Loading...
HomeMy WebLinkAbout1379 MARY DUNN ROAD - Health f 1379 Mary Dunn Road, Barnstable A=334 - 002.001 t t THE FOLLOWING ' IS./ARE THE BEST IMAGES FROM ' POOR QUALITY ORIGINAL (S) I m CE DATA TOWN OF BARNSTAB E , LOCATION_i �_ /+� / �!?'/ e0ae ,, -L(— . f Y �I /�L ' SEWAGE # V) VILLAGE_ C(.t�hiJI`IC�LY/� ASSESSOR'S MAP*LOT 3y-O02-c.l:�j INSTALLER'S NAME&PHONE NO.IN SEPTIC TANK CAPACITY S—�© LE LEACHING FACILITY: (type) $r.=!�1"/�f/ct70/S (size) IQ,r--W r Z— ,NO.OF BEDROOMS NC, i BUILDER OR OWNER Sill z B 'PERMITDATE: �/z• —V COMPLIANCE DATE: - -.. PE------• Separation Distance Between the: Sel Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet M2 Private Water Supply Well Leaching Facility (If any wells exist Pr'_� .on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist Ed within 300 feet of leaching facility) Feet Furnished_by A Az- 7 TOWN OF BARNSTAj E LOCATION SEWAGE # VILLAGE Jva�f�/�� ASSESSOR'S MAP & LOT 331-/-®OZ•aj INSTALLER'S NAME&PHONE NO. �d/'�G�� J GOJ7v�J• 77/--�.j�� SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) (size) NO.OF BEDROOMS y BUILDER OR OWNER z. - �9 PERMTTDATE: COMPLIANCE DATE: j Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by ear ; 3, 4ct 1 i3�J � 3 No. �41 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: M re, PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 3pprication for Migpogar *pgtem Congtruction Permit Application for a Permit to Construct( )Repair Upgrade( )Abandon( ) [JComplete System O Individual Components Location Address or Lot No. Owner's Name `ddsress and Tell..No. Assessor's Map/Parcel C Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 160f � Type of Building: ,,// Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder(/l�� Other Type of Building No. of Persons Showers( ) Cafeteria( ) - ' Other Fixtures //1 Design Flow ��� s gallons per day. Calculated daily flow `?'7 4&1 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. /A'-1X V"a /5 Description of Soil ����! Nature of Repairs or Alterations(Answer when applicable) 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 issued b his o of alth. --- / Signed Date Application Approved by Date 4— Application Disapproved for the following reasons Permit No. F2f Date Issued ` A 3 3. —. Fee r� �N THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: re, PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLES MASSACHUSETTS Application for Di6poml *pgtem Cow5tructtou Permit Application for a Permit to Construct( )Repair(/Upgrade( )Abandon( ) IM Complete System El Individual Components Location Address or Lot No. /7 >� // j /, Owner's Name Address and Tel.No. Assessor's Map/Parcel 7�( v� r a Zoll Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. ADS I`�`UI�i,CD�Isf t Type of Building: f Dwelling No.o` o Bedrooms a Lot Size sq.ft. Garbage Grinder(/41 Other Type of Building e5/ t�/1l. e No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow ZZ1( gallons per day. Calculated daily flow `7 7 gallons. Plan Date Number of sheets Revision Date —Title Size of Septic Tank Type of S.A.S. _ Description of Soil .A Q Nature of Repairs or Alterations(Answer when applicable) A A r Date last inspected: f • s,., , Agreement: f 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 issued b. his o of alth! Signed Date - ..ram• � A lication A roved b = Date "' PP PP Y Application Disapproved for the following reasons r ' Permit No. Date Issued Irl :�F' q t ——— THE COMMONWEALTH OF MASSACHUSETTS 33'Y 2!- BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CE IFY, that t On- ite Sewage Disposal System Constructed( )Repaired( ✓ Upgraded( ) Abandoned( )by 6 " l7ze l at 13757 'IC!° has been constructed in accordance with the provisions of Title 5 d the for Disposal System Construction Permit No'No'9 Y dated 'P .' . Installer Designer The issuance of thi e �'t ha not be construed as a guarantee that the s s[em`will function as des ' Date � `� Inspector � � // a ' --------------------=--- ---- _ No. ' °' �° t ! �B Z•�� Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Of 6pogal *pgtem Construction Permit Permission is hereby granted to Cons ct( )Rep it( /Upgrad ( )Abandon( ) System located at /. `� �W4 ` Pt/W J/1 ; 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: Construction must be completed within three years of the date of this it. Date: r % Approved I 1/6199 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS) I, R0�/�7`LJ �0/���1 /'hereby certify th/at the application for disposal wo rks construction permit signed by me dated �L>! concerning the /� ® property located at j � �!�/ dCli7�I '/0 e�i w Ulmeets all of the following criteria: }/ The failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. V The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. t/ There are no wetlands within 100 feet of the proposed septic system There are no private wells within 150 feet of the proposed septic system Y There is no increase in flow and/or change in use proposed r 11 There are no variances requested or needed Y The bottom of the proposed leaching facility will not be located less than five feet above the ma..dmum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor method when applicable] lif the S.A.S. will be located with 250 feet of any vegetated wetlands, the bottom of the proposed :. leaching facility will not be located less than fourteen(14)feet above the ma.,dmum adjusted groundwater table elevation, Please complete the following: A) Top of Ground Surface Elevation(using GIS information) 73 , Z, B) G.W.ElevationD+the MAX High G.W. Adjustment �7• DIFFERENCE BETWEEN A and B SIGNED : DATE: [Sketch proposed plan of system on back]. q:health folder:cert ar Pa sue` a� 6AJ�M✓ti,�• 7 G� TOWN OF BARNSTAB E LOCATION 7 / l?'/ OL1/�r1 /p SEWAGE # y�L� VILLAGE_ea Ofi�JCZC�I.tj. ,J //ASSESSOR'S MAP & LOT 3L/—ODZ.cbj INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size)NO.OF BEDROOMS BUILDER OR OWNER s©Cl Z PERMTTDATE: �7Z — COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet a. Private Water Supply Well and Leachin Facili ty ty (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by r. BARNSTABLE COUNTY a DEPARTMENT OF HEALTH AND THE ENVIRONMENT C� SUPERIOR COURT HOUSE V M POST OFFICE BOX 427 1 ' BARNSTABLE, MASSACHUSETTS 02630 n Phone:(508)362-2511 Ext. 330 A 5 S Public Health Administration 333 Environmental Health 383 Water Quality Analysis 337 Fax(508)362-4136 TDD(508)362-5885 r E ITT!( i T•^T' i LETTER C� _��I'T-'L�___ CONTROL _L Date 0= SSL1p . 9�gL96. ece_'Li—J.c -0 DaCe late of _xpi 1on . 9/9Z97 ---__ Ex-z1~-at_on Date In—v id _L 1 2 -,?ea=S -om aate. ssue). Dear Edward Souza, Ce= _- T _a� _ per=orne� a ='sK aSSessme_^__j ` SK assessment� -e n=pect_cn (C_-Cie One) of your ^vrocer y, i ocateC _t +'I3799 Mary Dunn lif,e�n- a a - ne nt no . anc re CCr LT. .Gs _ _ _-- C1�y or Town o_�Barnstabley COm� _cnce N'_ Con:o i O' 9/5/96 Cn at date se ect one) =here were f_0 u__en= i mac naz=_a.s nose ur en _ear hazar -s Ce^_ in _s c assCJJiiient _etc-t of b. 43/96 - - - --- - ) we-e =0u__u to have been CorreC-�_e^. _OunG the _^v OCcr '/ meets t:e :eCltlre Tien=S. =0= _nCer1M con-'- ra"d �! .; er MaSSacn usezts`C.I ^G} -aws , Chaz)cer ��� , Sect_Cn LC I a C 1. 05 C MR Cc'v . OQ0 . Reyu at1GP_S Lo- Lee- Po_Scni.S Prey en ,G n c . T..__-_ n a_.0 C P_�- Tn-S Letter o_ _nteYi ;Ti" C0nt-0i may be renewer once, =0- a__ aCC-t10P_ai one-year Ue-1GC , u_CP_ -e1nS:JeCt_On and -�Certl=�Cat1cP_ Wit/ a iicensec r1sk assessc- 3y the end oz this crici-ai 0P_e-ve-_ ceriod or, __ LP_-ls Le-ter -J -eCe� 1-_e'� �^�T =na end, of the second ear,, Mac:- 1setr law recr_1res you t0 obta_n a Letter C: F u 1 � Ccm-011ance for -h-_s crcber- �. T^' S DrODer�'_/ . rule;ram- commC'' areas SnG_i remain 1n Ccm 1'_aP_Ce wit the reculremen-s =or inter-. Cont_oi on!y as �on(= as there COP.tinues to be no ur�ae7t lead naza.ras , and as lcnc as f CJV i rql`, i ncludina encazsulants ,' iOrm nc ate_ eL L Ct v r bar over lead paint or other !eadea materials remain in place . See t_^_e reverse Side O_ this letter.- for the locatiOn (s) of surfaces which were covered Or e1CapSu_ =to d. Complete riStC aSSeSSSent relnScect_Or_ retort _S attaC_ned to th_s , 1 ette= O the -eSt 0= mV :{nOW_e O V ^Ge, the COSt _ -__ aha"e tent and conta_nment work oer -a=ored for~ir_cer cont_cl tha= %vou;d also- ''e s ret-red for -full coml7llance is $1 13(5[) (t d Should you fail to cam-clete any repair or restoration work necessary to m__ntain the requirements or this Letter of lr:teri�:: Control Wittli n 14 days 'Of toeing notified ed i P_ writing by an Occupant , and a licensed code enforcement risk assessor or risk assessor authorized t0 work as an acent c_ ae L State _ _OCrai1 finds the Dremises Ld11 t0 meet t.=ese requirements , VOU Sna'1 havva '3C. days t0 fi L 1 p. D` n 1 C �. er pr1 . bri nQ the Oremi SaS into CORD;_anc` +li_ t Le-ter_ 0= n. C _ :t Control a. t•-_'' having recei"ie^_ a_1 order to• ;restore Interim Cont.-o Measures, Or such greater time as allowed 1n' eXCeCt_or_al cases by ` ti-e Director, Or, in their own reSveCt1 ve C= ^S,, the IOCGI' Code enforcement agency Or board o healzh, or by ]u'G'_,c=al Order Sincerely, Jane Crowley Q2829/ C2829 Risk Assessor D,' !_Cense -Nu L-er RE'CERT 1 F_C]T 1 ON S T 3 T_vT E�'_ i Derfo=ed c e j a i O'.1 rei_''_S ect' ^r_ at th_S _pro7perty on. G?i .hat da, ( ?Ct on_, . =Here were no ur Jant 1 e-a _":azards those urgent leaf hazarC.S cite.^_ in _;sk assessmen _=c_ Cr_ CZ CiLeC aDOVe, Cr h e initial r.ecerri _Ca"1On reinscect..on r=pgrt on this prc^erty o= were =ou-a to have cee- corrected found the prCDerty meets the =eCuirement fOi interi fit control under Massachusetts General maws, Chapter 11i , Section 197 and 105 =I R 460 . 000 : Regulations for Lead Poisoning Prevention and Control . Thus ! =eCeiflay this Letter Of interim Cor_tr01 , and all its prOVisiorls apply, for the _eCe'_tifie^ tame1 periCd l have filled 1 at the .top of . the. first pace Of this Letter Of l;ltei'im Control, • Re er�' viP Ri Sk ASSeS SO . License- • DP-- --cnsa Numce RIS:Z ASSESSMENT' 31Ys7 IER23d CONTROL E2STOR`_' Mamie ��c , ._S i - C'_S i �iSSessor who Der-or-meO Z=SFC Assessment- SAME lame Cc L_C en.se NC . C= _c�aC i nS:ec�Cr N_^_O `e_-=C=i:e'd 0- ---_- nspec-iior_ (i_ d__reren- ) Date o- ReoccuCa=,/ Na7.e & License No . o- Risk Assessor Who Reins-oec 'on (_- a L}�iCa le) =='-"i0= eC *teOCCu^.GnCV Re ns-ecti o 9/5/96 Jane Crowley 02829/C2829 Date 0= Risk Assessment- Na?'ie !iCenSe_No. 0= R=S;{ Assessor 'N_^_C Re_nsoec ion Per=ome.^. R=SFC Assess-men= Re=nszeCt_C' Name (s) a^d LI' cease vumi er (-) c= Dept . o_ La-or and __dust_ies Autnorized ' nc C a n t=a c z Niino' =e'_'Loiu!ed A'ba=emert n c Contain-ent : �TaRe (S aild nGw=eSS (eS) O- U'_l 1 CenSeQ Property Owner ar Age_'it (s) o Per-orned Low-Risk Abatei:ten_ and/or Con ta_nment , or OCPer 4vCr'.t, SL'c_"i as Structural Repairs Cr Lead. Dust Cie?=i'na Edward Souza, 45 Barnhill Rd_ Barnstable MA . 02668 R= _S t�r_7EE T,Z]-D, D A_N= OR CT'=R T.Z.-I F� MST_ _A.L. � S S= COVER7D, IN TEE RIOR P,00M 1 Side Cu==cce x re. e C- C0 i RE-V ENT EXTERIOR Side a SurraCe/':XturAeCe Type of COV�R�`I -� =!J e i,��- C.cJ-L fT i..J)/IdQU,s t w �u BA BARNSTABLE COUNTY ems' DEPARTMENT OF HEALTH AND THE ENVIRONMENT SUPERIOR COURT HOUSE POST OFFICE BOX 427 O � �'! BARNSTABLE. MASSACNUSETTS 02630 Phone: (508)362-2511 Ext- 320 Public HeatthAdministration 333 • Environmental Health � �I water Qual'tty Analysis FAX (508)362-4186 TOO(508)362-5885 DATE: June 3, 19 6 ORDER TO CORRECT VIOLATIONS S' co 1996 45 Barnhill Rd. 9 2668 - Barnstable. MA 0 .. Rd. Barnstable MA Owner or agent of the property located at 1379 Mar Dunn went of the Director of the Childhood Lead Poisoning Prevention Program Be advised that an a� roe to be in violation of the has determined certain portions of the aforementioned residential property rty • � assachusetts General Laws (�IGL), Chapter 111, Section 197; the Regulations for following- - i isonina Prevention and Control, 10� Code of Malin viola on are detailed inegulations C the Lead Po Code. The specific areas 460.000; and the State Sanitary accompanying "Lead�pe�on/Surface Assessment Report:" , Conditions exist to this residence which'may endanger and/or materially impair the health of the occupants of these premises. DECLARATION OF Elvf1:RGENCY - Lead Poisoning Prevention Program declares that the presence revention The Director of the Childhood Le Regulations for Lead poisoning 1 Section 198 the aforementioned violation of the Lead Law to the Le d Law, NIGL Chapter and Control constitutes an emergency p thin the meaning of the Sanitary Code, Chapter I, 105 CMR 400.200 (B). and vin CORRECTION OF LEAD VIOLATION S . 189A-199B and the Department of Public Health's Regulations, The-Lead Law„MGL c-`111, ss yig 460.00 require that residential premises or for Lead Poisoning Prevention and Control, 105 C: 1111 for dwelling units bu ilt before 1978 have lead paint violations either abated n six li�sed the f proceed directly to deleading for full compliance compliance or brought under interim control when a child under the age premises or dwelling unit. You may ou enclosed inspection report. If you are interested in interim ca atr omt fete`Lead� by using the P hire a licensed private risk assessor to perform a risk assessment and is P Inspection/Risk Assessment Report" before you proceed. of Labor and Industries' Deleading regulations, 454 CMR 22 00, The Lead Law, the Department hi risk as the Regulations for Lead Poisoning Prevention and Control require that any er as wellloose paint, Plaster or residential lead abatement and containment activities, -whm�in the context of acluevuig putty intact, be performed by licensed _ interim control or full compliance. An owner or owned agelow-risk after amee ,and containment certain requirements of 105 CMR 460.175, may perform licence—again, whether in the activities in accordance with these regulations fiance a��e specificr low-low-risk and interim control or full cames as carpet, context of achieving Q• applying encapsulates; applying such covering _ containment activities are following: PP ymg hic, to surfaces, including siding of exterior vinyl, aluminum, plywood,cabinet do and acry in baseboards. In addition, an surfaces; removing doors, cabinet doors and shutters;and capping 460.020, and owner or owner's agent may Perform structural repay, as defined in 105 Cl� cleaningof leaded dust, as may be required for interim controls, except that by a licenalclean-up leader nsk abatement and containment work by required after the completion of high- • must be performed by licensed deleader. ORDER 460.000 as are hereby ordered to remedy all violations of MGL e to 11, 19-7 and control, You must You °r, if you wishpursue identified in the enclosed inspection report,o with the following schedule. correct the relevant violations in accordance receipt of this Order, you must provide to this agency a Within sixty (60) days Of y hi nsk abatement and copy of a signed contract with a licensed deleader, if laster intact, is required. If containment work, including making leaded paint, putty P our or your agent is doing owner/agent low-risk abatement and containment and/or y work, you must also provide with sixty (60) days s signed and completed interim control k, y f Training to Perform Owner/Agent Low-Risk CLPPP form entitled, "Documentation oes b Which Owner/agent Low-Risk Work and/or - abatement and Containment and Deadlines the contract must specify, and if you or Interim Control Work a Will Be Comp your agent will be performing low-risk abatement e containment work described above, that control work, then you or your agent will attest in,th he following schedule: the work will be completed according t nit and interior common areas (a)'., Violations o u as f the interior of the dwelling compliance, or required for interim must be abated or contained for full comp ' control, within ninety (90) days of your receipt of this Order. However, ' red and twenty (120) days from receiving the you have a total of one hund activities. Order to complete the following 3` • ou or your CI) any low-risk abatement and containment work dust-generating abatement or agent perform, as long as all containment work, including surfacehas been completed, red and to be done by a licensed deleade y any doors removed have been replaced, within ninety (90) days of your receipt of this Order. Cu) application of encapsulates by licensed Level II deleaders, as long as all dust-generating abatement or containment work, including surface preparation, required to be done by a licensed deleader, has been completed within ninety (9)) days of your receipt this Order; ('iii) installation of replacement windows, as long as you can demonstrate that new windows have been ordered within nine (90) days of your receipt this Order (b) Violations on the exterior of the residential premises and exterior common areas must be abated and/or contained for full compliance or days require gourd for interim controls, within one hundred and twenty ( 1. ) Y receipt of this Order. - that the unit will meet Any contract with a deleading contractor must also specify done by the licensed acceptable lead dust levels, as determined by the results of sampling inspector, in full compliance cases, or the licensed private risk code enforcement lead p if one is assessor, in interim control cases, at the time of the reoccupancy reins e�o�the contractor Should any of the dust samples fail to meet acceptable standards, necessary. ,fit until all dust samples meet acceptable levels. In will be required to reclean the entire reins ection is necessary and no cases involving interim controls in which no reoc kabatementanY eiand containment activities, hi n use no high -risk contractor involved because into were necessary, then you or your including making leaded paint, plaster or putty the unit to meet agent who performed required work will be responsible for cleaning b the licensed ' acceptable dust levels, as determine3 by the results of sampling Y room or interior private risk assessor at the time of the risk assessment reinspection. Any.. t be area in which one ore more surfaces does not meet acceptable dust levels must. ar - _ d b you or your agent in its entirety. recleaned Y ec Y r _ PROSECUIZON AND II.CIV PL1-NIT[VE DAjN AGES - 1 with any of the deadlines stipulated above will require this agency to initiate Failure to comply You�� Seven (7)business days. Compliance with this criminal or civil proceedings against y te documentation vithin Order will be deterrruned by this agency's receipt of the appropriation consists of the following: specified deadlines and/or by on-site reinspection. The documentation lead- aimed inc if any abatement and containment luding making P ra) work is necessary, contract with a licensed M; surfaces intact, a copy of a signed and dated deleading deleader; or our agent will be doing low-risk deleading work or such work as " b) You y for interim controls, a completed and signed structural repairs and lead-dust cleaning ion of Training to Perform Owner/Agent copy of the CLPPP form, "Documentat Containme nt and Deadlines by Which Owner/Agent Low- Low-Risk Abatement and Lacompleted;" Risk Work and/Or Interim Control Work Will be tter of Lead Paint (Re)o�Panry (Re)inspection Certification issued by a c) a Le licensed code enforcement lead inspector or licensed sephnte as mn Loose lead Paint,or, in cases which high-risk abatement and containment k' occu ants to be relocated from plaster or putty intact, is necessary, thus requiring P the unit for the duration of the work; results of all dust samples taken by the licensed code enforcement lead, d) copies of compliance cas inspector in full es or the licensed Private risk assessor in interim control cases; of Deleading Compliance by a licensed code enforcement lead r e) a Letter o a licensed private risk assessor. inspector or a Letter of Interim Control issued by thus agency at least ten(10) In addition, a copy of the deleading notification must be received e g cY commencement of deleading, whether performed by a deleader or you business days prior to any �mpliance or interim control. The law or your agent, and whether in the context of achieving.. hanCe In addition, you�Y become provides penalties of up to 5500 e°u�each to three times theamo�t of any actual damages for failure liable for civil punitive damagesq to comply with this Order. CORRE CTION OF VIOLATION By CODE ENFORCEMENT AGENCY the time periods stipulated above the aforementioned residential property is not brought If within P en may contract with a licensed deleader to into full complianCe or interim control, this ag cY Compliance or a Letter of Interim correct the violation(s) and obtain etter of�urt action Do reunburseeading self el Control, and bill the owner, oinitiate , RIGHT TO A HEARLNG pursuant to 105 CNa 460.900 of the Regulations for Lead Poisoning a hearing You may request g edures of 105 C�400.200 (B),,the Prevention and Control, in conjunction with the Proc for hearings n emergency public health matters. As already noted, the Sanitary Code provisionimer See"Declaration of Emerge section.) ncy" aforementioned violation constitutes an emergency. request a hearing only�You have complied with this Order. decision withi The hearing n� As such, you may en shall issue a written be provided within ten days of your request. This agency seven ddays after the hearing• _, - Director Inspector Massachusetts Department of ublic'Health Childhood Lead Poisoning Prevention Program (MDPH/CLPPP) c:\wpsmt...D i995NGENERu.`cncp$.L i.wp OUNTY BARNSTABLE ND THE ENVIRONMENT DEPARTMENT OF HEALTH A Z SUPERIOR COURT HOUSE " C POST OFFICE BOX 427 O _` !t BARNSTA6LE, MASSACHUSETTS 02630 phone: (508)362-251 t Ext.330 v Public Health Administration 333 •:.° _. . Environmental Health 383 I tJ Water Quality Analysis TOO 36 2 5885 June 3 1996 Mr, Edward Souza 45 Barnhill R Dear Mr. Souza, ,. n„n�� in �d the rroce^l at i 3�> »d Law, �fassaci:use:ts Ge^eral I have inspe T, ;iciat;on of u-e Lea Ps;,_) Lead Poiscring '-I veu =d I have �ou:.d lead pain- owre . o • 197 sI:C tPe DeParient OS psbilc e: V s t- -1 „C La;vs, Charter I i t Se;;:cn r �T:lat;ons 460.GGG. The L.- ons, IG� Cede of Iiassachuse.s R-- -eventior: .nd Cortrl pre^zises er dxeilinQ writs built before I978 Re :iat'er-s rec.uire that res.dencal or broug-nt under inters:-1 v and DP._ ed far fLj cor pdanc� La; G nt � ciations eit;:er abated and contemn .�eldir.? unit. I nave have lead p ire resice^.t:al ^rr�•'ases er d t'�— age of six lives in ' - " °• ,tea Inspect:orfSurface ssess,.,ent Reper`, wZtrt car.*poi wee^ a c::ud and . :�.v L,,- de:aned the spe=i-c are= of violations in ., licensed prv�te rsk assessor must iia..c-. A c�° aV pr,C.e t0 deleadi;ng for il:"i CCr.^.p �Ssessi.:l ?'e— �" be:Cre ,iCu wI11C1 ,ICL . "T ead IInS0eC'-C1' R:SiC Ce! C a r Sit assess—Me" 3r:C iSSLe 3 L... nd w;tn in te:'�^ cort=ci. pCCC.e oiscnInsz PreWention and Ccnt:ci T'erlth Lead P 1 EJ) days of your receiot of this letter, a �,fassac users Depa-r1ment Of?�:b'tic r_ re witi`uz six^Y that you Oretilde to me, ;ups,-r'iStC aDateTent aril Rzaulaticns recuir you and the deleader, if any You or cortt.�c a - a lice.^�e'' deieader, sim:ed by both Y u L or plaster intact, is repuired. Also, i Y ccrtainrr=em wce-c, including or Othel malcn$ leaded aaint, p t-y to do any low-r',sk abate' and contmr nen^wo c ntrol within rsiry (6G) vcur agent is planning e ,cr inte.:m of lead cuss that may be necessary str,;Cjral repairs or cleaning^Qr.�eu rr:us provide this or cr,wlth a signed.and cTmar- to Pe corm days of year receipt of this le•,. oeo formutled, "Docurnentatian of Lead Poison^ .Preve^.tion Preersn(CL- .) (>,ner/Agent Low _ 'sk �baternent and Containment and Deadlines by `Vnich Owmer/gent ew- Risk tivorti and /or Lnterirn Control Work Will be Completed.. you or our agent will be Performing low- with the licensed deleader must low- specify, and if Y for interim control, then you or your The contract ent work or other work necessary risk abatement and containment that the work will be completed attest in the CLPPp owner/agent form lotions o the interior and interior common areas � agent wall violations nine � paragraph � control, within ninety deadlines described in this p ds brought under interim s by the d gent lead hazar 120 days must be deleaded, or the identified urn you have one-hundred and twenty ( ) y s from your receipt of this letter. However, y O1u agent perform, as long as all (90) day any low-risk deleading work you or y complete the folMwina, including surface Preparation, required to be done d comp ent work, dust-generatmS abatement and contampl doors that were removed have baeasrallldust� by a licensed deleader has been completed, and any 90 days; application of encaps iants by Level 11 dele has been completed within within ninety ( ) ent work, including surface Preparation, a abatement or containm long as you can doc�.iment that new seneratin� ninety (90) days; and installation of replacement windows, as ordered within ninety (90) days. All exterior vuolations must be deleaded or windows have been or 20 days. brought under interim control within one hundred and twenty (1- ) by the that the unit will meet acceptable lead dust levels, determined The contract must also specify fiance, or a licensed private risk assessor, in the case of which I, in the case of full come if one is necessary, and that sampling reinspection, interim control, will conduct at the time of the reoccupancY until. � it meets acceptable standards for to reclean the unit if necessary ect.it a necessary and no deleading the deleader will be requiredan reap Q making dust. In interim control cases in which no reoccup cY ent activities, inciudin� , Q risk abatement and containm Q erformed required contractor involved because no � - our agent who p Laster or putty intact,were necessary, then you or y ol leaded Paint, P P leanin the unit to meet acceptable dust levels. the these eP atennsk work will be responsible for c ged b the results of sampling done by cases, dust levels will be determined y ection. Any room or interior area in which one or dust levels must be recleaned by you or your agent in its assessor at the time of the risk assessment reinsp F . more surfaces does not meet acceptable entirety. y al comphint d documents by the 61 st day, I must by law file a crimin If I do not receive the require the court up to500 for each day of non-comp fiance. against you in court. You may be fined by •and Industries (DLI) . i contractors licensed by the Department of Labor making a Under the law, only de.ea.ding f achieving interim control or full residential lead abatement and containment activities, including may engage in any ., loose paint. Plaster or putty intact---whether in the Conte agent may perform certain low-risk the required training, you or your compliances After completing 460.175 without a deleader's and containment activities in accordance with 105 1 or full compliance. These specific abatement1 'n such license—age, whether in the context of achieving interim enca sulants; applying g unties are the following: applying to surfaces, including siding low-risk abatement and containment acts lexi ass, and acrylic, et vinyl, aluminum, Ply"/00d° P and capping baseboards. In coverings as carpet,, doors, cabinet doors and shutters; be necessary for interim control, of exterior surfaces; removing erforrn any other work that may except that; addition,y y agent May of leaded dust, P you or our ag y P ent work by a h as structural repairs, as defined in 105 Cif fhigh-risk 0 abatementcleaning such completion , the final clean-up required after the coma licensed deleader. licensed deleader must be performed by j you or your agent may perform low-risk abatement and containment work, whether for full Before y compliance or interim control,You or your agent must read the Childhood Lead Poisoning Prevention video, if on Will Program �,ppp)'s educational booklet, view the CLPPP encapsulationubm CLPPP. I have ea losed a e and take a self-corrected exam that must be own d Their Agents." To.receive be performed, Work b Homeowners an g copy of the booklet, "Low-Risk Deleading Y package, including the a free copy of the complete ownerlage Office at 1 80 ment and 2 95t 71 n If you or your agent will be encapsulation video,-call the CLPPP C of leaded dust, you performing othe:,wrk for interim control, such as structural repairs and cleaning procedures or your agent must take safety precautions and perform cleanup in accordance with described in the CLPPP educational booklet"Interim Control of Lead Paint Hazards: a Step-by-Step Guide." I have also enclosed a copy of this booklet. ochures explaining the options of encapsulation and interim control. If I have also encl osed two br after reading"Deciding Whether to Encapsulate" you decide private lead inspector toperform this for encapsulation performed, you must hire a h P assessment. Results of on the enclosed as copy t of Assessment Report Form" and a copy as f the assessment shall be re of a list should be sent to me. tensed private lead inspectors. Only those surfaces approved by the licensed inspector will e li P a lies the encapsulant----a licensed Level II eligible for encapsulation, no matter who actually�a$er reading 'Interim Control of Lead Paint deleader or you or your agent. As noted above, Hazards: A New Option for Property Owners," You decide you would like to have a risk assessment as: e must hire a licensed private risk assessor to perform this assessment. Results of the performed, Y on/Risk Assessment Report Form" and a copy should assessment will be recorded on a"Lead olnsp� of licensed private risk assessors. be sent to me. I have enclosed a copy At least 10 business days before any necessary deleading work begins, whether in the context of full fiance or interim control, the deleader must provide written notification to DLI, all residential comp and CLPPP. It is your responsibility, as the owner of the occupants, the local board of health, parties. If you or your agent Premises, to make sure the contractor andos unt��ientwforms ou are responsiblefor providing the Will be performing low-risk abatement writt en notice of deleading to DLI, the residential occupants, the local board of health, and CLPPP, and for also writing on the form which low-risk abatement and containment activities you or your agent will be performing. ccu ants and pets must be relocated from the dwellin unit for occupants and pets st stay out he entire time that intenor All o p deleading work Performed by the licensed deleader is in progress. of the work area while you or your agent perform low-risk abatement and containment work, d up structural repairs, or cleaning of lead dust, but may return after Y must be out of the wellin or your agent has eunit stru P following completion of the work. However, occupants and pets. chipping or cracking 1 coverings to a surface with peeluig, for the day while you or your agent apply return upon completion of lead paint or piaster, or during spray application of encapsulants, but may P and . the own L in er's or owner's agent's cleanup and need not be out of the unit full compliance cases, a, pets who have been relocated from the unit may not return ti ireoe panty by conducting an on-site licensed private risk assessor, in interim control cases, approve on of the unit, including taking dust samples to assure that lead dust levels meet approved. reinspecu 25 hours work is done: the inspector standards. This reinspection will be done at hour the deleader performs a final clean-up, and the or risk assessor must wait at least on f t t 24 hours after the completion of deleading a leas work to perform that final clean-up. Deleaded surfaces are not to be repainted until after reins ection deleader must wait . ' All work is to be done in a workmanlike manner, and the property must be returned to a con dition Code. If any surfaces were scraped, that meets the requirements of Chapter II of the State Sanitary aint only after reinsoection.) If any they must be feathered, made smooth and repainted. s(Repaint have all panes of glass intact and must be windows and doorsere deleaded or replaced, y weathertight. any"Lead sment You are required to send a copy of my"Lead inspection/Surface assessment re inspection Report on repon o' m rtgaaees Inspection/Risk Assessment Report," and any risk and lienholders of record. dinQ the Department of Public Health's Lead Poisoning Prevention and Control Questions rear ions should be addressed to the CLPPP central office (1-80 Re'2lations should be addreor ssed Regulati Department of Labor and Industries gu to me. Questions regarding p to the DLI central office (617-727-1931 or regional offices. I urge you to con tact me as soon as possible to discuss your responsibilities in this case, the coati in ns ns eluded in this inspection report and the other material enclosed. You may reach me by ���a -��� �511 PXt 371--• a t Sincerely, M1 Jane Crowley Inspector#C2 8 2 9 Massachusetts Department of Public Health Childhood Lead Poisoning Prevention Program (DPH/CLPPP) c WP50\LE?.Dj99S,GENER�U.COVP:LI.WP6 r r , r { Dead I1�s ection/ Surface Assessment Form p . Barnstable County Health and Commonwealth of Massachusetts Environmental Department Childhood Lead PoisoningPrevention / s r Court House 470 Atlantic Avenue Page— of / Inspectorl'A �i�� Boston,MA 02210-2224 Barnstable, MA 02�i30 Met o Used: - �Na2S expiration da� i X-Ray Fluorescence License >* C, ;IY 1 Q Model )(k� Serial#a y� Address - Apt.# City . W31-71ql jl�ajr ' :lii 1� 'I,='nx �1111� PPcltrenfS 12ct." IBirthdate (M/D/Y) Sex CWI ne (Last, First, Init.) TOUYW_(,-111 Ch.'/ci s' /70 Y2 le- /ma's Last Name U Guardian's First Name R4U SLLI I Single Family Multi Family CO) Owner's Name: C06.11, 0/'C// O Number of Units Owner's — Address: Remarks/Calibration: own e' �,f 4'e-s-, t `-- KEY: CAP capped 7 -/ i / �. Z- /,j Y/ t{ cov covered /•y 3 I.Z !.-r 0-�" .3•.6 I• / (•.� DIP dipped o. 6 K J•0l ENC encapsulated e. v _O-b -6.L -0.3 0:a v o 0-6 O`4 b•C) v U MI made Intact NA not accessible Scales:(scores of o or 1 pass,scores of 2 fall): NEG nogalive PCs positive PRE prepared Sudace/Subsurlace 0=no painU all paint intact 9=<10%paint not intact 2=>10%paint not intact REM removed Substrate 0=intact 1=<10%needs repair 2->10%needs repair REP replacement Initial Tape Test 0=no paint removed 1=<1/16'paint removed 2->1116'paint removed REV reversed X-Cut Tape Test 0=no paint removed 1=<1116'paint removed 2=>1/16'paint removed SCR scraped to bare substrate Flour# Floor# C I I I I I I I r - r - r - - T - T - T - T - T - -r - T - 1 _ - - r - r - r - r - r - r - r - T - T - T - T - T - l - 1 - I I I I I I I 11 I I I I I I 1 I 1 I I 1 I I - r - r - - r - r - T - T - T - T - -r _ -1 _ - - r - r - r - r - r - r - r - T - T - T - T - T - � - � - 1-. I r I I I l I I I I I 1 I I I I I I I I I 1 I I r - T - r - T - T - * - T - * - - r - r - r - r - r - r - r - r - T - T - T - T - * - -{ - I 1 1 I I I I I I I I I I I I I I I I I I I I I I r - r - r - r - r - - 1- - T T - T - T - T - T -•* - - - r - r - r --r - r - r - r - T - T - T - I. I I I I I I 1 I 1 I I I 1 1 1 I I I I 1 I I I I I I - - r - r - r - r - - t - r - - t - t - t - - - t- - f— F- - r - r - r - t - r - t - t - t - Y - 1 - -r - ivOl1v'I (_� f41 I I' I I I I I I 1 I I I I I - r - r - r -ter - t r - r - r - r - r - r - r - t - t - t - t- t - t - , - ' g I ht l I it I I I I I - t - - t - t - t - t - t - I - - 1- - F - f— t- - r - 1- - t - t - t - t - + - + - t - + - - _ - - - r - I- - I- - - - - - - - - + - + - t - - - I- - I- - F - I- - 1- - +- - t = �- - + - + - + - + - + - + {.� -` 011 f - - - 1-I`c.lV 1J1 } + -� ' -��Wr -lr -" - _t" _ t- - V' - 1- - r- - 1- - + - + - -r' - + - i - i - . P _ I I- i + - + - - - + - -1 - -i - - {- - r- - F - t- - - - 1- - {- - + - + - + -4 - 4 - 4 - -{ - 1 I I I I I I I I I 1 I 1 I I I I I 1 I 1 I I I - r- - r- - �' - - {- - {- - + - + - - .1 _ { _ 4 _ _ _ _ F _.t- _ {- _ � _ - 1-' - + - 4- - + + - + - 4 - 4 1 I I I I I I I I I I I I t I 1 I I I I I I I I I I I A(street side) A(street side) Pb (lead) more than 1.2 mg/c1112 with x-ray fluorescence or positive with Na2S is Dangerous. ---INSP. DATE �1 Lead Ha ? 2.ln rkInpr ce progress (Y or N) REINSP. DATE 2.work In progress �•— ,/ I`Y' I �j� �1 `'.� 3.reoccupancy 4.failed I Inspector Lam/ 1.in compliance 1.In compliance REINSP. DATE 2.work in progress REINSP. DATE 2.worklnprogress 7= 3.reoccupancy 3.reoccupency 0 4.lailud 4.felled 1.in work in pnco 2.worklnpro9ro Full.Compliance Date REINSP. DATE ss 3.raoccupancy 4.lulled Inspector Did you complete a surface assessment for encapsulation? Y or N r EXPLANATION OF LEAD INSPECTIONISURFACE ASSESSMENT REPORT FORM COLUMNS sheet. ' ra on cover h uil. R Refer t o dia m 'de of dwe lling n Refer s B C or D side 9 9 Refers toarchitectural element s being tested. ed If two locations/su rfaces are lis ted in this column , subsequent se q uent S:Uf�F'ICs << . columns will be subdivided to provide specific information corresponding to each surface. s te sted d with an X RF an alyzer ze r and a The actual lead result. A numerical reading indicates that the surface wa r9u level o t lead. A" os'or n e notation da ero s indicates a n 2 cm'than 1. m reading or avera ge reading) P 9 9( 9a 9) indi cates that the surface ace was tested with sodiu m sulfi de, and no tation'md'cafes a dangerous e rous lev el of lea d. Each location testedmu st ha ve an individual dividuaI re sult recorded to the*Le ad'co lumn. mark or"yes' °notat ion ed A check ma ✓ ' ed surface s tested, the painted o d"o of h indicates the ,' Dose co lumn in ( ) Y The"L (loose)) P i intact.n this column me ans one or bo th of the surface s tested is not mt 1. If this colum n is left blank or has a'no" - 'r violation rega rdless o f their 'n violat n r surfaces are i 'o 's intact.Some lead ed s rf ' question i i a the surf aces m' means that 9 it m n notation, ' 's not int act. o if paint i only if' violation•others are in condition Y P ' Ration can be correc ted b a trained a surface in violation Mother or not s r column denoteswh The"owr abt' owner abatement Y I cl to own erla ent m a elect i column means tha t the trained *yes"in this t who is not a deleader. AY h omeowner/a en h9 9 Y A"no"in this column means ow 'sk del eadin activities.I n one of the specified' surface bperforming Bete ad this s rf Y 9 at only that a e s perm itted to delead thi s surfa ce. ddeed r i P a license I to prepare re er surface preparation)column denotes whether or not a deleader is required The'dirsrfprep* delead ) P P ( P P delead in e a en per forming certa in low-risk o sown r! t a t ained h m' being del eaded b r c advance of it n9 a surface in 9 9 Y . 9 P �> activities. A es"in thi s column me ans that a li censed ed deleader must be use to perf orm surfa ce prep aration if the ' Dose lead paint. surf ace with I e ' afriction/impact o cov nn' encapsulation r is ow-risk ac tivity selected 9 �v e "surface/subsurface with respect to potential condition column denotes the condition of the paint layers t forencapsulation. are ineligible ' ibili for enc apsulation.sulation. Surfaced subsurfaces rated a 2 eh 9 ty P le slat or masonry)'.e wood, plaster,m es the condition of the base substrate i .w The'substrate condition'column depot h n ( , p I encapsulation,unless ' 'bl for enca s i" 'are ineligible e a'on. Substrates ra ted a 2 i' oecasult� with respect to potential eligibility for n ,sp 9 Y P 9 P e substrate th repaired.b is a ceivin a u Surf ces re u al'o are scot ded in this col mn. etest(s)re uired for enca s l i p r The results of the initial tape g P 9 P o ca sulati n. e in a test are ineligible1 r en 7 on th initial tape o P u Surfaces 'n this column. S rf performed b the inspector are recorded i x cut tape test(s)The results of the optional . . o encapsulation. u e test are ineligible for o the x-c t to t receiving a 2 n h 9 9 P v o e deleadin of a articular surf ace *comments'column is for other observations that may be relevant t th ;CQMM�NfS <>'»> TheY 9 P The suitable for encapsulation'column indicates whether a surface is potentially suitable for encapsulation ulation based can a tape testing perfor med. A' es"indicates that the surface results of the inspector's evaluation and n l on theY Y P 9P be fu rther evalua ted by X-cut tape a teslin9 andpatch testing; a 'no ' es that the surface ace is ineligible ibIe for u io enca s tat .n P a determined to be in full compliance with the Lead >» The'd©lead date column indicates the date that the surface was p La w. The'delead method"column indicates the method by which each surface was deleaded to full compliance with the Le ad Law. Refer to the"key'o the cover pageforme thod code s. C:W05KEA019951FORMS1Ll SA.FRM - ' Conrnii;nwealllt tt•Massachusetts Childhood Leud Po soningh-evention 470 Atlantic Avenue + Boston,MA 02210-2224 InspectodAgency LEAD INSPECTION/ Page 2--ef Bamstable-County Health-and SURFACE ASSESSMENT FORM Emci r n nmen wL-De pa rtme n t Superior Court House Barnstable, MA 02630 /3� y �"Xry '0v� � . �e rr>S�Cc-j Address of Inspection: Apt# City KITCHEN SIDE LOCATION/ LEAD L OWR DLR SRF SUR/ SUBST INITIAL X-CUT COMMENTS SUIT for DELEAD DELEAD SURFACE ABT? PREP? SUBSUR COND TAPE TEST ENCAP? DATE METHOD Up walls/Low walls Q. Baseboards/Chao rail Q l Door ,to C' Door casing/Jamb 07. DoorPr Q.•Z Door casing/Jamb 0 4 Y1 Boor i Door casinghfemb 0•Z Door Door casing/Jamb Window sill Win casing/Apron Win header/Slops 0.t-1 Win sash/Mullions ).iA Ext sill/Part bead Ext side sash 0• Window sill 13• L Z Win casing/Apron 0 Z_ Win header/Stops U. Win sash/Mullions 0. Ext sill/Part bead 6 1x' Ext side sash f7 Window sill Win c sing/Apron Win h ader/Stops Win si sh/Mullions Exi s VPaft bead Ell side sash Up cab fiame/Door D Up cabinets walls J•j Up cab shlvs/Supp 0-0 Low cab frame/Door n Low cabinets walls U• Low cab shlvs/Supp C� Closet walls Cl i iteriof door Cl c sing/Jamb CI bas ards/Floor Cl sh If/Supports Shelves Diaweis O Z Redrator Floor(Threshold �j U• CeilinglCloset ceiling C2oZ�� CO �� W—(3- 96LICENSE N DATE 11GATURF. Cunuiiorki,cultli oCMussuclnrsclls Childhood [eAd Poisoningl'revention 470 Atlantic Avonuc' Boston,MA 02210-2224 Inspector/Agency LEAD INSPECTION/ Page of Z' BarAstable-Ceunly-Healtt� and SURFACE ASSESSMENT FORM EnVlrenmental--Department Superior Court House 'Barnstable, MA 02630 Address of Inspection` 3 c- P44 4 Apt# City �S X ROOM SIDE LOCATION/ - LEAD L OWR DLR SRF SUR/ SUBST IMTIAL X'-CUT COMMENTS SUIT for DELEAC DELEAD SURFACE ABT? PREP? SUBSUR COND TAPE TEST ENCAP? DATE METHOD Up wallslhw-wnHs- Bas etwaf ds/6Aeir-reil /� Door 011, n Door casing/Jamb , goof Door casinq1Jaffi6 Door , Door casing/Jamb _3 Dour Dsei-caswgLla • Window sill o•a?_ Win casinglApron Q•_- IWm heeder/Slops ) v Win sash/Mulliuns — I + ExI silUPaft bead CQ i Ext side sash Window sill Z Win casing/Apron Win header/Slops Win sash/Mullions 21 t} Ext silVParl bead J Exl side sash )duw sill Q •� GeV �e Win casing/Apron - J Win headei/Stops Js �1�C Win sash/Mullions 7 Ext silVParl bead i _ Ext side sash rU A Window sill 0,) Win casing/Apron �•—`� Win header/Slops p Z WinsasldMullions �L Ext silVPafl bea 0 V Ex1 side sash Closet walls Cl interior door -� Cl casing/Jamb Clbaseboaids/Flooi 3 Cl shelf/Suppoils 124 Radieroi Floor/Threshold V CeilinglClosel ceiling r i LICENSE It d. DATE C Cuouuunwurllh of 1v1ussaclhuselts Childhood /.cad Poisoningi'revention 470 Allanlic Avenuc • Iloslon,MA 02210-2224 - PageYof/ LEAD INSPECTION/ fl inspector/Agency Barnstable-Gounty-Health-and SURFACE ASSESSMENT FORM Envilronmental-0epar4ment Superior Court House Barnstable, MA 02630 n - /,37 `( /'�O--ry t# City All /1s '���'� Address of Inspection ROOM SIDE LOCATION/ LEAD L OW R DLR SRF SURI SU13ST INITIAL X-CUT COMMENTS SUIT for DELEA DELEAD SURFACE ABT? PREP? SUBSUR COND TAPE TEST ENCAP? DATE METHOD Up wallskovrwells 0.Z BasetwardslGHau tai4 ' f• Door l.� Door casing/Jamb (�•� Door (� yJ Door casing/Jamb Door Door casing/Jamb Door Door casing/Jamb Window sill Win casing/Apron Win headedSlops Q- Win sashlMullions Exl sill/Parl bead CC) Ext side sash Window s I n casing/Apron W n IieadedSlops - W n sastJMullions x1 sill/Pail bead ExI side sash Window oll Win casing/Apron m headedSlops in sashMlullions Exl sill/Pail bead Ext side sash Wrndo sill Win casing/Apron Win headedSlops Win sastvMullions Ext sill/Part bead Ext side sash Closel walls . Cl inlerior door Cl casing/Jamb 03 ClbaseboardslFloor j P!S/Cl shelf/Supports Radiator _ F loor/t lwa"ld Ceiling/Closet ceiling /L Q l/c O (-[��• /17 DATE LICENSE q /SICitJATl1RF. � F J 1 Conuiiiinwcallh of Massachusetts Childhood Lead PoisoningPrevention 470 Atlantic Avenue Boston,MA 02210-2224 Inspector/Agency LEAD INSPECTION/ Page of Bar -Geun"eattta-and SURFACE ASSESSMENT FORM Euui�aaen�at-Depa{-gent , Superior Court House Barnstable, MA 02630 / Address of Inspection' Apt# City ROOM SIDE LOCATION/ LEAD L OWR DLR SRF SUR/ SUBST INITIAL X-CUT COMMENTS SUIT for DELEAD DELEAD SURFACE ABT? PREP? SUBSUR COND TAPE TEST ENCAP? DATE METHOD Up walis/Lew-wags 0 Baseboards/eha4"it- r� Door V Door casing/Jamb ✓ Door Door casing/Jamb 10. Z1' Door Door sing/Jamb Door Door sing/Jamb Window sill 10,3 Win casing/Apron 0. 4 1 Win header/Stops 0. Win sash/Mullions 0.1 . Exl sill/Pad beak. Exl side su'h Window sill �' L Win casing/Apron Win headedSlops p. Win sashlMullions _�J Exl silVParl bez CO 4 Ext side sasi� f Window sill Win sing/Apron Win t adei/Slops Wins sh/Mullions Exl ilVParl bead I side sash Window sill Win 4singlApron Wm h ader/Slops Win s h/Mullions Exl si I/Parl bead E4 side sash Closet walls O Cl interior door 01 Cl casing/Jamb Q, Clbaseboards/Floor Q,U S j CI shelf/Supports k2adralor �e h .(� /1 FloorAThreshold ! . Ceding/Closet ceiling i 66z,�- LICENSE p r a n� DATES �� C CJ SIGNATURE . Cunutiunwciilllr iif hlussuchusclls Childhood Lend Poisoningl1revention 470 Allanlic Avcnuc 13oslon,MA 02210-2224 inspector/Agency LEAD INSPECTION/ Page of�& Barnstable-County-Wealth-and SURFACE ASSESSMENT FORM . Envirenmental-Depar4ment Superior Court House , Barnstable, MA 02630. Address of Inspection: 13 7 f 179tV,4-,z cityC�4ia ROOM SIDE LOCATIOW LEAD L OWR DLR SRF SUR/ SUBST INITIAL X'-CUT COMMENTS SUIT for DELEA DELEAD SURFACE ABT? PREP? SUBSUR COND TAPE TEST ENCAP7 DATE METHOD Up walls&vwvatts 0 Baseboardstehamir L. Door O Z Door casing/Jamb Door Door casing/Jamb 0 � -;)DI, 00r r casinglJamb Door D r casinglJamb Window sill O, Wm casing/Apron oZ gWin headcdSlops Win sas►dMUllions 42. Ext sill/Pail bead � �, Ext side sash Window sill Wincasing/Apron v ` Win headedSlops f7 r WinsasNMullions L/I Ext sill/Parl bead (U ll Exl side sash Window sill Win sing/Apron Win h adedStops Wins ►/Mullions Exl si/Pail bead E side sash Window sill Win ca iing/Apfoni Wm he der/Stops will sa INUIlions Exl si ail bead E side sash Closel walls JCl interior door ?. Cl casing/Jamb t F- Cl basebowds/Hoor TS I shell/Supports v• t Radmlor Floor/Threshold Ceihng1closel ceiling Am _ r LICENSE II �� o DATE Slr;rlaTl lfil' l;unnnuuwcullh ul A4ussudursclts , Childhood 1,cud 1'oisoningPrt�vculiOil 470 Allunlic Avcnuc Ruston,MA 02210-2224 LEAD INSPECTION/ Page 7 of Inspector/Agency SURFACE ASSESSMENT FORM flat nstabla_frnuntaeatth and _Etivi[ollmental.Depart ment Superior Court House Barnstable, MA 02630 �� �z� Address of Inspection. /3 7 9' ��y ,C��rr>,-) t# ci 2e '� BATHROOM SIDE LOCATION/ LEAD L OWR DLR SRF SUR/ SUBST INITIAL X-CUT COMMENTS SUIT for DELEA DEI.EAD ENCAP? DATE METHOD SURFACE ABT? PREP? SUBSUR COND TAPE TEST��11 Up walls/Low walls 0,f v Baseboards/Chair rail 0.Z Door Z Door casing/Jamb Door Door c sing/Jamb Window sill Win c sing/Apron Win h derlSlops Win sa IvMullions , Ext si art bead Ex side sash ' Window sill Wm casing/Apron 0./ _ Win headedSlops 0• / _ Wm sasldMullions a Ext silVParl bead POS CO✓ , Ext side sash >♦ Up cab Irame/Door Up cabinets walls 0.) tip cab shlvslSupp d: Low cab Ira el0oor Low c binets walls Low ca shlvslSupp Closel walls C1 interior door Cl asing/Jamb Cl bas ards/Floor Cl s ell/Supports _ Sjrel<es C(.0 0 1 Drawers R5d31w Floorl(hreshold C) C•edinglClosaceding 6,3/qr� &7, ( LICENSE N C o2�� DATE Conunonwcrillh of Messaclrusctts GiRdhood Lead PoisoningPrevention ' 470 Atlantic Avenue Boston,MA 02210-2224 Inspector/Agency LEAD INSPECTION/ Page�f lZ BamstaMe-£onrtty-kealthand SURFACE ASSESSMENT FORM Environmental Bepartmsnt Superior Court House Barnstable, MA 02630 / Address of InspectionJ3 7 f Aptf--�-/ City e_r^�2SXr%�ly/ HALLWAY SIDE LOCATION/ LEAD L OWR DLR SRF SUW SUBST INITIAL X-CUT COMMENTS SUIT for DREAD DELEAD SURFACE ABT? PREP? SUBSUR COND TAPE TEST ENCAP? DATE METHOD Up walls/Low walls Q.. BaseboardsehfftMil o Door Door casing/Jamb Door 6 ,C Door casing/Jamb Door L Door casing/Jamb Door 6, C� Door casing/Jamb Door +o ..IOJ•0 Door casing/Jamb Door Doo casing/Jamb Door Doo casing/Jamb Window sill Wr casing/Apron I Wi header/Slops WIII sash/Mullions t silVPa(t bead Ext side sash Window n casinglApron n header/Stops WIi sash/Mullions 1 sill/Parl bead Ext side sash Window si Wi casing/Apron Win headedSlops Win ash/Mullions Exl ill art bead xl side sash Closet walls 0 •L CI interior door 0-1 Cl casing/Jamb 0.Cl baseboards/Floor O-Z Cl shelf/Supports ) Closet wall I interior door C casing/Jamb Cl bas ards/Floor Cl! elf/Supports Radiator Floor/Threshold Ceiling/Closet ceiling r LICENSE H CC) C) DATE 7 GNATURE Cununumveallh of Massachusetts alitdl►ood Lead Po isoningPrevention 470 Atlantic Avenuc Boston,MA 02210-2224 Inspector/Agency LEAD INSPECTION/ Page of BarnstableZouAt�r-ktealil+and SURFACE ASSESSMENT FORM E ny i mnmealaW epa r4 r a n t Superior Court House Barnstable, MA 02630 Address of Ins ection: �j /�. i�j &C 0 Apt# City 466t,/7S' c�,6 EXTERIOR SIDE LOCATION/ LEAD L OWR DLR SRF COMMENTS DELEAD DELEAD SURFACE ABT? PREP? DATE METHOD Siding Cornerboards LOOS I-eweHrim Upper trim 104 J— Door ClDoor casing/Jamb Threshold Door ID r Door casing/Jamb L Threshold Door &SeI ✓l— T Door casing/Jamb Threshold Boor -Door casirrgMamb Window sill IWindow casing Win sash/Mullions Window sill Aa Window casing J. 7— Win saslVMullions play Window sill I e.{=-E CNn4-ef ' k4 3 / ! 3 Window casing 3,L V in r e,4 in sash/Mullions 0S Z Window sill 4\ / /V10 I T +.gZ S Window casing I r Win sash/Mullions f u Cellar win units /) heals Cellar win units Cellar win units Gellac�in.�+ails- Foundation Bulkhead Fences s ANAT LICENSE q c DATE C • Cuunuunwculthu(h.tassuchusells , Childhood Lend PoisoningPi-evention 470 Atlantic Avenue Boston,MA 02210-2224 ?' inspector/Agency LEAD INSPECTION/ Page—of � BaFAstable-Count-t-Nealtt►-and SURFACE ASSESSMENT FORM EnviFeA mania VDapaFtmant Superior Court House Barnstable, MA 02630 Address of Inspection Apt# City f�'i"ll SIDE LOCATION/ LEAD l R DLR SRF URI SUBST INITIAL X CUT COMMENTS SUIT for DELEA QELEAD SURFACE ABT? PREP? SUBSUR COND TAPE TEST ENCAP? DATE METHOD Up walls/Low walls Baseboards/Chair rail Door Door casing/Jamb Door Door casinglJamb Door Door casinglJamb Door Door casing Jain Windowsill I)IS Win casrnglApron T c Win sashlMullions E><Lcide�sesh Window sill / Win casing/Apron /� 1 fAA"ad"alops �J Win sastJMullions oos T r. id 5ul:eide•eesla— i — Window sill ,O- Win casing/Apron 4- C� _ i Win sastJMullions as L Window sill Win asinglApron Win wader/Slops Win aslJMullions Exl silVPafi bead xl side sash Closet wall I interior door C casing/Jamb CI bas boardslFloor Cl ielVsupporls ' Radialor Floor/tins old CedinglClo 1 ceilin / 911 IL/i/1610tV S COJ 4770,ei7?. LICENSE 0 0 n�_ DATE •ar.r•��n nrl Cunuuonwcalth of massachusctts Childhood Lead PoisoningPrevention 470 Ailr ritic AVC11-C Boston,MA 02210-2224 InspectorlAgency LEAD INSPECTION/ Page 1� of/Z and SURFACE ASSESSMENT FORM Barnstable eotmty+fea"-��+v+rer�er►ta+-Bep a rtme n t Superior Court House Barnstable, MA 02630 / 7 f /YICc�jr Av12� CI Address of Inspection: h G E s`1 G SIDE LOCATION/ LEAD L OWR DLR SRF COMMENTS DELEAD DELEAD SURFACE ABT? PREP? DATE METHOD Siding CofneO 6afds Lower im Upper im Door Door casing/Jamb Threshold Door Door casing/Jamb Threshold Door Door casing/Jamb Threshold Window ill Window casing Win sash/Mullions Window iill Window casing Win sash/Mullions Window ill Window casing Win sash/Mullions Window 411 Window casing Win sash/Mullions Foundali y LICENSE# ._ o Zd C_ DATE NATU Q RE � I r ' Canriuiiw�ullli cif Mussuchusclts Childhood head Poisoningl'revention 470 Atlantic Avenue Boston,MA 02210-2224 Barnstable County Health and SURFACE ASSESSMENT/ Pages of I � Inspector/ ��Cd4rimen�al Department STRUCTURAL DEFECTS PAGE Ouse BarAwabie, MA 02630 Address of Inspection/Risk Assessment: Apt# City SURFACE ASSESSMENT Scares(Scores of 0 or 1 pass,scores of 2 fail): Surface/Subsurface 0=no paint/all paint intact 1=<10%paint not intact 2->10%paint not intact Substrate 0=intact 1-<10%needs repair 2->101A needs repair Initial Tape Test 0=no paint removed 1-<1/16'paint removed 2=>1116'paint removed X-Cul Tape Test 0=.no paint removed 1=<1/16'paint removed 2=>1116'paint removed ROOM/ LOCATIOW LEAD L OWR DLR SRF SUR/ SUBST INITIAL X-CUT COMMENTS SUIT for DELEAD DELEAD SID SURFACE ABT? j PREP? SUBSUR COND TAPE TEST ENCAP? DAT METHOD RUCTURAL DEFECTS ROOM/ LOCATION/ LEAD PROBLEM REP REPAIR METHOD RECERT SIDE` SURFACE DATE DATE LICENSE# r a ��� DATE SIG RE