investigation/Inspection Report e - Rev. 6/04 �� I'INSPECTOR OWNER ADDRESS DATE _ - NORTH ANDOVER HEALTH DEPARTMENT 27 Charles Street • North Andover, MA 01845 Tel. 978 688-9540 • Fax: 978 688-9542 email: healthdept@townofnorthandover.com Complaint Investigation/Inspection Report Rev. 6/04 INSPECTOR ��� ��� t-y'sc� 4 ��_ �z�, Ll 2---c) I Z) B LA 9 tA c 9 b NORTH O tLED � q Ia*6�O0 �O COCMIC ■WICM ^• \�.ep°R�reo �Pa�.45 TOWN OF NORTH ANDOVER Health Department 1600 Osgood Street North Andover, MA 01845 (978) 688-9540 www.townofnorthandover.com NOTICE This dwelling is hereby CONDEMNED as UNFIT FOR HUMAN HABITATION under the authority of 105 CMR 410.000. Occupancy thereof is expressly prohibited. Removal of this notice may be by performed only with the authorization of the Board of Health. Address: 78 B Jefferson, North Andover, MA Posting Date: June 4, 2010 Ordered by: Susan Sawyer, Director of Public Health Restrictions: Access must be approved by the Health Department or the NA Police Department. Access may be allowed during daylight hours to retrieve belongings and conduct repairs. The animals have been removed for their safety and must remain off the property. For Info call NAPD (978) 683-3168 J V A 1 s Cqmplete items 1, 2, and 3: Also complete item 4 if Restricted Delivery is desired. ■ Print your name and address on the reverse so that we can return the card to you. ■ Attach this card to the back of the mailpiece, or on the front if space permits. 1. Article Addressed to: "o4 A. Signature X�❑ Agent B. R.e,r.gived by (Printed Name) Date of Deli D. Is delivery address differeat*f m item 1? ❑ Yes If YES, enter delivery address below: ❑ No 3. - e Type RCertified Mail ❑ Express Mail ❑ Registered ❑ Return Receipt for Merchandise ❑ Insured Mail ❑ C.O.D. 4. Restricted Delivery? (Extra Fee) ❑ Yes 2. Article Number 7005 0390 0003 4265 9106 (transfer from service label) PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540 UNITED STATES POSTAL SERVICE First -Class Mail 4 Postage & Fees Paid 1 USPS Permit No. G-10 • Sender: Please print your name, address, and ZIP+4 in this box • orth Andover Health Department 00 Osgood Street gilding 20; Suite 2-36 orth Andover, MA 01845 I _ Ii�iVVI� o Er • • •.. Ul -a OFFICIAL USE ru I Postage $ M O Certified Fee 0 0 Return Receipt Fee (Endorsement Required) �n D� Postmark Here C:3 Er Restricted Delivery Fee (Endorsement Required) M C3 7 Total Postage &Fees =Y io Sent To (- - ------ - --- -- Street, Apt. No.; or PO Box No. -- ---- - ------------------- if ------- �yjf T` �-- Certified Dail Provides: x- ■ A mailing receipt (--ea) 600a eunr:oose-u!!qd Sd ■ A unique identifier for your mailpleoe ■ A record of delivery kept by the Postal Service for two years Important Reminders: ■ Certified Mail may ONLY be combined with First -Class Mail® or Priority Maile. j ■ Certified Mail is not available for any class of International mail. • NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables, please consider Insured or Registered Mail ■ For an additional fee, a Return Receipt may be requested to provide proof of delivery. To obtain Return Receipt service, please complete and attach a Return Receipt (PS Form 3811) to the article and add applicable postage to cover the fee. Endorse mailplece "Return Receipt Requested". To receive a fee waiver for a duplicate return receipt, a USPS® postmark on your Certified Mail receipt is required. ■ For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent. Advise the clerk or mark the mailpiece with the endorsement "Restricted Delivery". ■ If a postmark on the Certified Mail receipt is desired, please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed, detach and affix label with postage and mail. IMPORTANT: Save this receipt and present it when making an inquiry. Internet access to delivery information is not available on mail addressed to APOs and PPOs. COMMONWEALTH OF MASSACHUSETTS NORTHEAST HOUSING COURT -�1,--+LPlaintiff V. - C, 5 JDefendant No. 5-L-V-bi))L% MOTION WITH HEARING AT LAWRENCE SESSION The undersigned L� >a ,�;- hereby moves this Court [_) to continue this case until [_] to amend [_] to dismiss this case (_) to remove default or dismissal and for relief from judgment and set the case for trial on [_) to stay execution until [ ] to issue execution [7Z] other ri;> ,- t-_ r -1�� �z 1 ,S for the following reasons: r' r i-. t �-, u % 2' �� t an Z7 ck c r This motion will be heard by the Northeast Housing Court at Courtroom 3, Northeast Housing Court, 2 Appleton Street, Lawrence, at 9:00 o'clock a.m.~Thursday, 200 . I (gave) (mailed) a copy of this motion onG/Pj-�r���y// to Gam' ignature and dat 1 J <. e' v^� .' Y1.' V r. i t Name Address Z_ 3 L 9-7 Telephone N v �s 0 0 N v �s � ti 0 _3 � � o o � o 0 o p � o w d = en E a � 0 O u Z.. L u bA N � O .O, � O c N � N � � y 00 n W � O � 3 lu'r- cd c o Id u� w° o COO o z U Ca son . o oo cl 0 C*O _ ❑ o 0 £ 5 U Lir O Q d a°i o N u as .� v,y'oxU� E U R U 00 �I fS i ) Q ti CW W - ' •� " 1E Ir MATERIAL SAFETY DATA SHEET SHOCKWAVE TM Per OSHA -recommended ANSI Z400.1-2004 standard format & in accordance with European standard format SECTION•• • COMPANY IDENTIFICATION. Product Name: ShockWaveTI Product Description: EPA Registered Disinfectant/Sanitizer/Cleaner/Fungicide Concentrate Product Code: 8310 Chemical Family: Quaternary Ammonium Chloride EPA Reg No. 61178-1-73884 Manufactured For: Fibedock Technologies Inc. Address: Fiberlock Technologies 150 Dascomb Road Andover MA, 01810 Contact Info: Tel: (800) 342-3755 Fax: (978) 475-6205 Emergency Phone: 24 Hour Contact: CHEM -TEL: (800) 255-3924 INTERNATIONAL 24 HOUR EMERGENCY Phone: 813-248-0585 Hazardous: Chemical Name CAS# Percent OSHAPEL ACGIH TLV 1 - Dimethyl Benzyl 68391-01-5 < 2.25 Not Established Not Established Ammonium Chloride N/A 2 - Dimethyl 68956-79-6 < 2.25 Not Established Not Established Ethylbenzyl Ammonium Chloride This product does not contains any toxic chemical(s) subject to the reporting requirements of section 313 of the Emergency Planning and Community Right -To -Know Act of 1986 and of 40 CFR 372. SECTION-• • • Potential Health Hazards: Skin Contact: Skin irritant. Prolonged or repeated contact may cause dermatitis. Eyes Contact: Severe eye irritant. Liquid and mists may injure the eyes causing comeal damage. Inhalation: Inhalation of vapors or mists may cause irritation of the throat and respiratory tract. High vapor concentrations may cause central nervous system effects. Ingestion: Irritating to the mouth, throat, and gastrointestinal system. Burning, pain, and diarrhea expected with large doses. Eyes: Immediately flush eyes with large amounts of water for 15 minutes holding eyelids open. Get medical attention immediately. Skin: Remove contaminated clothing. Flush affected areas with large quantities of water. Seek medical attention if irritation persists. Ingestion: Drink 3-4 glasses of milk or water. Do not induce vomiting. Get medical attention immediately. Inhalation: Remove victim to fresh air and monitor. Seek medical attention if symptoms persist. MSDS DATE: 4/8/09 SECTION 5: FIRE -FIGHTING MEASURES Product is non-combustible Flash point: Autoignition Temperature: F: Not flammable F: Not Established C: Not flammable C: Not Established Extinguishing Media: Use extinguishing media appropriate for surrounding fire Water Spray OK Carbon Dioxide NO Foam NO Dry Chemical OK Halon NO Other N/A SPECIAL FIRE FIGHTING PROCEDURES: Self-contained breathing apparatus and protective clothing should be worn when fighting chemical fires. Use water spray to keep fire -exposed containers cool. Accidental Release Measures: Personal Precautions: Do not get in eyes. Do not take internally. Avoid skin contact. Prevent prolonged or repeated breathing of vapor or spray mists. Keep unnecessary people away. Floor may be slippery, use care to avoid falling. Remove all sources if ignition. Ventilate the area. Remove with inert absorbent. Environmental Precautions: Keep spills and cleaning run-offs out of municipal sewers and open bodies of water. Comply with local, national and state regulations. Handling and Storage: Maximum Storage Temperature: 100°F (38°C), minimum 35°F (2°C). Keep closure tight and containers upright to prevent leakage. Product is non-combustible. SECTION 8: EXPOSURE CONTROLSIPERSONAL PROTECTION Precautions: Use only with adequate ventilation. Work Hygienic Practices: Avoid contact with skin. Do not get in eyes. Do not take internally. Avoid breathing vapors or spray mists. Ventilation: Use in well -ventilated areas. Provide local exhaust to keep TLV of Section 2 ingredients below acceptable limit. Respiratory Protection: No special requirements. Avoid breathing mists. Eye Protection: Chemical goggles recommended when spraying diluted product. Skin Protection: Wear neoprene, rubber, vinyl, or nitrile gloves to prevent skin contact if prolonged skin contact is likely. Wash hands before eating, smoking or using the wash room. Other Protective Equipment: Eyewash station should be provided nearby. Page 1: MSDS for Fiberlock Technologies ShockWaveTm Disinfectant/Sanitizer/Cleaner/Fungicide Concentrate No. 8310 SECTION . CHEMICAL PROPERTIES 68391-01-5 Appearance: Thin liquid Solubility in Water: Total Odor: Pleasant Color: Light Blue odor Boiling Point: 210°F Viscosity @ 77°F: 60-75 Kreb Units Evaporation Rate: Slower Vapor Density Heavier (Butyl Acetate=l) (AIR = 1) @ 68'F: Vapor Pressure: 20mm Hg @ Specific Gravity (H20 = 1.040 68 F 1) @ 68°F: pH 11.5-12.0 Percent Volatile 90+ Stability: Stable Incompatibility: None Hazardous Decomposition or By -Products: Will not occur Hazardous Polymerization: Will not occur. E7 4N I [•] �` fi i lliti [•):11K•] R•le'1 Pf2\ � I n 17q :11'dt\ I [•] C Toxicological Information: No Data Available SECTION• • • • Ecological Information: Toxic to Fish. LC.(Rainbow Trout) = 0,930ppm, LC,(Bluegill) = 0.515ppm SECTIONDISPOSAL • . • Waste Disposal Method: Dispose of in accordance with Federal, State/Provincial, and Local regulations regarding pollution. Do not dump into sewers, any body of water or onto the ground. SECTION•• • • U.S. Department of Transportation Proper Shipping Name: "Non Regulated" Hazard Class:"Non Regulated" Shipping Class: Cleaning Compound SECTION 15: REGULATORY INFORMATION U.S. Federal Regulations: TSCA (TOXIC SUBSTANCE CONTROL ACT): All components of this product are in compliance with the inventory listing requirements of the U.S. Toxic Substances Control Act (TSCA) Chemical Substance Inventory. CERCLA (COMPREHENSIVE RESPONSE COMPENSATION, AND LIABILITY ACT): Releases of this material to air, land, or water are not reportable to the National Response Center under the Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA) or to state and local emergency planning committees under the Superfund Amendments and Reauthorization Act (SARA) Title III Section 304. SARA TITLE III (SARA 313): No ingredients in this product are subject to SARA 313 (40 CFR 372.65C) Supplier Notification. SARA TITLE III (SARA 311/312): Ingredients in this product are subject to SARA 311/312 Immediate (acute) Health Hazard Supplier Notification. CALIFORNIA SAFE DRINKING WATER AND TOXIC ENFORCEMENT ACT (PROPOSITION 65): No Components of this product are on the California Proposition 65 lists. New Jersey Right to Know Hazardous Substance List: This product contains no components subject to reporting requirements Canada: Workplace Hazardous materials Information System (WHMIS)-listed material: This product contains the following components subject to reporting requirements: Sodium carbonate. SECTIONOTHER INFORMATION To comply with New Jersey DOH Right -To -Know labeling law (NJAC 8:59 — 5.1 & 5.2) No.:, CHEMICAL INGREDIENTSCAS. Water 7732-18-5 68391-01-5 Dimethyl Benzyl Ammonium Chloride 68956-79-6 Dimethyl Ethylbenzyl Ammonium Chloride 9016-45-9 Nonionic Surfactant 497-19-8 Sodium Carbonate (+) Contents Partially Unknown HMIS HAZARD RATING Health 2 Flammability 0 Physical Hazard 0 Personal Protection B HAZARD INDEX: O=Minimal, 1=Slight, 2=Moderate, 3=Serious, 4=Severe This company cannot anticipate all conditions of handling and use of this product. Therefore, this company accepts no responsibility for results obtained by the application of this information, or the safety and suitability of our products either alone or in combination with other products. It is the responsibility of the user to provide a safe workplace, using the health and safety information contained herein as a guide. This company will accept no liability for damages or loss incurred from the improper handling and use of this product. Page 2: MSDS for Fiberlock Technologies ShockWaveT°" DisinfectanUSanitizer/Cleaner/Fungicide Concentrate No. 8310 MATERIAL SAFETY DATA SHEET SHOCKWAVE TM Per OSHA -recommended ANSI Z400.1-2004 standard format & in accordance with European standard format Product Name: ShockWaveT" Product Description: EPA Registered Disinfectant/Sanitizer/Cleaner/Fungicide Concentrate Product Code: 8310 Chemical Family: Quaternary Ammonium Chloride EPA Reg No. 61178-1-73884 Manufactured For: Fiberlock Technologies Inc. Address: Fiberlock Technologies 150 Dascomb Road Andover MA, 01810 Contact Info: Tel: (800) 342-3755 Fax: (978) 475-6205 Emergency Phone: 24 Hour Contact: CHEM -TEL: (800) 255-3924 INTERNATIONAL 24 HOUR EMERGENCY Phone: 813-248-0585 Hazardous: Chemical Name CAS# Percent OSHAPEL ACGIH TLV 1 - Dimethyl Benzyl 68391-01-5 < 2.25 Not Established Not Established Ammonium Chloride N/A 2 - Dimethyl 68956-79-6 < 2.25 Not Established Not Established Ethylbenzyl Ammonium Chloride This product does not contains any toxic chemicals) subject to the reporting requirements of section 313 of the Emergency Planning and Community Right -To -Know Act of 1986 and of 40 CFR 372. SECTION-• • • Potential Health Hazards: Skin Contact: Skin irritant. Prolonged or repeated contact may cause dermatitis. Eyes Contact: Severe eye irritant. Liquid and mists may injure the eyes causing comeal damage. Inhalation: Inhalation of vapors or mists may cause irritation of the throat and respiratory tract. High vapor concentrations may cause central nervous system effects. Ingestion: Irritating to the mouth, throat, and gastrointestinal system. Burning, pain, and diarrhea expected with large doses. SECTION4:• MEASURES Eyes: Immediately flush eyes with large amounts of water for 15 minutes holding eyelids open. Get medical attention immediately. Skin: Remove contaminated clothing. Flush affected areas with large quantities of water. Seek medical attention if irritation persists. Ingestion: Drink 3-4 glasses of milk or water. Do not induce vomiting. Get medical attention immediately. Inhalation: Remove victim to fresh air and monitor. Seek medical attention if symptoms persist. MSDS DATE: 4/8/09 Product is non-combustible Flash point: Autoignition Temperature: F: Not flammable F: Not Established C: Not flammable C: Not Established Extinguishing Media: Use extinguishing media appropriate for surrounding fire Water Spray OK Carbon Dioxide NO Foam NO Dry Chemical OK Halon NO Other N/A SPECIAL FIRE FIGHTING PROCEDURES: Self-contained breathing apparatus and protective clothing should be wom when fighting chemical fires. Use water spray to keep fire -exposed containers cool. Accidental Release Measures: Personal Precautions: Do not get in eyes. Do not take internally. Avoid skin contact. Prevent prolonged or repeated breathing of vapor or spray mists. Keep unnecessary people away. Floor may be slippery, use care to avoid falling. Remove all sources if ignition. Ventilate the area. Remove with inert absorbent. Environmental Precautions: Keep spills and cleaning run-offs out of municipal sewers and open bodies of water. Comply with local, national and state regulations. Handling and Storage: Maximum Storage Temperature: 100°F (38°C), minimum 35°F (2°C). Keep closure tight and containers upright to prevent leakage. Product is non-combustible. Precautions: Use only with adequate ventilation. Work Hygienic Practices: Avoid contact with skin. Do not get in eyes. Do not take internally. Avoid breathing vapors or spray mists. Ventilation: Use in well -ventilated areas. Provide local exhaust to keep TLV of Section 2 ingredients below acceptable limit. Respiratory Protection: No special requirements. Avoid breathing mists. Eye Protection: Chemical goggles recommended when spraying diluted product. Skin Protection: Wear neoprene, rubber, vinyl, or nitrile gloves to prevent skin contact if prolonged skin contact is likely. Wash hands before eating, smoking or using the wash room. Other Protective Equipment: Eyewash station should be provided nearby. Page 1: MSDS for Fiberlock Technologies ShockWaveTm Disinfectant/Sanitizer/Cleaner/Fungicide Concentrate No. 8310 SECTION 9: PHYSICALAND CHEMICAL PROPERTIES 68391-01-5 Appearance: Thin liquid Solubility in Water: Total Odor: Pleasant Color: Light Blue (+) Contents Partially Unknown odor Boiling Point: 210°F Viscosity @ 77°F: 60-75 Kreb Units Evaporation Rate: Slower Vapor Density Heavier (Butyl Acetate=l) (AIR = 1) @ 68°F: Vapor Pressure: 20mm Hg @ Specific Gravity (H2O = 1.040 68 F 1) @ 68°F: pH 11.5-12.0 Percent Volatile 90+ Stability: Stable Incompatibility: None Hazardous Decomposition or By -Products: VYII not occur. Hazardous Polymerization: Will not occur. Toxicological Information: No Data Available Ecological Information: Toxic to Fish. LC.(Rainbow Trout) = 0.930ppm, LC,(Bluegill) = 0.515ppm SECTIONDISPOSAL • . • Waste Disposal Method: Dispose of in accordance with Federal, State/Provincial, and Local regulations regarding pollution. Do not dump into sewers, any body of water or onto the ground. SECTION 14: TRANSPORT INFORMATION Department of Transportation Shipping Name: "Non Regulated" Hazard Class: "Non Regulated" Shipping Class: Cleaning Compound REGULATORYSECTION IS: .- • U.S. Federal Regulations: TSCA (TOXIC SUBSTANCE CONTROL ACT): All components of this product are in compliance with the inventory listing requirements of the U.S. Toxic Substances Control Act (TSCA) Chemical Substance Inventory. CERCLA (COMPREHENSIVE RESPONSE COMPENSATION, AND LIABILITY ACT): Releases of this material to air, land, or water are not reportable to the National Response Center under the Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA) or to state and local emergency planning committees under the Superfund Amendments and Reauthorization Act (SARA) Title III Section 304. SARA TITLE III (SARA 313): No ingredients in this product are subject to SARA 313 (40 CFR 372.65C) Supplier Notification. SARA TITLE III (SARA 311/312): Ingredients in this product are subject to SARA 311/312 Immediate (acute) Health Hazard Supplier Notification. CALIFORNIA SAFE DRINKING WATER AND TOXIC ENFORCEMENT ACT (PROPOSITION 65): No Components of this product are on the California Proposition 65 lists. New Jersey Right to Know Hazardous Substance List: This product contains no components subject to reporting requirements Canada: Workplace Hazardous materials Information System (WHMIS)-listed material: This product contains the following components subject to reporting requirements: Sodium carbonate. SECTIONOTHER INFORMATION To comply with New Jersey DOH Right -To -Know labeling law (NJAC 8:59 — 5.1 & 5.2) CAS. No.: 7732-18-5 CHEMICAL INGREDIENTS Water 68391-01-5 Dimethyl Benzyl Ammonium Chloride 68956-79-6 Dimethyl Ethylbenzyl Ammonium Chloride 9016-45-9 Nonionic Surfactant 497-19-8 Sodium Carbonate (+) Contents Partially Unknown HMIS HAZARD RATING Health 2 Flammability 0 Physical Hazard 0 Personal Protection B HAZARD INDEX: O=Minimal, 1=Slight, 2=Moderate, 3=Serious, 4=Severe This company cannot anticipate all conditions of handling and use of this product. Therefore, this company accepts no responsibility for results obtained by the application of this information, or the safety and suitability of our products either alone or in combination with other products. It is the responsibility of the user to provide a safe workplace, using the health and safety information contained herein as a guide. This company will accept no liability for damages or loss incurred from the improper handling and use of this product. Page 2: MSDS for Fiberlock Technologies ShockWaveTm Disinfectant/Sanitizer/Cleaner/Fungicide Concentrate No. 8310 DRIEAZ Material Safety Data Sheet (USA) MILGO-SR FIRE 0 HAZARD RATING: HEALTH 1 0 REACTIVITY 4 = EXTREME 3 = HIGH 2 = MODERATE 1 = SLIGHT 0 = INSIGNIFICANT SPECIFIC HAZARD SECTIONPRODUCT INF• ' • Product NameProduct Use Product Identification Number MILGO-SR Deodorizer % Manufacturer's Name Oral LD50 Supplier's Name DRI-EAZ PRODUCTS INC. Isopropyl Alcohol 3-6% Street Address 5840 mg/kg Street Address 15180 Josh Wilson Road Burlin ton WA 98233 1 0.30% Information Telephone Number Date Prepared City, State, Zip 360 757-7776, 800 932-3030 Aril 22 1999 Emergency Telephone Number Sig. of Preparer (optional) Emergency Telephone Number 800 535-5053 Marketing Dept. SECTION. Appearance and Odor SECTION Light green liquid with lemon frac HAZARDOUS INGREDIENTS % CAS NUMBER Oral LD50 Dermal LD50 ACGIH TLV Isopropyl Alcohol 3-6% 67-63-0 5840 mg/kg 13 g/kg OSHA PEL 400 ppm TWA 500 ppm STEL Glutaraldehyde 1 0.30% 1 111-30-8 1 N/A N/A 0.2 ppm Ceiling STEL SECTION. Appearance and Odor Solubility in Water Light green liquid with lemon frac rance Infinite Boiling Point (°C) Vapor Pressure (mm Hg) Vapor Density (Air=1) 100 °C N/A N/A Specific Gravity (H2O=1) Percent Volatile by Volume (%) pH 1 N/A 7.0-7.5 Mac Alive:DesktoD Folder:MSDS MILGO-SR ADr-99.doc PRODUCT IDENTIFIER MILGO-SR SECTION -DATA E ROUTE(S) OF ENTRY Skin Contact 9 Skin Absorption 0 Eye Contact O Inhalation O Ingestion 17 Health Hazards (Acute and Chronic) May cause skin ore a irritation. Vapor may be irritating to the respiratory tract. CARCINOGENICITY NTP? IARC Monographs? OSHA Related? N/A NIA N/A Signs and Symptoms of Overexposure Eye, skin or respiratory irritation. Medical Conditions Generally Aggravated by Exposure May aggravate an existing dermatitis. Emergency and First Air Procedures SKIN: Wash with water. Use dermatologist -recommended hand creams. EYES: Flush with water for 15 minutes. If eye irritation persists, see a physician immediately. INHALATION: Remove to fresh air. INGESTION: Drink plenty of fluids. If nausea persists, see a physician. GENERAL ADVICE: If irritation persists, see a physician. SECTION• • SAFE HANDLING AND USE - Steps to be Taken in Case Material is Released or Spilled Small amounts, flush with water to sewer connected to legal sewage treatment. Or recover free liquid, soak up with solid absorbent remove to legal landfill. Waste Disposal Method Triple -rinse container, dispose in legal incinerator or landfill. Precautions to be Taken in Handling and Storing Standard handling procedures. Keep away from children. Other Precautions Use caution when handling any chemical substance. SECTION• -• Repiratory Protection Use face mask in small areas. Important to have proper ventilation. Use organic vapor respirator with re -filter if aerosolin . VENTILATION Local Exhaust Mechanical Special Other Open windows Use fans or airmovers N/A N/A Protective Gloves Use rubber, butyl- or poyethylene gloves when handling concentrate. Eye Protection Use side -shield safety goggles when handling concentrate. Other Protective Clothing or Equipment Normal work clothes and shoes. Wash contaminated clothing before reuse. Work/Hygienic Practices Wash hands and skin with soap and water after use. This form complies with OSHA's Hazard Communication Standard, 20 CFR 1910.1200. Dri-Eaz believes the above information is reliable. Handling of the designated product shall be restricted to qualified persons. Dri-Eaz makes no warranty, expressed or implied, with respect to such information and assumes no responsibility whatsoever for any damage which results from the use of such information or the designated product. Users must make their own tests when using the designated product with any other product or any process. Mac Alive:Desktoo Folder:MSDS MILGO-SR Apr-99.doc MATERIAL SAFETY DATA SHEET SECTION I - PRODUCT IDENTIFICATION Product Name: Benefect® Broad Spectrum Disinfectant Product Use: Disinfectant Regulatory Class: Registered Product— EPA # 74771-1 D.O.T. Classification: Not Regulated TDG Classification: Not Regulated Manufacturer: Sensible Life Products (div. of LBD Ltd.) Address: 7 Innovation Drive, Flamborough, Ontario L9H 71-19 Telephone: (905) 690-7474 Emergency Phone: (905) 690-7474 SECTION II -ACTIVE INGREDIENTS HEALTH 0 FLAMMABILITY 0 REACTIVITY 0 Ingredients CAS# WT% ACGIH-TLV I LC50 I LD50 Oils, thyme 8007-46-3 0.1 — 1 None established I Not available 1 4700 mg/kg oral, rat SARA — Section 313 (Toxic Chemical Release Reporting) 40 CFR 372 — No ingredients above reportable quantities. Toxic Substances Control Act (TSCA) — All the ingredients are listed or exempt from listing on the Chemical Substance Inventory. California Proposition 65 — No ingredients listed. SECTION III - PHYSICAL AND CHEMICAL DATA Boiling Point (°C): As for water Specific Gravity (H20=1): 1.00-1.02 Vapor Pressure (mm Hg): Not applicable % Volatile (Wt%): Not applicable Vapor Density (Air = 1): Not applicable Evaporation Rate: As per water Solubility in Water: Some separation occurs, agitation required. pH (100%): 5.0 — 6.0 Physical State: Liquid Viscosity: As per water Appearance: Light tan Odor: Lemon — spice SECTION IV - FIRE AND EXPLOSION DATA Flammability: Not flammable by OSHA criteria Flash Point (°C, TCC): None to boil LEL: Not applicable Hazardous Combustion Products: None UEL: Not applicable Auto -ignition Temperature: Non-combustible SECTION V - REACTIVITY DATA Conditions for Chemical Instability: Stable Incompatible Materials: Not known Reactivity, and Under What Conditions: As for water Hazardous Decomposition Products: None Page 1 of 2 SECTION VI - TOXICOLOGICAL PROPERTIES Route of Entry: Skin most likely EFFECTS OF ACUTE EXPOSURE: None known Eye: No effect as per FIFRA CFR 10 Part 162.10 Skin: No effect as per FIFRA CFR 10 Part 162.10 Ingestion: No effect as per FIFRA CFR 10 Part 162.10 Inhalation: No effect as per FIFRA, CFR 10 Part 162.10 EFFECTS OF CHRONIC EXPOSURE: Skin: No data available Irritancy: Non -hazardous by OSHA criteria Respiratory Tract Sensitization: No data available Carcinogenicity: Non -hazardous by OSHA criteria Teratogenicity, Mutagenicity, Reproductive Effects: No data available Synergistic Materials: Not available SECTION VII — PREVENTATIVE MEASURES Gloves: None required Eye Protection: None required Respiratory Protection: None required Other Protective Equipment: None required by OSHA or NIOSH Engineering Controls: General ventilation adequate Leak and Spill Procedure: Before attempting clean up, refer to hazard data given above. Small spills may be absorbed with non-reactive absorbent and placed in suitable, covered, labeled containers. Prevent extremely large spills from entering sewers or waterways. Contact supplier for advice. Waste Disposal: In accordance with federal, state, and local government requirements prior to disposal. Recycle empty container. Storage and Handling Requirements: Store airtight at room temperature. Keep out of the reach of children. No special handling requirements. SECTION VIII - FIRST AID If irritation occurs, rinse affected area thoroughly with cool water. If swallowed, drink plenty of water. SECTION IX - PREPARATION INFORMATION Date: 2008/07/14 MSDS Prepared by: Sensible Life Products (div, of LBD Ltd.) Telephone: (905) 690-7474 DISCLAIMER The information contained herein is believed to be accurate and also represents the best information obtained by the manufacturer and recognized technical sources. Health and safety precautions in this data sheet may not be adequate for all individuals and product uses. It is the user's obligation to evaluate the information contained in this sheet along with the safe uses of the product. Good personal hygienic practices should be followed. Sensible Life Products assumes no responsibility for injury or damage from the use of Benefect Broad Spectrum Disinfectant that in any way differs from what is provided in the label directions. Page 2 of 2 North Andover Police Department 566 Main Street North Andover, Ma. 01845-4099 (978) 683-3168 Incident Report Call Takers Remarks: Create User ID: Date & Time No Caller Remarks Listed Incident Number: 2010000012402 File No: N/A Dispatch Incident Number: 2010000013244 Print Date: June 10, 2010 Printed By: pgallagh Incident Number: 2010000012402 Page 3 of 3 PlFormSingle 12/01/09 North Andover Police Department Incident Number: 2010000012402 566 Main Street File No: N/A North Andover, Ma. 01845-4099 Dispatch Incident Number: 2010000013244 (978) 683-3168 Print Date: June 10, 2010 Incident Report Printed By: pgallagh Incident Information Occurred Day of Date Time Occurred Day of Date Time Reported Date Time On/From Week Officer Title Officer Name To Week Patrolman William H Brush III On Patrol Officers Patrolman Stephen M Diminico Fri 06/04/2010 1:50:02PM Stephen M Diminico Fri 06/04/2010 1:50:02PM 6/4/2010 1:50:02PM Reported As Incident Type - Primary Arresting Officer Well Being Check Well Being Check Incident Address Reporting Officer 78 Jefferson Street, North Andover, MA 01845 Patrolman Stephen Diminico Sector Stat. Area Sub Stat. Area 7T7=act Landmark Business Name Incident Types -Other N/A Associated Persons Summary Type Name(Last, First, MI) Date of Birth I Sex I Home Phone # Cell Phone # Work Phone # Involved SWEENEY, HELEN C j 8/4/1949 F N/A N/A N/A ------------- --- --- --- Address: 78 Jefferson Street, North Andover, ----- ------------------------ ------------ !MA 01845 Associated Businesses Summary Type Name Primary Phone # I Secondary Phone # No Associated Businesses reported for Incident #: 2010000012402 Involved Officers Officer Title Officer Name Officer Type Division Patrolman William H Brush III Responding Officer Patrol Officers Patrolman Stephen M Diminico Reporting Officer Patrol Officers Patrolman Stephen M Diminico Responding Officer Patrol Officers IBR/UCR Offenses Offense Number IBR Type Chapter Section Statute ID / IBR Type Description No Incident Offenses Recorded for Incident M 2010000012402 Complaint Charges Seq # I Chapter I Section I Name(Last, First, MI) I Description of Offense No Complaint Offenses Recorded for Incident M 2010000012402 i Vehicle Info Vehicle No. I Vehicle Make I Vehicle Model I Vehicle Year VIN Primary Color Secondary Color Plate No. State No Vehicle Info Recorded for Incident M 2010000012402 Property No Property Info reported for Incident #: 2010000012402 Citations Citation No Code Date Status Statute Description No Citations reported for Incident#: 2010000012402 Incident Number: 2010000012402 Page 1 of 3 PlFormSingle 12/01/09 North Andover Police Department 566 Main Street North Andover, Ma. 01845-4099 (978) 683-3168 Incident Report Narratives for Incident Number 2010000012402 ? Yes Other Narratives not authorized for print? None Narratives this user authorized to print: Narrative by: Patrolman Stephen Diminico Division: Patrol Officers Incident Number: 2010000012402 File No: N/A Dispatch Incident Number: 2010000013244 Print Date: June 10, 2010 Printed By: pgallagh Date & Time . Narrative Description Entered by Status Reviewed by Last Edit Date 06/04/2010 16:38 Patrolman Stephen Open 06/04/2010 Diminico I Ofc. Diminico was dispatched to 78 Jefferson to meet the NA board of Health for a well being check and report the following. When I arrived I was met out front by Deb from the Board of Health. She stated the neighbors have been complaining of the bad odor coming from the unit and no one has seen the resident at 78B a Helen Sweeney for at least a week. One neighbor stated her car was not in the parking lot. I knocked on the front door in an attempt to raise someone but there was no answer. A strong odor of cat urine could be smelled coming from inside the unit. Inside the front window I could see a golden retriever dog that was barking at me and jumping on the window sill. The floor in the living room was full of urine stains as well as massive amounts of dog feces. In order to check the well being of Helen Sweeney the NAFD was called to the scene and forced entry to the front door of 78B Jefferson Street. I checked the inside of the unit and there was no person found inside. The entire unit was full of trash everywhere. There was dog and cat waste everywhere you looked. Trash was stack up on itself and was ceiling high in places. While assess the scene the Board of Health determined the unit condemned and in no condition for human or animal inhabitants. While the dog was being removed from the unit and placed in the back of 321 for transport, Helen came home. Helen was advised that she couldn't go into her unit and the dog was being taken by the NAPD. Helen became very upset and stated, "I should just die." The NAFD ambulance was then called to the scene and Helen was transported to LGH for a mental health evaluation. The dog was taken in 321 by myself to the Andover Animal Hospital for boarding and the Board of Health stood by on scene to secure the unit. Signature - Reporting Officer Incident Notes: Create User ID: Date & Time No Incident Notes Listed Incident Dispatcher Remarks: Create User ID: system Date & Time 06/04/2010 16:33:42 Signature - Reviewing Officer 2010/06/04 13:51 Lundquist, Joan 546: HEALTH DEPARTMENT REQUESTS A WELL BEING CHECK, OFFICER DIMINICO IS RESPONDING. 2010/06/04 14:37 Lundquist, Joan 546: OFFICER DIMINICO REPORTS NO ONE HOME AT THIS TIME, WAYNE NADER WILL BE ASSISTING WITH THE DOG AND CATS,. 2010/06/04 15:26 Bonanno, Jonathan 554: A-2 RESPONDING FOR A 60 Y/O FEMALE MENTAL EVAL. RUN# 1076 2010/06/04 15:38 Lundquist, Joan 546: ENROUTE MILEAGE TO HFH 43623. OFFICER DIMINICO REPORTS HE WILL BE TRANSPORTING THE DOG TO THE ANDOVER ANIMAL HOPITAL. 2010/06/04 16:09 Vieira, Brighid 556: A2 ENDING MILE TO HFH 43631 --------------------------------------------------------------------------------------------------------------------------- ----------- Incident --------- Incident Number: 2010000012402 Page 2 of 3 PIFormSingle 12/01/09 North Andover Police Department Incident Number: 2010000012402 566 Main Street File No: N/A North Andover, Ma. 01845-4099 Dispatch Incident Number: 2010000013244 (978) 683-3168 Print Date: June 10, 2010 Incident Report Printed By: pgallagh Call Takers Remarks: Create User ID: Date & Time No Caller Remarks Listed 1 Incident Number: 2010000012402 Page 3 of 3 PIFormSingle 12/01/09