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0134 PRINCE AVENUE - Health
134 PRINCE � `.-. Yj'1 rsT�n.s � L s v , No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ZIppYtcation for ]Dtg;pool *pztem Con.truction Vermtt Application for a Permit to Construct( , )Repair V)Upgrade( )Abandon( ) JU Complete System 0 Individual Components Location Address or Lot No. 1340 v-(A C.e A-v-2 A M Owner's Name,Address and Tel.No. Assessor's Map/Parcel 7( 0 5, Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. iJ�vS�ie/� J-1*4 ,T-A>-1 J'Qs�/ 1rvG $uX CF92 �orPJ�DE2l� �eC CItlP/'. S'.A-ipwec.�i Zo/0 Type of Building: Dwelling' No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design.Flow F gallons per day. Calculated daily flow 71rl gallons. Plan Date 6 —2— o 6 Number of sheets / Revision Date /1 o r Title Size of Septic Tank /YV-0 _—Ty pe of S.A.S. 30 .a � 7-/J7ooS Description of Soil f l._/i Nature of Repairs or Alterations(Answer when applicable) D/9e C esS"ev".�, Gv/fGt "516 2,d//,,,f 7A-i;k. Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with.the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been i ue �thisBoof Health. Signed O Date —6 ®� Application Approved by Date Application Disapproved for the following reas s Permit No. Date Issued No. ©� D >. .yw Fee /OQ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes . PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLES MASSACHUSETTS ZfppYication`for 30iopooal *potent Construction Permit Application for a Permit to Construct( . )Repairy)Upgrade( )Abandon( ) Complete System ❑Individual Components Location Address or Lot No.1 3 4 P✓(A,C.e_Q-e- /Y1 M Owner's Name,Address and Tel.No. 7-A2d� /� � //� y Assessor'sMap/Parcel <� �'�� D Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. fj o Jt tt`7 2 F 0.-,a,}'7 Do I7(-e �/gL /V!/. S�"70•..i,C Lr d� P 2a/o 33 2r77 Type of Building: Dwelling No. of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures ,/ Design.Flow �T gallons per day. Calculated daily flow f� gallons. Plan Date (n -2- O 6 Number of sheets 1 Revision Date Ha.,- t Title Size of Septic Tank tt /S'V tl Type of S.A.S. 305� =w ry'7a.-S Description of Soil tal,4 e'1 w Nat ut/re of Repairs or Alterations(Answer when applicaSb``lle)�'Z�114414e_ - l�. t�'/ n� ' C (%+I T Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5-of-the-Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been'ssued�y this Board of Health. Signe Date —/ — 96 Application Approved by _ > Date Application Disapproved-for the following reasoner U s Permit No.Z6& Date Issued D THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the.On-site Sewage Di posal System Constructed ( )Repaired (1k )Upgraded( ) Abandoned( )by "jo,.S e /d S'yj,";Itn4 C at�/?e- e"Vice ✓..Q ti✓S��NJ iu<'/1 S has been constructed in accordance witH the provisions of Title 5 and the for Disposal System Construction Permit N . _ dated ' /0 Installer /d' Designer ;�7. The issuance of hi t hall not be construed as a guarantee that t e system wll> f n<tio as des�grred. Date . 1 l 11 Inspecto —————— --------------- ——————Fee THE COMMONWEALTH OF MASSACHUSETTS ( i(� PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS 1=igpo!6al *pgtent Construction Permit Permission is hereby granted to Construct( )Repair(X )Upgrade( )Abandon( ) System located at / 3V Pl-(N C Q A-v-e i"C` ,S M. <l S and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construct'°n;mu/sbe completed within three years of the date o i ,e';t Date:__f7 Approved by = TOWN OF BARNSTABLE v LOCAnON 124 &WC-P..,f�1 V-C' SEWAGE # -21d66 - 3. ? VILLAGE ASSESSOR'S MAP & LOT—A0 Of INSTALLER'S NAME&PHONE NO. RQU;,6le A:( �a��" ��✓Q SEPTIC TANK CAPACITY /�a LEACHING FACILITY: (type)3o5�D if. (size) aX 36 � '�/Z•ZS NO.OF BEDROOMS T BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: -7— /cl"G 6 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility 2C) Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 260 feet of leaching facility) �U�`�— Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching�faacili Feet Furnished by `Id Liq 40 b S o'v i r. O Q Town of Barnstable ' Regulatory Services Thomas F.Geiler,Director A Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office:.508-862-4644 Fax: 508-7.90-6304, Installer&Designer Certification Form Date: _-V 15 Xb(,-.g Designer: VIPj, iMig ItJ , L✓ Installer: 23OycS�ie /c/_Y rl 6,�CeZ.x Address: . 4k Aa�� �'f�I t'� Address: 13o t via On —2—I 0 — 0 was issued a permit to install a (date) (installer) septic system at Ad /k.4 of AV&IMA16N J M IU-, based on a design drawn by (address) . '-Dgyo' MAb( )J, Q�. dated JUKE Z, ZDC)b (designer) 1-certify that-the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank- I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the.septic system)but in accordance with State&Local Regulations_ Plan revision or certified as built by designer to follow. °Fi'�s o� DAVID (Installer's Signature) B. m g MASON 0 9 No' 0 �; FQ/STEP(G _ rTAa���' (Designer's Signature) (Aix er's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE '9lL& NOT BE ISSUED UNTIL BOTH -THIS FORM AND AS- BUILT CARD ARE RECEIVED BY M.RARNSTABLE PUBLIC HEALTH DIVISION, THANK YOU. Q:Health/Septic/Designer Certification Form. f Notice: This Form Is To Be Used For the Repair Of Failed Septic Systems Only PERCOLATION TEST AND SOIL EVALUATION EXEMPTION FORM I,�°►yID -P, ,MIA50� iX�,hereby certify that the engineered plan signed by me dated:P4121ZOD�),concerning the property located at 1w—Z AYE, Mq-0� MI —&meets all of the following criteria: • Two soil evaluations excavated for detailed examination(no hand augering) and two percolation tests shall be conducted. • This failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. • The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. • The bottom of the proposed leaching facility will be located no less than five feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor method when applicable] Please complete the following: A) Top of Ground Surface Elevation(using GIS inform£fion) - 20`100 B) G.W. Elevation �10 +adjustment for high G.W.Z,D DIFFERENCE BETWEEN A and B C0 SIGNED : � DATE: U Fi 2 NOVICE F ; Based upon the above infoririafion;.a repair permit will be issued for bedrooms maximum. No additional bedrooms are authorized in the fiitute withouE engines red septic system plans. N q:\Sep ticiperccxemp.doc u IqF A7 L[U' 1CTCyaraao�oi rta�s a��o A�¢culcnuubs �-{um / 7 fC v. r--W g-7-R jrlojrc,yh 17%J The plans and spwltioatiotta f i every on site system SW be prepared as foQows: (1) Every system stall be designed by a Massachusetts Registered Pkaf sdand Engineer or a Maw Reghtered Sanknon provided that such Sanitarian shall not des[gn a system designed to discharge score don 2A00 PUDRS Per daY to 310 C HR 15.203. Any ocher agent of the owm am»Plans far the of a sgstatt deigned to Vchug*not matt am than 2.000 gallons per day pursuant.to 310 CMR 15.203 provided y are reviewed by a Ma4sacbuseets Registered Sankn ian=it approved by the approving authority; A 2) Every plan submitted for approval mast be dated andbear the stamp and signatureof the des*w, (3) Evap plan Ewa ttew systan or plat for ilm upgrade or arpaosiou of an ecisting system :11ich regaiem a varium to a pt+opaty line sedxwk "srust.alsc reference a plan which beats the stamp aml signamm of a- Miassaelaiisetts- Liceoaed Land Surveyor in accordance with KC.L.e: 112.f S10; (4) Every play for a aysrem shall be of suitable scale(one inch=40 fees or fewer for plot plans and one inch a 20 feet or fewer for details of system components) and shall include kdon eL a} the legal boundaries of dte facility to be served: (b) the how"attd ration of any aWams appurtemt to or which could impact the . (c) the loeafin of the all dwrWhWs)or bml mj&)casting and pro;wed on file facilky . idendflodou of d=to be served by the Wsw= d) •-the'locacion of existing or proposed imparv� areas. iadtfdag driveways and e} location and dimensions of the systern(fig Mam amen); systan demon ons,uWatbag design daily sewage flour.septic tank capacity /AllicMa qutrpd and .son ab ( P q-taa is dedgued fox North turves and ercistutg and pmP�costume . to and k8 of�nervation hok awls including the dam of test.existing grade detntti�s trlatlted on each as. wad the saaw of do wr esencative of the ppuw tg a vAoft Wd sail avalwon, location and Msft of peacolaxion ants kg dd dM of test and the names of fhe rep ilwa IvC of the Mpmoing ao*a ty and sod orabaaeot V AD ttmte and number W din Sao Evalumor of teoout (ir) loaadwt ai eret<y .-am atspply.pwAic md PtivaSC6 L vvfuhia 400 feet-of the PropaN d SYMW= tom in dre tree of-aft water suppgw aetd gradd:psckcd public water sir wells. 2.. widds 250 fea of the ptopond system, location is dca case.of evbctar public water supply wells,and 3. wig LID feet of the proposed syssetn locadoa its the wee of private Neater. OUP*Wells; U lars�of tatjr sudatoe wages of the wea[dr,tivet9. wetlakk salt gushes, Wand or coastal banks, regokaboay flaedty- . velocity mom. su faaa wafer sappffrs.trilowdes to=dace water stem%artifled vernal PD.*private water supplies or suctm goes, $rwd paced or tubdw pftc: vri*: y wells. subsurface draina.leacNag eam6 basML at dry welts:and the location of any:nitrogen Pansitfic frees idacdfed'in 310 CMR 15.215 vti*71n which paoai- prbpaaed ►� wee toe w& 19cee s of water lines and odor mabstniace tsuM s Galin fact�uq; N obsavad turd stfjnsoed -water eievat in tare vivaiiy_df the aye a 1� P a�an Me plat lle�g 28 vent=to dte.ptoriSioAs of 310 CMR 13. M songlu � (t� w�.the PM *a_ login aw ekvda of as b bin SO*T4 flea�do haw wbkh is not shbj=m or loss&A*is-proposed. (t) w dodag is-propt .scants :�iSa-���dw d - �,� Mposed E but trot&dW to doing&mdiw ally y taawcs said .swtttber- aw.dqv&Per when a l ad Fitter oralvivalent ah mative ug iaaology./s;a ep , a co nPlae Plan sari f t<e sys 1L.l►Y - a is plaaa,m show the W;aaan a `ihr iaer'tity iadodnig the -estistisg sue: (n) the street tmusiI and lot number,if nay,of thf¢*0W.and = OE THE Taw The Town of Barnstable ? 31ABS9TaBL 'r Department of Health, Safety and Environmental Services Naas oaYa.��� Public Health Division 367 Main SLreet,lyannis,MA 02601 Office 508-790-6265 Thomas A.McKean FAX 508-775-3344 Director of Public Health LEAD DETERMINATION REPORT FORM Date of Determination: q- Z 5` Z 00 y Inspector: 6- 1 4A E- fNot rr �.5 fo L', 2 ,S, License#: D 3 3 IS` Method Used: L- Sodium Sulfide Expiration date: //-/L/-00 - �— X-Ray Fluorescence Model: Serial #: Property Address: ih e_q Ave ,✓C- Apt. # /(rl ass fa"S 441 j/J Description of.Property: L-�Single family Multi-family # units Garage Fence Other structures Age of Property: Pre-1978 Post_-1978 Occupant: T� ck)f C"O- £e_ Occupants under six years of age: K f_v t„l t3<v-C,L, DOB: (o - 1 �v `9 7 DOB: DOB: Occupant's Telephone: 4 Zr-5-03 7 Property Owner(s): %e d. * ALA a-,- Owner's Address: -r>K /PRSG.v, + 7 f�/� Owner's Telephone: W — 6 01 6 - 0 7S` Z Lead Hazards found? Yes-Z No An X-ray fluorescence reading greater than 1.2 mg/cm2 or a gray or black reaction to sodium sulfide indicates a dangerous level of lead and constitutes a positive determination. Deleading of lead painted surfaces as a result of this report or subsequent inspection must be performed by a licensed deleading contractor and/or by an owner/agent who is trained to perform specific work as required under the Lead'Law. Contact the Childhood Poisoning Prevention Program for additional information regarding deleading and training. C:\1VP50\LEADl995\GEN ERA LS`IOLTRIIEAD\LEADREPT.DOC 12/96 LOCATION SOURCE Pb 1. Child's bedroom Window parting bea exterior ' 1 area') o 2. Child's bedroom Windowsill 3 S ,.e 3. Living room Window parting bead/exterior sill area 4. Kitchen Window parting bead/exterior sill area 5. Interior :r? ;ing paint , 6. Exterior Flaking paint P lide, �oS 7. Exterior Cellar window units 8. Exterior Window sills below 5' 5:d' Iiv cc 9. Exterior Main entry door casing 10. Interior Outside comer of baseboard 11. Kitchen or Bathroom Chair rail 12.. Bathroom Windowsill D S--da 13. Exterior Threshold 14. Interior hallway (common area) Stair tread or stringer 15. Interior hallway (common area) Balusters 16. Interior hallway (common area) Door casing B S,c�q- 17. Porch Stair tread or riser 18. Porch Railing cap 19. Porch Balusters 20. Porch Support columns(<6" diameter or square) 21. Porch Staircase stringer 22. Exterior Bulkhead 23. Garage/Outbuilding Door casing or jamb 24. Interior Closet door or baseboard (uncapped) 25. Interior Cabinet door, shelf, or wall CG i (d) doo,, too G In i ��fUw /4 rf CL( l (C2 �(/i�YlOYTc�� ✓llCr C:\WP50\LEAD1995\CENERAL\NOLTRHEAD\LEADREPT.DOC 12/96 Town of Barnstable ' Regulatory Services °FTHE T Thomas F.Geiler,Director ti Public Health Division * * * anxcvsTnsc.s, y MASS. �w Thomas McKean,Director QD i6?9• �� iDTfo Mg. 367 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 October 17,2000 Theodore J. &Mary F. Curley 548 Pleasant Street Milton, MA 02186 Dear Mr. & Mrs. Curley: Glen E. Harrington, R.S. of the Town of Barnstable Public Health Division did a lead paint determination of the home or apartment you own at 134 Prince Avenue, Marstons Mills, MA on September 29, 2000. This determination found read paint in violation of the Lead Law, Massachusetts General Laws, chapter 111, section 197, and the Massachusetts Department of Public Health's (DPH's) Lead Poisoning Prevention and Control Regulations, 105 Code of Massachusetts Regulations (CMR) 460.000. These laws require owners of homes or apartments built before 1978 to have lead paint violations deleaded for full compliance or brought under interim control when a child under six years old lives there. A private risk assessor has to do a risk assessment and give you a lead inspection/risk assessment report before you can go ahead with interim control. A private lead inspector has to do a lead inspection and give you a lead inspection report before you can go ahead with deleading for full compliance. If you already have a Letter of Compliance, contact this agency and the state Childhood Lead Poisoning Prevention Program, at 1 (800) 532-9571, immediately. The Order that comes with this letter has important information telling you: • what you have to do • what deadlines to meet • what documents you have to send to this agency • who can do the necessary work • what the penalties are for not meeting the Order's requirements. Please call me at this office at 508-862-4644 as soon as possible to discuss this Order and how to meet it. To help you take the first step—getting a full inspection or risk assessment—a list of lead inspectors is enclosed. We recommend that you check references and check if the inspector is still licensed. You can check on the license by calling the state Department of Public Health's Childhood Lead Poisoning Prevention Program (CLPPP) before hiring an inspector. To get a list of risk assessors for interim control, call CLPPP's central office at 1-800-532-9571. You can also get two other helpful materials from CLPPP. One is a guide explaining all the choices for full compliance deleading and interim control. The other has places to call to get money to help with deleading. Again, you can get these by calling CLPPP at the number above. Requirements for Doing Deleading Work High-risk deleading: If you need to or choose to have high-risk deleading work done, such as having lead paint stripped or scraped, you have to hire a deleading contractor. A list of deleading contractors is also enclosed. Just as in the case of inspectors, we recommend you check references and check if the deleader is still licensed. You can check on the license by calling the state Department of Labor and Workforce Development (DLWD) at 1-800-425-0004. - i odera��e-risk deleading: _!before �,oi�or your agent can do rnod:rate-risk deleading wojlc such as removing windows and woodwork, you have to take a course,pass it and get a certificate from CLPPP. These courses are given by a number of groups and organizations at various places, times and prices. To find out about when and where the courses are, call CLPPP at 1-800-532- 9571. Remember that you still have to meet the deadlines in the Order. If a course for owners to do moderate-risk deleading is not available at a convenient time or place for you to meet the deadlines of this Order, you won't be able to do moderate-risk deleading work yourself. You then have to use other methods to delead, or hire a licensed lead-safe renovation contractor. To get a list of these contractors, or to check their licenses, call DLWD at 1-800-425-0004. Low-risk deleading: Before you or your agent can do only low-risk deleading work, such as covering surfaces, you have to read the CLPPP low-risk booklet, take a self-corrected exam that you send in to CLPPP, and get a certificate from CLPPP. If you want to encapsulate, you have to first call CLPPP's encapsulant coordinator, who will go over your inspection report with you and discuss surfaces that may be good for encapsulation. You have to read CLPPP's encapsulation booklet, take a self-corrected exam that you send in to CLPPP and get a certificate from CLPPP. To get a free copy of the low-risk booklet, or to speak to the CLPPP encapsulant coordinator, call CLPPP at 1-800-532-9571. Interim control work: If you or your agent will be doing other work for interim control, such as structural repairs and cleaning of leaded dust, you have to take safety steps and clean up in the way described in the CLPPP booklet for interim control. To get a copy of this interim control booklet, call CLPPP at the above number. Deleading work has to be carefully done to be safe. To protect the people who live in the home or apartment, you have to keep them out of the home or apartment, or area being worked on, in these ways: • All people and pets have to be temporarily moved from the home or apartment for the whole time that high- or moderate-risk deleading work is taking place inside the home or apartment. You have to provide the residents with a reasonable alternative place to live for this period. People and pets who have been temporarily moved from their home or apartment can only come back after a licensed private lead inspector or licensed private risk assessor says it is safe for them to return. The inspector or risk assessor does this after reinspecting the home, including taking dust samples to assure that lead dust levels meet approved standards. This reinspection will be done at least three hours after deleading work is all done. • People and pets have to stay out of the work area while you or your agent does most low-risk deleading work or structural repairs or cleaning of lead dust. They also have to stay out of the work area while there's any deleading work in common areas outside the home or apartment, as long as they have another regular way (not a fire escape) to go in and out of the building. In these cases, people and pets can use the area after cleanup following the end of the work in that area. ti • People and pets have to stay out of the home or apartment for the workday while you or your agent put coverings over a surface with peeling, chipping or cracking lead paint or plaster, or during applying of encapsulants with an airless sprayer. They also have to stay out for the day during deleading in common areas when they do not have another regular way (not a fire escape) to go in and out of the building. When people and pets are out of their home or apartment for the day, it means they can come back to the home or apartment after cleanup at the end of the workday, and don't have to be out overnight. AN work for deleading and interim control has to be neatly and properly--done,-in a professi_�nal way, and`the home or apartment has to be returned to a condition that meets the requirements of the State Sanitary Code. Deleaded surfaces can't be repainted until after they have passed. reinspection by a licensed private lead inspector or risk assessor. You have to give written notice about common area lead paint violations to all other residents of the building. "Notice to Tenants of Lead Paint Hazards" is enclosed for that purpose. You also have to send a copy of the lead inspection report or lead inspection/risk assessment report, and any reinspection reports, to all mortgagees and lienholders of record. If you have questions about the Department of Public Health's Lead Poisoning Prevention and Control Regulations, you can ask me, or call the CLPPP central office (1-800-532-9571 or 617- 753-8400). If you have questions about the Department of Labor and Workforce Development's (DLWD) Deleading Regulations, you can ask me, or call the DLWD central office (1-800-425- 0004 or 617-727-1933). Remember to refer to the attached Order for mo4D ; out what you have to do. Wt �� Inspector Telephone: BHCOV.DOC 1/2000 �T"E The Town of Barnstable s� Department of Health Safety and Environmental Services MM6 - o 639., �� Public Health Division 367 Main Street,Hyannis,MA 02601 Office 508-790-6265 Thomas A.McKean FAX 508-775-3344 Director of Public Health DATE: October 16, 2000 ORDER TO CORRECT VIOLATIONS) Theodore J. & Mary F. c„�_ 548 Pleasant Street Milton, MA 02186 Owner or agent of the property.located at 134 Prince Ave. , Marstons Mills: Be advised that an agent of the Board of Health has determined certain portions of the aforementioned residential property to be in violation of the State Sanitary Code Chapter II, "Minimum Standards of Fitness for Human Habitation," 105 Code of Massachusetts Regulations (CMR) 410.750(J). This violation also constitutes a violation of the Lead Law, Massachusetts General Laws (MGL), Chapter 111, Section 197, and the Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. Conditions exist in this residence which may endanger and/or materially impair the health of the occupants of these premises. DECLARATION OF EMERGENCY The Director of the Childhood Lead Poisoning Prevention Program and the Board of Health declare that the presence of the aforementioned violation of the Lead Law and the Regulations for Lead Poisoning Prevention and Control constitutes an emergency pursuant to the Lead Law, MGL Chapter I 11, Section 198 and within the meaning of the Sanitary Code, Chapter I, 105 CMR 400.200(B). CORRECTION OF LEAD VIOLATIONS) ~The wv1GL 6."1'1`l, ss. 1"89H-]99s; and the Department ;,f;?Lbli;,'Heulth's Ft.cgu(ations fbr:''reac Poisoning Prevention and Control, 105 CMR 460.000, require that residential premises or dwelling units built before 1978 have lead paint violations either abated and contained for full compliance or brought under interim control when a child under the age of six lives in the residential premises or dwelling unit. If you are interested in interim control, then you must hire a licensed private risk assessor to perform a risk assessment and issue a "Lead Inspection/Risk Assessment Report" before you proceed. If you are interested in deleading for full compliance, then you must hire a licensed private lead inspector to perform a lead inspection and issue a "Lead Inspection/Surface Assessment Report" before you proceed. C:\wPSO\LEAD199S\GENERAL\CENERAL.DOC\BIIOTC39A.DOC RED'. 10M7 The Lead Law, the Department of Labor and Workforce Development's Deleading Regulations, 454 CMR 22.00, as well as the Regulations for Lead Poisoning Prevention and Control require that.any high- risk residential lead abatement and containment activities, including making loose paint, plaster or putty._ intact, be performed by licensed deleading contractors—whether in the context of achieving interim control or full compliance. An owner or owner's agent, after meeting the training requirements of 105 CMR 460.175, may perform certain low-risk abatement and containment activities in accordance with these regulations without a deleader's license—again, whether in the context of achieving interim control or full compliance. These specific low-risk abatement and containment activities are the following: applying encapsulants; applying such coverings as carpet, vinyl, aluminum,plywood, plexiglass, and acrylic, to surfaces, including siding of exterior surfaces; removing doors,cabinet doors and shutters; and capping baseboards. In addition, an owner or owner's agent may perform structural repairs, as defined in 105 CMR 460.020, and cleaning of leaded dust, as may be required for interim control, except that the final clean-up required after the completion of high-risk abatement and containment work by a licensed deleader must be performed by a licensed deleader. Violations of these requirements shall be punished by a fine of not less than $500 nor more than $1,500 for each offense. ORDER You are hereby ordered to remedy all violations of MGL c. 111, s. 197 and 105 C*IR 460.000; as---� identified by a licensed private lead inspector or, if you wish to pursue interim control, you must remedy all.urgent lead hazards identified by a licensed private risk assessor. Whether you pursue full compliance or interim control, you must correct the relevant violations in accordance with the following schedule: Within sixty (60) days of your receipt of this Order, you must provide to this agency a copy of a signed contract with a licensed deleader, if any high-risk abatement and containment work, including making leaded paint, putty or plaster intact, is required. If you or your agent is doing owner/agent low-risk abatement and containment and/or interim control work, you must also provide within sixty (60) days a signed and completed CLPPP form entitled "Documentation of Training to Perform Owner/Agent Low-Risk Abatement and Containment and Deadlines by Which Owner/Agent Low-Risk Work and/or Interim Control Work Will Be Completed." The contract must specify, and if you or your agent will be performing low-risk abatement and containment work or interim control work, then you or your agent will attest in the CLPPP form described.above, that the work will be completed according to the following schedule: (a) Violations of the interior of the dwelling unit and interior common areas must be abated or contained for full compliance, or as required for interim control, within ninety (90) days of your receipt of this Order. However, you have a total of one hundred and twenty (120) days from receiving the Order to complete the following activities: (1) any low-risk abatement and containment work you or your agent perform, as long as all dust-generating abatement or containment work, including surface preparation, required to be done by a licensed deleader, has been completed, and any doors removed have been replaced, within ninety (90) days of your receipt of this Order; (ii) aFpilcat.i;n of encapsulants by licensed Ley ;! .II.deleaders; as ir)ng"as a"'rl rust. generating abatement or containment work, including surface preparation required to be done by a licensed deleader, has been completed within ninety (90) days of your receipt of this Order; (iii) installation of replacement windows, as long as you can demonstrate that new windows have been ordered within ninety (90) days of your receipt this Order. CAW P50\L EA D 1995\G ENE RA L\G EN ERA L/DOC\BHOTC39A.DOC REV 10/9; i- ,y (b) Violations on the exterior of the residential premises and exterior common areas must be ' abated and/or contained for full compliance or as required for interim control, within one hundred and twenty (120) days of your receipt of this Order. Any contract with a deleading contractor must also specify that the unit will meet acceptable lead dust levels, as determined by the results of sampling done by the licensed private lead inspector or risk assessor at the time of the reoccupancy reinspection, if one is necessary. Should any of the dust samples fail to meet acceptable standards, the contractor will be required to reclean the entire unit until all dust samples meet acceptable levels. In interim control cases in which no reoccupancy reinspection is necessary and no deleading contractor involved because no high-risk abatement and containment activities, including making leaded paint, plaster or putty intact, were necessary, then you or your agent who performed required work will be responsible for cleaning the unit to meet acceptable dust levels. In these cases, dust levels will be determined by the results of sampling done by the licensed private risk assessor at the time of the risk assessment reinspection. Any room or interior area in which one or more surfaces does not meet acceptable dust levels must be recleaned by you or your agent in its entirety. You must comply with all of the deadlines stipulated above, and with all applicable sections ef-4 05 C 460.000. Compliance with this Order will be determined by this agency's receipt of the appropriate documentation within the specified deadlines. The documentation consists of the following: a) if any high-risk abatement and containment work is necessary, including making lead-painted surfaces intact, a copy of a signed and dated deleading contract with a licensed deleader; b) if you or your agent will be doing low-risk deleading work or such other work as may be required for interim control, such as structural repairs and lead-dust cleaning for interim control, a completed and signed copy of the CLPPP form, "Documentation of Training to Perform Owner/Agent Low-Risk Abatement and Containment and Deadlines by Which Owner/Agent Low-Risk Work and/or Interim Control Work Will be Completed," c) a Letter of Lead Paint (Re)occupancy (Re)inspection Certification,issued by a licensed private lead inspector or risk assessor, in cases in which interior high-risk abatement and containment work, such as making loose lead paint, plaster or putty intact, is necessary, thus requiring occupants to be relocated from the unit for the duration of the work; d) copies of results of all dust samples taken by the licensed private lead inspector or risk assessor; e) a Letter of Full Deleading Compliance issued by a licensed private lead inspector or a Letter of Interim Control issued by a licensed private risk assessor. ,In addition, a copy of the deleading notification must be received by this agency at least ten (10) days prior to any commencement of deleading, whether performed by'a deleader or you or your agent, and whether i„ the context.of full compliance or interim conir ol. V PENALTIES Failure to comply with this order will result in criminal prosecution. The law provides penalties of up to $500 for each day of non-compliance. In addition, you may become liable for civil punitive damages equal to three times any actual damages for failure to comply with this order if a child becomes poisoned. C:\WM\LEA1)1995\CEN ERA 1.\CENFR,XL.DOC\BIIOTC39A.DOC REV 10/97 i CORRECTION OF VIOLATION BY CODE ENFORCEMENT AGENCY e If within the time periods stipulated above the aforementioned residential property is not brought into full compliance or interim control, this agency may contract with a licensed deleader to correct the violation(s) and obtain a Letter of Full Deleading Compliance or a Letter of Interim Control, and bill the owner, or initiate court action to reimburse itself. RIGHT TO A HEARING You may request a hearing pursuant to 105 CMR 460.900 of the Regulations for a Lead Poisoning Prevention and Control, in conjunction with the procedures of 105 CMR 400.200(B), the Sanitary Code provision for hearings in emergency public health matters. As already noted, the aforementioned violation constitutes an emergency. (See "Declaration of Emergency" section.) As such, you may request a hearing only if you have complied with this Order. The hearing will be provided within ten days of your request. This agency shall issue a written decision within seven days after the Baring. Inspector Director Certified Mail No. 7099 34160 Q'(7/0 -7?&1( 03.S-y C:\WP50\LEAD1995\GENERAL\GENERAL.DOC\BHOTC39A.DOC REV 10/97 Town of Barnstable F THE Tp� do Regulatory Services Thomas F. Geiler,Director + BARNSTABLE, 9� 1 MASS. ,off Public Health Division alFo��a Thomas McKean,Director 367 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 DISCLAIMER CONCERNING LEAD DETERMINATION REPORT The information contained in this report concerning the presence of lead paint does not constitute a comprehensive lead inspection. The surfaces tested represent only a portion of those surfaces that would be tested to determine whether the premises are in compliance with the Massachusetts Lead Poisoning Prevention Law(Massachusetts General Laws,chapter 111, sections 189A through 199B). Serious lead poisoning hazards are created when materials containing lead paint are disturbed, unless proper safety guidelines are followed. Therefore,Massachusetts's law requires that: A licensed deleader must do all high risk deleading, such as scraping or the use of caustics. Property owners, their unlicensed agents, and licensed lead-safe renovators may do some deleading activities without a deleader's license. Before they do so, though, owners, their agents, and lead-safe renovators must become trained and receive authorization to perform these activities. Owners and their agents should contact the Childhood Lead Poisoning Prevention Program for more information on the specific activities they may perform and on how to become trained and authorized to perform these deleading activities. Lead-safe renovators are licensed by the Department of Labor and Workforce Development and should contact them for training and authorization requirements. Letters of Full Compliance will be withheld if unauthorized deleading has occurred. Any renovating or rehabilitation of premises containing dangerous levels of lead paint must be done in compliance with the procedures set forth in the Deleading Regulations issued by the Department of Labor and Workforce Development (454 Code of Massachusetts Regulations 22.11), including sealing off the work area from adjacent areas, and performing a thorough clean- up. Any deleading work done on the basis of this report will not qualify the property owner for a state income tax credit, nor will the cost of such deleading be reimbursable under any state loan or grant program. In order to qualify for such programs, the premises must first be subject to a comprehensive lead paint inspection. If a child under six resides in this dwelling,the property owner may face criminal or civil liabilities unless all lead paint violations have been corrected. This lead report cannot assure that the property owner has met his or her obligations under the law. It is unlawful for rental property owners to use the presence of lead as the basis for discrimination against tenants or potential tenants with young children. N q/wp/leadsisc Documentation of Training to be an Authorized Owner/Agent And Intention to Comply with the Order to Correct -Please complete this form and mail it to the code inspector enforcing the case. His or her address is included in the Order to Correct. I, the owner, or I,the (print owner's name) owner's agent (fill in one), (print agent's name) do attest to the fact that I have complied with the owner/agent deleading training prerequisites of 105 CNM 460.000,the Lead Poisoning Prevention Regulations,and passed an exam to qualify for and perform specific abatement and containment work. I further attest to the fact that I will complete the abatement and containment work that I will perform in compliance with 1-05 CMR 460.000,the Lead Poisoning Prevention Regulations, and within the deadlines stipulated in the Order to Correct Violation(s). Finally, I attest that I will not exceed the scope of my low-risk authorization/moderate risk authorization (circle appropriate-level of authorization). Signature of Owner or Agent Authorization Number (Address of unit where work will be performed) Name of Code Enforcement Lead Inspector: Drive"'"?Documentation to perform training all tlmellnei days so letterhead doc rev.1/00 NOV-21-2000 03 : 15 PM HAMMOND DELEADING 508 821 7684 P. 01 WGfld►"YS d 66Rf1i01'0«CINiO.1NOONMpoSId Os01mb A O/O�bMY�•w P Vf►N VI•P•VM Wu Pfq"owo s Aad*. SYI mig Aid pm mop vso&. LiWVAv&AV1D Tobpbats t 7��y zip Coda 7 Add=voles dm v=k will bs dooms: Na (1f egy), Hoot BMW /";A�r,/ c odfas tb.Pea�q► s i ofkmllr t..I 1�1lfilMudteiu " ie�sot e x�e naa 0 g prim iatast(mods 0 Appb*Vk4 sift oa s am i ° S a �d"oul t Owe a tsmo at(low r!d` o Cmpamsot a covet o 06: The vlo*v4Il bit om/ ,od Will bft bTW4V&Tb*wwk be dolt In dko j-=�m or , h cm of Dgdm p mme_ f-,�sr�^/ - — BwminSPbease a �• h� Y est**A=iY atsfllOWO pavooe T&o hwe ompliod wft tt a tee ft**"Mts of dw bbuwhA"u lurid hbmbw P1 =*Co"`RgFlQdM 105 CM 4d0.600•V40MM wc*.l fllr hw i+dodo mdwi% d: ( vs193 opt alga mri ;b* be oart3m�W"Cs IM=bod abon.Alt die moo aa�`ioedioft ltltgrpeopom seat ds�b • 1 gooltpo�oltiro tilt• , S• hoeingPt+e dw"R%aft DPH Fmt(617)2A48r36 1 NEW&.BoOWMA02129-1 15 4, atr0l�i? Dd.WD ' 39!aimobbaytOu't,.Bommk MA 021H Foot(617)719-75a 1. Leral DOW OtPA It ACodo FsbtO mwd Agmq •tilts tm k faf%s too=oRlte;o b fames,sdt MA m m*m Com woe at(611)?V.Wt TOTAL P.12 1 I LEAD PAINT INSPECTIONS BY FRED HLMMILA Lead Inspector/Risk Assessor Lic. IIUR 2736 16 Quaker Road, East Sandwich, N1A 02537 Telephone (508) 888-8378 'toll free 1-800-286- 8378 17AX (508)888-8378 LETTER OF INTERIM CONTROL Date of Issue : Z d O Recertification Date : U r J Final Expiration Date : ;�a_e-cif, Exri" ,ration : �oZJQ (invalid if later than 2 years . = from date of issue) . 1 > Dear' C�V_L�� This letter is to certify that I performed risk assessment ' risk asses ment reinspection (circle one) of your p_ ca ed at 1,34 P aJCCE f{lI�li UE apartment no. ,- and relevant common areas, in the City or Town of HIV2�7DA)S MILLS for com r anee with the recruirements for, interim control on y U On that date (select one) : there were no urgent lead hazards those urgent lead hazards c ' ted in the initial risk assessment report of were found to have been cor ected. I found the property meets the regiiirements for interim control under Massachusetts General Laws, Chapter 111 , Section 197 and 105 CMR 460 . 000 : Regulations for Lead Poisoning Prevention and Control . This Letter of Interim Control may be renewed once, for an additional one-year period, upon reinspection and recertification by a licensed risk assessor . By the end of this original one-year period, or, if this Letter is recertified, by the end of the second year, Massachusetts law requires you to obtain a Letter of Full Compliance for this propercy. This property and relevant common areas shall remain In compliance with the requirements for interim control only as long as there continues to be no urgent lead hazards, and as long as i E y coverings, including encapsulants, forming an effective barrier over lead paint or other leaded materials remain in place . See the reverse side of this letter for the location (s) of surfaces which were covered or encapsulated. A complete risk assessment reinspection report is attached to this .letter . To the best of my knowledge, the cost o-f- any abatement and containment work performed for interim control that would also. be required for full compliance is $ Should you fail to complete any repair o: restoration work necessary to maintain the requirements of this Letter ofF Interim Control within 14 days of being notified in writing by an occupant , and a licensed code enforcement risk assessor or risk assessor authorized to work as an agent of the State Program finds the premises fail to meet these requirements, you shall have 30 days to . bring the premises into compliance with this Letter of Interim Control after having received an Order to Restore Interim Control Measures, or such greater time as allowed in exceptional,"'cases the Director, or, in their own respective cases, the •:local code% enforcement agency .or board of health, or by judicial girder. � . Sincerely, is Asse or DPH License Number RECERTIFICATION STATEMENT I performed a recertification reinspection at this property on On that date (select ene) : there were no urgent lead hazards those urgent lead hazards cited in the initial risk assessment report of , cited above, or of the initial recertification reinspection report on this property of were found to have been corrected. I found the property meets the requirements for interim control under Massachusetts General Laws, Chapter 111 , Section 197 and 105 CMR 460 . 000 : Regulations for Lead Poisoning Prevention and Control . Thus I recertify this Letter of Interim Control, and all its provisions apply for the recertified time period I have filled in at . the top of the first page of this Letter of Interim Control . Recertifying Risk Assessor DPH License Number Lead Inspection Report Page of LEAD PAINT INSPECTIONS BY ERED REMMILA Method used: Lead Inspector/Risk Assessor Uc.#12736 Na,S Exp.Date Jill. a 16 Quaker Road, East Sandwich, MA 02537 ®X-Ray Floumscense Telephone(508)888-8378 � - Model.�f�►�llb!p'�erial# Address At.N f� lri " C G- t� City Zip Code j I L L sFm Owner Name": 1 — Owner Address: 7' Single Family 6 Multi-Family [3 Client Name(If different from owner): #Units Condominium[] Clleat Address: Daycare ❑ KEY: ANtosAamuibw�� �Deleadi� Other Comments: Lv Ip c VwL,+no 1N CWAF coy ca"rW Q" � fi KINL Lao" WC 13 y PRpue-F/-U& Un M" Fit Prod NA t1bU"ns ,. W w.d flAt'..Sp N`� h ILLS 0 HW � � Kwaved ros tb.wVG scx saVW n SUV t p� va Madow "` vn wy RApLeo.n.ol hA':�/'� — 'tS J�^J"iTS Floor# C Floor# C . .: . . ... . .. . . . . . ;. . .. . . . ..; • ; ; ..; .:.. A(street side) A(street side) Pb (lead)more than 1.2 mg/cm' with x-ray fluorescence or positive with NazS is Dangerous. INSP.DATE Lead Hazards? y (Y or N) Frederic j_Hernmila _12736 1�• j 12736 Inspector (print) SiguturV Lic.# INSPECTION HISTORY PAGE eager, Property Address; (sL) 3 9(-r LV A7J�SWE (City) M Z S7D-f S HILLS (Apt/t�loor) 9 (zip) p Z(oq� WSPECTION ACTIVITY KEY ME OR FAW EXAMPLE BOX 1.Rem.Reutspection 6.Interim Control P Pass 2,Reinspection 7.Recertification F Fail inspection activity number 3.Dust Taken 8.Post Compliance Assess.Determ. pass or fail 4,Dust received 9:Maintained Comp S.Full,Delead Compliance 10. Restored Comp I s for 6 Lic# kA AAA Lic# _ In or Inspector yrl r Lic# (, Lic# Inspector Inspector Lic# Lic# Inspector Inspector FF} Lic# Lic# Inspector Inspector Lic# Lic# Inspector Inspector . TT-1 B . Lic# Lic# Inspector _ Inspector :r Lic# Lic# DATES-- —COMENTS: ax 4 .r 1. yk y TOWN OF BARNSTABLE LOCATION CC AAC, SEWAGE # VILLAGE ASSESSOR'S MAP & LOT Or76 Q05 INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY �GPc�� LEACHING FACILITY:(type) ,`� Cpo (size) NO. OF BEDROOMS _PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No S� �Ue�2t L.cLO / _ rILO 60 i i i/� 1�. �� 1 � `� � � Lead Inspection Report. Pa�e� Pf LEAD PAINT INSPECTIONS BY FRED HEMMILA Method used; Lead Inspector/Riak Assessor Lic.#I2736 [O Na,S Exp.Dace a 16 Quaker Road, East.Sandwich, MA 02537 ®X-Ray Flourescense Telephone(508)888-8378 y� p � Model let9 �crial# � Address Apt.# Q I / h/ ; C F; city Zip Code D L L S �] Owner Name': — t{' Owner Address: ., ` 7 1' Single Family E 6 Multi-Family ❑ Client Name(If different from owner): #Units Condominium❑ Client Address: Daycare ❑ KEY: Inspection Delesding Other omments:C AN Aw«.asw wA" CAP CWW GO (` (l tUL�l 170 11/ Lvov � eic DWW , �,.rEN �r mew- WIMP Pat � 139 PRIAGf AOL— ►NA No c Nac� am � NA)fs7P AX h lLt_S 02,6W riso Wapdve KrMW ros ftwhl. sex savor to am Floor# C Floor# C }� • . . . : . , B D t3 D . . . . , . , . A(street side) A(street side) LL Pb (lead) more than 1.2 mg/cm' with x-ray fluorescence or positive with Na2S is Dangerous. INSP.DATE y Lead Hazards? / (Y or M Io 3 Frederic��HemmIla 12736 _ 12736 Inspector (print) Signatur Lie.# INSPECTION HISTORY PACE r.8� ar . Property Address: - (St) 3 I (:C �til gut.►� (City) M iY-S7a AJ 5 HILLS (Apt/Floor) 9 (Zip)AL( qe INSPECTION ACTIVITY KEY PASS OR FAIL EXAMPLE BOX I.Reocc.Reinspection 6.Interim Control P Pass 2.Reinspection 7. Recertification F Fail inspection activity number 3.Dust Taken S.Post Compliance Assess.Determ. pass or fail 4.Dust received 9:Maintained Coup S.Full Delead Compliance 10.Restored Comp Inspector Inspector Lie# E- Lie# Inspcctor Inspector Lie# Lie N Inspector Inspector E- Lie# E- Lie# Inspector Inspector Lie N Lic# Inspector IEnspector EA ILie# Lic# — Inspector Inspector Lie# FT Lie# Inspector Inspector Lie# Lie N Frei. i l.Hemmilo_.,12736 !1/1 L G Page of Inspector(print) ' _ Lic# Signatur Date Address of Lead Inspection JA/ Ap►.# _ City l`� s'nj�J MILLS ROOM SIDE LOCATION/ LEAD TYPE OF COMMENTS DELEAD DELEAD SIDE LOCATIOtU LEAD TYPE OF COMMENTS DELEAD DELEAD SURFACE HAZARD DATE METHOD SURFACE HAZARD DATE METHOD Up walls 00 AIM L Window SDI Mll AIM L Low Walls AIM L � .v A1M L Baseboards AN L Win Casing 0,() ANA L Cf►air ran AIM L 2— Win Header MA AIM L Radiator AIM L Int Stops W AIM L FW AIM L Win Int sash Mn AIM L Calling (� AIM L SW Exterior w L Dw AIM L Pa as a w Door Casing AIM L Blind Stop o . w L Door Jamb O AIM L Win Ext Sash w L Threshold AIM L /� Window Siu 1. W AIM L CDoor AIM L 0 APrDn AIM L Door Casing AIM L Win Casing AIM l Door Jamb A/M L Win Header W AIM L Threftld! I AIM L Int Stops W AIM L 0 Door AIM L Win Int Sash MA AIM L Door Gang AIM L Exterior sip w L Door Jame L Pan Bead W L Threshold L Blind Stop Mll L Door AAIM L Win Ext Sash 0 0 W L Door Casirg AIM L Closet Door AIM L Doorjamb AIM L Cl Casing AIM L Threshold AIM L Closet Jamb— am A/M L Window sip W AIM L Ciosat wells A/M L _4 Apron AIM L Cl Baseboard AIM L Win casing AIM L Closet Polo AIM L Win Header 0 MII AAd L Ckml Shelf A/M L Int Stops bN AIM L Cl Supports A/M L Win Int Sash L Closet Floor L Exterior SIU M!i L G Coset Ceiling L Pan Bead L L Pi L 3. Blind stop L 21+�1 r�. p. win Ext Sash lVtWL COMMENTS: h11,s a 6, STR to g1oC 'b -M 7E7U+PJ7-5 EXCLUDED SURFACES:Surfaces listed in these boxes can be made intact only b a licensed deleader. SIDE LOCATION MEASURE:LOOSE PAINT DELEAD DELEAD SIDE LOCATION MEASURE:LOOSE PAINT DCLEAD DELEAD MORE THAN 288 SO.IN. DATE METHOD MORE THAN 288 SQ.IN. DATE METHOD r ri .L.Hemmila_ 12736 . jl/�t lv Z'3�b Page of inspectdr(print) ' _ Lic# Signature Date Address of Lead inspection 13 Pi-1 wr H Jc1E Apt# ROOM SIDE LOCATIONI LEAD TYPE OF COMMENTS DELEAD DEL.EAD SIDE LOCATION! LEAD TYPE OF COMMENTS DELEAD DELEAD SURFACE HAZARD DATE METHOD SURFACE HAZARD DATE METHOD Up wau j AAA L Window Sig W AIM L Low Wage AIM L Apron AIM L 8d30boards 6 V A401 L Wln Casing AIM L Chair ni0 AIM L Win Header MA AIM L Radiator (j AIM L Int Stop MA AIM L Floor ARM L Win Int Sash W kM L Caging AN L Exterior SW MII L Door CL 66 AIM L Part Bead MA L r i Door Cuing F AIM L Blind Stop .AM L Door Jamb AIM L Win Ext Sash W L Threshold AIM L Window Sig MA AN L Door (A/Mj L Apron A/M L Door Casirp L Win Cuing AIM L Door Jamb AIM L Win Header MA AIM L Threshald A/M I. Int Stops W AIM L Door AIM L Win Int Sash MA AN L Door Casing AN L Exterior Sig IM L Door Jamb AIM L Part Bead M11 L Threshold AIM L &od Stop Mil L Door AIM L Win Ext Sash Mn L Door Casing AIM L Closet Door J AN L Door Jamb AIM L CI Casing Q� AIM L Threshold AIM L Coset Jamb AIM L window Sig 6D MA AIM L closet walls AIM L Apron AIM L CI Baseboard AIM L Win casing L CIMI Pole C-1 AIM L Win Header W AIM L Closal Shell Q AIM L Int Stops W AIM L Cl Supports AIM L Win Int Sash W AIM L Closet Floor 0 L Exterior SIB MA L Closet CeilLI L Part Bead Mrl L B"Slop MA L win Ext Sash 00 W L COMMENTS: EXCLUDED SURFACES:Surfaces listed in these boxes can be made intact only by a licensed deleader. SIDE LOCATION MEASURE:LOOSE PAINT DELEAD DELEAD SIDE LOCATION MEASURE:LOOSE PAINT DELEAD DELEAD MORE THAN 288 SO.IN. DATE METHOD MORE THAN 288 SO.IN.1 DATE METHOD Frederic.L'Hemmila. _12736 . , �/� 1'n 17 C d Page —�- of R Inspector(print) - t.ic# Signature Date Address of Lead Inspection �- '. �'l2(A1 CC- Apt# — City � S�anU I LLS ROOM SIDE LOCATION LEAD TYPE OF COMMENTS DELEAD DELEAD SIDE LOCATION! LE°-.D TYPE OF COMMENTS DELEAD DELEAD SURFACE HAZARD DATE METHOD SURFACE HAZARD DATE METHOD Up malls AIM L Wlnd"SW 66 W A/M L Low Wags 00 AIM L ' Q Ap= 0 AIM L Baseboards AIM L Win Casing Q AN L chair rail AIM L Win Header W AIM L Radiator AIM L Int Stops W AN L Floor AIM L Win Int sash C) W AN L ceiling AIM L ExtertaSW UQ Mn L Door d AIM L Part Baad IWI L Door casing AIM L Blind Stop w L (>C Dos Jamb AIM L Win EA Sash w L Z Threshold tY AIM L Window Sig Mll km L GDoor D AN L Apron ,� L Door Casing AIM L Win Casing AN L Door Jamb AIM L Win Header W!I AIM L Z Threshold AIM L Int Stops MII AIM L Door 00 AN L Win Int Sash W AIM L Door Casing 1)v AN L Exlerlor Sig L Door Jamb AIM L Pad Bead w L Threshwld AIM L Blind Stop w L Door AN L Wk,Ext Sash w L Door Casing AIM L Closet Dos AN L Door Jamb AIM L CI Casing AIM L Threshold AIM L Closet Jamb AIM L Window sir W AIM L Closel Walb AIM L AP= Ll L9 ARM L CI Baseboard AIM L Win casing 00 AIM L Closet Pole AIM L Win Header Od AWI AIM L Closet Sher A/M L Int Stops W AIM L Cl Supports AIM L WWI Int Sash () tWi AIM L lClo3al Floor L Exterior SW L16 I W L Closet Ceiling L Part Bead W L Blind Stop Mrt L Wn EA$ash fWl L COMMENTS: EXCLUDED SURFACES:Surfaces listed in these boxes can be made intact onl b a licensed deleader. SIDE LOCATION MEASURE:LOOSE PAINT DELEAD DELEAD SIDE LOCATION MEASURE:LOOSE PAINT DELEAD DELEAD MORE THAN 288 S0.IN. GATE METHOD (MORE THAN 288 SO.IN.) DATE METHOD —Frederic-1.Hemmila--12_736 e Page �1_ of jj Inspector(print), UC# Signature bate Address of Lead Inspection �Q�VIf(,E /}��U�f Apt# - V Ci ,tJ I ROOM — `. SIDE LOCATION LEAD TYPE OF COMMENTS DELEAD DELEAD SIDE LOCATIONI LEAD DELEAD DELEAD TYPE OF COMMENTS SURFACE HAZARD DATE METHOD SURFACE HAZARD DATE METHOD Up rralb AIM L Window SW Mn AIM L tar Wsh AIM L Apron AIM L ' Baseboards p AN L win casing AArt L Chair ral AN L Win Neadu MA AIM L Radiates AIM L Int S" MA AIM L ' Fbor AIM L Win Int Sash ANI AN L 5' M, Calling / AIM L Exterior SID MA L l.. i, Ooa C L V90 AIM L Part Bead a DoorCaakrp AIM L Blind Stop Mll L d� Door Junb AIM L Win Ext Sash MA L Threshold ^. A/M L Window Sig MA AIM L Door © AAA L Ap.dl AIM L I Door camp AN L Win Casing AIM L x Door Jamb AIM L Win Header MA AIM L Threshold AIM L tint Stops MA AAN L Door AIM L Win Int sash MA AIM L Door Casing AIM L Exterior Sig MA L DwJemb AIM LPert Bead MN L TMeslwld AIM L Blind Stop Mn L !y ` '' U AIM L Win Ext Sash MA L a•::'.' w Door Casing AIM L CbsatDoor (� AIM L OoorJamb AIM L El casi ng AIM L z.: Threshwld AN L Cbaet Jamb AIM L t `l, Window Sill W AIM L CbselWalb AIM L I s Apron AIM L ('I Baseboard AIM L Win MSN AIM L ECimeptfto Pole A1A1 L f. Win Header MA AIM L Shell AIM L Ins Stops MA AIM L Clorts AIM L ;4 win Int Sash MI AN L t L _Exterior SIY MA LCeiling L Pan Bead Min L Blind Stop do MA L r [Win Ext Sash W L COMMENTS: ! EXCLUDED SURFACES:Surfaces listed in these boxes can be made intact only b a licensed deleader. sg i SIDE LOCATION MEASURE:LOOSE PAINT DELEAD DELEAD SIDE LOCATION MEASURE:LOOSE PAINT DELEAD DELEAD ,. MORE THAN 288 SO.IN. DATE METHOD GATE METH MORE THAN tea SO I !?N _Frederic I Hemmila 12736 &k W lv 2 v Page of(! Inspector(print) L1c# Sig re Date Address of Lead Inspection 134 Apt# City 5 Jql LLS KITCHEN 6kSf-h6vr Af&5 PEEP Tv 6e r-w SIDE LOCATIOW LEAD TYPE OF COMMENTS DELEAD DELEAD SIDE LOCATIOW LEAD TYPE OF COMMENTS DELEAD DELEAD SURFACE HAZARD DATE METHOD SURFACE HAZARD DATE METHOD Upwalb AIM L WbdowSYl ANI AIM L Gwab AN L Apron AN L Baseboards AIM L Win Ca*q AN L { Chaord AIM L Win Header MA AIM L RadWw AIM l Int stops w AN L ` Fbor AIM L Win Int Sash MA AN L Cerprq AIM L Exterbr SW MA L ., Dos . AIM L Part Bead bN L x� s Dow Caabp AN L aw sop Mn L t�, Door,lamb AIM L Wh Ext Sash bN L Threshold AIM L Clout Door AIM L Door AIM L G Caahg AIM L IJ DoorCasgg IUM L CbsetJemb AIM L Door Jamb AAN L Closet Welb AIM L Thwallold AIM L G B � L Door AIM L Cbset Pole AIM L DoorCulty AIM L CbwSheb AIM L DoorJamD AIM L G Support AIM L : Tin" AIM L Closet Flow L ODos, AIM L CbaetCeUinp L 000r Cae4p AN l Up Cab Frame AIM L r • DoorJamb AIM L Cab Door AIM l Threshold AIM L Up Cab Walb AN L Window Sid W AIM L Up Cab ShMQ0 AIM L AI AIM L Support AIM L Win� L Low Cab From AIM L P' Win Header Mai AM1 L Cab Door p AIM L un Saps MA AIM L Low Cab Walb AIM L Win kn Sash MA AIM L Low Cab Shiva AIM L ' Exterior SA MA L Support AIM L PartBsed MA L Drawers AIM L >. BWrd Stop 00 MA L jL IN , WIn Ed Sash MA L �J 0 Cammergx s � 3. EXCLUDED SURFACES:Surfaces listed in these boxes can be made intact o nly b a licensed deleader. SIDE DATE METHOD SIDE DATE METHOD LOCATION MEASURE:LOOSE PAINT LOCATION MEASURE:LOOSE PAINT MORE THAN 288 SO.IN. MORE THAN 288 SO.IN. ny 4�${i a age of Inspector(print), Lic# Sign (e Date Address of Lead inspection I!2 q P e t tJ66 4lVCA)d a Apt# BATHROOM SIDE LOCATION/ LEAD TYPE OF COMMENTS DELEAD DELEAD , SIDE LOCATION/ LEAD TYPE OF COMMENTS DELEAD DELEAD SURFACE HAZARD DATE METHOD SURFACE HAZARD DATE METHOD Up wane AtA AIM L Low Cab Frem AIM L Low Welb r(} AIM L G Cab Door AIM L Baseboards AIM L low Cab Walls AIM L Cluilr rail . AIM L EC ShM AIM L Radiator 0 AIM L Supports AIM L Floor L Drawers AIM L CMIN L Closet Door AIM L Door AIM L Closet Casing AIM L Door Casing AIM L Closet Jamb AIM L Door Jamb AIM L Closet Walla AIM L Threshold o AIM L Cl Baseboard AIM L Door AN L Closet Pole AIM L Door Casing AIM L Closet Shell AIM L DoorJamD AIM L CbsSuppo rta AIM L Threshold AIM L Closet Floor L Window W MA AIM L Closet Calling L Apron AIM L Win 03N AN L Win Header MA AIM L Ill Stops MA AIM L Win Int Sash MA AIM L Exterior Sig MA AIM L Part Bead MA AIM L BWd Stop Mn AIM L Win Ext Sash MA AIM L Up Cab Frame AN L Cab Door AIM L Up Cab ShW AIM L y Supports AN L , „ Comment Comments: EXCLUDED SURFACES:Surfaces listed in these boxes can be made intact only b a licensed deleader. SIDE LOCATION MEASURE:LOOSE PAINT DELEAD DELEAD SIDE LOCATION MEASURE:LOOSE PAINT DELEAD DELEAD MORE THAN 288 SO,IN. DATE METHOD MORE THAN 288 SO.IN. DATE METH Lr g. x T` . ,lot •Y�. rreaeric J. rlemmna 'iu w U Page of Inspector(print) Lic# Sign a Date Address of Leadlnspection f��t' P�f'/I/ Apt# City ►yJ�2STaNS h/LL,S "BATHROOM Q rf 0 aM g " SIDE LOCATIONI LEAD DELEAD DELEAD SIDE LOCATION! LEAD DELEAD DELEAD TYPE OF COMMENTS TYPE OF COMMENTS SURFACE HAZARD DATE METHOD SURFACE HAZARD DATE METHOD Up wage AIM L Low Cab Fram AIM L f Low Walls AIM L Cab Door AIM L Baseboards AIM L Low Cab Walls Q AIM L Chdr reY AIM L low Cab Shlvs Q AIM L Radiator AN L Support 00 AIM L Floor L Drawers 07 AIM L Cuing L Closet Door AIM L Goan AIM L Closet Casing AIM L Door Casing AIM L Closet Jamb AIM L Door Jamb p AIM L Closet walls AIM L Threshold AIM L Cl Baseboard AIM L Door AN L Closet Pole AIM L Dos Caft AIM L Closet Shell AIM L r ' DoorJamb AIM L Clos Support AIM L Thre told AN L lClosetFloor L >45 n Window Shc Mll AIM L Closet cap ing L (� Apron AIM L Win casing AIM L { Win Header W AIM L IM Stops Mn AIM L Ind Sash Mn AIM L Exterior SW 100W AIM L ,. Part Bead MI AIM L Bond$top W AIM L 't Win Ext Sash MII AIM L Up Cab Frame AIM L Cab Door AIM L Up Cab Shlvs AIM L Supports AIM L Comments' Comment: EXCLUDED SURFACES:Surfaces listed in these boxes can be made intact only b a licensed deleader. SIDE LOCATION MEASURE:LOOSE PAINT DELEAD DELEAD SIDE LOCATION MEASURE:LOOSE PAINT DELEAD DELEAD MORE THAN 288 S0.IN. DATE METHOD MORE THAN 288 S0.IN. DATE METHOD ,.;: Fr erfc j..Hemmila.--, 2 3 d v Page of Inspector(firint) . ° Lic# knature Date Address of Lead Inspection I3 T Pp-110ck7- i VC , Apt# Clty RA)�JP A)3 HALLWAY SIDE LOCATIOW LEAD TYPE OF COMMENTS DELEAD DELEAD SIDE LOCATIOW LEAD TYPE OF COMMENTS DREAD DELEAD SURFACE HAZARD DATE IMETHOD SURFACE HAZARD DATE METHOD Upwah AIM L wuxiowSw W AIM L Low Welb 00 Any L AIM AN L Baseboards p AIM L win Casing AIM L Chair ral AIM L win Header W AIM L Radiator AN L Int Stops MA AIM L Floor Q AIM L I Win Inl Sash W AIM L Casing D D AIM L Exterior$ld MA L Dtot A!M L Part Bead MA L Door Casing AIM L Blind Stop MII L Door Job 0 AIM L Win Ext Sash W L Th,re,h,old AN t L Closet Door h6 AIM L Door AIM L J CI Cuing © AIM L Door Casing AIM L Closet Jamb 011 1 AIM L Doorjamb AN L Closet Webs LA AN L Threshold AIM L CI Baseboard 00 AIM L Door AIM L Closet Polo AIM L Door Cubg AIM L Closet She# AIM L a Door Jamb AIM L , Cl Sappods AIM L Threshold AIM L Closet Floor L Door AN L CI Cs!ri g L Door Casing AIM L Closet Door AIM L Door Jamb AIM L Cicasig AIM L Threshold AN L Closet Jamb AN L Door AN L Closet Wald AIM L Door Cuig AIM L CI Baseboard AIM L ' Door Jamb AN L CkaelPole AIM L ¢ Threshold AIM L Closet She# ' AIM L Window SA AIM L CI Suppob AIM L I ' ` , Apron AIM L Ckoel Floor L Win Casing AIM L CI Cei ing L 3 Win Header W AIM L Jf7 ADDr?-G(_ Int Stops Mil AIM 'L Win lot Sash W AIM L Exterior SA w L Part Bead W L Blind Stop MA L Win Eri Sash Mil L }' EXCLUDED SURFACES:Surfaces listed in these boxes can be made intact only b a licensed deleader. y: SIDE LOCATION MEASURE:LOOSE PAINT DELEAD DREAD SIDE' LOCATION MEASURE:LOOSE PAINT DELEAD DREAD MORE THAN 288 SQ.IN. DATE METHOD MORE THAN 288 SQ.IN. DATE METHOD rrederlc]. Hemmila 1273699 e I p . Page �'' of Inspector(print) Lic# ignature Date Yl Address of Lead Ins '3 2//i/ l/t�Ut Apt# �" City N��AJ5 ' _ P A- EXTERIOR SIDE LOCATION/ LEAD TYPE OF COMMENTS DELEAD DELEAD SIDE LOCATION LEAD TYPE OF COMMENTS DELEAD DELEAD A SURFACE HAZARD DATE METHOD A SURFACE HAZARD DATE METHOD S&q L WW.W so AIM L Caner Boards L A Win Ceslrq AN L A Lower Trim — L Window Sash AIM L H Upper Trim, window Sul AIM L * Vt., Win above 5' L a A Win cam AIM L t Poft above S L Window sash AIM L -*tiff` LIP slam Door AN L Cadar Win Sid AIM L w,r Door AIM L A Cat win Sash AIM L A Door casbg AIM L :, Cal Wln Frame AN L Door Jamb AIM L CailarWlnSIR AIM L Z Threahold AN L A Cal win Sash AIM L ANA L Cal Win Frans AIM L e*yk. Sform Dos AIM L cedar Win sm AIM L Dos AIM L A Cel win Sash AIM L A Dow Caq AIM L Cel Win Frame AIM L DoorAft AIM L C darWln81 AIM L ThreftW AN L A Cel Win Sash AIM L +. ` Iplai>s AIM L. Cal Win Frame I AIM L Door AN L A Foundation L A Door casaq AIM L A ulldvad -- AIM L Dow AN L A Fences AIM L Threshold AIM L Shutters AN L Door AIM L Newel post AN L A Dw caslrq AIM L Rdd%Cap AIM L �.. OoorJamb AIM L HandreB AN L TWt*ld AN L A Balusters AN l Window Sll AN L lower Ral AIM L f ' A Win Casbq AIM L Treads AIM L WWM Sash AIM L Risers AIM L I Wind"SAY. I q AIM L Spear Any L A win Caalrq AIM L wmm Sash AIM L ` COMMENTS: EXCLUDED SURFACES:Surfaces listed in these boxes can be made intact only b a licensed deleader. -~ SIDE MEASURE:LOOSE PAINT DELEAD DELEAD LOCATION SIDE LOCATION MEASURE:LOOSE PAINT DELEAD DELEAD ,. n A E THAN 1440 SO,IN: DATE METHOD A DATE METHOD RE THAN 1440 SO.IN. A A A A Frederic 1 Hemmila 12736 D 2 3 Page .�' of Inspector(paint} -- `! Uc# Si tore Cate Address of lead Inspection Apt# City EXTERIOR SIDE LOCATION/ LEAD TYPE OF COMMENTS DELEAD DELEAD SIDE LOCATION/ LEAD TYPE OF COMMENTS DELEAD DELEAD B SURFACE HAZARD DATE METHOD B SURFACE RO DATE METHOD Siding 013 L Window Sw A/M L Comer Boards 00 L B Win Casing .Z, AIM L B Lower um L Window sash AIM L Upper Trim Window SB A/M L Win above S B Win casing A/M L Parch above 5 Window Sash AIM L Storm Door j AIM L Calla Win Sitl AIM L Door /VM L B Cal Wln Sash AN L B Door Casing AIM L' Cell Win From AN L Door Jamb AN L Cellar Win SIN AIM L Threshold AIM L B cel Win Sash AIM L IOdcpiats AN L Cal Win Frame AIM L Storm Door AN L %eAar Win SIU AIM L Door AIM L B Cel Wln Sash A/M L B Door Casing AIM L Cel Wfn Frartre AIM L Door Jamb AIM L Cellar Win Sill A/M L Threshold AIM L B CN Win sash AN L Aim L Cel Win Frame AIM L Door AIM L Foundation L B Door Casing AIM L BWN%w --j AIM L Door Jamb AIM L Fencea AIM L Threshold AIM L B Shutters AIM L Door AIM L Newel post A/M L 8 Door Casirg AIM L Railing Cap AIM L Door Jamb AN L Handrail A/M L Threshold MM L 8 Balusters AIM L Window Sip 'Alm) L I Lower Rai AIM L CasingIft Am Treads AIM L Window Sash 65 AIM L I Risers A/M L Wind"IN . L Stringer AIM L 8 Win Casing AIM 77 RWN Sash AIM L COMMENTS: EXCLUDED SURFACES:Surfaces listed in these boxes can be made Intact only b a licensed deleader. SIDE LOCATION MEASURE:LOOSE PAINT DELEAD DELEAD SIDE LOCATION 'MEASURE:LOOSE PAINT DELEAD DELEAD B (MORE THAN 1440 SO.IN. DATE METHOD B MORE THAN 1440$O.IN.) DATE METHOD B B B B Frederic. Hemmila' 127364aA�%14wl.� -_ /1)/2-V6 6 Page of Inspector(pnn) Uc# ginature Da e Address of Lead Inspection /3 PK(A1C,9_ Apt# City l WJ_08 IfU, EXTERIOR SIDE LOCATION/ LEAD TYPE OF COMMENTS DELEAD DELEAD SIDE LOCATION/ LEAD TYPE OF COMMENTS DELEAD DELEAD C SURFACE HAZARD DATE METHOD C SURFACE HAZARD DATE METHOD SIdkV L Window Sig - AIM L Comer Boards L C win Casng AIM L C Lower u n L Window Sash I or AIM L UpperTdm L Window Sig AIM L Win above 5 C Win Casing AJM L Pomh above L Window Sash AIM L #. ��- Storrs Door AIM L Cellar win Sitl AIM L Door AIM L C Cal Win Sash AIM L C Door Casing AIM L Ce+Win Fmm Aim L Door Jamb AN L Cellar Win SUI AIM L Tlvwhold AIM L C CM win sash AIM L Kb*te AIM L Cal Win Frame AIM L Storm Door `-- AIM L Cellar Win Sill AIM L `+ Door hfr I AIM L C Cel Win Sash AIM L C Door Caslnp V AIM L Cel Win Frame AIM L Door Jamb AIM L Cellar Win Sip AIM L Threshold Co V AIM L C Cal win Sash AIM L V AN L Cal Win Frame AIM L Door AIM L C Foundatlon Li C DoorCasbrg AIM L C Bulkhead � AIM L Door Jamb AIM L C Fences AIM L Threshdd AN L ShuGers a AN L Door AN L Newel post AIM L C. Door Cesinp AIM L Raging Cap AIM L Door Jamb AIM L Handrail AIM L Threshold AIM L C Bahaters AIM L window sip AIM L Lower Rap AIM L C WlnCastp AIM. L Treads AIM L Window Sash AIM L Risers AIM L Window Spl AIM L Stinger AIM L C Wln Casing AIM L Window Sash AIM L COMMENTS: EXCLUDED SURFACES:Surfaces fisted in these boxes can be made intact on b a licensed deleader. SIDE LOCATION MEASURE:LOOSE PAINT DELEAD DELEAD SIDE :LOCATION MEASURE:LOOSE PAINT DELEAD DELEAD C E THAN 1440 SOAlf .IN. DATE METHOD C MORE THAN 1440$O.IN. DATE METHOD C C C C J`�f•Mil:�'. - 3�.A. , I W.10? r ci ir' , / A .11 MUM fig, JLO WA L=I/���� ur✓�����■� ' ���■�■■i�s� Puri®���■ uar ���a�� u9DIOJLWOPI■ �== mm 2 NO OVA r r • r r :r: 1 1 m® u �� u�s��� � ® ftedericj. Hemmila 12/30 /* 23�� Page of(7 Inspector(print) lic I Signature Date Address of lead Inspection A'i fA 0J E Apt$ city hAt}RS7DuS h I CC S SIDE LOCATION/ LEAD TYPE OF COMMENTS DELEAD DELEAD SIDE LOCATION/ LEAD TYPE OF COMMENTS DELEAD DELEAD A SURFACE HAZARD DATE METHOD C SURFACE HAZARDDATE METHOD A Swq L C Sidap o L Comer Boards L Comer Bollft Gj L LoweTran L C LowerTtlm L Upper Trim L Upper Trim L Door AN L Door AN L A Door Caelrp AIM L C Dow Crisp AIM L Door Jamb AN L Door Jamb AN L Thmmdhold AIM L Threshold AIM L Wndow Se AN L Wndow 811 AN L A win Caslnp AN L C wb C&*V AIM L Win AIM L Win Sash AIM L FaundWim_ AN L F ZOon AIM L Cammefft Camrents: Excluded Sudaoes.Swbm AsW In fhb box can be made Intact ont by a kensW deleader. Excluded Surfaces:Surfaces Ibted In this box can be made Mead only a I mmW deleWer. FA LOCATION MEASURE:LOOSE PAINT DELEAD DELEAD SIDE LOCATION MEASURE:LOOSE PAINT DELEAD DELEAD E THAN 1440 SO.IN. DATE METHOD C ORE THAN 1440 SO.IN. DATE METHOD C C SIDE LOCATION! LEAD TYPE OF COMMENTS DELEAD DELEAD SIDE LOCATIOW LEAD TYPE OF COMMENTS DELEAD DELEAD 8 SURFACE HAZARD DATE METHOD D SURFACE HAZARD DATE METHOD 8 Sldlrp L D soap AAL Comer Boards D L Caner Boards L 8 Lam Trim L D jLowerTlh L Upper Trim L Uper Trim L Door AIM L Door AIM L B Dos Cssag AIM L D Door Casing AIM L Dos Jamb AN L Door Jamb AIM L ThmhaW AVM L Threshold AIM L Wndow so AIM L Window Sip AIM L B W1n C=N AN L D wIn Casing AIM L Win Sash AIM L win Sash AIM L Foundation AVM L Foundation ✓ AIM L ca awft carwrrents: AW p o A- 0•u -Excluded Surfam Surfaces listed In Ihb box can be made Intact ont by a Bcensed deleader. Excluded Surfaces:Surfaces 4Sted In this box can be made Intact onivy a kensed deleader. SIDE LOCATION MEASURE:LOOSE PAINT. DELEAD DELEAD SIDE LOCATION MEASURE:LOOSE PAINT PELEAD DELEAD 6 THAN 1440 So.IN. DATE METHOD O MORE THAN 1440$o.IN. DATE METHOD s B p ` r enc emml a v Page of inspector " Q Lic# Spaturf Me Address of Lead Inspection Apt# City h/15 GARAGE SLOE I LOCATION! LEAD TYPE OF COMMENTS OELEAD DELEAD SIDE LOCATION LEAD TYPE OF COMMENTS DELEAD DELEAD A SURFACE HAZARD, DATE METHOD C SURFACE HAZARD DATE METHOD A Sidfnq L Siding L Conner Boards L Comer Boards — L LowerTrlm L LowerTdm L Ups TAm PC I Upper Trh Door AIM L Door AIM L A Door cukv L C Door Casing AAA L DoorJamb L Door Jamb AN L Threshold AN TMeshold AIM L window sm AN L Window Sin AIM L A Win Casing AIM L C Win using AN L win Sash AIM L Win Sash . AIM L Foundation AIM L AIM L ComnwdL cwmwb: Excluded SAM'Surfaces listed In this box can be made intact ont by a licensed deleader. Excluded Surfacm:Surfaces toted In this box can be made hNacl onlNv a tioensed debeder. SIOE LOCATION MEASURE:LOOSE PAINT DELEAD I DELEAD SIDE LOCATION MEASURE:LOOSE PAINT DREAD DELEAD A RE THAN 1440 SO.IN. DATE METHOD C ORE THAN 1440$O.IN. DATE METHOD A A C A C SIDE LOCATION LEAD TYPE OF COMMENTS DELEADI DELEAD SIDE LOCATION LEAD TYPE OF COMMENTS DREAD DELEAD B SURFACE HAZARD DATE METHOD D SURFACE HAZARD DATE METHOD B Siding L D Siding L caner Bolvda L Comer Boards L B Lower Trim — L D LowerTdm L UpperTdm L UporTdm L Door AIM L Door AIM L B Door Casing AIM L D Door casing AIM L DoorJamb AIM L Door Jamb AIM L Threshold AIM L Threshold AIM L Window Stil Iky AIM L Windowsill AIM L Win Castrg AIM L D Win Casing 0,iK,I AIM L ash `L Win S AIM L win Sash AIM L Foundation AIM L Foundation AIM L Ca 0wa is; Excluded Sudaoes:Sudaaes listed in M box can be made Intact ent by a licensed deleader. Excluded Surfaces:Surfaces listed In this box can be made Intact only a licensed deleader. SIDE LOCATION MEASURE:LOOSE PAINT DELEAD DELEAD SIDE LOCATION MEASURE:LOOSE PAINT DREAD DELEAD B THAN 1440 SO.IN. DATE METHOD D MORE THAN 1440 SO.IN.) DATE METHOD B B p B p ASSESSORS MAP: # 74, TEST O E T HOLE E LOGS NOTES: PARCEL: C��' _ _ _ FLOOD ZONE: ,�/ /jl�i�l1C C SO I L EVALUATOR: 5 Mk%J WITNESS: WM_ `►q' 1) The installation shall comply with Title V and Town of Barnstable Board of REFERENCE: �71�'E� c�3 '"�` /9Z$2 �''�// Health Regulations. tom •__. _ _ DATE: b gu Q sY 2 The installer shall verifythe location of utilities sewer inverts and septic � Zg / '�-/ ` �3� -�/Z���� �77_ PERCOLATION l ON RAT � Z t�l ( � ) components prior to installation and setting base elevations. p 3) All gravity septic piping to be 4 inch Sch 40 PVC at 1/8 per foot. The first TH- 1 TH-2 two feet out of the dbox to the leaching shall be level. '� A IDYM1 to 4) This plan is not to be utilized for property line determination nor any other Ay Purpose other than the proposed system installation. - Q 5) All septic components must meet Title V specifications. l2► Ib gj '�1 1+11 nit 6) Parking shall not be constructed over H 10 septic components. 7) The property is bounded by property comers and property lines. LOCATION MAP�� i:5) S 8) The propertyowner shall review design considerations to approve of total g PP design flow and number of bedrooms to be considered for design. Receipt of payment for the plan and installation based on the plan shall be deemed approval of the design flow by the owner. 9 The existing leaching r) g ac g o cesspools shall be pumped and filled with material per Title V abandonment procedures. Those within the proposed SAS shall be - `- !� V removed along with contaminated soil and replaced with clean washed sand .__X i v two. � l ly�� No _ per Title V specs. . �- ---- 10)System components to be 10 feet from water line. Sewer lines crossing the (c� O water line shall be sleeved with 4 inch SCH 40 PVC with ends grouted if 00"Rc��_A$4S E P T I C SYSTEM DESIGN applicable. 0 11) If a garbage grinder exists it is to be removed and is the responsibility of the FLOW ESTIMATE owner to ensure such. 12)The installer is to take caution in excavation around the gas line if applicable. BEDROOMS AT IiD GAL/DAY/BEDROOM 410 GAL/DAY — SEPTIC TANK — GAL/DAY x 2 DAYS - GAL USE15DO GALLON SEPTIC TANK _.ABSORPTION SYSTEM • 22 SIDE AREA: Zx 3t,.q -- tZX5 X2 , D,_71 % 14H BOTTOM AREA: r� SEPTIC SYSTEM SECT ION ,r,5, Him y ' butN M1c1t. p Q�. MnJ, 1( n 164 r, ott fM,t�L F►aaa tL 3�M►4X. - `,� L 1 GAL 1 o o th SEPTIC TANK 2I,�U Z 14 ' _ fix;__ �� �- \�� =- \ • to - SrorE�,G \11 + b U i I o�� DAVbMASON �� 9NOAM SITE AND SEWAGE PLAN '� o z ��►rrAa\a LOCATION : 13�I �1 t �l( i P�yfi Wj i t.L '� (0 2 PREPARED FOR :440M CXLC Amo w .. y CALE DAV I D B . MASON* DATE: (o 2,106 s DBC ENVIRONMENTAL DESIGNS W EAST SANDWICH . MA DATE HEALTHI AGENT ( 508) 833-2177