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DEMO-0574-2018 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-0574-2018Date Issued: Thursday, January 10, 2019 This is to certify that work requested to be done as shown by Permit Number DEMO-0574-2018 has been completed. 239.7-1-29 Tax Map Number: 155 ASSEMBLY POINT RD Location: Richard Kukuk Owner: Richard Kukuk Applicant: This structure may be occupied as a: Demolition of SFD only (asbestos report received) By Order of Town Board TOWN OF QUEENSBURY Cross Ref. Z-AV-75-2017 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-0574-2018 Tax Map No: 239.7-1-29 Permission is hereby granted to: Richard Kukuk For property located at: 155 ASSEMBLY POINT 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 Type of Construction Owner Name: Richard Kukuk Demolition-Residential $0.00 Owner Address: 6 Bradbury ST Total Value $0.00 Clifton Park,NY 12065 Contractor or Builder's Name/Address Electrical Inspection Agency Chris Crandall 63 Woodchuck Hill Lake George,NY 12845 Plans&Specifications Demolition of SFD only (asbestos report received) Cross Ref.Z-AV-75-2017 $ 150.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Wednesday, September 11,2019 (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 ueen ury; 4ue•. y� . - .er 11,2018 14 SIGNED BY: 1, \ for the Town of Queensbury. Director of Building&Code Enforcement DEMOLITION APPLICATION Office Use OnlyPermit#: 1Q • oS' • 20 lb Permit Fee:$ L O.00 Town of(Zccnsbury Invoice:#: 742 Bay Road, Queensbury, NY 12804 P:518-761-8256 www.queensbury.net Demolition Location: ) SC- 4�SeWtI2fr Tax Map ID#: 3 yco Z3g, **AN ASBESTOS REPORT IS REQUIRED WITH ALL DEMOLITION APPLICATION SUBMISSIONS** CONTACT INFORMATION: • Applicant: Name(s):: RtJA 144 _k.,! Mailing Address, C/S/Z: e„•..LI hi- Sr C/I /°a.^k- 01 ( / 2O6 3- Cell Phone: ( 3 7& ) 7,5— 7Z R7 Land Line: ( ) Email: u_k ® JL,yC �r • Primary Owner(s): 7-,) ( nil Name(s): �a 0Z4/r-2 PI 1 Mailing Address, C/S/Z: ;{ SEP 0 7 maCell Phone:_( ) Land Line: _( L _ Email: TOWN OF QUEENSBURY BUILDING (3, UOL)1.7: • Contractor: Business Name: 4Lri5 d ai f Contact Name(s): Mailing Address, C/S/Z: 6.2 W004 P_4 moo. I Zc5e5' Cell Phone: ( 8 ) 'n. -- ` 61 f Land Line: _( 57P ) 7f1/43 - 6Vd/ Email: e ,ri Crat,4 4.1 i LIt ® 0, rri j . Coqvv• Contact Person for Building & Code Compliance: qZ.Ck Cell Phone: _( Tie ) 7 — 724'7 Land Line: _( ) Email: Demolition Application Revised June 2017 DEMOLITION INFORMATION: 1. Where will demolition material be disposed? L._0(.0,3- /li 1 ce � e, 2. Type of structure to be demolished: a. Residence '7 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 g. Public Sewer h. Other j2� �,�.e ) CA-TV i. None 4. Have ALL utilities been disconnected? Yes No Pit h4 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. 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: Fic_kt,4 1A& . \ c., k.4.,k SIGNATURE: we l DATE: / " 7---/� Demolition Application Revised June 2017 ANSON HYDROGEOLOGIC CONSULTANTS V AN VLEET, PLLC I tE ll 7r5) September 6, 2018 j ; i! SEP 0 7 2018 if I? Mr. Richard Kukuk i O Vif N OF C2 l y f•�, s 4 4../Z i,5 6 BradburyStreet �� B�,I ;;i3 f€^ _�_ r l Clifton Park,NY 12065 ` RE: Pre-Demolition Asbestos Survey Re-inspection 155 Assembly Point Road Queensbury,NY 12804 FILE COPY Dear Mr. Kukuk: Hanson Van Vleet, LLC conducted a follow up inspection for suspect asbestos containing materials (ACM) at a residential structure located at 155 Assembly Point Road, in the Town of Queensbury, Warren County, New York, Tax ID: 239.7-1-29. The property is on the east side of Assembly Point Road,approximately seven tenths of a mile north of its intersection with Route 9L. The initial survey and sampling were conducted on April 3, 2018. The follow up survey re-inspection was conducted on September 5,2018 to confirm the removal of previously identified ACM by the homeowner,prior to demolition of the structure. Inspection Results The initial survey identified asbestos containing building materials in approximately 120-square feet of sheet vinyl flooring installed in the kitchen of the residence, at a concentration of 12% chrysotile asbestos by volume. No mastic was found as ociated with the sheet vinyl flooring in the kitchen. Sheet vinyl flooring and the associated mastic in .he bathroom were both also identified as ACM with concentrations of chrysotile asbestos of 9.4%, and 28.5%respectively. No other asbestos containing materials were identified in the laboratory analysis. An asbestos survey letter report dated April 11, 2018 describes the initial pre-demolition ACM survey and laboratory analytical results. No Suspect ACM materials were identified associated with the structure at the time of the re-inspection on September 5,2018.The asbestos containing vinyl flooring in the kitchen and vinyl flooring and mastic in the bathroom were removed by the homeowner prior to the follow up inspection. No suspect ACM remained associated with the structure on September 5, 2018. Conclusions Upon removal of previously identified ACM by the homeowner, no suspect ACM is present at the residential dwelling to be demolished at 155 Assembly Point Road, in the Town of Queensbury, Warren County, New York, Tax ID: 239.7-1-29. NYS Code Rule 56 regulations do not apply to owner occupied single family dwellings where the owner performs the work. (NYS Code Rule 56 Subpart 56-1.3 (a)). No further abatement is required prior to demolition. If you have any questions regarding this survey,please contact us at(518) 371-7940. TOWN OF QUEENSBURY 239.7-1-29 DEMO-0574-2018 BUILDING DEPARTMENT Kukak, Richard Based on our limited examination,compliance with our comments shall not be construed as 155 Assembly the plans and specifications are In Point Rd full compliance with the Building Codes of Demo of New York State. SFD only 1 , ANSON GEOLOGIC&ENVIRONMENTAL CONSULTANTS V AN VLEET, LLC April 11, 2018 Mr. Richard Kukuk 6 Bradbury Street Clifton Park,NY 12065 RE: Pre-Demolition Asbestos Survey 155 Assembly Point Road Queensbury,NY 12804 Dear Mr. Kukuk: Hanson Van Vleet, LLC conducted an asbestos containing material (ACM) survey of the residential structure located at 155 Assembly Point Road, in the Town of Queensbury, Warren County, New York, Tax ID: 239.7-1-29. The property is on the east side of Assembly Point Road, approximately seven tenths of a mile north of its intersection with Route 9L. The survey is being conducted prior to the demolition of the residence at the property. HVV is licensed by the New York State Department of Labor under license # 05-0220 to perform asbestos inspections, sample collection and surveys. The survey was conducted by a NYSDOL licensed Class D Inspector, in accordance with 12 NYCRR Part 56, as amended effective September 5, 2006 (referred to as Industrial Code Rule 56) and 29 CFR Part 1910 dated April 10, 1994. The survey was conducted on April 3, 2018. A copy of the NYSDOL Asbestos license is attached to this letter. METHODS The asbestos survey was conducted on April 3, 2018. Prior to initiating sampling, an on-site inspection of the buildings was performed in accordance with Subpart 56-5(e) of 12 NYCRR Part 56. INSPECTION RESULTS The inspection revealed a single-story three-bedroom, one-bathroom, seasonal residence, approximately 1410-square feet in size. County records indicate that the structure was originally constructed in 1946. Exterior construction materials consisted of wood siding, asphalt shingle roofing, and aluminum, vinyl, and wood framed windows and doors. Only two hinged windows on the east side of the structure exhibited window glazing. Suspected ACM sampled on the exterior of the residence consisted of asphalt roof shingles, and window glazing on the hinged porch windows on the east side of the structure. Interior construction consisted of; sheet vinyl flooring in the kitchen and bathroom, with carpet over wood subfloor or hardwood floors elsewhere throughout the structure. Walls and 902 Route 146 (518)371-7940 Clifton Park,New York 12065 Fax(518)371-5885 Pre-Demolition ACM Survey 155 Assembly Point Road Queensbury,NY Page 2 of 2 ceilings consisted of drywall with mudded joints, drywall with wooden molding, wood paneling, with a drop ceiling in place in the sunroom. Suspected ACM sampled on the interior of the residence consisted of, sheet vinyl flooring in the kitchen, Sheet vinyl flooring and associated mastic in the bathroom, drywall, joint compound, and drop ceiling tiles. The basement did not contain any suspected asbestos materials. All insulation observed throughout the structure was fiberglass. Asbestos Containing Material Results Samples of suspected ACM were submitted to EMSL laboratories for analysis by PLM and TEM methods. Sheet vinyl flooring installed in the kitchen was identified as ACM with a concentration of 12% chrysotile asbestos. No mastic was found associated with the sheet vinyl flooring in the kitchen. Sheet vinyl flooring and the associated mastic in the bathroom were both identified as ACM with concentrations of chrysotile asbestos of 9.4%, and 28.5% respectively. No other asbestos containing materials were identified in the laboratory analysis. The laboratory analytical results for the samples collected are attached to this report. Conclusions Sheet vinyl flooring in the kitchen and sheet vinyl flooring and the associated mastic in the bathroom were identified as asbestos containing building materials. Materials are considered asbestos containing if they contain 1% or more of asbestos. Prior to demolition of the building, all asbestos containing sheet vinyl flooring and the associated mastic (glue), must be removed from the structure in accordance with NYSDOL Code Rule 56. Code rule 56 regulations do not apply to owner occupied single family structures wherein the owner performs the asbestos removal. If you have any questions regarding this survey, please contact Hanson Van Vleet LLC at (518)371-7940. Very truly yours, Hanson Van Vleet, LLC ‘1111111 94-/ James Gironda NYSDOL Class D Inspector Certificate#07-05263 JG/jg CC: NYSDOL EMSL Analytical, Inc. EMSL Order: 031807556 Customer ID: HANS22 EMVIS 307 West 38th Street New York,NY 10018 ' Tel/Fax:(212)290-0051/(212)290-0058 Customer PO: ... http://www.EMSL.com/manhattanlab@emsl.com Project ID: Attention: James Gironda Phone: (518)371-7940 Hanson Van Vieet, LLC Fax: (518)371-5885 902 Route 146 Received Date: 04/04/2018 9:36 AM Clifton Park,NY 12065 Analysis Date: 04/08/2018-04/09/2018 Collected Date: 04/03/2018 Project: 155 ASSEMBLY POINT ROAD, NY Test Report:Asbestos Analysis of Bulk Material Non-Asbestos Analyzed Test Date Color Fibrous Non-Fibrous Asbestos Sample ID 1A Description ROOF-ASPHALT SHINGLES 031807556-0001 Homogeneity Heterogeneous PLM NYS 198.1 Friable Not Analyzed PLM NYS 198.6 VCM Not Analyzed PLM NYS 198.6 NOB 04/08/2018 Black 10.50%Glass 89.50%Other Inconclusive:None Detected TEM NYS 198.4 NOB 04/09/2018 Black 100.00%Other None Detected Sample ID 1 B Description ROOF-ASPHALT SHINGLES 031807556-0002 Homogeneity Heterogeneous PLM NYS 198.1 Friable Not Analyzed PLM NYS 198.6 VCM Not Analyzed PLM NYS 198.6 NOB 04/08/2018 Bled( 8.70%Glass 91.30%Other Inconclusive:None Detected TEM NYS 198.4 NOB 04/09/2018 Black 100.00%Other None Detected Sample ID 1 C Description ROOF-ASPHALT SHINGLES 031807556-0003 Homogeneity Heterogeneous PLM NYS 198.1 Friable Not Analyzed PLM NYS 198.6 VCM Not Analyzed PLM NYS 198.6 NOB 04/08/2018 Black 12.00%Glass 88.00%Other Inconclusive:None Detected TEM NYS 198.4 NOB 04/09/2018 Black 100.00%Other None Detected Sample ID 2A Description PORCH WINDOW-GLAZING 031807556-0004 Homogeneity Heterogeneous PLM NYS 198.1 Friable Not Analyzed PLM NYS 198.6 VCM Not Analyzed PLM NYS 198.6 NOB 04/08/2018 White 100.00%Other Inconclusive:None Detected TEM NYS 198.4 NOB 04/09/2018 White 100.00%Other None Detected Sample ID 2B Description PORCH WINDOW-GLAZING 031807556-0005 Homogeneity Heterogeneous PLM NYS 198.1 Friable Not Analyzed PLM NYS 198.6 VCM Not Analyzed PLM NYS 198.6 NOB 04/08/2018 White 100.00%Other Inconclusive:None Detected TEM NYS 198.4 NOB 04/09/2018 White 100.00%Other None Detected ( Initial report from:04/09/2018 11:38:50 ) ASB 198x 0009 0001 Printed 4/9/2018 12:25:02PM Page 1 of I EMSL Analytical, Inc. EMSL Order: 031807556 Customer ID: HANS22 E IVI SL: 307 West 38th Street New York,NY 10018 Tel/Fax:(212)290-0051/(212)290-0058 Customer PO: ... http://www.EMSL.com/manhattanlab@emsl.com Project ID: Test Report:Asbestos Analysis of Bulk Material Non-Asbestos Analyzed Test Date Color Fibrous Non-Fibrous Asbestos Sample ID 2C Description PORCH WINDOW-GLAZING 031807556-0006 Homogeneity Heterogeneous PLM NYS 198.1 Friable Not Analyzed PLM NYS 198.6 VCM Not Analyzed PLM NYS 198.6 NOB 04/08/2018 White 100.00%Other Inconclusive:None Detected TEM NYS 198.4 NOB 04/09/2018 White 100.00%Other None Detected Sample ID 3A Description KITCHEN FLOOR-SHEET VINYL 031807556-0007 Homogeneity Heterogeneous PLM NYS 198.1 Friable Not Analyzed PLM NYS 198.6 VCM Not Analyzed PLM NYS 198.6 NOB 04/08/2018 Beige None 88.00%Other 12.00%Chrysotile TEM NYS 198.4 NOB 04/09/2018 Positive Stop(Not Analyzed) Sample ID 3B Description KITCHEN FLOOR-SHEET VINYL 031807556-0008 Homogeneity PLM NYS 198.1 Friable Not Analyzed PLM NYS 198.6 VCM Not Analyzed PLM NYS 198.6 NOB 04/08/2018 Positive Stop(Not Analyzed) TEM NYS 198.4 NOB 04/09/2018 Positive Stop(Not Analyzed) Sample ID 3C Description KITCHEN FLOOR-SHEET VINYL 031807556-0009 Homogeneity PLM NYS 198.1 Friable Not Analyzed PLM NYS 198.6 VCM Not Analyzed PLM NYS 198.6 NOB 04/08/2018 Positive Stop(Not Analyzed) TEM NYS 198.4 NOB 04/09/2018 Positive Stop(Not Analyzed) Sample ID 4A Description BATHROOM FLOOR-SHEET VINYL 031807556-0010 Homogeneity Heterogeneous PLM NYS 198.1 Friable Not Analyzed PLM NYS 198.6 VCM Not Analyzed PLM NYS 198.6 NOB 04/08/2018 Green None 100.00%Other inconclusive:<1.00%Chrysotlle TEM NYS 198.4 NOB 04/09/2018 Positive Stop(Not Analyzed) Sample ID 4B Description BATHROOM FLOOR-SHEET VINYL 031807556-0011 Homogeneity Heterogeneous PLM NYS 198.1 Friable Not Analyzed PLM NYS 198.6 VCM Not Analyzed PLM NYS 198.6 NOB 04/09/2018 Green None 90.60%Other 9.40%Chrysotile TEM NYS 198.4 NOB 04/09/2018 Positive Stop(Not Analyzed) ( Initial report from:04/09/2018 11:38:50 ) ASS 198x 0009 0001 Printed 4/9/2018 12:25:02PM Page 2 of I EMSL Analytical, Inc. EMSL Order: 031807556 Customer ID: HANS22 EMBL 307 West 38th Street New York,NY 10018 Tel/Fax:(212)290-0051/(212)290-0058 Customer PO: http://www.EMSL.com/manhattanlab@emsl.com Project ID: Test Report:Asbestos Analysis of Bulk Material Non Asbestos Analyzed Test Date Color Fibrous Non-Fibrous Asbestos Sample ID 4C Description BATHROOM FLOOR-SHEET VINYL 031807556-0012 Homogeneity PLM NYS 198.1 Friable Not Analyzed PLM NYS 198.6 VCM Not Analyzed PLM NYS 198.6 NOB 04/09/2018 Positive Stop(Not Analyzed) TEM NYS 198.4 NOB 04/09/2018 Positive Stop(Not Analyzed) Sample ID 5A Description BATHROOM FLOOR-MASTIC 031807556-0013 Homogeneity Heterogeneous PLM NYS 198.1 Friable Not Analyzed PLM NYS 198.6 VCM Not Analyzed PLM NYS 198.6 NOB 04/09/2018 Tan None 71.50%Other 28.60%Chrysotile TEM NYS 198.4 NOB 04/09/2018 Positive Stop(Not Analyzed) Sample ID 5B Description BATHROOM FLOOR-MASTIC 031807556-0014 Homogeneity PLM NYS 198.1 Friable Not Analyzed PLM NYS 198.6 VCM Not Analyzed PLM NYS 198.6 NOB 04/09/2018 Positive Stop(Not Analyzed) TEM NYS 198.4 NOB 04/09/2018 Positive Stop(Not Analyzed) Sample ID 5C Description BATHROOM FLOOR-MASTIC 031807556-0015 Homogeneity PLM NYS 198.1 Friable Not Analyzed PLM NYS 198.6 VCM Not Analyzed PLM NYS 198.6 NOB 04/09/2018 Positive Stop(Not Analyzed) TEM NYS 198.4 NOB 04/09/2018 Positive Stop(Not Analyzed) Sample ID 6A Description WALLS AND CEILINGS-DRYWALL 031807556-0016 Homogeneity Homogeneous PLM NYS 198.1 Friable 04/09/2018 Gray 6.00%Cellulose 70.00%Gypsum None Detected 24.00%Non-fibrous(other) PLM NYS 198.6 VCM Not Analyzed PLM NYS 198.6 NOB Not Analyzed TEM NYS 198.4 NOB Not Analyzed Sample ID SB Description WALLS AND CEILINGS-DRYWALL 031807556-0017 Homogeneity Homogeneous PLM NYS 198.1 Friable 04/09/2018 Gray 5.00%Cellulose 75.00%Gypsum None Detected 20.00%Non-fibrous(other) PLM NYS 198.6 VCM Not Analyzed PLM NYS 198.6 NOB Not Analyzed TEM NYS 198.4 NOB Not Analyzed ( Initial report from:04/09/2018 11:38:50 ASS 198x 0009 0001 Printed 4/9/2018 12:25:02PM Page 3 of E EMSL Analytical, Inc. EMSL Order: 031807556 EMSL 307 West 38th Street New York,NY 10018 Customer ID: HANS22 Tel/Fax:(212)290-0051/(212)290-0058 Customer PO: http://www.EMSL.com/manhattanlab@emsi.com Project ID: Test Report:Asbestos Analysis of Bulk Material Non-Asbestos Analyzed Test Date Color Fibrous Non-Fibrous Asbestos Sample ID 6C Description WALLS AND CEILINGS-DRYWALL 031807556-0018 Homogeneity Homogeneous PLM NYS 198.1 Friable 04/09/2018 Gray 60.00%Gypsum None Detected 40.00%Non-fibrous(other) PLM NYS 198.6 VCM Not Analyzed PLM NYS 198.6 NOB Not Analyzed TEM NYS 198.4 NOB Not Analyzed Sample ID 7A Description MUDDED DRYWALL JOINTS-JOINT COMPOUND 031807556-0019 Homogeneity Homogeneous PLM NYS 198.1 Friable 04/09/2018 White 68.00%Ca Carbonate None Detected 32.00%Non-fibrous(other) PLM NYS 198.6 VCM Not Analyzed PLM NYS 198.6 NOB Not Analyzed TEM NYS 198.4 NOB Not Analyzed Sample ID 7B Description MUDDED DRYWALL JOINTS•JOINT COMPOUND 031807556-0020 Homogeneity Homogeneous PLM NYS 198.1 Friable 04/09/2018 White 64.00%Ca Carbonate None Detected 36.00%Non-fibrous(other) PLM NYS 198.6 VCM Not Analyzed PLM NYS 198.6 NOB Not Analyzed TEM NYS 198.4 NOB Not Analyzed Sample ID 7C Description MUDDED DRYWALL JOINTS•JOINT COMPOUND 031807556-0021 Homogeneity Homogeneous PLM NYS 198.1 Friable 04/09/2018 White 30.00%Ca Carbonate None Detected 5.00%Mica 65.00%Non-fibrous(other) PLM NYS 198.6 VCM Not Analyzed PLM NYS 198.6 NOB Not Analyzed TEM NYS 198.4 NOB Not Analyzed Sample ID 8A Description SUNROOM CEILNG-DROP CEILING TILES 031807556-0022 Homogeneity Heterogeneous PLM NYS 198.1 Friable Not Analyzed PLM NYS 198.6 VCM Not Analyzed PLM NYS 198.6 NOB 04/09/2018 Gray 9.50%Glass 90.50%Other inconclusive:None Detected TEM NYS 198.4 NOB 04/09/2018 Gray 100.00%Other None Detected Sample ID 8B Description SUNROOM CEILNG-DROP CEILING TILES 031807556-0023 Homogeneity Heterogeneous PLM NYS 198.1 Friable Not Analyzed PLM NYS 198.6 VCM Not Analyzed PLM NYS 198.6 NOB 04/09/2018 Gray 7.90%Glass 92.10%Other Inconclusive:None Detected TEM NYS 198.4 NOB 04/09/2018 Gray 100.00%Other None Detected ( Initial report from:04/09/2018 11:38:50 , ASS 198x 0009 0001 Printed 4/9/2018 12:25:02PM Page 4 of E EMSLEMSL Order: 031807556 Analytical, Inc. Customer ID: HANS22 EMSL 307 West 38th Street New York,NY 10018 Tel/Fax:(212)290-0051/(212)290-0058 Customer PO: http://www.EMSL.com/manhattanlab@emsl.com Project ID: Test Report:Asbestos Analysis of Bulk Material Non Asbestos Analyzed Test Date Color Fibrous Non-Fibrous Asbestos Sample ID 8C Description SUNROOM CEILNG-DROP CEILING TILES 031807556-0024 Homogeneity Heterogeneous PLM NYS 188.1 Friable Not Analyzed PLM NYS 188.6 VCM Not Analyzed PLM NYS 188.6 NOB 04/09/2018 Gray 10.50%Glass 89.50%Other Inconclusive:None Detected TEM NYS 188.4 NOB 04/09/2018 Gray 100.00%Other None Detected ( Initial report from:04/09/2018 11:38:50 ASB_198x_0009_0001 Printed 4/9/2018 12:25:02PM Page 5 of 6 EMSLEMSL Order: 031807556 Analytical, Inc. West 38th Street New York,NY 10018 Customer ID: HANS22 EMS 307 Customer PO: Tel/Fax:(212)290-0051/(212)290-0058 http://www.EMSL.com I 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: 4/4/2018 Sample Receipt Time: 9:36 AM Analysis Completed Date: 4/8/2018 Analysis Completed Time: 11:52 PM Analyst(s): Emmanuel Moise PLM NYS 198.1 Friable(4) Yolanda Chow PLM NYS 198.1 Friable(2) Tiquasha Thompson PLM NYS 198.6 NOB(13) Genevieve Trapan/TEM NYS 198.4 NOB(9) Samples reviewed and approved by: James Hall,Laboratory Manager or Other Approved Signatory NOB=Non Friable Organically Bound N/A=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 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.org/labcert/elapcert/forms/VermiculitelnterimGuidance_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.Interpretation 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 NVLAP,NIST,or any agency of the federal government.This report may contain data that is not covered by the NVLAP accreditation. Samples analyzed by EMSL Analytical,Inc.New York,NY NYS ELAP 11506 ( Initial report from:04/09/2018 11:38:50 , ASB 198x 0009 0001 Printed 4/9/2018 12:25:02PM Page 6 of 6 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 Hanson Van Vleet, LLC FILE NUMBER: 05-0220 LICENSE NUMBER: 28463 902 Route 146 LICENSE CLASS: RESTRICTED DATE OF ISSUE: 03/27/2018 Clifton Park, NY 12065 EXPIRATION DATE: 03/31/2019 Duly Authorized Representative—James Gironda: 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. ro:Are• 41"1".46a4r Eileen M.Franko, Director SH 432(8/12) For the Commissioner of Labor STATE OF NEW YORK - DEPARTMENT OF LABOR 1,5BESTOS CERTIRCATE • JAMES GIRONDA CLASS(EXPIRES) D INSP(i 1/18) • MUST BE CARRIED ON ASBESTOS PROJECTS • Print Date: Friday, September 7,2018 7:41 AM From: National Grid-Customer Connections<no-reply@nationalgrid.com> To: RMKUKUK@NYCAP.RR.COM Subject: Important information from National Grid. nationaigrid 09/07/2018 07:41:46 AM RICHARD KUKUK 155 ASSEMBLY POINT RD QUEENSBURY NY 12804 Work Request Number: Dear RICHARD KUKUK, Your request for DEMO/NEW SERVICE has been processed for Electric sevice. Our representitive N/A will be contacting you regarding your request. If you have any questions you can contact your representative directly at . Thank you, we appreciate your business. Have a safe day, National Grid Additional Comments: RICHARD-YOU WORK ORDER NUMBER FOR THE DEMOLITION PORTION OF THIS PROJECT IS 27010833 AND FOR YOUR NEW SERVICE YOUR WORK ORDER IS 27010885.YOU WILL BE CONTACTED WITHIN 3-5 BUSINESS DAYS IN REGARDS TO BOTH ORDERS, IF YOU HAVE ANY QUESTION PRIOR TO THAT PLEASE CALL 1-800-260-0054. FiTal ECELIVLErrN)) 1 ini `9 ! I I 9, �1 E I SEP072018 1.12) TOWN O LJ1TRJN & COD S , r Prt Demolition ACM Survey Re-inspection • 15 Assembly Point Road Town of Queensbury,New York Page 2 of 2 Very truly yours, Hanson Van Vleet, PLLC \4111i iPt' James Gironda NYSDOL Class D Inspector Certificate#07-05263 Attachments: - Site Location Map - Pre-Demolition ACM Survey Report Dated April 11, 2018 - Initial Pre-Demolition Survey Laboratory Results - Hanson Van Vleet, PLLC Asbestos License - James Gironda Class D Inspector Certificate - - � I� - I - I� I I I �- I I I 11 �- I I I . I I I I � � I I I I I I I I I I - . I I I I I I I I � I � I � I I - I � I � I . I I I I I I I I I I I I I . I . I I I I � I I � I I . I I � I I � ., ­ I I - . I . � � . I I'� � I I .11 I .. I .�, � I . I . I . � � . � I � �, I I_� ­- I .�� I I I I � ­ � I I 1, 11 I I � � I I - I I I � I I I I I � I I I I . � � � 1,� 1, . I - � 1, I . 1. �I I I 11 I . . I. � � . I I I .. �. � I I I I 11 �I I I � I I I. I I I . I � I I. I � I I. � I � I � - I I . 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I I � I I I ''I I 1, I I � I I I I _011MINOWN - 1A I I I I � I I I _',_......�1­1­11� , 0-u I III 0 V, - I I I I I � "',-1 --V,, T r-," I ,I , I I i I --,�-----.---�--------,--"--�-,�,-- I RATION OR ADDITION TO A SURVEY I I 11-41A Fv ,,,I��,I llw� I I � � - ' , I 111 , , ---,- I . - , � ff I ­p �, 041 � _,_ .1 _4-­--------T-----­ . I I ­1 I "I I � I I I �_ I ,e_ � � I . � , I I . � � I 1, I��� I �I I-I I I I - I I I ,A 110ENSED LAND SURVEYORS SEAL IS A . . I I� " � I . I I I - � I I , � � � I 11 I I I . I MAP BEARINC I I I I I I I I "'SECTION 7209,SUB-DIVISION 2.OF THE - " 1 L' I I . I , , -1 � . ;�, 9, , .1 � I I 1�. I I I I � VIOLATION�Or' -- . , �" A I I � I k,.,,� y �, I, 1 'i - - " I . " , .P I "00NA S.V .r�� , I I � �;E'wmP'­`T � L .1 I I I I . ,4-%%A W - I I I � � . - I � � � I . I I ,rr � I I I L I 1� ,� I � . I I � NEW YORK STATE EDUCATION LAW I � I . I I I I � I I I 11 � I _____ L ,------+-�--,------,-----�---�,-�- I _____,_'_,1_______1----,.��,--",f,-�---,�,-�-,.,-�-�---'I......- , � � I I I E I � �` � I , "I I 11 I �. I I � I .I � 11 � I ­1 - i I I I . ,.1 I I., I I : I � "ONLY COPIES FROM-THE ORIGINAL OF THIS SURVEY I I I � � I I I 11 , , , , I I � "­­"�A4 � I I . � � � I . : , 'At,4 A-1, I I I I MARKED NTH AN ORIGINAL OF THE LAND SURVEYORS I � . I , 11 I I . I . owgrom I I I I - I Lt'�,'�"% ` I 0 v I - " 1, I a,v, " A �f . I'll I .-----.I------ ­__1____ � N Ill - 'ff E r �, V F T n � ­ I 11 11 --"�-��.-Il�1--�1--��-�",-",�----�-�---,-�� I � . I I - ( '' I I 11 -I. . I "CERTIFICATIONS INDICATED HEREON SIGNIFY THAT I I I V, U u I , 'U", 1,_-) " I .1 I � I � , . I 1�) , S '­ �" i �,LA 1, Tm_74 � � SEAL SHALL BE CONSIDERED TO BE VALID TRUE COPIES," I r-drqq AIIIN % , .11" .A-, W`� _, , _', _.,._-j """` `_ e *'�' � "! _` � _", THIS SURVEY WAS PREPARED IN�ACCORDANCE WITH THE T 0 � ,:::� - "I D G'E' " " I - L-) I, I I �I r AJ I � I � . I - . I - I I '� ,,,r�,_� I � I ____.____,__,1�' � �,,­­j% ­�,' _A� __al�, `i,,�,�% ­F- , "" �1, � a �� 11 4V N -t , 6 ­�, I 4; 'I I . . ­­'­1­­--- ",'�­,',­­"jq,� 1�' -jg"� 1�11-11�1� 1�'n­"Y­ _���,,i�', 4-R, ,_ 4T­­q,, � �`-', I I �_, 'r 41 w � I I I . I � .1 I I � ,� 3 ,,q V,` I EXISTING CODE OF PRACTICE FOR LAND SURVEYORS ADOPTED � I I I I � I-- -_ ,� �11 � �i R " `�11 �, I " ""' , SSOCIATION OF PROFESSIONAL , L . I A, M I , �N I � E I - � , 1�__.,F, I I I '. i � , -, A � -1 I I I . I I . I I I u I I I . ki 4 , - 11'A m , ,� - -1 I I . I I .I �� I . I I � I i " I 1 � I " I I -, , , - � I . �� I �- " `1 �1. ,-,, -1 i ,� - '11 � i BY THE NEW YORK STATE A � , ,1__�� , A 1­01 1, ,,, I " � LAND SURVEYORS.SAID CERTIFICATIONS SHALL RUN ONLY WEET I C Fi . � 6, ` A i'�, "--,,,,- ". ,`k,_,,;," ,", 9 "I Q�� _11-A JL V41 I �_ _1"',11] * ­�.,, "'A -,� _i_� 'J_ ,--ir �,�,,,-, ,A�`,L TO . � I � I t I � � . , � THE PERSON FOR WHOM THE SURVEY IS PREPARED,AND � . . I � ­__11_L____,_______.___11_ _ __ I __ . �W L ­ __��� �K,_ , , I I _'___­ ! I 'L 1 1. I,� MW�� I , �­� � I , ", - I � , I �_�,., I 1� - A I `1'11__� ��11 L J T _ I I I � � , I I I � I . , -", "t,7, . I I I I /,!) t__, `J" ",YS 7-FM ' A"i"'Ot P T-1­7N I 1, ON HIS BEHALF TO THE TITLE COMPANY,GOVERNMENTAL I - . County, N'�f I J,_ GENCY AND LENDING INSTITUITION LISTED HEREON,AND urt Subdivision, Town o f Queensbur "W"I"", /1�R 1 SEP IS�`", __1 " ''" Ridgewoo.d Co I I yq �, arren �J, 9 ', i , FATI E, ! � I ­­ ,�, ,,�7,,,, I . � . I I . --�,---��"-"-�---,--t,�-�----------�------ . 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I I . I � � � I I � I I I � � I I I I I . I I � I I I I I I I � I I I� I I � I I I I I I I I I . . � . � - I � I I . . I I I � I I I I I I I � � I , I I . 11 I I � I � � I � I � � � I I I I I I I . I I � I - I . I I I I I I I � I I . � I I I I I I I I I I I I � I I I I � I � 11 � I I I I I I � I I I I � I . I I I S.B.L.# 239.07---1_-41 �332.63 Lands n/f of ���° I- 327.57T / Thomas W. McGuire v � rrlj`/i/j/ ''333.01 327.56 Margaret J. McGuire / / , Garage%! L.119 2 .24 3 / -- f%%/%ff�i,�f j P GAPPED IRON P#� S L.# 2 9 1--30 7.8' FROM CORNER •. 'r;/%%�%%;; #i 57 Assembly Point Road 333.83 IRON PIPE Lands n/f of 3.9 FROM / % Bruce B. Brown & Sarah S. Brown e329.58 @33i.57 � CORNER p. "f 331-7e 327.91 Ut 0330.8 %;Log house''% / . 033118 18 '. 32..6 327.44 ri�. ""BUR �� Shed �,% /,�;i'%,i t � i �329.613 `' It 33.2.53 ) ��l/ �i�/ ., .9 ` fill/ 327.09 0331.03 8 33i.93 0331.23 i 326.86 326.80 c ..:N ..f(xj � 331.86 ��2tti7" t34 Shed/j-�i''%fi 327.51 IRON PIPE '/'''! '4'4 Tot0.9 NORTH 5.2 d� �327.25 " / �.._ =• = - 326,73 e 323.67 32.13 329.32 320.71 � l �326.583.5 '�'" _ --. .. !> ....> 329.42 a Approximate FOP e _ s Grit vet dr .�. .- .. "` wetland oreca 329.82 - tvew Y -. - a _ _ 32�.70 ._ - . delineated) .. _ � .._ 28.08 of del 3 .5 29 0 +p. I~.r= R N PIPE 0 I {/ E ! - f4 a1d .fie. e.$ � � - ` ...Y.'.[ - f i T T 31 _ 4 _ _ _ . - 3 . _ - - `�:-;`=� _l� `- '>:� _ 3 �.�9 � Q.2 -SOUTH _ - 14 68 ' - t ":� ~:..• _ 331.33 Y�.-- �' �3t3 58 328.10 .. oac 31 'S =�--•s=e.' y1 � 328.6 o'i c, . � > . � 33Q.58 33t1.23 . >>,3 .46 ! -f 331.54 327.21 ? 22.9 3 0.85 r ! �'Wood frame-;�F% ,,,,/, '„ : CAPPED IRON PIN 1 ///% /, ,///,//i,,� lid'f jji%/f327.21 ® .. .. 31s �/i/°garage ,� _ 326.99 326.53 0.7' FROM ��L6.13 0329.47 �`%fj'��,'-r:�/f/�///,�,f/ et �329.98 32$.38�Cellar %'��i i%,ri�'i'/'i�/,:"'a <. .,>, 21.41 � � - �•>'-- � A. ��-�. / /,` ,f 328.58� Moor >.. 330.46 f CORNER /� /� '" >. . .1 fl%/% / !/�ii�/'l'/�f// f 327.10 /i/ /' �%'r'/ /i/�j; ®,` ��` -,"21_ 1> . �p 4• 330.43 t l 330.9 .f,/if/f/f/ / ! J // U lti .. > /, ,/�/ i 330.3� j i �/fi'//rf/ �lj 9 .. `'> >s'•"fD . ,� � .. {one story�1%i��,`,,"326.65 .>. 32c.�4 c �.. .. IRON PIN/ �.. ,s`� 326.9 ,�; '�/; �/\ .. - �' wood frames r/;,, ,, 319.70 .. >. 0) 5.0 FROM Porch ;�,� 3 CORNER A. �.` a .� --- f houSB�,/f �f ... c . _.,� 327.53 /` %/� �i`��/l/ 325.2®s 2a.Q7 1 f 27-�� 329.178 , , ,,, , .... .. o 327.73e 328.46 03 0327.79 /i;i;/ice, `'��,�/ f�';// 326.48 ..• \ •• , ir� / g . ,4 , v V� ,... �. ._, � � � ,�i Shed � ��/%��j`� /'�/ t��(('fJ�'�t� ...� Q- • 313,78 -� ° "� i/ l 327.49 // /f/; i, fill. �i /t ...-. 319. 4 -�-� .. tip Shed`' nr"�,� !�., 1 327.27 l /i//�; r!.: �` ><.. ,( .. >, ij,' %= 328.5t7� s �/;/i�/,. �i�r.f�i v ,. .>, t� C 0326.40 `�/� ---� 329,32 /,, ,;f I ,;r 326.5 ..!. .>. 314.4 1 . . - +Q' 326.45o /i/, ,�f�Deck�yJ ..>.f !.. / „ /��/ jrf��r;:i 326.55 3 9.1 h $328.61f t ri;, �Y 329.-73 I i;'r�i, ,'�-� l'.,' •' . � IRON / f �� 32s.a1 �� 1 32s.z1 %�.! � /,,,�' j�, ��,� 3�s.61 °� •y PIPE r. fd{i !!i rl / Ifl i 1� !1 � 11�,,1: r ,,1/;, 317.76. `315.93 1 .4 329.02 { 327.$ , _ r 1 1 Sri IRON PIPE �d vts/i 32i.19j ..T. .. c.. Cb 325.69 ,j/ / '1 { }i;ti.�, ��� ties ,7 .. ...T �..�b .. '� °,;, , }� FOUND Qlll LINE / '�- /26.4-4 324.74® p >. .,..... .. 07 S.B.L. 239.07-1-21.1 ,/ ,;- �� 325.75° 319.60� ".".` Lands n/f of ,/•;f;;/•r;,/ice/���,;/.;,, 1 32 11 3194 .,.. >•>, � TWO story' / /`{ ��1 l t 318.42 >31a�94 t I o 4- 1 5 Knox Road LL.0 / / l' .. �?. wood frar�e�//'/,f `�',��,�l� S.B.L# 239.07-1--28 s 75 3�7. L.4085 .155 f�... �///'1// '©eck - 0325-94 i`- 31 . 3 '..f .••m P rhouse// //, ' 153 Assembly Point Road } t -22 _ j / /�/✓�j , Silt �j j��} �r installed�s n�l 319.35 t� /� J,•,/.//I/;,,;! tt. Silt fence to . .. Jj1, .� Lands n/f of .... IRON PIPE oliene Beth BuE�ncuInstallat ton 1 1t St completed A ins�}eCt 3 7B FOUND r� LINE3�7. L.1180 p.229beginning ..>. .. to demolition. >... ._. 0318.95 a 315.3 ••-.•.•- Wclter line Please contact this office to schedule an �8.21 .>..... x can 514117 ' 0�ltion. 314.5 inspection of the site to any demo REV. DATE 'BY CHK DESCRIPTION 6(uce ��� ( 0 2Z 0 05/04/17 EAC ACS FIELD SURVEY DATE Elevation note' Parcel # Deed Reference: This survey was prepared without the benefit of an up-to-date abstract of title and is there-- Spot elevations and contour lines hereon are Richard H. Kukuk and Josephine E. Kukuk to Kukuk fore subject to any and all agreements., condi- with reference to N.A.V.D. 1988, as determined0. 851 Property Trust, dated November 21, 1990 and re- tions, covenants, easements, restrictions and b G.P.S. measurements taken on site on -Acrecorded in the Warren Count Clerics Office on Nov-� (37,062.57 S .ft. Y rights-of-way of record, as well as any other May 4�. 2017. Contour interval is 2 feet. � ) ember 30, 1990 in Book 810 of Deeds at page 75. facts which sold abstract would disclose_ Certifications indicated hereon signify that this survey was prepared in accordance with the .MC U MAP A }�� � existing Code of Practice of Land Surveys adopted by the N.Y. State Association of Profes® OF IANM OF sional Land Surveyors. Said certifications shall run only to the title insurance company, _ governmental agency, and lending institution listed hereon and to the assignees of the lending f t institution. Certifications are not transferable to additional institutions or subsequent owners. SAM t _ s , ; _ �lAy U il �' TT a . • N SURVEYING AENGINEERING, Unauthorized alteration or addition to a survey map bearing a licensed land surveyors seal is LAD RVEYIN AND R.G. AT y pOj "I' iCJ �GY 12845 a violation of Section 7209, Subdivision 2 of the N.Y. State Education Law. Only copies from = F the original of this survey marked with an original of the land surveyors embossed seal shall 1 BARLEY ROAD SUITE S.B.L� 239.07--1=29 CLIFTON PARK NY 12065 t �` be considered to #:ae valid copies. PHONE: (518) 383-8001 FAX: (518) 383-602fi I � �„ 3 , t > DRAWN BY: EAC TOWN OF QUE€NSBURY SCALE. 0 f . In addition, only copies from the original of this survey marked with an original of the land � � ,� ,;�I „ �V 49 _ CHECKED BY: ACS COUNTY of WARREN DWG. NO.. 7946 surveyor's signature in RED shall be considered to be valid copies. 011 5a� ,��ocia� � ' ts -, �c�d pi J f L L ��, t d 1 l.t {1 j . •" e 6 t roA, orize�ni�plicabon is a g id�ion of Ppplica'Hle�Gri S, ANDREW C.sCr;.,�FFER-,�.s. ucEMSE i4� 049901 DATE: 05/04/17 STATE OF NEW YORK REV.: 0 'min®