DEMO-0652-2022 Office Use.CIO
Permit GrJo7'aoa
DEMOLITION APPLICATION
#: �M
Permit Fee:.$ l(0 5. oo .
-Town of Qgeens6
Wy Invoice#: 7
742 Bay Road,Queensbury;NY::12804
Flood Zone? Y R e v i e a 'we d-B
P:518-761-8256 vuvirw.gueensbury.net
11 ii
]Demolition Locatioinc I�� �1 : l e eTaxMap ID:# �9 - I::� ::
. . Ny �a�aa .
**AN.ASBESTOS REPORT IS REQUIRED WITH. ALL
DEMOLITION APPLICATION.SUBMISSIO S**
DEMOLITION INFORMATION:
L.-Where Will demolition:material be disposed.. %�' -rev ..�✓(�.N�s
2. Type of.structure a demolished:
a. Res iden d. Storage.Building�
b.:,Garage e.. Other:
C. Business .. . .
3. . What type pities are:connected to the structure:
a•:: Gas f. Well=Water P
El
b. Fuel Oil.: g. Public Sewer.
c....Propan .. . . . . . h. Othe
d: Electric 1. None
e. P.ublic- ater
4. Have:ALL utilities (wate.r, electric, etc.):been disconnected? ::Yes N.o
ADDITIONAL:I:N FORMATION:
1.: T.wo.inspections_are:required: an:inspection to:determine that utilities are
disconnected; and a final inspection after the structure is removed and the site is
cleaned .up and gra.ded:.. -
2.' Twenty-four (24) hour notification is::required for inspections.
3. Workers'.Comp insurance information is required to be submitted with this application.
Declarationi'l acknowledge:that-h6structure(s)will:be.removed from the parcel until the demolition application has,
been.reviewed and.approved bVthe Town of.Qdeensbury Building.&Code Enforcement and Zoning Departments and a
permit has been issued:::
have read sand agree to:the above:
PRINT NAME: r�Fkv MS .
SIGNATURE: DATE: !e)
ZDZZ
Demolition Application Revised June 2022
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Applicant:
Name(s): 1JU6Wt)e wi th&'M' S
Mailing Address,-C/S/Z: PO 6OX a1L// i 010-Lyj jaA A)V /aUQ
Cell Phone: ONO Land Line: _�/St- -loS�o- as'29
Email: �d Gvm�Co�->sa- F�bf ma��• Ca�rr1
• Primary Owner(s):
Name(s): FYi rn y and aura .Sialra-4r.
Mailing Address, C/S/Z: •33 SLL1a4.y'?-- Rood
Cell Phone: �Il - SSS�- .�Co�i l Land Line:
Email: 5)r)a`?''ra�h gg 0i4f/odk.Com '
❑ Check if all work will be performed by property owner only
• Contractor: (List all additional contractors on the back of this form)
Contact Name(s): (-'rcndal) F'-KClpa 0:+t]g nc�
Contractor Trade: E-kC
Mailing Address, C/S/Z: 3. l t)Dp C. al A?oDd
Cell Phone: �5-1 Lj �b - 41&9 9 Land Line: 5-)E- 09 3-- a4l�l
Email: Christ►randy lldO.S a? Qj ib . c� -
**Workers' Comp documentation must be submitted with this application**
Contact Person for any questions regarding this project: ftkn-e (.t�
Cell Phone: -1 Land Line: 6- k - (pSIP " S'
Email: W w—MS ClmSf- 0 hbflYYa 0am
Demolition Application Revised June 2022
$a 2202
BUILDING DEPARTMENT Ij6 8 PA 128tti
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.
TOWN OF-QUEENSiBURY D E~01[1,� E
BUILDING & CODES QEPT. - OCT 2 2022
Reviewed B : _
Date: TOWN OF OUEENSBURY
BUIi_DING'c'CODES
To Whin ft,j,I M FILE COPY
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227.9-1-4 DEMO-0652-2022
Sinatra Jr, Frank & Laura
105 Rockhurst Rd
Demolition of SFD
Michael J ,Stevens
Licensed Asbestos Inspector
PO Box 2202 Glens Falls, NY
12801
MIKE STEVENS
RE: Pre-Demolition Asbestos Building Survey REPORT
105 ROCKHURST ROAD
CLEVERDALE NY
12820
r
Dear MR FRANK SINATRA
Please find the attached Pre-Demolition Asbestos Building
Survey Report completed for the Property Located at:
105 ROCKHURST ROAD NY 12820
If you have any questions or require additional information,
please feel free to contact:
Mike Stevens @ 518-656-3270
Sincerely,
Michael J. Stevens
PRE-DEMOLITION ASBESTOS SURVEY
105 ROCKHURST RD
CLEVERDALE NY
12820
Background Information:
Buildings) Location:
105 ROCKHURST RD
CLEVERDALE NY
12820
Party Performing Survey: Michael J. Stevens
PO Box 2202, Glens Falls, NY 12801
Laboratory Used For Sample Analysis:
Amerisci New york
117 East 30h Street
New York, New York 10016
NYSDOH ELAP Laboratory ID # 11480
OWNERS INFO MIKE STEVENS
PO BOX 2202
GLENS FALLS NY
12801
Pre-Demolition Asbestos Building Survey
105 ROCKHURST RD
CLEVERDALE NY 12820
INTRODUCTION
ON SEPTEMBER 23 2022 FRANK SINATRA OF 105 ROCKHURST RD
CLEVERDALE NY 12820 retained: Michael.J. Stevens to preform an
asbestos survey of the property located at 105 ROCKHURST RD
CLEVERDALE NY 12820
The BUILDING is located AT 105 ROCKHURST RD CLEVERDALE NY
12820 IS A structure of approximately 2000 square feet on a 75000
SQUARE FOOT LOT(construction date is approximately 1955 according
to County records). The residence consists of wood frame
construction, WOOD CLAPBOARD. SIDING AND ASPHALT SHINGLE
ROOF
The purpose of this survey was to complete a pre-demolition asbestos
survey in accordance with Industrial Code Rule (ICR) 56. At the request
of the client destructive sampling techniques( i.e. breaking through
sheetrock walls, removing tiles, etc.) were utilized.
The remainder of this report describes building inspection procedures,
a summary of the results, conclusions and recommendations. A site plan
and building specific sampling locations are depicted.
Michael J. Stevens assumes no responsibilities for the implementation
or enforcement of the procedures, work practices, engineering controls,
or other asbestos-control methods recommended, required or
mentioned in this document.
;re-D.emoltion Asbestos
Building
:. ..:
Buil in. g Survey
1. :R I: . RAD0 .
�CLt �Di1V2820
Summary Of Results
A material is considered by the EPA to be Asbestos-containing if at least
one sample collected from the homogenous area shows asbestos
present in an amount greater than 1%. Based on review of the
Laboratory results, none of the submitted friable and non-friable ACM
samples analyzed contain asbestos.
Survey
Building Inspection Procedure
Mr. Michael J. Stevens, a New York State Certified Inspector
Certification #72900) conducted an asbestos survey of the building(s)
on AUGUST 9 2022 which included both the interior and exterior
portions of the BUILDING
Mr. Stevens visually inspected-the residence for suspect asbestos
containing materials (ACMs). The roof of the residence was.accessed
with a ladder: Methodologies used were generally consistent with
USEPA publications: "Guidance for.Controlling Asbestos Containing
Materials in Buildings" (June 1985) and "Asbestos in Buildings:
Simplified Sampling Scheme for Friable Surfacing Materials" (dated
October 1985). The documents were used for their asbestos survey
concepts, such as identifying homogenous materials, quantifying
materials, and evaluating friability(potential to crumble with hand
pressure) and condition (good, damaged or significantly damaged).
Over 3,000 products are currently known to contain asbestos.Although
no comprehensive list of ACMs exists, Mr. Stevens utilized the USEPA's "
Sample List of Suspect Asbestos-Containing Materials" as a general
guide to identify and document suspect ACMs within the building, In
addition, in some cases, Mr. Stevens utilized their experience and the
knowledge obtained through training courses to identify suspect ACMs.
Mr. Stevens inspected all spaces of the building, including storage
T rooms, utility rooms, and crawl spaces.
During the survey,the inspector classified each suspectACM as one of
three types: 1) surfacing material applied by spray or trowel, 2) thermal
insulation on pipes,tanks, boilers and related features, 3) miscellaneous
not classified as surfacing material or thermal system insulation. The
inspector touched all assumed or suspected materials on all surfaces,
including waI s,-ceilings, structural members, and mechanical
equipment, to determine their friability, or the extent to which the
material, when dry, may be crumbled, pulverized, or reduced to powder
by hand pressure. In addition, the inspector assessed the condition of
each suspect ACM and classified the material as either 1) good 2)
damaged 3) significantly damaged. A suspect ACM is considered in good
condition if.there are no visible signs of damage, is considered damaged
if the material contains less than 25% localized damage or less than
10% distributed damage and is considered significantly damaged if the
material contains greater than 25% localized damage or greater than
10% distributed damage.
It should be noted that in accordance with the Occupational Safety and
Health Administration (OSHA), Asbestos Construction Standard 29 CFR
1926.1101, any thermal insulation, surfacing materials, floor tiles,
roofing felts and shingles found in buildings constructed no later than
January 1, 1981 are presumed ACMS
• r a
To arrive at a preliminary_evaluation of ACM, Mr. Stevens considered
the following in its assessment: 1) location of the ACM; 2) condition of
the material, such as damage and severity of damage; 3) accessibility to
building occupants; 4) the potential for disturbance; 5) known or
suspected causes of damage; and 6) preventative measures that might
eliminate the likelihood of future damage.
s s
Pre-Demolition Asbestos Building
Survey
105 ROCKHURST RD
CLEVERDALE NY
12820
Conclusions & Recommendations
Conclusions
Based on the completion of the survey,.No regulated asbestos materials
(>1%) were identified at the site based on materials sampled.
Recommendations _
Based on the results of this survey, Mike Stevens has-the following
recommendations at this time.
• Prior to any demolition activities, a copy of the asbestos survey
should be provided to the demolition contractor and local
asbestos control board.
• Maintain a copy of this asbestos survey with the property.
• If un-assessed suspect ACM is identified during demolition
activities, retain an asbestos building inspector to sample the
material(s).
• One copy of the asbestos survey report should be immediately
transmitted by the building owner as follows:
1) One copy of this report must be immediately transmitted by the
building owner, or their agent, to the local government entity
charged with issuing a permit for such demolition,-renovation,
remodeling or repair work under applicable NY Stat laws.
2) The completed asbestos survey for controlled demolition (as per
Subpart 56-11.5) or pre-demolition asbestos projects shall also be
submitted to the NEW YORK STATE DEPARTMENT OF LABOR
Pre-Demolition Asbestos Building Survey
10S ROCKHURST RD -
CLEVERDALE NY12820
OCTOBER 212022
LABORATORY RESULTS
105 ROCKHURST- ROAD
CLEVERDALE NY 12820
Please Reply To:
- AmeriScii New York
117 EAST 30TH ST.
AM*ERI Scl _ - _NEW YORK,NY 10016
TEL:(212)679-8600 • FAX:(212)679-3114
LABORATORYELECTRONIC TRANSMITTAL
To: Michael Stevens _From: Valeriu Voicu
Michael J. Stevens PimeriSci Join#: _222102178 =
Fax#: Subject: ELAP-PLM/TEM 5 day Results
Client Project_ 105;-_105 Rockhurst; 105
Email: mikesoldcars@gmail.com Rockhurst Rd., NY
Date: Wednesday, October 19,2022 Number of Pages:- -
Tlme: 11:56:11 (including cover sheet)
Comments: -
NOTE:Attached report is to be considered preliminary until final review with accompanying analysis summary letter is issued.
CONFIDENTIALITY NOTICE: Unless otherwise indicated,the information contained in this communication is confidential information
intended for use of the individual named above. If the reader of this communication is not the intended recipient,you are hereby notified that
any dissemination,distribution or copying of this communication is prohibited. If you have received.this communication in error,please
immediately notify the sender by telephone and return the original message to the above address via the US Postal Service at our expense.-
Samples are disposed of in 60 days or unless otherwise instructed by the protocol or special instructions in writing. Thank you.
Certified Analysis Service 24 Hours A Day•7 Days A'Week Competitive Prices
visit our web site-www.amerisci.com
Boston• Los Angeles•New York•Richmond
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T.
An DER'^c l 117 EAST Y 10 16
IVI _v` I NEW YORK,NY 10016
TEL(212)679-8600• FAX:(212)679-3114
PLM Bulk Asbestos Report
Michael I Stevens Date Received 10/14/22 AmeriSci Job# 222102178
Attn: Michael Stevens Date Examined 10/18/22 P.O. #
PO Box 2202 ELAP# 11480 Page 1 Of 7
RE: 105; 105 Rockhurst; 105 Rockhurst Rd., NY
Glens Falls, NY 12801
Client No. / HGA Lab No. Asbestos Present Total % Asbestos
1 222102178-01 No NAD
Location:Living Room/Kitchen Walls/Ceiling-Compound (by NYS ELAP 198.1)
by Valeriu Voicu
on 10/18/22
Analyst Description:White, Homogeneous, Non-Fibrous, Bulk Material
Asbestos Types:
Other Material: Cellulose Trace, Non-fibrous 100%
2 222102178-02 No NAD
Location:Living Room/Kitchen Walls/Ceiling-Compound (by NYS ELAP 198.1)
by Valeriu Voicu
on 10/18/22
Analyst Description:White, Homogeneous, Non-Fibrous, Bulk Material
Asbestos Types:
Other Material: Cellulose Trace, Non-fibrous 100%
3 222102178-03 No NAD
Location:Living Room/Kitchen Walls/Ceiling-Compound (by NYS ELAP 198.1)
by Valeriu Voicu
on 10/18/22
Analyst Description:White, Homogeneous, Non-Fibrous, Bulk Material
Asbestos Types:
Other Material: Cellulose Trace, Non-fibrous 100%
4 222102178-04 No NAD
Location:Living Room/Kitchen Walls/Ceiling-Compound (by NYS ELAP 198.1)
by Valeriu Voicu
on 10/18/22
Analyst Description:White, Homogeneous, Non-Fibrous, Bulk Material
Asbestos Types:
Other Material: Cellulose Trace, Non-fibrous 100%
5 222102178-05 No NAD
Location:Living Room/Kitchen Walls/Ceiling-Sheetrock (by NYS ELAP 198.1)
by Valeriu Voicu
on 10/18/22
Analyst Description:Brown/White, Heterogeneous, Fibrous, Bulk Material
Asbestos Types:
Other Material: Cellulose 13%, Non-fibrous 87%
See Reporting notes on last page
AmeriSci Job#: 222102178 Page 2 of 7
Client Name:Michael J. Stevens
PLM Bulk Asbestos Report
105; 105 Rockhurst; 105 Rockhurst Rd., NY
Client No. 1 HGA Lab No. Asbestos Present Total % Asbestos
6 222102178-06 No NAP
Location:Living Room/Kitchen Walls/Ceiling-Sheetrock (by NYS ELAP 198.1)
by Valeriu Voicu
on 10/18/22
Analyst Description:Brown/White, Heterogeneous, Fibrous, Bulk Material
Asbestos Types:
Other Material: Cellulose 10%, Non-fibrous 90%
7 222102178-07 No NAD
Location:Living Room/Kitchen Walls/Ceiling-Sheetrock (by NYS ELAP 198.1)
by Valeriu Voicu
on 10/18/22
Analyst Description:Brown/White, Heterogeneous, Fibrous, Bulk Material
Asbestos Types:
Other Material: Cellulose 15%, Non-fibrous 85%
8 222102178-08 No NAD
Location:Living Room/Kitchen Walls/Ceiling-Sheetrock (by NYS ELAP 198.1)
by Valeriu Voicu
on 10/18/22
Analyst Description:Brown/White, Heterogeneous, Fibrous, Bulk Material
Asbestos Types:
Other Material: Cellulose 13%, Non-fibrous 87%
9 222102178-09 No NAD
Location:Bathroom Ceiling/Walls-Compound (by NYS ELAP 198.1)
by Valeriu Voicu
on 10/18/22
Analyst Description:White, Homogeneous, Non-Fibrous, Bulk Material
Asbestos Types:
Other Material: Cellulose Trace, Non-fibrous 100%
10 222102178-10 No NAD
Location:Bathroom Ceiling/Walls-Compound (by NYS ELAP 198.1)
by Valeriu Voicu
on 10/18/22
Analyst Description:White, Homogeneous, Non-Fibrous, Bulk Material
Asbestos Types:
Other Material: Cellulose Trace, Non-fibrous 100%
11 222102178-11 No NAD
Location:Bathroom Ceiling/Walls-Compound (by NYS ELAP 198.1)
by Valeriu Voicu
on 10/18/22
Analyst Description:White, Homogeneous, Non-Fibrous, Bulk Material
Asbestos Types:
Other Material: Cellulose Trace, Non-fibrous 100%
See Reporting notes on last page
F
AmeriSci Job#: 222102178 Page 3 of 7
Client Name:Michael J. Stevens
PLM Bulk Asbestos Report
105; 105 Rockhurst; 105 Rockhurst Rd., NY
Client No. / HGA Lab No. Asbestos Present Total % Asbestos
12 222102178-12 No NAD
Location:Bathroom Ceiling/Walls-Sheetrock (by NYS ELAP 198.1)
by Valeriu Voicu
on 10/18/22
Analyst Description:Off-White/Brown, Heterogeneous, Fibrous, Bulk Material
Asbestos Types:
Other Material: Cellulose 10%, Non-fibrous 90%
13 222102178-13 No NAD
Location:Bathroom Ceiling/Walls-Sheetrock (by NYS ELAP 198.1)
by Valeriu Voicu
on 10/18/22
Analyst Description:Off-White/Brown, Heterogeneous, Fibrous, Bulk Material
Asbestos Types:
Other Material: Cellulose 10%, Non-fibrous 90%
14 222102178-14 No NAD
Location:Bathroom Ceiling/Walls-Sheetrock (by NYS ELAP 198.1)
by Valeriu Voicu
on 10/16/22
Analyst Description:White/Brown, Heterogeneous, Fibrous, Bulk Material
Asbestos Types:
Other Material: Cellulose 20%, Non-fibrous 80%
15 222102178-15 No NAD
Location:Bathroom Floor-Vinyl Flooring (by NYS ELAP 198.6)
by Valeriu Voicu
on 10/18/22
Analyst Description:Off-White/Beige, Homogeneous, Non-Fibrous, Bulk Material
Asbestos Types:
Other Material: Non-fibrous 1.6%
16 222102178-16 No NAD
Location:Bathroom Floor-Vinyl Flooring (by NYS ELAP 198.6)
by Valeriu Voicu
on 10/18/22
Analyst Description:Off-White/Beige, Homogeneous, Fibrous, Bulk Material
Asbestos Types:
Other Material: Fibrous glass 3%, Non-fibrous 3.8%
17 222102178-17 No NAD
Location:Bathroom Floor-Vinyl Flooring (by NYS ELAP 198.6)
by Valeriu Voicu
on 10/18/22
Analyst Description:Beige, Homogeneous, Non-Fibrous, Bulk Material
Asbestos Types:
Other Material: Fibrous glass 1%, Non-fibrous 3.1%
See Reporting notes on last page
AmeriSci Job#: 222102178 Page 4 of 7
Client Name:Michael J. Stevens
PLM Bulk Asbestos Report
105; 105 Rockhurst; 105 Rockhurst Rd., NY
Client No. / HGA Lab No. Asbestos Present Total % Asbestos
18 222102178-18 No NAD
Location:Bedroom 1 Walls/Ceilings-Compound (by NYS ELAP 198.1)
by Valeriu Voicu
on 10/18/22
Analyst Description:White, Homogeneous, Non-Fibrous, Bulk Material
Asbestos Types:
Other Material: Cellulose Trace, Non-fibrous 100%
19 222102178-19 No NAD
Location:Bedroom 1 Walls/Ceilings-Compound (by NYS ELAP 198.1)
by Valeriu Voicu
on 10/18/22
Analyst Description:White, Homogeneous, Non-Fibrous, Bulk Material
Asbestos Types:
Other Material: Cellulose Trace, Non-fibrous 100%
20 222102178-20 No NAD
Location:Bedroom 1 Walls/Ceilings-Compound (by NYS ELAP 198.1)
by Valeriu Voicu
on 10/18/22
Analyst Description:White, Homogeneous, Non-Fibrous, Bulk Material
Asbestos Types:
Other Material: Cellulose Trace, Non-fibrous 100%
21 222102178-21 No NAD
Location:Bedroom 1 Walls/Ceilings-Sheetrock (by NYS ELAP 198.1)
by Valeriu Voicu
on 1.0/18/22
Analyst Description:Brown/White, Heterogeneous, Fibrous, Bulk Material
Asbestos Types:
Other Material: Cellulose 8%, Non-fibrous 92%
22 222102178-22 No NAD
Location:Bedroom 1 Walls/Ceilings-Sheetrock (by NYS ELAP 198.1)
by Valeriu Voicu
on 10/18/22
Analyst Description:Brown/White, Heterogeneous, Fibrous, Bulk Material
Asbestos Types:
Other Material: Cellulose 5%, Non-fibrous 95%
23 222102178-23 No NAD
Location:Bedroom 1 Walls/Ceilings-Sheetrock (by NYS ELAP 198.1)
by Valeriu Voicu
on 10/18/22
Analyst Description:Brown/White, Heterogeneous, Fibrous, Bulk Material
Asbestos Types:
Other Material: Cellulose 3%, Non-fibrous 97%
See Reporting notes on last page
AmeriSci Job#: 222102178 Page 5 of 7
Client Name:Michael J. Stevens
PLM Bulk Asbestos Report
105; 105 Rockhurst; 105 Rockhurst Rd., NY
Client No. / HGA Lab No. Asbestos Present Total % Asbestos
24 222102178-24 No NAD
Location:Bedroom 2 Walls/Ceilings-Compound (by NYS ELAP 198.1)
by Valeriu Voicu
on 10/18/22
Analyst Description:White, Homogeneous, Non-Fibrous, Bulk Material
Asbestos Types:
Other Material: Cellulose Trace, Non-fibrous 100%
25 222102178-25 No NAD
Location:Bedroom'2 Walls/Ceilings-Compound (by NYS ELAP 198.1)
by Valeriu Voicu
on 10/18/22
Analyst Description:White, Homogeneous, Non-Fibrous, Bulk Material
Asbestos Types:
Other Material: Cellulose Trace, Non-fibrous 100%
26 222102178-26 No NAD
Location:Bedroom 2 Walls/Ceilings-Compound (by NYS ELAP 198.1)
by Valeriu Voicu
on 10/18/22
Analyst Description:White, Homogeneous, Non-Fibrous, Bulk Material
Asbestos Types:
Other Material: Cellulose Trace, Non-fibrous 100% C
27 222102178-27 No NAD
Location:Bedroom 2 Walls/Ceilings-Sheetrock (by NYS ELAP 198.1)
by Valeriu Voicu
on 10/18/22
Analyst Description:Off-White/Brown, Heterogeneous, Fibrous, Bulk Material
Asbestos Types:
Other Material: Cellulose 3%, Non-fibrous 97%
28 222102178-28 No NAD
Location:Bedroom 2 Walls/Ceilings-Sheetrock (by NYS ELAP 198.1)
by Valeriu Voicu
on 10/18/22
Analyst Description:Off-White, Homogeneous, Fibrous, Bulk Material
Asbestos Types:,
Other Material: Cellulose 2%, Non-fibrous 98%
29 222102178-29 No NAD
Location:Bedroom 2 Walls/Ceilings-Sheetrock (by NYS ELAP 198.1)
by Valeriu Voicu
J
on 10/18/22
Analyst Description:Off-White/Brown, Heterogeneous, Fibrous, Bulk Material
Asbestos Types:
Other Material: Cellulose 3%, Non-fibrous 97%
See Reporting notes on last page
AmeriSci Job#: 222102178 Page 6 of 7
Client Name:Michael J. Stevens
PLM Bulk Asbestos Report
105; 105 Rockhurst; 105 Rockhurst Rd., NY
Client No. / HGA Lab No. Asbestos Present Total % Asbestos
30 222102178-30 No NAD
Location:Roof Shingles-Asphalt Shingles (by NYS ELAP 198.6)
by Valeriu Voicu
on 10/18/22
Analyst Description:Black, Homogeneous, Non-Fibrous, Bulk Material
Asbestos Types:
Other Material: Fibrous glass Trace, Non-fibrous 33.6%
31 222102178-31 No NAD
Location:Roof Shingles-Asphalt Shingles (by NYS ELAP 198.6)
by Valeriu Voicu
on 10/18/22
Analyst Description:Black, Homogeneous, Non-Fibrous, Bulk Material
Asbestos Types:
Other Material: Fibrous glass 1%, Non-fibrous 36.2%
32 222102178-32 No NAD
Location:Roof Shingles-Asphalt Shingles (by NYS ELAP 198.6)
by Valeriu Voicu
on 10/18/22
Analyst Description:Black, Homogeneous, Non-Fibrous, Bulk Material
Asbestos Types:
Other Material: Fibrous glass 1%, Non-fibrous 30.6%
33 222102178-33 No NAD .
Location:Roof Shingles-Asphalt Shingles (by NYS ELAP 198.6)
by Valeriu Voicu
on 10/18/22
Analyst Description:Black, Homogeneous, Non-Fibrous, Bulk Material
Asbestos Types:
Other Material: Fibrous glass 1%, Non-fibrous 28.7%
34 222102178-34 No NAD
Location:Roof Shingles-Asphalt Shingles (by NYS ELAP 198.6)
by Valeriu Voicu
on 10/18/22
Analyst Description:Black, Homogeneous, Fibrous, Bulk Material
Asbestos Types:
Other Material: Fibrous glass 2%, Non-fibrous 27.5%
See Reporting notes on last page
AmeriSci Job#: 222102178 Page 7 of 7
Client Name:Michael J. Stevens
PLM Bulk Asbestos Report
105; 105 Rockhurst; 105 Rockhurst Rd., NY
Reporting Notes:
Analyzed by:Valedu Voicu Reviewed by:Feyza Gungor
Date:10/18/2022
*NAD/NSD=no asbestos detected;NA=not analyzed;NA/PS=not analyzed/positive stop,(SOF-V)=Sprayed On Fireproofing containing Vermiculite;
(SM-V)=Surfacing Material containing Vermiculite;PLM Bulk Asbestos Analysis using Olympus,Model BH-2 Pol Scope,Microscope,Serial#:229915,by
Appd E to Subpt E,40 CFR 763 quantified by either CVES or 400 pt ct as noted for each analysis(NVLAP 200546-0),ELAP PLM Method 198.1 for NY
friable samples;which includes the identification and quantitation of vermiculite,or ELAP 198.6 for NOB samples,or EPA 400 pt ct by EPA 600-
M4-82-020(NY ELAP Lab 11480);Note: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(also see EPA Advisory for floor tile,FR 59,146,38970,8/1/94)National Institute of Standards
and Technology Accreditation requirements mandate that this report must not be reproduced except in full without the approval of the Iab.This PLM
report relates ONLY to the items tested.RI Cert AAL-094,CT Cert PH-0186,Mass Cert AA000054,NJ Lab ID #NY031.
END OF REPORT
AmeriSci Job#: 222102178 Page 1 Of 3
Client Name: Michael J. Stevens
Table
Summary of Bulk Asbestos Analysis Results
105; 105 Rockhurst; 105 Rockhurst Rd., NY
Sample Heat Acid Insoluble
AmeriSci HG Weight Sensitive Soluble Non-Asbestos **Asbestos%by **Asbestos%by
Sample# Client Sample# Area (gram) Organic% Inorganic% Inorganic% PLM/DS TEM
01 1 — — — — NAD NA
Location: Living Room/Kitchen Walls/Ceiling-Compound
02 2 — — — — NAD NA
Location: Living Room/Kitchen Walls/Ceiling-Compound
03 3 — — — -- NAD NA
Location: Living Room/Kitchen Walls/Ceiling-Compound
04 4 — — — -- NAD NA
Location: Living Room/Kitchen Walls/Ceiling-Compound
05 5 — — -- — NAD NA
Location: Living Room/Kitchen Walls/Ceiling-Sheetrock
06 6 — — -- — NAD NA
Location: Living Room/Kitchen Walls/Ceiling-Sheetrock
07 7 — — — — NAD NA
Location: Living Room/Kitchen Walls/Ceiling-Sheetrock
08 8 — — — — NAD NA
Location: Living Room/Kitchen Walls/Ceiling-Sheetrock
09 9 — — -- — NAD NA
Location: Bathroom Ceiling/Walls-Compound
10 10 — — — — NAD NA
Location: Bathroom Ceiling/Walls-Compound
11 11 — — — — NAD NA
Location: Bathroom Ceiling/Walls-Compound
12 12 - — — -- NAD NA
Location: Bathroom Ceiling/Walls-Sheetrock
13 13 — — — — NAD NA
Location: Bathroom Ceiling/Walls-Sheetrock
14 14 — — — — NAD NA
Location:'Bathroom Ceiling/Walls-Sheetrock
15 15 0.187 67.3 31.1 1.6 NAD NAD
Location: Bathroom Floor-Vinyl Flooring
16 16 0.143 66.3 26.9 6.8 NAD NAD
Location: Bathroom Floor-Vinyl Flooring
See Reporting notes on last page
AmeriSci Job#: 222102178 Page 2 of 3
Client Name: Michael J. Stevens
Table I
Summary of Bulk Asbestos Analysis Results
105; 105 Rockhurst; 105 Rockhurst Rd., NY
Sample Heat Acid Insoluble
AmeriSci HG Weight Sensitive Soluble Non-Asbestos *'Asbestos%by "Asbestos%by
Sample# Client Sample# Area (gram) Organic% Inorganic% Inorganic% PLM/DS TEM
17 17 0.133 66.4 29.5 4.1 NAD NAD
Location: Bathroom Floor-Vinyl Flooring
18 18 — — — — NAD NA
Location: Bedroom 1 Walls/Ceilings-Compound
19 19 — — — — NAD NA
Location: Bedroom 1 Walls/Ceilings-Compound
20 20 — — — — NAD NA
Location: Bedroom 1 Walls/Ceilings-Compound
21 21 — — — — NAD NA
Location: Bedroom 1 Walls/Ceilings-Sheetrock
22 22 — — — — NAD NA
Location: Bedroom 1 Walls/Ceilings-Sheetrock
23 23 — — — — NAD NA
Location: Bedroom 1 Walls/Ceilings-Sheetrock
24 24 — — — — NAD NA
Location: Bedroom 2 Walls/Ceilings-Compound
25 25 — -- — — NAD NA
Location: Bedroom 2 Walls/Ceilings-Compound
26 26 — — — — NAD NA
Location. Bedroom 2 Walls/Ceilings-Compound
27 27 — — — — NAD NA
Location: Bedroom 2 Walls/Ceilings-Sheetrock
28 28 — — — — NAD NA
Location: Bedroom 2 Walls/Ceilings-Sheetrock
29 29 — — — — NAD NA
Location: Bedroom 2 Walls/Ceilings-Sheetrock
30 30 0.548 20.8 45.6 33.6 NAD NAD
Location: Roof Shingles-Asphalt Shingles
31 31 0.247 19.3 43.6 37.2 NAD NAD
Location: Roof Shingles-Asphalt Shingles
32 32 0.244 21.8 46.6 31.6 NAD NAD
Location: Roof Shingles-Asphalt Shingles
See Reporting notes on last page
AmeriSci Job#: 222102178 Page 3 Of 3
Client Name: Michael J. Stevens
Table I
Summary of Bulk Asbestos Analysis Results
105; 105 Rockhurst; 105 Rockhurst Rd., NY
Sample Heat Acid Insoluble
AmeriSci HG Weight Sensitive Soluble Non-Asbestos **Asbestos%by **Asbestos%by
Sample# Client Sample# Area (gram) Organic% Inorganic% Inorganic% PLM/DS TEM
33 33 0.299 23.8 46.5 29.7 NAD NAD
Location: Roof Shingles-Asphalt Shingles
34 34 0.171 24.4 46.1 29.5 NAD NAD
Location: Roof Shingles-Asphalt Shingles
Analyzed by:Feyza Gungor Reviewed by:Feyza Gungor �"' (/
Date:10/19/2022
**Quantitative Analysis(Semi/Full);Bulk Asbestos Analysis-PLM by Appd E to Subpt E,40 CFR 763 or NYSDOH ELAP 198.1 for New York friable samples or NYSDOH ELAP 198.6 for New York NOB samples;
TEM(Semi/Full)by EPA 600/R-93/116(or NYSDOH ELAP 198A for New York samples).Analysis using Hitachi,Model H600-Noran 7 System,Microscope,Serial#:542-26-10.NAD=no asbestos detected
during a quantitative analysis;NA=not analyzed;Trace= <1%;(SOF-V)=Sprayed On Fireproofing containing Vermiculite;(SM-V)=Surfacing Material containing Vermiculite;Quantitation for beginning
weights of<0.1 grams should be considered as qualitative only;Qualitative Analysis:Asbestos analysis results of"Present'or"NVA=No Visible Asbestos"represents results for Qualitative PLM or TEM
Analysis only(no accreditation coverage available from any regulatory agency for qualitative analyses):NVLAP(PLM)200546-0,NYSDOH ELAP Lab 11480,N1 Lab ID #NY031.
Warning Note:PLM limitation,only TEM will resolve fibers<0.25 micrometers in diameter.TEM bulk analysis is representative of the fine grained matrix material and may not be representative of non-
uniformly dispersed debris for which PLM evaluation is recommended(i.e.soils and other heterogenous materials).
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NOTES OCTOBER 21 2022
STRUCTURE IS A TWO STORY BUILDING
ASPHALT ROOF WITH NO UNDERLAYMENT
WOOD SIDING NO UNDERLAYMENT
MAN DOORS ARE WOOD AND METAL NO GLAZING FOR THE GLASS
BARE FIBERGLASS INSULATION
REPLACEMENT WINDOWS NO CALK
BARE HARDWOOD FLOORS
AGE OF STRUCTURE POSTED AT 1955
ALL DRAIN AND WATER PIPES ARE PLASTIC OR COPPER
EXTERIOR FINISH IS STAIN OVER PINE CLAPBOARD
PORCH IS BARE WOOD UNFINISHED
Wrk Sta`N�� to #?ep�iitrre► t=.�f:ta�a'����7:f:..
ClMsion oigi;tybnd W allh-
ucenseqp �fi ISit' ,t_..•
State Campus; tulldiE3g
Albin I�11'.1224Q
= W1Y -ASBESTOS H ANDLlNG LIGE p" •�: '�-
aves ?w :' :,FILE NUMBER: '(��i'29� _ y '`
K; `'
LICENSE NUMBER �0. � ��
P.O Box`2202x 5 . ::a. L Et�dSE.GLASS.: E . a . '
ism
-' `Iftikf Iis,.:iiY 1280
fitp4J1)4 _
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' ,.5..:;:.:s Gv� tip. •::v ���
billy A dRe resentativez-4",Michaei ' .vsn 6x
` is'k-m lhas Wen issued in acei i ielance with��ip}iaablr3 pro�+isicn�of Ai�iel'o,6 of the U6r Law of New��ir1��>afe of>y
die Net�+,X k'St4Codes,Rules I Regutatig6s<42IV"��,tr'RR Part 3b) It is�ct to sus nsion or revocat#on or a(1) ; rr
s oils vio ation o€state,federal de al laws vt�tb.r�gard.to, he coriduc?_f,s�f A estos'prvj Zt,or,(2)demo Irate
repoiiasibilify iY the anduct of anyFjC involving,asigstos or asbsis
j• ,
�.
This-l v d oit� for the contractor named:above and'tl s license ar a pliotocpp�t must b ;promi i by display et)at#fie
asbes s project ro sit 4:4�'hi license verifies th$t*1tpersons.emp1Gyed lid the licensee on asi= sbestc ;�proj .in ?t Y
State Iiis a Geer�isstr`ed ant"A�bestos Certificate,app#c+pr 'i _i-i ie.tyip"! l:err ey p y fit date
t.. �'th- erform b the�t'ew Yo ,=
Departcitt of.Lior.
s.
L04r
Eileen M.Franko, Director
y.-
5H 482(8112) For the Comnussioner of Labor
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