DEMO-0589-2023 Office Use Only
Permit#: 0 `eq--Zn 2�
)
DEMOLITION APPLICATION
Permit Fee:$ I b5—
Town of Queensbury
Invoice#: (0, 18
742 Bay Road,Queensbury,NY 12804
6)
P:518-761-8256 www.queensbury.net Flood Zone? Y Reviewed Byg---VkA
Demolition Location: 65? '7j1'Z --i�,-‘ l.i'i Tax Map ID #: I7 g`'f
**AN ASBESTOS REPORT IS REQUIRED WITH ALL
DEMOLITION APPLICATION SUBMISSIONS**
DEMOLITION INFORMATION:
1. Where will demolition material be disposed? PO '--P Pfvi � i�-t Ctice(/if
2. Type of structure to be demolished:
a. Residence ) d. Storage Building -�.
b. Garage X e. Other:c. Business
3. What type of utilities are connected to the structure: zg
a. Gas f. Well-Water Pump Sep I y 2�, f1
b. Fuel Oil g. Public Sewer Qbls�l 23
c. Propane h. Other '' L;1,
f�/
d. Electric X i. None �Z eta&Y
e. Public Water
4. Have ALL utilities (water, electric, etc.) been disconnected? Yes iL No
ADDITIONAL INFORMATION:
1. Two 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 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: 0'k Ci /(RL
SIGNATURE: '/� _ DATE: QI�/S7Z3
Demolition Application Revised June 2022
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Applicant:
Name(s): c"r-(sow
Mailing Address, C/S/Z: (l v( (I ►arc Dr 5Nfl-rcre0A r (-t_SSc 12266
Cell Phone: i 2.c— S—U — Land Line:
Email: 9cArL5C(5 13A-tS- avr�� 11_� ( 1 CdLA-1
• Primary Owner(s):
Name(s): CSGIA.
Mailing Address, C/S/Z:
Cell Phone: Land Line:
Email:
a 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):
Contractor Trade:
Mailing Address, C/S/Z:
Cell Phone: Land Line:
Email:
**Workers' Comp documentation must be submitted with this application**
Contact Person for any questions regarding this project: lJ (
Cell Phone: Land Line:
Email:
Demolition Application Revised June 2022
`' f '
t Waste Management Green Ridge LF Reprint
4 'ct / Y%1, 424 Peters Rd
Ticket# 124722
`°_'' ° Gansevoort, NY, 12831
WASTE MANAGEMENT Ph: (518) 636-2141
Customer Name CASHCUSTOMERS CASH CUSTOMER Carrier CASH CASH CUSTOMER
Ticket Date 09/15/2023 Vehicle# 1 Volume
Payment Type Credit Card Container
Manual Ticket# Driver
Hauling Ticket# Check#
Route Billing # 0000068 li'A
State Waste Code Gen EPA ID
Manifest
Destination Grid I 25 LIFT 1
Profile ()
Generator
Time Scale Operator Inbound Gross 7120 lb
In 09/15/2023 09: Outbound SD #605115 Tare 7040 lb
Out 09/15/2023 10: Outbound SD #605115 Net 80 lb
Tons 0.04
Comments
Product LD% Qty UOM Rate Tax Amount Origin
1 CDTC-CDTC - DEMOLI 100 0.04 Tons 109.05 $109.05 WAR
2 WWM-P-Waste Water 100 % 14.50 $15.81 WAR
3 ENERGY-Energy Surc 100 % 8.20 $8.94 WAR
Amt $133.80, Amt Tendered $133.80, Chg Due $0.00
Total Tax
Driver's Signature ( N
Total Ticket
$133.80
t , .
. 411111 TOWN OF QUEENSBURY
4TO WI BUILDING & CODES EPT. .
foo-- lope 4Reviewe By:
A al I, , 7.u. . j Date:
2
INK 4p58
..,________„_, 7 :
Capital District Inspections SEP ' j
P.O. Box 2581 ~- !� 'To tivp,r AJ � -.4L-V,seLifiv
Glenville, NY 12325-0581
TOWN OF QUEENSBURY
518 688-9517 BUILDING 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.
Address: 67 Brayton Lane r 0
FIL
Queensbury, NY 12845
Owner: Eric Carlson
Project: Pre-Demolition Asbestos Survey
Date: June 22, 2023
239.12-2-84 DEMO-0589-2023
Carlson, Eric
67 Brayton Ln
Demolition of residence & garage
This report contains the results of a pre-demolition asbestos survey in accordance with NYS
Department of Labor Industrial Code Rule 56. The survey was completed on the date listed
above at the address listed above by Capital District Inspections (CDI). The purpose of this
report was to identify any Asbestos Containing Materials (ACM) at the address listed above.
CDI took samples of all Suspected Asbestos Containing Materials (SACM) in the areas of the
building as directed by the owner. Asbestos containing material is defined as any material that
contains more than 1% asbestos. Any materials that contain 1% or less asbestos will be defined
as Non Asbestos Containing Materials (NACM).
Every effort was made to identify all suspect materials in accessible areas. There is the
possibility that suspect materials were not identified in non-accessible areas. If suspect material
is discovered during the demolition project it needs to be sampled before it is disturbed. CDI
returned to site at the request of owner to narrow down locations of asbestos.
Attached to this report is the following required information:
Appendix A- Laboratory results of all bulk samples taken
Appendix B—Chain of Custody for all of the homogeneous areas sampled
Appendix C—Laboratory License
Appendix D—CDI's current Asbestos Handling License
Appendix E—CDI's Asbestos Inspector(s) who performed the survey
CDI has analyzed the laboratory results that were taken on 6-22-23 and has determined
that there is no asbestos containing materials present in any of the samples taken. It is
determined that the white taping compound previously identified as ACM is only in the
addition which is approximately100 sf based on floor area. There is no ACM in the white
taping compound in the main house which can be seen in the attached results. There is no
ACM in the existing garage or shed.
If you have any questions regarding this report feel free to contact Capital District Inspections at
(518) 688-9517. The invoice has been included under separate cover. Payment is due at time of
receipt of this report.
Sincerely,el
.A-1\
Jo Carlson
Capital District Inspections
r
Append 1 x A
y •�t ' t PA RADI:GM
179 Lake Avenue,Rochester,NY 14608 Office:(585)647-2530 Fax (585)647-3311
���,:;ti ^
b [N.VInOn/{r N.'r':At SrAVICit, INC
PLM&TEM BULK ASEESTOSANALYSCS.REPORT
Vitt NY.SDOH ELAP ilk tftod.198.1,198A.and l n6
Client: Capital D'strictIrispections Job No: 4913-23
Location: 67 Brayton Lane Page: 1 of 2
Sample,Date: 6/22/2023
:PLM Asbestos PLM N TEM Asbestos TEM PLM Non-
Fibers Type& Total 0 Fibers Type& Total Non-Asbestos Fibrous
i Client ID Lab ID .Sampling Location Description Percentage Asbestos B Percentage Asbestos" Fibers Type& Matrix
1 Percentage Material
1 42982 Kitchen/Family White Taping None Detected 0% Not Required ' ' N/A— None Detected 100%
Compound
I'
2 42983 Bed 1 White Taping None Detected 0% Not Required N/A None Detected 100%
Compound
t
i 3 ,42984 Bed 2 White Taping None Detected 0% Not Required N/A None Detected " 100%
Compound
i
i 4 • 42985 Bed 3 White Taping None Detected 0% Not Required N/A None Detected 100% •
i - Compound
" 5 42986 Bath Wall . White Taping None Detected 0% 'Not Required N/A None Detected 100%
I Compound
i
6 42987 Shed Roof Brown Shingle Inconclusive 0% ' ' None Detected : cL0% Fiberglass 10% 90%
I No Asbestos
3 Detected
i 7 '.42988 Shed Tar Black Tar Paper Inconclusive 0% None Detected ' <1,0% None Detected 100%
I No Asbestos 1/
Detected
8 42989 Garage ' Gray Shingle Inconclusive 0% , None Detected <L0% Fiberglass 5% 95%
I No Asbestos
Detected
9 42990 Garage Black Tar Paper Inconclusive 0% None Detected : <1.0% None Detected ` 100% '
No Asbestos v
Detected
KEY TO NOB COLUMN SYMBOLS
No Symbol in the NOB column denotes sample analyzed by ELAP Method 198.1(PLM).
V NOB(non-friable organically bound)denotes material analyzed by ELAP Method 198.6(PLM)and 198.4(TEM)as'noted.
i denotes material analyzed by CLAP Method 198.6(PLM)per NYSDOH.This Method does not remove vermiculite and may underestimate the level of asbestos
present in a sample containing greater than 10%vermiculite.
9 denotes friable material analyzed by ELAP Method 198.6(PLM)and 198.4(TEM)as noted.
X denotes sample prepped only by ELAP Method 198.6.
"•Polarized-light microscopy Is not consistently reliable in detecting asbestos in Boor coverings and similar non-friable organically bound materials.
quantitative transmission electron microscopy is currently the only method that can be used•to determine if this material can be considered or treated as non-asbestos •
containing.
PLM Bulls Asbestos Analysis by New YorkStute tleparugcnt of Health,,ELAP Method 1901,198,4'and 1O8,6('Polarrzed Light Microscopy end Transmi,sing Electron?atr nscnpy Methods for
Identifying and Quantitating Asbestos in Bulk Samples and In Non-Friable Organically Bound Bulk Samples<')or EPA 600/M4-82-020 per 40 CFR 763(NVLAP Lab Code 200530-0),
ELAP ID No.: 10958
Lab Code 200530-0 for PLM Analysis
Microscope: Olympus 8H-211211874 Microscope: )EOL-100CX-II NF,M-156094.87
PLM Analyst:T.Bush TEM Analyst:T.Ma
Date of Analysis: 6/29/2023 Date of Analysis: 6/30/2023 b
Laboratory Results Approved By: A,U112.--L.. •ZLt{' ---mot
Asbestos Technical Director or Designee Fernanda Weinman
Paradigm Environmental Services,Inc,Ls nut responsible for the data supplied by an independent inspector.National Institute of.Siagdards and Technology Accreditation
requirements mandate that this report must not be reproduced except in full without the approval of the laboratory.This PLM report relates ONLY to the items tested.This
report must not he used to claim product endorsement by NVLAP or any agency of the U.S.Government Quality control data(including 95%confidence limits and/or ,
laboratory and analysts'precision)Is available upon request.
4913-23 6/30/2023
CHAIN OF CUSTODY FO1? BULK ASBESTOS ANALYSIS -
'
r
f' 179 Lake Avenue.Rochester-New York 1460% Office:585.647-2530
1815 Love Road,Grand Island,New York 14072 Office:716.775•5777
,PARADIS
: •••«•••., . Client: Contact; OFFICE USE ONLY
CAp'I-f Z 1 Distr+c•- Zr1.5.PeCi r* "Sohn CiAr 150 r P�{�
v' Ph/one Number(:: p Email Address for Data: Job#: ` 113-2
(5 I 6 S(�--15 I, eAp..4•�l 0�15414♦1'lflspkG-1'tof15 e,1 3Gr1•Cc�/7t
Client Mailing Address: Results To: T'arnAroundTime: 6-36 Page of
CAPi•1>ai•Dis�r.ak ZesPet noes - -pl-FAcksii•c#•in td zas a smuts,Coj-ys • .1 f ,.2 _30 S fl Other 1 'i
Date Sampled: Material Type/Quaptity: Date Logged In: 6 22-23
4.0. g•ox 25Z 1 -A. ."_,Ps_j Ft'able NOB TEM !Logged in By:cB
• Project Location:
tor)
Git yak Illy. 4 =05131 G ;o .;.Ce fc .. ,
' ' Client ID Lab ID 'Sampling;Location Color Material She Type of Material
`kvtl'tG cs7--NiKPe
re
' 9 23 1•3>r v l - (-,)v- l-r9 . > / i PC V.k - Co01.TTOac
tt
,3 l 3�D a Lt.) IZ1._ _i• !+Putt. r do-rri.,•, •
jr
4 9 985 • I3ciD 3 L.t)1.4N-r1= 7 1, . 71APtn.x, Pot w1
o '
(l .
g S. • 9817 . ; Toy-r t-a- rtiA-1-1.__. - . w k4c' j .) 1 ►t-v ivnr.n- - ra reline 4
•
•6 4 . Y•87 , ;1 • .:a rd ;�ao - rz 43cw-n I rt . t5HWY...�-
7. _"7 q$3 ::�el V t b1 t. l,,.1i:.:. '° 1 `� r, •Y2-..pr—t2'
8 939 (` =.t t za-. st_ c.e l 6,��,� :1, .,
•
9 t q.QG valor-1`2 r4 Cx ? C6l,0: C-1e ( " .-�° -a .1 -
10 =_ ___ ________ .
Sampled By: : Date: All samples will be analyzed by the appropriate New Perk:lime Departateal at Htaltb methods 090.1,19R-4
' Sohn CA f'Sort - `i!- and 198.6)unless EPA 6001M4/821020 per 40 CFR 76.1 sad/ar EPA 600/R-93/116 methods are requested. s
f
Transported to Paradigm By: Date: " ' CHECK TO AUTOMATICALLY PERFORM TEM ON NOBS I
UPS 2 roand 4' 4., or provide TEM contaci name: '
T()TALUMBFR()F SAMPLES ()N`ALI,CI•iAINS.()I:'trccivrtl By: Dine: N
jj
f
6 Z7 •�3 ia?2 (•us1-()DY: •
-
k
A?pencil x a
- NEW YORK STATE DEPARTMENT OF HEALTH
WADSWORTH CENTER
ZF
Ift ,' ,. � 4 Expires 12:01 AM April 01,2024
,Ik_ Issued April 01,2022
I E1�, � Revised March 30,2023
CERTIFICATE OF APPROVAL FOR LABORATORY SERVICE
Issued In accordance with and pursuant to section 502 Public Health Law of New York State
MR,STEVE DEVITO NY Lab Id No:10958
PARADIGM ENVIRONMENTAL SERVICES INC
179 LAKE AVENUE
ROCHESTER,NY 14608
Is herebyAPPROVED 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 600/M4/82/020
Asbestos in Non-Friable Material-PLM Item 198.6 of Manual(NOB by PLM)
Asbestos in Non-Friable Material-TEM Item 198.4 of Manual
Lead in Dust Wipes EPA 6010C
Lead in Paint EPA 6010C
Sample Preparation Methods
EPA 3050E
Serial No.: 66263
Property of the New York State Department of Health. Certificates are valid only at the address shown and must be
conspicuously posted by the laboratory. Continued accreditation depends an the laboratory's successful ongoing
participation in the Program. Consumers may verify a laboratory's accreditation status online
at https:llapps.health.ny.gov/pubdoh/applinkslwc/elappublicweb/,by phone(518)485-5570 or by email to elapephealth.ny.gay.
Page 1 of 1
. . ,
Appendix D
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This liCeiis-e,has been issued in accordance'Witlf„4iiiliCabieta-OVigiolisTotAffielelt)of the Lab‘Pr Law of New".kOrl State and of.
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asbestostproject wO-rksite.:4:7his license verifies.thatall,pirabliKelnprdye „hylt"e_licensee on an asbestos project iiiNew York
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SH 432(8/12) For the Commissioner of Labor
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Appendix
STATE OF NEW-YOR EiET4T1ENT:OF LABOR
ASBESTOS CERTIFICATE •-
• ,4 '••'* JOHN F CARLSON
..CLASS(EXPIRES)
DiNSP(02/24)
=';'; •.z,
MUST BE CAMEO ON,ASBESToS P kalECTS-
intim mum-mita
MAP REFERENCES
i) Map Entlt/etl: "Su trvetae o/the Margwct Dole oyla
May tlgfe: l�vfng T et. Deed Book 529f, Page
Prepared By 320, No. 6] Bray[on Lan®"
y 15 2016
Northeeat Lund SLrvey & [antl
Dewlap,nent c.naan.nes. Pc
2) Warren county Real Property Tox Map
Town o! Oueansbury
Sactlon 238.12
BoecNa 84
LEGEND:
CIRF danotas Capped /ran Rad Found
CONC denote. Concrete
IPF denote. Iron PTpa Favnd
NM denote. Nl 1— --..y UxRty Pde
OHUL denotes Olrerheod —11, Lines
RET denofes ftetalning
A06GHGORING PROPERTIES NOTE.
ROULIER RESIDENCE ON LAKE WATER SUPPLY WABTEWATFR
INFORMATION PRONpEO THROUGH TOWN F)L£S
PT-0646-2020
R MOVA NO S-
I. EXISPNC TREES ONSITE TO BE EVALUATED /N TERMS OF
PUNT HEALTH, LONGENTY, HUMAN SAFETY, AND
PC ENTIAL IMPACT FROM CCNSTRUCPON. TREE
PROi CPON AND REMO ALS TO BE AD.NSTED
ACCORDINGLY.
2. TOP SOIL TO SE SIRMPED, STOCKPILED, AND REUSED AS
PART OF LANDSCAPING / RESTORA PON WORK
REMOVALS LEGEND:
L4WN B UNDBG4PE
ARFTS TO BE RELIOVED
EE.— GM— lD BE
1--� EMWEp
BxIS1iNG BUILDINGS TD BE
R OVEO
STT I CONSTRUCt10N
X ExISBNG SRE FE4TURE TO
BE REMOVED
i--F—F TENPORgRY SILT PENCE
WORK u- 11NE
SOIL ANALYSIS,
SOIL TEST PITS AND /NFTL TRA PON TEBTS W£AE PERFORMED
DE-AND OBSERVED BY A MEMBER OF ENI4PONMENTAL
— ON ARRX 13, 2022
' 336 ""
O' — e' FOREST DUFF, ORGANICS qND ROOTS TO 8"
AB. SILTY LOAN, BROWN
)6" B — ' CREHSH BROWN,LOAM
DAMP WITH DEPTH
NO SIGNS OF SEASONAL
PHIGH GROUNDWATER
— TFI _
3" ;DARK BROWN TOP S-
S 22" AED BAOWN SANDY LOAM
SEASONAL HIGH GRWNOWATER O 22' (t333.f7)
TP83, — so')
3� — 3" DARK BROWN TOP SOIL
3" — 24" RFD BROIMV SANDY LOAM
SEASONAL HIGH CRWNOWATER O 24" (5336.50)
i4 (EL 3 00')
EXPOSED CEDGE O S33f.00'
l Taf:
STABIUZAPON RATE OF 18 INCHES PER HOUR
LTa
STABILIZATION RATE OF 5 INCHES PER HOUR
GRAPHIC SCALE
W„,o, a
a W
(IN FEET)
1 INCH = 20 FT.
LANDS N/F OF
MICHAEL U. CANTANUCCI
AND KIMBERLY CANTANUCCI
BOOK 1108 OF DEEDB AT PACE -6
U g
U) CL
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Z U)
W K
Z W c
2 Z e-
0 a g
. Q ;R
> IL
w b
O
N N
M
N
N }Q'
0
u- a m
U) W X LU.
U
Z z
2Q
>J
0
�Z a.
2O g
! Z I
(n 0 Q Ill W
LLI�m0W3
F-
= LL
OM6 °wog
U ~ZZ
itcai3�
IL W 0p0
1"=20'
FINAL PLANS
iHEET TITLE:
EXISTING
CONDITIONS &
REMOVALS PLAN
iHEET:
2of9
FILE pY