WTC Visual Survey Form I
Premise Address: IS i4 GrJ T sT
Block: 15 Residential 0 Commercial Name of Building:
Lot: 1 C) Mix Use 0 Other -~
# of Stories: AKA's: 1 8 -ciO r 'r
Building Owner/Management Telephone Number: ( )
Name: FAX:
Address:
On Site Contact
Name: Telephone Number.
Building Owner Management Activities
Interior Survey Performed ❑ Yes ❑ No
Exterior Survey Performed ❑ Yes ❑ No
General Clean Up ❑ Yes ❑ No Locations:
ACM Clean Up ❑ Yes ❑ No Locations:
Air Monitoring 0 Yes ❑ No Locations:
Copies of All Reports and Data Requested Yes
visual inspection Results:
Facade:
Inspected Debris
North ❑ NIA ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑%to 1" 0>1"
South ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑Yto1" 0>1"
East ❑ NIA ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑%tol" 0>1"
West ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑%to 1" 0>1"
Facade Description:
Roof
Debris: ❑ No Visible /Fine Layer ❑ % to 1" ❑ > 1"
Description:
Setbacks N/A ❑
Floor Debris: ❑ No Visible/Fine Layer ❑ 1/ to 1" ❑ > 1"
Floor: Debris: ❑ No Visible/Fine Layer ❑ '/2 to 1" ❑ > 1"
Floor. Debris: ❑ No Visible/Fine Layer ❑ % to 1"
0> 1"
n>
Floor: Debris: ❑ No Visible/Fine Layer ❑'/2 to 1" 1"
Floor. Debris: ❑ No Visible/Fine Layer ❑ % to 1" ❑ > 1"
Standardized inspection form documenting building characteristics, asbestos materials assessment, and visual inspection results for facade debris on all four sides.
Joint memorandum from NYC DEP and DOH advising building owners on post-9/11 maintenance, re-occupancy issues, and hazardous material assessments including asbestos.