WTC Visual Survey Form
4
Premise Address:
b AkiA
Block: Residential 0 Commercial Name of Building:
Lot: Mix UseD Other
# of Stories: 15 AKA's:
Building Owner/Management: Telephone Number. ( )
Name: AX:
Address: I gi>
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 ❑ Yes ❑ No Locations:
Copies of All Reports and Data Requested I Yes
visual inspection Results:
Facade:
Inspected Debris
0>1"
North
South
East
N/A
N/A
❑ NIA
D
Yes ❑ No
Yes ❑ No
❑ Yes ❑ No
JJ No Visible/PineLayer ❑%to1"
No Visible/Fine Layer ❑ % to 1"
❑ No Visible/Fine Layer ❑%2to 1"
0>1"
0>1"
West ❑ N/A ❑ Yes ❑ No ❑ No Visible/Fine Layer ❑yato 1" 0>1"
Facade Description:
Roof
Debris: ) No Visible !Fine aver ❑ Ya to 1" 0>1"
Description: '
Setbacks N/As
Floor Debris: ❑ No Visible/Fine Layer ❑'/tol" 0>1"
Floor. Debris: ❑ No Visible/Fine Layer E]%to1" 0>1"
Floor Debris: ❑ No Visible/Fine Layer ❑Yato1" 0>1"
Floor. Debris: ❑ No Visible/Fine Layer ❑Y2to 1" 0>1"
Floor. Debris: ❑ No Visible/Fine Layer ❑Y2to1" 0>1"
Comments
DEP inspection form for 50 Broadway documenting building characteristics, facade conditions, and asbestos-containing material survey across multiple building faces.