Demo-0803-2019 4 '=g TOWN OF QUEENSBURY
742 Bay Road, Queensbury,NY 12804-5904 (518)761-8201
Community Development- Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: DEMO-0803-2019 Date Issued: Tuesday, January 14, 2020
This is to certify that work requested to be done as shown by Permit Number DEMO-0803-2019
has been completed.
Tax Map Number: 226.15-1-16
Location: 108 LAKE PKWY
Owner: Brett West
Applicant: Brett West
This structure may be occupied as a: Demolition of residence
(asbestos report received) By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Compliance DOES NOT relieve the
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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
t a 1
742 Bay Road, Queensbury,NY 12804-5904 (518)761-8201
Community Development- Building & Codes (518) 761-8256
BUILDING PERMIT
Permit Number: DEMO-0803-2019
Tax Map No: 226.15-1-16
Permission is hereby granted to: Brett West
For property located at: 108 LAKE PKWY
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
Type of Construction
Owner Name: Brett West Demolition-Residential $0.00
Owner Address: 106 BAY PKWY Total Value $0.00
Lake George,NY 12845
Contractor or Builder's Name/Address Electrical Inspection Agency
Rick McGuire
65 Buttermilk Falls RD
Fort Ann,NY 12827
Plans& Specifications
Demolition of residence
(asbestos report received)
$150.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Monday,January 4, 2021
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbury before the expiration date.)
Dated at the Town of Queensbury; /J Friday, January 3,2020
SIGNED BY: �j fd for the Town of Queensbury.
Director of Building&Code Enforcement
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Office Use Only
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DEMOLITION�APPLICATION�--� Permit#:
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-it $ 06
Town ofQueensbury — ---
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742 Bay Road, Queensbury, NY 128045��' 1 20 �
P:518-761-8256 www.gueensbury.net
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Demolition Location: I mkt' dr�44f j4 6-1&� Tax Map ID it:
**AN ASBESTOS REPORT IS REQUIRED WITH ALL
DEMOLITION APPLICATION SUBMISSIONS**
CONTACT INFORMATION:
• Applicant:
Name(s): <CC4 �
Mailing Address, S/Z: 166ar wilj4 I-ALe 6 /VY 2
Cell Phone: 04 ) — _ ST7Land Line: � )
Email: -.FC Phe ' - ®�'1
• Primary Owner(s):
Name(s):
Mailing Address, C/S/Z:
Cell Phone: _( ) Land Line: _( )
Email:
❑ Check if all work will be performed by homeowner only
• Contractor: Workers' Comp documentation must be submitted with this application
Contact Name(s): e&r r 1� GZ4jjj@
Contractor Trade:
Mailing Address, C/S/Z:
Cell Phone: _( ) Land Line: _( )
Email:
"List all additional contractors on the back of this form
Contact Person for Building & Code Compliance: _Cr4hr_c�6
Cell Phone: _( ) Land Line: ( )
Email:
Demolition Application Revised Februa 201
i
DEMOLITION INFORMATION:
04 Where will demolition material be disposed?
2. Type of structure to be demolished:
a. Residence
b. Garage
c. Business
d. Storage Building
3. What type of utilities are connected to the structure:
a. Gas
b. Fuel Oil
c. Propane
d. Electric
e. Public Water
f. Well-Water Pump
Public Sewer rt
S Other
i. None
4. Have ALL utilities been disconnected? Yes No
ADDITIONAL INFORMATION:
1. Two inspections may be required: an inspection to determine that utilities are disconnected, if
necessary, and a final inspection, after the structure is removed and the site is cleaned up and graded.
2. Twenty-four(24) hour notification is required for inspections.
3. Workers' Comp insurance information is required to be submitted with this application.
Declaration: I acknowledge that no structure(s)will be removed from the parcel until the demolition application has
been reviewed and approved by the Town of Queensbury Building&Code Enforcement and Zoning Departments and a
permit has been issued.
I have read and agree to the above:
PRINT NAME:
SIGNATURE:.-z DATE:
Demolition Application Revised February 2019
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AirWater Environmental,LLC.
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November 25, 2019
Brett West
C/O 108 Lake Parkway
Lake George,New York 12845
RE: ASBESTOS SURVEY REPORT SINGLE FAMILY RESIDENCE
108 LAKE PARKWAY LAKE GEoRGE,NEW YoRK 12845
Dear Brett:
AirWater Environmental.LLC.is pleased to submit the attached Pre-Demolition Asbestos Survey
Report for the above-referenced site. The findings of the survey and the laboratory analysis of
samples obtained indicate that none of the samples obtained contain greater than 1%.
If you have questions regarding the findings of this survey,please do not hesitate to contact us.
Sincerely,
AirWater Environmental LLC.
TOWN OF QUEENSBURY
John Snyder BUILDING & CODES T°
Principal Reviewed Y: _
Date: Z
Enclosure
TOWN OF QUEENSBURY
BUILDING DEPARTMENT
Based on our limited examination,compliance
with our comments shall not be construed as
indicating the plans and s ecifications are in 266.15-1-16 DEMO-0803-2019
full compliance with the Building Codes of West Brett
New York State,
108 Lake Pkwy
Demolition Only
4E Vatrano Road Albany,New York 12205
(518)391-8030
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AirWater Environmental,LLC. r
PRE-RENOVATION/DEMOLITION
ASBESTOS SURVEY REPORT
ASBESTOS SURVEY REPORT-SINGLE FAMILY RESIDENCE
108 LAKE PARKWAY LAKE GEORGE,NEW YORK 12845
Survey Date:November 14, 2019
Prepared for•
BRETT WEST
C/O 108 LAKE PARKWAY
LAKE GEORGE,NEW YORK 12845
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AirWater Environmental,LLC.
TABLE OF CONTENTS
1.0 PURPOSE AND SCOPE OF SERVICES...............................................................1
2.0 REPRESENTATIVE ASBESTOS-CONTAINING MATERIAL SURVEY.....1
2.1 Homogeneous Areas........................................................................................1
2.2 Hazard Assessment Factors.............................................................................1
2.3 Sampling Strategy............................................................................................2
2.4 Laboratory Analytical Results.........................................................................3
3.0 RESULTS....................................................................................................................3
4.0 ASSUMPTIONS AND LEMTATIONS.............................:....................................4
ATTACHMENTS
Attachment A Laboratory Analysis Report with Chain of Custody Documentation
Sample and Asbestos Location Drawing
Attachment B Company,Personnel and Laboratory Accreditations and Licenses
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AirWater Environmental,LLC.
1.0 PURPOSEAND SCOPE OFSERVICES
The purpose of this project was to conduct a pre-demolition asbestos survey of the single-family
home located at 108 Lake Parkway Lake George,New York 12845.
AirWater Environmental LLC provided the following services.
Conduct a representative asbestos survey in the identified areas,which include:
1. Survey the site building.
2. Identify accessible suspect asbestos-containing materials(ACMs)that were not
previously tested.
3. Quantify ACMs,including material condition and location.
4. Collect and analyze bulk additional samples of suspect friable and non-friable
materials to eliminate suspect materials as asbestos containing.
2.0 REPRESENTATIVEASBESTOS-CONTAINLNGIVIATERIAL SURVEY
AirWater Environmental LLC conducted a pre-renovation/demolition asbestos survey of the
single-family home located at 108 Lake Parkway Lake George,New York 12845. A NYS
Certified and AHERA trained asbestos inspector conducted the asbestos survey of the building
materials targeted for demolition.
The areas were visually inspected for the presence of materials in the path of demolition that are
suspected to contain asbestos. Bulk samples of the identified suspect ACMs were collected and
placed into individual containers for transport to a National Voluntary Laboratory Accreditation
Program(NVLAP) and a New York State Department of Health Environmental Laboratory
Approval Program (ELAP)-accredited laboratory for analysis. Materials visibly identified as
non-asbestos(fibrous glass, foam rubber,wood, etc.)were not sampled. The asbestos survey
consisted of three basic procedures: 1) conducting a visual inspection of the structures;2)
identifying homogeneous areas (HAs) of suspect surfacing,thermal system insulation, and
miscellaneous materials; and 3) sampling accessible, friable and non-friable suspect materials.
2.1 Homogeneous Areas
Prior to collecting any samples,HAs were identified and listed to develop a sampling strategy.
A homogeneous sampling area can be described as one or more areas of material that are similar
in appearance and texture and that have the same installation date and function. The actual
number of samples collected from each homogeneous sampling area may vary,based on the type
of material and the professional judgment of the inspector.
2.2 Hazard Assessment Factors
From the list of suspect homogeneous materials, a physical assessment was performed for each
material on the list. A physical assessment includes evaluating the condition,assessing the
potential for disturbance, and determining the friability of each material. Friability is a term used
to describe the ease in which a building material inherently lends itself to disturbance. By
definition, "friable"materials are those that can be crumbled or reduced to powder by hand
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AirWater Environmental,LLC.
pressure when dry. Each material on the list was further classified into one of three categories,
which have specific sampling requirements for each category.
Surfacing Materials: Refers to spray-applied or troweled surfaces such as plaster ceilings
and walls,fireproofing,textured paints,textured plasters,and spray-
applied acoustical surfaces.
Thermal System Insulation: Refers to insulation used to inhibit heat gain or loss on pipes,boilers,
tanks,ducts, and various other building components.
Miscellaneous Materials: Refers to friable and non-friable products and materials that do not fit
in any of the above two categories such as resilient floor covering,
baseboards,mastics,adhesives,roofing material, caulking,glazing,
and siding. This category also contains wallboard and ceiling tile.
All confirmed ACMs were then assessed by their condition as good(intact), fair(damaged) or
poor(significantly damaged)per Title 40 Code of Federal Regulations Part 763. Material with
localized significant damage was also assessed as poor when observed.
2.3 Sampling Strategy
The asbestos inspection was conducted according to New York State Department of Labor
Industrial Code Rule 56 guidelines using a minimum number of samples collected from each
HA,which also meets the sampling requirement found in 29 CFR 1926.1101.
Sample collection depends on the category that the HA falls into and the amount of material
present;as follows:
GUIDELINES FOR DETERMINING THE NUMBER OF SAMPLES TO TAKE
HA CATEGORY HA SIZE `SAMPLES REQUIRED
Surfacing Materials <1,000 SF 3
1,000-5,000 SF 5
>5,000 SF 7 or more
Thermal System Insulation No Stipulation 3+(Must also sample all repairpatches)
Miscellaneous Materials No Stipulation Per ABERA,these materials must be sampled"in a
manner sufficient to determine whether or not they
contain asbestos"typically 2-3 samples based upon
inspectorjudgment.
If the analytical results indicated that all the samples collected per HA did not contain asbestos,
then the HA(material)would be considered a non-ACM. However, if the analytical results of
one or more of the samples collected per HA indicate that asbestos is present in quantities of
greater than 1 percent asbestos by weight(as defined by EPA), all of the HA(material)would be
treated as an ACM regardless of any other analytical results. Material,which can visually be
determined to be non-asbestos (i.e., fibrous glass, foam rubber, etc.)by the accredited inspector
are not required to be sampled.
Miscellaneous materials require adequately representative sampling,which is typically done by
collecting from two to three samples per material. Inspectors typically rely on other survey
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AirWater Environmental,LLC.
observations such as the condition, friability, and quantity of material to determine what would
be a sufficient amount of samples to accurately evaluate the presence or absence of asbestos
content.
Actual collection of a bulk asbestos sample involves physically removing a small piece of
material and placing it in a marked, airtight container. Sample containers are marked with a
unique identification number,which is also noted in the field notes.
2.4 Laboratory Analytical Results
The samples were sent to Atlas Environmental Lab in New York,New York for analysis.
• Friable Samples—Friable suspect asbestos containing material samples were analyzed
utilizing Method EPA/600/R-93/116 with New York State ELAP 198.1 revision to facilitate
compliance with both AHERA and the New York State Department of Health polarized light
microscopy(PLM)analytical techniques. All fibers observed were identifiedto determine
whether or not they contained asbestos.
• Non-Friable Samples—Non-friable organically bound(NOB) suspect asbestos containing
material samples were analyzed utilizing Method EPA/600/R-93/116 with New York State
ELAP 198.6 and 198.4 revisions to facilitate compliance with both AHERA and the New
York State Department of Health polarized light microscopy(PLM)and transmission
electron microscopy(TEM) analytical techniques. These non-friable organically bound
samples must be weighed to record initial sample weights,then subjected to muffle furnace
and acid bath sample preparation to eliminate the organic constituents. If the remaining
inorganic sample residue is 1%or less of the original sample weight,the sample is
considered a non-asbestos containing material. If the remaining inorganic sample residue is
greater than 1%of the original sample weight then the sample must be analyzed using either
PLM or TEM analytical techniques to determine that the sample is an asbestos containing
material(positive)or TEM to prove that the sample is a non-asbestos containing material
(negative). A non-friable organically bound sample must be proven a non-asbestos
containing material utilizing the NYS ELAP 198.4 TEM test method to be in compliance
with the New York state Department of Health.
3.0 RESULTS
The results of the pre-demolition asbestos survey of the single-family home located at 108 Lake
Parkway Lake George,New York 12845 indicated that the none of the samples obtained
contained greater than 1% asbestos.
Attachment A contains the complete asbestos laboratory analysis report with chain of custody
documentation and a sample location diagram. Attachment B contains the Company,Personnel
and Laboratory Accreditations and Licenses.
The building survey included limited destructive sampling for"hidden"materials. If, during the
course of demolition, any material is discovered that is not listed in the laboratory samples
results it must be treated as asbestos containing material and handled appropriately or sampled
by an inspector according to NYS and EPA regulations.
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AirWater Environmental,LLC.
One(1)copy of the results of the building/structure asbestos survey shall be immediately
transmitted by the building/structure owner as follows:
• One(1) copy of the completed asbestos survey shall be sent by the owner or their agent to the
local government entity charged with issuing a permit for such demolition,renovation,
remodeling or repair work under applicable State or local laws.
• The completed asbestos survey for controlled demolition(as per Subpart 56-11.5) or pre-
demolition asbestos projects shall also be submitted to the appropriate Asbestos_Control
Bureau district office.
• The completed asbestos survey shall be kept on the construction site with the asbestos
notification and variance, if required,throughout the duration of the asbestos project and any
associated demolition,renovation,remodeling or repair project.
4.0 ASSUMPTIONSAND LIMITATIONS
The results, findings, conclusions, and recommendations expressed in this report are based only
on conditions that were noted during the inspection of the single-family home located at 108
Lake Parkway Lake George,New York 12845 on the date of the survey work.
• The selection of sample locations and frequency of sampling was based on observations
and the assumption that like materials in the same area are homogeneous in content.
• Refer to Section 1.0 Purpose and Scope of Services of this report to see clarification of
survey locations that were in our scope of work. (This is Standard in Surveys)
• Exterior areas below grade were not inspected. Foundation sealers,buried piping,and
other items may exist below grade which may contain asbestos.
• Masonry was excluded from the survey.
• Vermiculite was not discovered during the survey. It may existing in concealed spaces.
If found it must be assumed to contain asbestos and must be abated accordingly. Random
penetrations were made to walls, ceilings, attic floor, and block foundation and no
vermiculite was observed. It still may exist in the structure as only full demolition will
reveal all materials.
• The siding was observed where possible in several areas. No cement board or transite
siding was observed. Only full removal of the outside siding would reveal all layers and
locations of other materials. If discovered,work must stop, and the discovered materials
must be tested. The exterior siding should be cored prior to demolition.
• This report reflects the conditions found at the date and time of the inspections. Conditions
of the area may change due to external events or forces. Re-inspection of the area may be
required prior to the start of any work if an extended period of time has passed or if
disturbances have occurred.
• Electrical wiring and electrical components were not sampled as it could not be confirmed
that the building was de-energized at the time of the survey. The power was on.
• Additional layers of flooring,wall systems,or ceiling systems may exist. Only full demolition
would reveal all layers. If discovered these items must be sampled if not sampled previously.
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AirWater Environmental,LLC
All quantities are estimates. The asbestos abatement contractor is to confirm the quantity prior to
bidding.
Limited destructive sampling was conducted as it was undecided if the building was to be re-occupied.
The floors,walls,and ceilings should be cored prior to demolition. Additional materials may be found
under carpets, floors,and inside walls and ceilings.
Our professional services have been performed,our findings obtained,and our conclusions and
recommendations prepared in accordance with customary principles and practices in the fields of
environmental science and engineering. This statement is in lieu of other statements either
expressed or implied. This report does not warrant against future operations or conditions,nor does
it warrant against operations or conditions present of a type or at a location not investigated.
Page 5
ATTACHMENT A
SULK SAMPLES WITH CORRESPONDING RESULTS
SAMPLE LOCATION DIAGRAM
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Atlas Environmental Lab,Corp.
255 West 36th Street,Suite#1503
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New York, NY 10018
Phone:(212)563-0400 Fax:(212)563-0401
www.atiasenvironmentallab.com
Bulk Asbestos Report by PLM-TEM
Client: Airwater Env.; 4E Vatrano Road,Albany, NY, 12205 Lab ID: BK1119418
Project Name/No.: 108 Lake Pkwy Date Received: 11/20/2019
Project Address: 108 Lake Parkway PLM Date Analyzed: 11/20/2019
Collected by: Client TEM Date Analyzed: 11/22/2019
Work Area: Structure Report Date: 11/22/2019
PLM TEM
Client Lab ID# Description/Location Analyst Description ORG% All% ASI% Non Asbestos% Asbestos%
ID# Fibrous% Fibrous% &Type &Type
01 BK1119418-1 Text.Cell. White,Homogeneous,Friable Not Applicable 0% 100% NAD
02 BK1119418-2 Text.Cell. White,Homogeneous,Friable Not Applicable 0% 100% NAD
03 BK1119418-3 Text.Ceil. White,Homogeneous,Friable Not Applicable 0% 100% NAD
04 BK1119418-4 Text.Cell. White,Homogeneous,Friable Not Applicable 0% 100% NAD
05 BK1119418-5 Text.Cell. White,Homogeneous,Friable Not Applicable 0% 100% NAD
06 BK1119418-6 Text.Cell. White,Homogeneous,Friable Not Applicable 0% 100% NAD
07 BK1119418-7 Text.Cell. White,Homogeneous,Friable Not Applicable 0% 100% NAD
O8 BK1119418-8 Text.Cell. White,Homogeneous,Friable Not Applicable 0% 100% NAD
as
09 BK1119418-9 Text.Cell. White,Homogeneous,Friable Not Applicable 0% 100% NAD
10 BK1 11 941 8-1 0 Sheetrock Grey/Brown,Homogeneous, Not Applicable 0% 100% NAD
Friable
Page 1 of 3 PM20 REV2,July 2019
Atlas Environmental Lab,Corp.
255 West 36th Street, Suite#1503
New York, NY 10018
1f° Phone:(212)563-0400 Fax:(212)563-0401
www.atiasenvironmentallab.com
Bulk Asbestos Report by PLM-TEM
Client: Airwater Env.; 4E Vatrano Road,Albany, NY, 12205 Lab ID: BK1119418
Project Name/No.: 108 Lake Pkwy Date Received: 11/20/2019
Project Address: 108 Lake Parkway PLM Date Analyzed: 11/20/2019
Collected by: Client TEM Date Analyzed: 1 1/2212 0 1 9
Work Area: Structure Report Date: 11/22/2019
PLM TEM
Client Lab ID# Description/Location Analyst Description ORG% AIM ASI% Non Asbestos% Asbestos%
ID# Fibrous% Fibrous% &Type &Type
11 BK1 1 1 941 8-1 1 Sheetrock Grey/Brown,Homogeneous, Not Applicable 0% 1000/. NAD
Friable
12 BK1119418-12 Joint Compound Grey/Brown,Homogeneous, Not Applicable 0% 100% NAD
Friable
13 BK1119418-13 Joint Compound Grey/Brown,Homogeneous,Friable Not Applicable- 0% 100% NAD
w�
14 BK1119418-14 Laundry Floor White,Homogeneous, 82.1 7.0 10.9 0% 100% NAD NAD
Non-Fibrous Inconclusive
15 BK1119418-15 Laundry Floor White,Homogeneous, 82.3 5.2 12.6 0% 100% NAD NAD
Non-Fibrous Inconclusive
16 BK1119418-16 Roof VB Black,Homogeneous, 50.0 29.8 20.2 0% 100% NAD NAD
Non-Fibrous Inconclusive
17 BK1 1 1 941 8-1 7 Roof VB Black,Homogeneous, 49.3 20.6 30.1 0% 100% NAD NAD
Non-Fibrous Inconclusive
18 BK1119418-18 Roof Shingle Black,Homogeneous, NAD
g Non-Fibrous 20.8 4.9 74.3 0% 100% Inconclusive NAD
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Page 2 of 3 PM20 REV2,July 2019
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Atlas Environmental Lab, Corp.
255 West 36th Street,Suite#1503
' New York, NY 10018
Phone:(212)563-0400 Fax:(212)563-0401
f I i www.atlasenvironmentallab.com
Bulk Asbestos Report by PLM-TEM
Client: Airwater Env.; 4E Vatrano Road,Albany, NY, 12205 Lab ID: BK1119418
Project Name/No.: 108 Lake Pkwy Date Received: 11/20/2019
Project Address: 108 Lake Parkway PLM Date Analyzed: 11/20/2019
Collected by: Client TEM Date Analyzed: 11/22/2019
Work Area: Structure Report Date: 11/22/2019
PLM TEM
Client Lab ID# Description/Location Analyst Description ORG% AII% ASI% o 0
ID# y p ° Non Asbestos/o Asbestos/o
Fibrous/° Fibrous% &Type &Type
19 BK1 1 1 941 8-1 9 Roof Shingle Black,Homogeneous, ° ° NAD
g Non-Fibrous 23.1 20.5 56.4 0% 100% Inconclusive NAD
Quantitative Analysis(Semi/Full):Bulk Asbestos Analysis-PLM by EPA 600/M4-82-020 per 40 CFR or ELAP198.1(friable)and 198.6(NOB)samples for New York.
NAD=no asbestos detected,NAPS=Not Analyzed/Positive Stop,Trace=<1%,FBGL=Fiberglass,CELL=Cellulose,CHRY=Chrysotile,Amo=Amosite,CRO=Crocidollte,ANTH=Anthophylite,TRE=Tremolite,ACT=Actinolile,NA=not applicable.
PLM is not consistently reliable in detecting Asbestos in floor coverings and similar non friable organically bound materials.NAD or Trace results by PLM are inconclusive.
TEM is currently the only method that can be used to determine if this material can be considered or treated as non asbestos containing in NY State.
All samples were prepared and analyzed in accordance with the EPA'TEM Method for Identifying and Quantifying Asbestos in Non-Fibrous Organically Bound Bulk Samples"ELAP 198.4".
ORG%=Ashed Organic%,AII=Acid Insoluble Inorganic%,ASI=Acid Soluble Inorganic%
This"Summary of Analytical Results"shall not be used by the client to claim product certification,approval,or endorsement by NVLAP,NIST,ELAP or any agency of the U.S Government.The results relate
only to the items tested.This report may not be reproduced,except in full,without the written approval of AEL.Atlas Environmental lab did not collect the analyzed samples and thus accepts no liability with
regard to their collection and/or maintenance.AEL relies on client's data.The liability of Atlas Environmental Lab corp with respect to the services charged,shall in no event exceed the amount of the invoice.
NYS-ELAP#11999,NVLAP Lab Code:500092-0,NJ ID:NY034,PA ID:68-05662,CT ID:PH-0154
PLM Analyst:AS TEM Analyst:VR Approved by:
Page 3 of 3 PM20 REV2,July 2019
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Atlas Environmental Lab,Corp
255 West 36"'Street,Stdte# 1503
1\1 Ow York,NY 100 IS
Plione:(212)563-0400 Fax:(212)563-0401
BULK Material for Asbestos, Chain of CustOft
Client Contact Name -f Project Name& No.-,Z'(-?9
Address Phone Number Project Location
P%k Email L /Oa
Work Area ts'Tf2
Analysis Requested: -NOB zNOgr- >4
_-TEM � p on V positive per homogeneous material, SOF/SM-V(198.8)
i Turn Around Time: ❑ Sa-ne Day E]24 Hrs.AX48 Hrs. El 72 Hrs.
If Vermiculite present, proceed to Method 198.8: TAT:
Friable/ Homogenous Accept
Field ID AEL Location/Description Non Area Sample
Lab ID Friable Yes/No
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Relinquished B, 1�U1171a Date: Tj Tjime-
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Datej J/ Time:
Analyst: 4 Sign-aMre. Date: Time:
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255 West 36"'Sueot, Soite# 1503
NonYork''NY 10018
Ph000:(212)563'0400 Pxx:(212)563'0401
BULK rubterial for Asbestos, Chain Of Cust0d.y
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Address Phone Number '---Oroject Location
Work Area
Analysis Requested4 PLM,'�"°^'wOe. oa. op on V positive per x000uenouvn material, aonSm-V(1oo.8)________
Turn Around Time: 0SamaDayE]24Hrs. Fl72Hru.
|f Vermiculite present,proceed to Method i88.8:_ TAT:
Friablel Homogenous Accept
Field ID AEL Location/Description Non Area Sample
Lab ID Friable Yes/No
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Sampled By- Date: Time:
Received-gy: Date: Time:
�A—nalyst: Signature: Date: Time:
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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
Airwater Environmental, LLC FILE NUMBER: 1&97582
LICENSE NUMBER: 97582
P.O. Box 1071 LICENSE CLASS: RESTRICTED
DATE OF ISSUE: 11/21/2018
Averill Park, NY 1201.8,_ EXPIRATION DATE: 11/30/2019
Duly Authorized.Representative—John T Snyder.-.
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 withiegard 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(8/12) For the Commissioner of Labor
John T Snyder
Asbestos Inspector Expires 03/31/2020
OHN t SNYDER lit'.:,,
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Town of Queensbury- Building and Codes- Fire Marshal
742 Bay Road-(518)761-8256 Building (518)761-8206 Fire Marshal
Case Number: DEMO-0803-2019 Case Module: Permit
Inspection Date: Fri Jan 10, 2020 Inspection Status: Passed
Inspector: Charles Dyer Inspection Type: Demolition
Job Address: 108 LAKE PKWY Parcel Number:- 226.15-1-16
Lake George, NY, 12845
Contact Type Company Name Name
Contractor McGuire, Rick
Applicant West, Brett
Granted Permission West, Brett
Primary Owner West, Brett
Checklist Item Status
Building Inspector Notes Failed
Asbestos Removed Documentation Passed
Electric Disconnected Passed
Oil/Gas Disconnected Passed
Septic/Sewer Line Disconneted Passed
Property Cleaned Up and Graded Passed
Jan 10,2020 Page(1)
• e ® - ® ® o0026440,20)
Checklist Item Status
Okay to Issue Certificate of Compliance Passed
Dyer,Charles
Jan 10,2020 Page(2)