DEMO-000012-2017 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
w Community Development-Building& Codes (518)761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: DEMO-000012-2017 Date Issued: Tuesday, October 10, 2017
This is to certify that work requested to be done as shown by Permit Number DEMO-000012-2017
has been completed.
Tax Map Number: 227.17-1-50
Location: 119 SEELYE RD
Owner: Susan Kaidas,Michael Kaidas
Applicant: Michael Kaidas
This structure may be occupied as a: Demolition Only--Boathouse 495 s.f.
Asbestos Survey Received By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Compliance DOES NOT relieve the
property owner of the responsibility for compliance with Site Plan,
Variance,or other issues and conditions as a result of approvals by the
Director of Building&Code Enforcement
Planning Board or Zoning Board of Appeals.
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development- Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: DEMO-000012-2017
Tax Map No: 227.17-1-50
Permission is hereby granted to: Michael Kaidas
For property located at: 119 SEELYE RD
In the Town of Queensbury,to construct or place at the above location in accordance with application together
with plot plans and other information hereto filed and approved and in compliance with the NYS Uniform
Building Codes and the Queensbury Zoning Ordinance
Tvne of Construction
Owner Name: Susan Kaidas Demolition-Residential $0.00
Owner Address: PO Box 268 Total Value $0.00
Cleverdale,NY 12820
Contractor or Builder's Name/Address Electrical Inspection Agenc,,
Waste Management
12 Wing ST
Fort Edward,NY 12828
Plans&Specifications
Demolition Only--Boathouse 495 s.f.
Asbestos Survey Received
$30.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Thursday,January 25,2018
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensb before the irati n date
Dated at the Town f Queen W ,January 25,2017
SIGNED BY: for the Town of Queensbury.
Director of Building&Code Enforcement
Town of Queensbury Building & Codes Office Use OnIV
Received
DEMOLITION PERMIT APPLICATION Permit#:
NO WORK MAY COMMENCE UNTIL PERMIT IS ISSUED Permit Fee 2��T1LLv(2sS:�16
Provide 2 plot plans drawn to scale, showing lot boundaries with dimensions and adjacent roads/streets. Show all existing structures
on property and Indicate/which are to be demolished. Indicate the location of all utilities
Date 1.�[raf'�o1Demolition Location �� SG G d
Tax Map ID z2ls�L_�_ r� CJr�✓/ /LO/tLG Y1/y
APPLICANT _14A/———r S OWNER /CI � _1i✓_ /p�4�----
Address Po� 26�� I/ �� ���y � Address Po_ _� 6 —L3Sf��1
Phone —--------- Phone
CONTACT PERSON FOR BUILDING&CODES COMPLIANCE: /Gf/AsfL 2L/Dr; ---------pho„e;
I. Person Responsible for Work /G/f��L '4 ,4 5
2. Where will demolition material be disposed? 141A /�/✓ _t^rye N T
3. All buildings to be demolished require an Asbestos Survey MA' P/ZO --/ 7 —
4. Any building substantfatly damaged by fire must obtain an Asbestos Removal Permit from the Department of Labor
S. Asbestos Information: The Asbestos Removal Report must be Hied with our office before demolition begin
a) Is there any asbestos in the building to be demolished --Yes _—No
b) If Yes,our office needs the following Information __Yes ----No
Name of firm removing the asbestos
License number of firm
Indicate where the asbestos material will be disposed
6. Structure Information
a) Indicate the structure(s)to be demolished --_ Residence —_ G ragJOWNff CODES
--- Storage Bldq.>, r-
b) Size of Structure S T
c) Number of Stories r
d) Foundation Type ( &WO loeex /j )N 4 nz MyAmi
e) Foundation
f) Structure(s)
7. Utilities Information
a) Indicate utilities for this structure---Gas --- Electric --- Propane —_—Public Water —_—Public Sewer
__—On-site well water pump Afb N --r—
a)
a) Have you notified the Town Water Department for public water and sewer disconnect? _---yes ___—No
b) Have all utilities been disconnected? __--Yes ---- No
B. Signature
Print Name: �G L----f--- --------------- Date
Signature: ........................................ Date --
Town of Queensbury Building& Codes - Demolition Permit - December 2014
227.17-1-49 DEMO-000012-2017
(1)-RIPAne Kaidas, Michael & Susan
113 Scelye Road
ENVIRONMENTAL SERVICES DeinoOnly — Boathouse 195s.1'.
REPORT OF
PRE-DEMOLITION ASBESTOS INSPECTION
Location of Inspection: 119 Seelye Rd.Cleverdale, NY
71
i
Performed For: Kaidas Properties
P.O. Box 268
Cleverdale NY, 12820
Date of Report: November 7, 2016
Date(s)of Inspection: November 11, 2016
Project Number: 16-19979-A
Material or E C v
Area Inspected: Entire residence and boat house
Asbestos Materials: Residence:
Sink Sound Deadener TOWN OF OUEENSBURY
Boat House: BUILDING & CODES
None
Non-Asbestos
Materials Tested: Linoleum, cove base mastic,Joint compound, drywall,wallboard,
wallboard mastic, 2 x 4 ceiling tile paper, roof vapor barriers&shingles,
flashing tar, rolled roofing
Inspection By: Alpine Environmental Services-11MN OF OUEENSBURY
New Karner Rd.
Albany NY, 12205 BUILDING & CODES PT.
Albti
www.AlpineEnv.com Reviewed By:
Date:
Inspector(s): Matthew Fiore
Senior Industrial Hygienist
NYSDOL Asbestos Inspector(Cert.#04-04675 TOWN OF QUEENSBURY
1BUILDING DEPARTMENT
Based on our limited examination,compliance
with our comments shall not be construed as
indicating the plans and specifications are in
full compliance with the Building Codes of
New York State.
438 New Karner Road 9 Albany,New York 12205•Phone:(518)250-4047
November 2016 119 Seelye Rd.
Cleverdale,New York
Scope and Purpose
This report is intended to document an asbestos inspection of the residence and boat house located at
119 Seelye Rd., Cleverdale, New York for the purpose of demolishing the structures.The inspection was
performed on November 7, 2016.
"Asbestos containing materials", as defined by the United States Environmental Protection Agency
(EPA), is any material containing greater than 1% by weight of asbestos. Friable samples (samples easily
crushed/pulverized by hand pressure), were analyzed via Polarized Light Microscopy (PLM) and Non-
Friable samples (samples not easily crushed/pulverized by hand pressure), were analyzed via
Transmission Electron Microscopy (TEM) by EMSL Laboratory of New York, New York, a New York State
Department of Health Approved Laboratory (ELAP #11506). As of April 2011 the NYS Department of
Health requires that ceiling tiles be analyzed by TEM if they contain cellulose.
Structure Descriptions
Residence:
The residential structure inspected was a one story wood structure built over a dirt crawl
space. The interior walls and ceilings were wood. The floors were mostly wood with some
linoleum flooring present. The windows had been previously removed. The electrical wire
insulation was observed to be plastic coated. Only non-insulated pipes were observed in the
crawl space. A gas space heater and a fire place were present for heating. The roof was
asphalt shingle.
Boat House:
The boat house structure was 1 story bare wood structure built over a floating dock. No
heating or water systems were present. The electrical wire insulation was observed to be
plastic coated.The roof was asphalt shingle.
Limitations
Quantities, if any, listed in this report are estimated only and must be field verified by the owner or
contractor.
Results of Asbestos Inspection
TABLE 1.Asbestos Containing Materials—119 Seelye Rd., Cleverdale, NY
Homogeneous Location Substrate Condition Estimated Friable Sample#
Area I Quantity
Sound Kitchen Metal Good 6 Sq ft No 08-01
Deadener Sink
*Dimensions and Quantities are estimates only and should be field verified by the contractor.
Page 2 of 3
438 New Kamer Road•Albany,New York 12205 9 Phone:(518)250-4047
November 2016 119 Seelye Rd.
Cleverdale,New York
TABLE 2. Non-Asbestos Containing Materials— 119 Seelye Rd.,Cleverdale, NY
Non-Asbestos Materials Locations Sample#s
Linoleum Kitchen And Bathroom 07-01, 07-02
Cove Base Mastic Bathroom 06-01, 06-02
Joint Compound Kitchen and Small Front Porch 01-01,01-02
Drywall Kitchen and Small Front Porch 02-01, 02-02
Wallboard Bathroom 03-01,03-02
Wallboard Mastic Bathroom 05-01, 05-02
2 X 4 Ceiling Tile Paper Bathroom/Vanity Area 04-01, 04-02
Roof Vapor Barriers Residence and Boat House Roofs 09-01,09-02
Shingles Residence and Boat House Roofs 10-01, 10-02
Flashing Tar Residence Roof 11-01, 11-02
Rolled Roofing Residence Roof 12-01, 12-02
Conclusion
According to 12 NYCRR 56, the building owner (or owner's agent) is required to transmit this asbestos
inspection report to any local government permit issuing agency (i.e. building department) for any
demolition, renovation or remodeling.
In addition, if this inspection is for the purposes of demolition, the building owner (or owner's agent) is
also required to transmit this inspection report to the Asbestos Control Bureau, New York State
Department of Labor.
This inspection report is required to be displayed on site during all related construction work.
Disturbance/Abatement of any asbestos containing materials, as well as air monitoring, must be
performed by a NYS DOL licensed contractor, in accordance with state and federal regulations(NYS DOL
ICR 56 and US EPA 40 CFR).
If I can be of any further assistance to you on this matter, please contact me at (518) 250-4047 Ext 315.
MattFPAloineEnv.com
Sincerely,
Alpine Environmental Services, Inc.
Matthew Fiore(#04-04675)
NYS Department of Labor Asbestos Inspector
Enclosures:Sample Results, Alpine's Handling License, Inspector Certificates and EMSL ELAP Certificate
Page 3 of 3
438 New Karver Road•Albany,New York 12205•Phone:(518)250-4047
EMSL Analytical, Inc. EMSLOrder.. 031633586
307 Wast 38th Street New York,NY 10018 Customer ID: ALP150
TeVFar(212)290-00511(212)290-0058 Customer P0: 16-19979-A
http:/Mw .EMSLcom/manhattanlab@emstcom Project ID:
Attention: Alpine Environmental Services Phone: (518)250-4047
438 New Kamer Road Fax:
Albany, NY 12205 Received Date: 11/0812016 10:31 AM
Analysis Date: 11110/2016-11/11/2016
Collected Date: 11/07/2016
Project: 16-19979-A/119 SEELYE RD. CLEVERDALE, NY
Test Report:Asbestos Analysis of Bulk Material
Analyzed
Non-Asbestos
Test Date Color Fibrous Non-Fibrous Asbestos
SamplalD 01-01 Description FRONT PORCH CEILING-JOINT COMPOUND
031633585-0001 Homogeneity Homogeneous
PLM NYS 198.1 Friable 11/10/2016 white 55.00%Ca Carbonate None Detected
10.00%Mica
Inseparable paint I coating layer included in analysis 35.00%Non-fibrous(other)
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOB Not Analyzed
TEM NYS 198A NOB
Not Analyzed
Sample ID 01-02 Description FRONT PORCH CEILING-JOINT COMPOUND
031633586-0004 Homogeneity Homogeneous
PLM NYS 198.1 Friable 11/10/2016 white 65.00%Ca Carbonate None Detected
4.00%Mica
31.00% Non-ebrous(other)
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOB Not Analyzed
TEM NYS 198.4 NOB
Not Analyzed
Semple ID 02-01 Description FRONT PORCH CEILING-DRYWALL
031633586-0003 Homogeneity Homogeneous
PLM NYS 198.1 Friable 11110/2016 Brown/Gray 15.00%Cellulose 70.00%Gypsum None Detected
15.00%Non-fibrous(other)
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOB
Not AnalyzW
TEM NYS 198.4 NOB Not Analyzed
Sample to 02-02 Description FRONT PORCH CEILING-DRYWALL
0316335860004 Homogeneity Homogeneous
PLM NYS 198.1 Friable 11/1012016 Gray 6.00%Cellulase 70.00%Gypsum None Detected
24.00% Non-fibrous(other)
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NDB Not Analyzed
TEM NYS 198.4 NOB Not Analyzed
Sample ID 03-01 Description BATHROOM-WALL BOARD
0316335860005 Homogeneity Homogeneous
PLM NYS 198.1 Friable 11110/2016 Browm 80.00%Cellulose 20.00%Non-fibrous(other) None Detected
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOB Not Analyzed
TEM NYS 198.4 NOS Not Analyzed
Initial Report From:11/11/2018 11:49:49
Printed 111112016 11:49:50AM Page 1 of 3
EMSL Analytical, Inc. EMSL Order: 031633586
307 Nkst 38th Street New York,NY 10018 Customer ID: ALP150
Tel/Fax(212)290-0051 I(212)290-0058 Customer PO: 16-19979-A
http:/A~v.EMSL.com/manhatianiab@emsl.com Project ID:
Test Report:Asbestos Analysis of Bulk Material
Analyzed Non-Asbestos
Test Date Color Fibrous Non-Fibrous Asbestos
Sample ID 03.02 Description BATHROOM-WALLBOARD
031633586-0006 Homogenafty Homogeneous
PLM NYS 198.1 Friable 11/102016 Brown 90.00%Cellulose 10.00%Non-fibrous(other) None Detected
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOB Not Analyzed
TEM NYS 198.4 NOB Not Analyzed
Sample 10 04-01 Description FIBERGLASS CEILING TILE-PAPER
031633586-0007 Homogeneity Homogeneous
PLM NYS 198.1 Friable Not Analyzed
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOB 11/11 2 01 6 White 100.00%Other Inconclusive:None Detected
TEM NYS 198.4 NOB 11/11/2016 White 100.00% Other None Detected
Sample ID 04-02 Description FfBERGLASS CEILING TILE-PAPER
031633586-0008 Homogeneity Homogeneous
PLM NYS 198.1 Friable Not Analyzed
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOB 11111/2016 White 100.00%Other Inconclusive:None Detected
TEM NYS 198.4 NOB 11/11/2016 White 100.00% Omer None Detected
Initial Report From: 11/112016 11:49:49
Printed 11111 201 6 11:49:50AM Page 2 of 3
EMSL Analytical, Inc. EMSL Order: 031633586
307 West 38th Street New York,NY 10018 Customer ID: ALP150
Tel/Fax(212)290-00511(212)290-0058 Customer PO: 16-19979-A
http://www.EMSL.com/manhattanlab@emsl.com Project ID:
Test Report:Asbestos Analysis of Bulk Material
The samples in this report were submitted to EMSL for analysis by Asbestos Analysis of Bulk Materials via NYS ELAP Approved Methods.The
reference number for these samples is the EMSL Order ID above.Please use this reference number when calling about these samples.
Report Comments:
Sample Receipt Date: 11/8/2016 Sample Receipt Time: 10:31 AM
Analysis Completed Date: 11/10/2016 Analysis Completed Time: 3:07 AM
Analvst(s):
L-'
Ghaly Hemaya PLM NYS 198.1 Friable(3) Yolanda Chow PLM NYS 198.1 Friable(3)
(V"aw\ tl 4IawC� w � 1^ �S f
KamelAlawawda PLM NYS 198,6 NOB(2) Gerald lannuzzi TEM NYS 198.4 NOB(2)
Samples reviewed and approved by:
James Hall,Laboratory Manager
or OtherApproved Signatory
NOB=Non Fdable Organically Bound N/A=Not Applicable VCM=Vermiculite Containing Material
-In New York State,TEM is cumently the only method that can be used to determine if NOB materials can be considered or treated as non-asbestos containing.
All samples examined for the presence of vermiculite when analyzed via NYS 198.1.
-NYS Guidelines for Vermiculite containing samples are available at http://www.wadsworth.ogAabcert/elapcertHorms/VenniwlitelntedmGuidance_Rev070913.pdf EMSL
maintains liability limited to cost of analysis.This report relates only to the samples reported above and may not be reproduced,except in full,without written approval by
EMSL.EMSL bears no responsibility for sample collection activities or analytical method limitations.Interpretabon and use of test results are the responsibility of the client
Samples were received in good condition unless otherwise noted.
This report must not be used by the client to claim product certification,approval,or endorsement by NVIAP,NIST,or any agency of the federal government This report may
contain data that is not covered by the NVLAP accreditation.
Semple.—h,.0 by EMSLM*ybml,me N.York,NY NYS EIRP 115
Initial Report From:11/11/2016 11:49:49
Printed 11/11/2016 11:49:50AM Page 3 of 3
)rdeYID: 031633586 +crNicv,. Inc.
-413 \ew Kanner Rd. l i W 'leu
AlNatic, \}' I??pi email: \IjttF a AlpineEm.coin
CHAIN OF CUSTODY
Client: Alpine En\ironmental Scr\ iC., Project:. 119 Seec Rd. CIc\erdale. \Y
Proie.t Number:- 16-19979-A
Contact: Matthe\\ Fiore Sampled By: klalthe\\ Fiore
Phone: >18-2io--10.17 Date finte Collected: 1 1 7 201G
Turnaround Fime: 72 hr P.O. lumber: ��k 4 6 cr?,Ye ch(cP
Los Sample Sample Sample \nal"is Rz,ull+
\o. No. Location Material
01-01 Front Porch Ceiling . fi
faint , Stop at
Compound �1'S Stratied PLN First Positive
01-02 Front Porch Ceiling Joint NYS Stratified PI AI
Compound
02-01 Front Porch Ccilin,g DnWS S Strarificd P(.\tStop at
First Positive
02-02 Front Porch Ceiling Dry\\all NYS Stratified PIA1
03-01 Bathroom Wall Board NYS Stratified MAI Stop at
First Positive
U:-0'_ Bathroom Wall Board \Y� Stratified PLAI
114-01 Fiberglass Ceiling Tile � Stop at
b Paper \1"S Stratified f L\J
First Positive
04-02 Fiberglass Ceiling Tile Paper NYS Stratified PIAT
i
3
C 9x
I I rt o•
69— —
Disposition of Samples: :�ccept Rciect Explain T`
Comments:
LDf
o .V
i Rclinqui�hzd 13y: ; Kzczi\zJ Ili: Date: -Ipjyz: r
Page t ot' I G
l
)rderID: 031633586
Alpine Environmentnl.Services,Inc. �q
)rder:D;-031633586 Phone:(5 IS)250=4047
Albany,NY 12205u v einail:MattF@Alpin-Eny.com
CHAIN OF CUSTO Y
Client:Alpine Enuiromnental Servit es. Project:. 119 gee lee:Rd.Cleardalm.NY
Project Numl er. 1649979-A
Contact: Matthew Fiore Sampled By: Matthew Fiore
Phone: 518-250-4047 Date/Timeollected: 11/7/2016
Tumaround Time: 72 hr P.O.Number b'&
Log maple 'Sample Sample
No. No. Location Material, A ysis Results
01-01 Front Porch Ceiling Joint NYSStra ified PLM Stop at
Compound First Positive
nt
01-02 Front Porch Ceiling CompoJO10und NYS Stra fied PLM
02- -03 -Front Porch Ceiling .Drywall NYS Strat 45d,P1,M Stop at
First Positive
02-02 Front Porch Ceiling Drywall ` NYS Strat fied PLM
03-01 Bathroom Wall Board NYS Strat fled PLM Stop at
First Positive
03-02 Bathroom _ Wa11.Board N'YS'Strat ed PLM
04-01 Fiberglass Ceiling Tile Paper NYS Strati ted PLM Stop at
First Positive
04-02 Fiberglass Ceiling Tile Paper NYS Strati led PLM
as
o
r*t
Disposition of Samples:Accept_ Reject Explain
Comments: ?'
0
0
Relinquished IIy: Received By:
Date: j�
W /J.31 m
Page I of I
l�L i 1
Paqe I Of 1 � l I l l
EMSL Analytical, Inc. EMSL Order. 031633520
307 West 38th Street New York.NY 10018 Customer ID: ALP150
Tel/Fax(212)290-0051/(212)290-0058 Customer PO:
httip flwww.EMSIL.wrn/manhattanlab@emsl.com Project ID:
Attention: Matthew Fiore Phone: (518)250-4047
Alpine Environmental Services Fax:
438 New Kamer Road Received Date: 11/08/201610:31 AM
Albany, NY 12205 Analysis Date: 11/11/2016
Collected Date: 11/07/2016
Project: 16-19979-A/119 SEELYE RD. CLEVERDALE, NY
Test Report:Asbestos Analysis of Bulk Material
Analyzed Non-Asbestos
Test Date Color Fibrous Non-Fibrous Asbestos
Sample to 05.01 Description BATHROOM WALL BOARD-MASTIC
031533520-OM Homogeneity Heterogeneous
PLM NYS 198.1 Friable Not Analyzed
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOB 11/11/2016 Yellow 100.00% Other Inconclusive:None Detected
TEM NYS 198.4 NOB 11/1112016 Yellow 100.00% Other None Detected
Sample ID 05.02 Description BATHROOM WALL BOARD-MASTIC
031633520-0002 Homogeneity Heterogeneous
PLM NYS 198.1 Friable Not Analyzed
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOB 1111 112 01 6 Yellow 100.00% Other Inconclusive:None Detected
TEM NYS 198.4 NOB 11111/2016 Yellow 100.00% Other None Detected
Sample 10 06-01 Description BATHROOM COVE BASE-MASTIC
031633520-0003 Homogeneity Heterogeneous
PLM NYS 198.1 Friable Not Analyzed
PLM NY3198.6 VCM Not Analyzed
PLM NYS 198.6 NOB 11111/2016 Yellow 100.00% Other Inconclusive:None Detected
Final residue mass<1%
TEM NYS 198.4 NOB 1111112018 Yellow 100.00%Other None Detected
Sample ID 06-02 Description BATHROOM COVE BASE-MASTIC
0316335200(1(19 Homogeneity Heterogeneous
PLM NYS 198.1 Friable Not Analyzed
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOB 11/1112016 Yellow 100.00%Other Inconclusive:None Detected
TEM NYS 198A NOB 11/11/2016 Yellow 100.00% Other None Detected
Sample to 07-01 Description KITCHEN-LINOLEUM
0316335200005 Homogeneity Heterogeneous
PLM NYS 198.1 Friable Not Analyzed
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOB 11111/1016 Beige 100.00% Other Inconclusive:None Detected
TEM NYS 198A NOB 11111/2016 Beige 100.00% Other None Detected
Initial Report From:11/11/201612:33:22
Printed 11/111201612:33:23PM Page 1 of
EMSL Analytical, Inc. EMSLOrder.. 031633520
307 West 38th Street New York,NY 10018 Customer ID: ALP150
TelfFaz(212)290.0081/(212)290-0058 Customer PO:
http://www EMSL.com/manhattaniab@emsl.com Project 10:
Test Report:Asbestos Analysis of Bulk Material
Analyzed Non-Asbestos
Test Date Color Fibrous Non-Flbrous Asbestos
Sample ID 07-02 Description BATHROOM-LINOLEUM
031633520-0005 Homogeneity Heterogeneous
PLM NYS 188.1 Friable Not Analyzed
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOB 11/11/2016 Beige 100.00% Other Inconclusive:None Detected
TEM NYS 198.4 NOS 1111112016 Beige 100.00% Other None Detected
Sample ID 08-01 Description KITCHEN SINK-SOUND DEADENER
031533520-0007 Homogeneity Heterogeneous
PLM NYS 198.1 Friable Not Analyzed
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOB 11111/2016 Black None 98.70% Other 1.18% Chrysotile
TEM NYS 198.4 NOB 11/11/2016 Positive Stop(Not Analyzed)
Sample ID 08-02 Description KITCHEN SINK-SOUND DEADENER
031633520-0008 Homogeneity
PLM NYS 198.1 Friable Not Analyzed
PLM NYS 198.6 VCM Not Anatyzed
PLM NYS 198.6 NOB 11/11/2016 Positive Stop(Not Analyzed)
TEM NYS 198.4 NOB 11/11/2016 Positive Stop(Not Analyzed)
Samplelo 09411 Description CAMP ROOF-VAPOR BARRIER
031633520-0009 Homogeneity Heterogeneous
PLM NYS 198.1 Friable Not Analyzed
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 196.6 NOB 11111/2016 Black 100.00% Other Inconclusive:None Detected
Final residue mass ct%
TEM NYS 198.4 NOS 11/1112016 Black 100.00%Other None Detected
Sample ID 0302 Description BOAT HOUSE ROOF-VAPOR BARRIER
03/83352P00/0 Homogeneity Heterogeneous
PLM NYS 198.1 Friable Not Analyzed
PLM NYS 198.6 VCM NotAnalyzed
PLM NYS 198.6 NOB 11/11/2016 Black 7.90%Glass 92.10%Other Inconclusive:None Detected
TEM NYS 198.4 NOB 11/11/2016 Black 100.00% Other None Detected
SamplelD 10-01 Description CAMP ROOF-SHINGLE
031633520-0011 Homogeneity Heterogeneous
PLM NYS 198.1 Friable Not Analyzed
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 196.6 NOB 11/11/2016 Brown 1.60%Glean 88.40%Other Inconclusive:None Detected
TEM NYS 198.4 NOB 11/11/2016 Brovm 100.00% Other None Detected
Initial Report From:11/112016 12:33:22
Printed 11/112016 12:33:23PM Page 2 of 4
EMSL Analytical, Inc. EMSL Order: 031633520
307 West 38th St eet New York,NY 10018 Customer ID: ALP150
Tel/Far.(212)290-00511(212)290-0058 Customer PO:
http://w .EMSLwm I manhattaniab@emsl.com Project ID:
Test Repon:Asbestos Analysis of Bulk Material
Analyzed Non-Asbestos
Teat Date Color Fibrous Non-Fibrous Asbestos
Sample ID 10-02 Description BOAT HOUSE ROOF-SHINGLE
0:116335200012 Homogeneity Heterogeneous
PLM NYS 19&1 Friable Not Analyzed
PLM NYS 198.6 VCM Not Anatyzed
PLM NYS 198.9 NOB 11/11/2016 Brovm <I.00%Glen 100.00% Other Inconclusive:None Detected
TEM NYS 198.4 NOB 11/11/2016 Brown 100.00% Other None Detected
Sample ID 11-01 Description ROOF FLASHING-TAR
031633520-0013 Homogeneity Heterogeneous
PLM NYS 198.1 Friable Not Analyzed
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOB 11/11/2016 Black 100.00% Other Inconclusive:None Detected
TEM NYS 198.4 NOB 11/11/2016 Black 100.00% Other None Detected
Sample 10 11-02 Description ROOF FLASHING-TAR
031633520-0014 Homogeneity Heterogeneous
PLM NYS 198.1 Friable Not Analyzed
PLM NYS 198.6 VCM Not Anatyzed
PLM NYS 198.6 NOB 11/11/2016 Black 100.00% Other inconclusive:None Detected
TEM NYS 198.4 NOB 11/11/2016 Black 100.00% Other None Detected
Sample ID 12-01 Description CAMP ROOF-ROLLED ROOFING
0316335200015 Homogeneity Heterogeneous
PLM NYS 198.1 Friable Not Analyzed
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.6 NOB 11/11/2016 Black 100.00%Other Inconclusive:None Detected
TEM NYS 198.4 NOB 11111/2016 Bieck 100.00% Other None Detected
Sample ID 12-02 Description CAMP ROOF-ROLLED ROOFING
031633520-0016 Homogeneity Heterogeneous
PLM NYS 198.1 Friable Not Analyzed
PLM NYS 198.6 VCM Not Analyzed
PLM NYS 198.8 NOB 11/1112016 Black 100.00% Other Inconclusive:None Detected
TEM NYS 198A NOB 11/11/2016 Black 100.00% Other None Detected
Initial Report From:11/11/2016 12:33:22
Printed 11/11/2016 12:33.23PM Page 3 of 4
EMSL Analytical, Inc. EMSL Order: 031633520
307 West 38th Street Nev,York,NY 10018 Customer ID: ALP150
Tel/Fax:(212)290-00511(212)290-0058 Customer PO:
http.1/www.EMSLcom I manhattanlab@emsLcom Project ID:
Test Report:Asbestos Analysis of Bulk Material
The samples in this report were submitted to EMSL for analysis by Asbestos Analysis of Bulk Materials via NYS ELAP Approved Methods.The
reference number for these samples is the EMSL Order ID above. Please use this reference number when calling about these samples.
Report Comments:
Sample Receipt Date: 11/8/2016 Sample Receipt Time: 10:31 AM
Analysis Completed Date: 11/11/2016 Analysis Completed Time: 4:57 AM
Analvst(s):
z
Shahmkur Mahmud PLM NYS 196.6 NOB(15) Alicia FolgarTEM NYS 198.4 NOB(14)
Samples reviewed and approved by: %�jJ�
/"V—"
Hall,Laboratory Manager
or Other Approved Signatory
NOB=Non Friable Organically Bound NIA=Not Applicable VCM=Vermiculite Containing Material
-In New York State,TEM is currently the only method that can be used to determine if NOB materials can be considered or tested as non-asbestos containing.
All samples examined for the presence of vermiculus when analyzed via NYS 198.1.
-NYS Guidelines for Vermiculite containing samples are available at http:/A~.mdsxw6l.orgAabcerUela
maintains liability limited to cost of analysis.This pceNfameprodu ed,excenmGuidanm Rev0ittena pro al SL
report relates ortty to the samples reported above and may not be reproduced,except in full,without written approval by
EMSL EMSL bears no responsibility for sample collection activities or analytic medrod limitations.Interpretation and use of test results are the responsibility of the client
Samples were recelved In good condition unless otherwise noted.
This report must not be used by the client to claim product certification,approval,or endorsement by NVLAP,NIST,or any agency of the federal government This report may
contain data that is not covered by the NVLAP accreditation.
e0-Pp --'Yretl by ENSLAr-Vy Inc Nix York NY NYS a 11508
Inifial Report From:11/11/2016 12:33:22
Printed 111111201612:33:23PM Page 4 of 4
lyderID,: 031633520
(Drderi:;: 031633520 etvices;Inc, (j �jl �3 7 SZG Phone:''{3'I9)2504047
438 New Kamer Rd.
�• Neny,NY 12205 email:MattF@AlpineEnv.com
CHAIN OF CUSTODY
Client:Alpine Environmental Services Project:-119 Seclye Rd- Cleverdale-NY
Project Number: 16-19979-A
Contact:Matthew Fiore Sampled By: Matthew Fiore
Phone:518-250-4047 Date/Time Collected: 1 U712016
Tutstaround Tune:-72--hr .P:O.•-Number. TJX 'IGS-1 qqF(a q I fp,P
Log Sample Sample Sample Analysis Results
No. No. Location Material
05-01 Bathroom Wall Board Mastic Asbestos Stop at
NYS Protocol First Positive
05-02 Batluoom-Wall Board -Mastic Asbestos
NTYS Protocol
06-01 Bathroom Cove Base Mastic Asbestos, Stop.at
NTYS Protocol First Positive
06-02 Bathroom Cove Base Mastic Asbestos
NYS Protocol
07-01 . _ Kitchen---__ Urtoletun -• = --Asbestos _
NYS Protocol
07-02 Bathroom Umoleum Asbestos
NYS Protocol
08-01 Kitchen Sink Sound Asbestos Stop at
Deadener NYS Protocol First Positive
.08-02 KitchewSink Sound
Asbestos
Dea4em. NYS Protocol
09,OT Camp Roof Vapor Asbestos _� 3
Barrier NYS Protocol N
09-02 Boat House Roof Vapor Asbestos .e - �3
Barrier NYS Protocol t rn>
10e01 Camp.Roof Shingle '� StOS
NYS'Protocol- = rn
10:02 -BoacHottseftoof 3idngle Asbestos
NYS Protocol — >
11-01 Roof Flashing Tar Asbestos Stop at
NYS Protocol First Positive
11.42 Roof Flashing Tar Asbestos
NYS Protocol
� Page 1 of 2 ,
Paqe 1 Of 2
rderIp: 031633520
OrderID: 03163352C 3tVice5, 1iie; 03[b33SZG Pione:(518j250=4047
4j9 New[Caner Rd.
Y,
Albany,NY 12205 email:hiattF@AipineEnv.c-om
12-01 Camp Roof Rolled Asbestos Stop at
Roofing NYS Protocol First Positive
12=02
Camp Roof Rolled. Asbestos i
Roofing NYS Protocol
Disposition of Samples: Accept_ Reject Explain
Comments:
Relinquished By. Received Ey: Date: Time:
r /G /0;31 Ar"
CDT
O�
O
C, r
Page 2of2
Page 2 C' 2
New York State—Department of Labor
Division of Safety and Health
License and Certificate Unit
State Campus,Building 12
Albany,NY 12240
ASBESTOS HANDLING LICENSE
Alpine Environmental Services, Inc. FILE NUMBER: 00-0320
LICENSE NUMBER: 29095
438 New Kamer Road LICENSE CLASS: RESTRICTED
DATE OF ISSUE: 06/22/2016
Albany, NY 12205 EXPIRATION DATE: 07/31/2017
Duly Authorized Representative—Craig Petreikis:
This license has been issued in accordance with applicable provisions of Article 30 of the Labor Law of New York State and of
the New York State Codes, Rules and Regulations(12 NYCRR Part 56). It is subject to suspension or revocation for a(1)
serious violation of state,federal or local laws with regard to the conduct of an asbestos project,or(2)demonstrated lack of
responsibility in the conduct of any job involving asbestos or asbestos material.
This license is valid only for the contractor named above and this license or a photocopy must be prominently displayed at the
asbestos project worksite. This license verifies that all persons employed by the licensee on an asbestos project in New York
State have been issued an Asbestos Certificate,appropriate for the type of work they perform, by the New York State
Department of Labor.
Eileen M. Franko, Director
SH 432(8112) For the Commissioner of Labor
STATE OF NEW YORK- CEPARTMENT OF LABOR
ASBESTOS CERTFICATE -
MATTHEW J FIORE
CLASS(EXPIRES)
CATEC(03/17) DINSP(03/17)
H PM (03117)
MUST BE CARRIED ON ASBESTOS PROJECTS
STATE OF JEW YORK-, EPARTMENT OF LABOR
MOLD ASSESSOR -
MATTHEW FIORE
EXPIRES: 01-18
s
NEW YORK STATE DEPARTMENT OF HEALTH
WADSWORTH CENTER
Expires 12:01 AM April 01, 2017
Issued April 01, 2016
CERTIFICATE OF APPROVAL FOR LABORATORY SERVICE
Issued in accordance with and pursuant to section 502 Public Health Law or New York State
MR. JAMES HALL NY Lab Id No: 11506
EMSL ANALYTICAL, INC
307 WEST 38TH STREET
NEW YORK, NY 10018
is hereby APPROVED as an Environmental Laboratory for the category
ENVIRONMENTAL ANALYSES SOLID AND HAZARDOUS WASTE
All approved subcategories and/or analytes are listed below:
Miscellaneous
Asbestos in Friable Material Item 198.1 of Manual
EPA 600IM4182/020
Asbestos in Non-Fnable Material-PLM Item 198.6 of Manual(NOB by PLNI)
Asbestos in Non-Friable Material-TEM Item 198.4 of Manual
Lead in Dust Wipes EPA 70008
Lead in Paint EPA 7000B
Sample Preparation Methods
EPA 30508
Serial No.: 54297
Property of the New York State Department of Health. Certificates are valid only at the address
she=,must be conspicuously Posted,and are pnmed on secure paper. Continued accreditation depends
on successful ongoing participation in the Program. Consumers are urged to call(518)485-5570 to
verify the labdralonrs accreditatlon status.
Page 1 of 1
Alpine
ENVIRONMENTAL SERVICES
November 17, 2016
Michael Kaidas
Kaidas Properties, LLC
113 Seelye Road
Cleverdale, NY 12820
Re: Asbestos Materials Removal Confirmation at:
One Story Seasonal Residential Structure
119 Seelye Road
Cleverdale, New York
Michael,
As requested, Brian Gould, NYSDOL Asbestos Project Monitor, visited the site at the
above address on November 16th, 2016 for the purpose of verifying the removal of
asbestos containing materials previously identified in the asbestos pre-demolition
inspection performed in November 2016, Alpine Project Number#16-19979-A.
The asbestos material identified during the pre-demolition inspection, namely: sink with
asbestos sound deadener (undercoating), was observed to have been removed from the
building.
If Alpine Environmental Services can be of further assistance on this matter, please
contact Craig Petreikis at our office at (518) 250-4047, ext. 313.
Sincerely,
Alpine Environmental Services, Inc.
Brian Gould
NYS Department of Labor Asbestos Project Monitor (#95-02582)
O IPF=B.on RR'pe POund
IRF-1.CSpTedd Fond
va irr CI RF=CaPPe01m7 Roe FOurN
BMF=BaMey MB0aF0uM
nW=NBB1y R5b
Unca RIF Of lamp Post
Joan d M1MWd MiOeJ -Wed
417BR28 =SIpW WeX
_ _ =Wood FarW
.-MNd FWw PpW
Ra'in�
y LTi.I 1 348.96'
B
S37 tine
\
^ 5 122.14-
23.2. .
2'E
14 f1'
ALOnO 58oro
Tax P6mN'24].17-149
TO�NN OF QUEENSBURY Aree 5
CODES 4Da.". SR. ft. a,
0.93z scree °a r
BUILDING ® «®« �� i 19.40 'JO'E
a c &- <..e e• --o --- Lake
S88°08'30'W
fir. ❑ y ° .+,.' 14.36' George
(D � 033.]3' see"50'64•W Y pm
Sea Nde2
DeeUReMrenws' Q.e� .1� -.:' � oercn�
Tax Pertel'227.1)-149 ��
MrtlreelA IO.
J000,( w p� )
To �k (See NWa 1)
h6ch.IA KAOSSz 70 Tar PaW8221.1]-1L ®❑...,, I Tle llee
Susan P.wep;i7 0 Area M-08'26-W
OISS,Pay BWF 606.Page 1781 977 �00593x acr..T 102.]6'
s101 101'z Along SeOro
Ter Panel:22)41]-150
fBe
GWR,MiFam8y WNe Truq 10 No /
GuyRM ToNn,TrToualee
S...I(aldas z / / / ❑M 1'x
DaledOrrober19.2016 \�---------- - -�
RWk 6148,Pop 169 a (See NOle l) Ie).02'
111.75' \ry 3B)°4�,1IJ'W
lAd2L4nwr.... r.w.•n n•
p F.IamntBe ®
: w I'�
311.1)' nal p,wM1 1 OY ....w:..� �
®
M.POIUMe OI
Or,vogBC McCoy
Harry CmpenlerM oy
Dated'Wober6,1972
Lazl Reds.d'June 7,1994
o,q Of Xe7BMCCamdM 227.17-1-49 DEMO-000012-2017 Ien� Of
Map OIASurvaY Meda kr Ra6M197 l GROo NdeS
W'tlre A.6A~belIa 1 /� 91bJe] f1E r&lslFoDnm,ssAM E9ratt MComro7
RenxOC:Augv.0 10.19766 Kaidas, Michael& Susan Over ExiDdm to w,fdyAoundar.. Ol
By JMn B.Ven OWm 'AoExIEo IIIT Lo.Iny.....,...'
m.
Map OIA Survey Mace Tw 113 Seelye Road 2J An Eeeem.nfg RmFnC Mal I)eVoo OfTheFomhady.Bouou Run Fmm Mal Pa6W Groin
ACwmBapH070BMn9D ' &SA6oI On
Gvy R_FWnlefon A Coume 588°OBOO'W.11.36'...,Sad Eesomenl
Dated AVwmaer 71996 Demo Only- Boathouse ''195 s.f: 61MX Be6rea MlMma sad Rea Tp EaW IMcr
R y r18.
BV. Gus. 5Mver
By Van OWen 6
a uory
an D us eh M., PT . Bax.., made for
Steves _ Michael A. Kaidas 3_1
Land Surveyors Susan Kaidas
.error,
109 Naelland Rad WeeWabuq, Naw York IPPO{ -..,°v-,4°=444,.. TW WD of W.®.b¢q, l/arren Covnb, New York
r F 06
618TW2-8474 Naw York IJa. No. 60136 NO OAIE DEC`RIP710/1
Tu Partek:W.f7-148650