DEMO-0738-2018TOWN 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-0738-2018 Date Issued: Monday, January 28, 2019
This is to certify that work requested to be done as shown by Permit Number
has been completed.
DEMO-0738-2018
Tax Map Number:
Location:
Owner:
296.15-1-15
43 COUNTRY CLUB RD
Clute Enterprises, Inc.
Applicant:Clute Enterprises, Inc.
This structure may be occupied as a: Demolition Only of SFD
Asbestos report received By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Compliance DOES NOT relieve the
property owner of the responsibility for compliance with Site Plan,
Variance, or other issues and conditions as a result of approvals by the
Planning Board or Zoning Board of Appeals.
Director of Building & Code Enforcement
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-0738-2018
Tax Map No: 296.15-1-15
Permission is hereby granted to: Clute Enterprises,Inc.
For property located at: 43 COUNTRY CLUB 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: Clute Enterprises,Inc. Demolition-Residential $0.00
Owner Address: 6 Holden AVE Total Value $0.00
Queensbury,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
Rick Carbone
Plans&Specifications
Demolition Only of SFD
Asbestos report received
$ 150.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Tuesday,November 26, 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 o uee ; to .,, o:1, - .er 26,2018
i
040
SIGNED BY: \ for the Town of Queensbury.
Director of Building&Code Enforcement
IOffice Use Only '��
-73
Pe #: i
DEMOUTI r.''1
�w., r rmitPermit Fee:$ �)T}
NOV 2 6 2018
— Invoice:#:
limn �,t(ticcnsbur��
742 Bay Road,Queensbury, NY 12804 TOWN OF QUEENSBURY
P: 518-761-8256 www•aueensburv.net
BUILDING&CODES
Tax Map ID #:
Demolition Location: 471- C - WITH ALL
REPORTx
**AN ASBESTOS IS REQUIRED APPLICATION SUBMISSIONS
*
DEMOLITION
CONTACT INFORMATION:
cs
Name(s):
Mailing Address, C/S/Z: Land Line: -)
Cell Phone: _______—)
Email:
• Prin . Owners : �, G ,ye
Name(s):
Mailing Address, C/S/Z: Land Line: _(_—)
Cell Phone: _(__)
Email:
• Contractor:
Business Name: �-e
Contact Name(s): �,
Mailing Address, C/S/Z: Land Line: _( l-)
Cell Phone: _(��) � �'
Email:
Contact Pers or Building & Code Compliance: L-C-L �?T
Land Line: _( L_�
Cell : _( � �" C_\� e_. r i'" '�
Emaill::
Revised June 2017
Demolition Application
•
DEMOLITION INFORMATION:
1. Where will demolition material be disposed? 1 --
2. Type of structure to be d molished:
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
g. Public Sewer
h. Other
i. None
4. Have ALL utilities been disconnected? Yes V 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.
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: )
✓ ,/� r��
4�
SIGNATURE. — ' �, DATE: L ti �� (N,
Demolition Application Revised June 2017
OV NEW
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Asbestos Project Notification
Project Reference Number: 26379939 Type: Amended Notification
Status: Notification Received Notification Received: 11/15/2018
Payment Status: Paid in full Number of amendments: 1
Notification Entered By: Clean Air
Environment
Contractor Information
FEIN:352487477
Clean Air Environmental Services, Inc. Mailing Address
215 1/2 North Perry Street.
Johnstown NY 12095
Asbestos License Number: 76946
Duly Authorized Representative
Adam Bido, Other
Phone Number: 518-366-4450
E-mail Address: abido@cleanaires.com
Project Information
Project Start Date: 11/28/2018
Project End Date: 1/30/2019
Project Location County: Warren
Worker Compensation
Worker Compensation Policy#: A232984417
WC Exemption Certificate#:
Number of your employees you expect to be on project: 5
Will temporary workers be used? NO
If yes, name of temporary agency:
Project Location
Building Name: 43 Country Club
Room or Location: exterior
Bridge ID#:
Address Line 1: 43 Country Club
Address Line 2:
City Town or Village: Queensbury
State: New York
Zip Code: 12804
1
Building Information
Current Use: Residential - 1 family
Prior Use: Residential - 1 family
Approximate Year Built: 1960
Size(sq.ft): 2000
Is this fee exempt project?: NO
Reason:
Building Representative/Site Contact
Name: Larry Clute
Phone Number: 518-793-7277
E-mail Address:
Cell Phone Number:
Phase Details
Phase# Phase Start Date Phase End Date Phase Location Phase Scope
Sub-Contractor Details
Name: Asbestos License Number:
Night/Weekend/Shift Work Details
Party for Whom Work is being Performed
First Name: Last Name:
Organization: Clute Enterprises
Apt./Suite: Address Line 1: 6 Holden Ave
Address Line 2: City Town or Village: Queensbury
Province: State: NY
Zip Code: 12804 Country: United States
Contract Dollar Amount: $0.01
Variance Information
Procedures and Type of Equipment and Ventilation Systems Used
controlled demolition Code Rule 56
Air Monitoring Firm
Name: Asbestos License Number:
Alpine Environmental Services, Inc. 29095
Laboratory Performing Analysis
Name: ELAP Registration Number:
Alpine Environmental Services 11570
Type of Asbestos Work
Pipe Related: Yes Siding: No
Clean up: Yes Vessel covering: No
Caulking/mastic: No Spray-on insulation: No
Roofing/flashing: Yes VAT: No
Demolition: Yes Demolition Ref#:
Other-specify:
Waste Transporter
Name: Clean Air Environmental
NYS DEC or EPA Permit Number: 4A-688
Phone Number: 5183664450
Apt./Suite:
Address Line 1: 215 1/2 N. Perry St.
Address Line 2:
City Town or Village: Johnstown
Province: NY
State: NY
Zip Code: 12095
Country: United States
Landfill
Name: Green Ridge Landfill
Phone Number: 518-636-2141
Apt./Suite: New York
Address Line 1: 424 peters Rd.
Address Line 2:
City Town or Village: Gansevoort
Province:
State: NY
Zip Code: 12381
Country: United States
Type and Amount of Asbestos Containing Material
Friable linear feet: 0 Friable square feet: 1200
Non-friable linear feet: 0 Non-friable square feet: 0
Fee
Total linear feet: 0.0
Total square feet: 1200.0
Total Fee: 2000.0
Project Fee Schedule
If the notification was submitted prior to 4/7/09,the actual project fee is one half of the amount shown on the fee
schedule
Linear Feet: Fee Square Feet: Fee
0-259 feet: $0 0- 159 feet: $0
260-429 feet: $200 160-259 feet: $200
430-824 feet: $400 260-499 feet: $400
825- 1649 feet: $1000 500-999 feet: $1000
1650 or more feet: $2000 1000 or more feet: $2000
Remarks
piCEEO E
Michael J Stevens NOV 26 2018
Licensed Asbestos Inspector
WN OE QUEENSBURY
PO Box 2202 Glens Falls, N BUILDING&CODES
12801
296.15-1-15 DEMO_0738-2018
September 1 9 2018 Clute Enterprises Inc
43 Country Club Rd
LARRY CLUTE Demolition Only (SFD)
RE: Pre-Demolition Asbestos Building Survey Report
43 COUNTRY CLUB ROAD
QUEENSBURY NY 12804
Dear LARRY CLUTE
Please find the attached Pre-Demolotion Asbestos Building
Survey Report completed for the Property Located at:
43 COUNTRY CLUB ROAD QUEENSBURY NY 12804
If you have any questions or require additional information,
please feel free to contact:
Mike Stevens @ 518-656-3270
Sincerely,
Michael J. Stevens
5ECIEEIVE,
NOV 2 6 2018 1 l7 -Demolition Asbestos Building Survey
3 COUNTRY CLUB ROAD
TOWN OF QUEENSBURY Q EENSBURY NY 12804
BUILDING& CODES
PRE-DEMOLITION ASBESTOS SURVEY
43 COUNTRY CLUB ROAD
QUEENSBURY NY 12804
Background Information:
Building(s) Location: 43 COUNTRY CLUB ROAD
QUEENSBURY NY 12804
12804
OwnerName/Address: DKC HOLDING INC
6 HOLDEN AVE
QUEENSBURY NY 12804
Party Performing Survey: Michael J. Stevens
PO Box 2202, Glens Falls, NY 12801
Laboratory Used For Sample Analysis:
Amerisci
117 East 30th Street
New York, New York 10016
NYSDOH ELAP Laboratory ID # 11480
Pre-Demolition Asbestos Building Survey
DKC HOLDING INC
6 HOLDEN AVE
QUEENSBURY NY 12804
TVECEOVER
11 NOV 262018
TOWN OF QUEENSBURY
BUILDING&CODES
LABORATORY RESULTS
Please Reply To:
AmeriSci New York
• • D V AMER/Sc! T : 679-8600 E AX 2 2 N679-31114
NOV 2 6 2018
TOWN OF QUEENSBURY
BUILDING&CODES
FACSIMILE TELECOPY TRANS ' •
To: Michael Stevens From: Ivan H.Reyes
Michael J. Stevens AmeriSci Job#: 218092222
Fax#: Subject: ELAP-PLM/TEM 5 day Results
Client Project: 43; 43 Country Club; 43 Country
Email: mikesoldcars@gmail.com Club Rd,NY
Date: Monda Sete ber 17 2 1 0
y, p m 0 8 Number of Pages.
Time: 16:21:55 (includin cover sheet)
Comments:
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
AmeriSci New York
AMERI Sci 117 EAST 30TH ST.
NEW YORK, NY 10016
TEL:(212)679-8600 •FAX: (212)679-3114
PLM Bulk Asbestos Report
Michael J. Stevens Date Received 09/12/18 AmeriSci Job # 218092222
Attn: Michael Stevens Date Examined 09/17/18 P.O. #
PO Box 2202 ELAP # 11480 Page 1 of 5
RE: 43; 43 Country Club; 43 Country Club Rd, NY
Glens Falls, NY 12801
Client No. / HGA Lab No. Asbestos Present Total % Asbestos
#1 218092222-01 No NAD 1
Location: Bedroom 1 Wall-Drywall/Compound (by NYS ELAP 198.1)
by Ivan H. Reyes
on 09/17/18
Analyst Description: OffWhitelTan/White, Heterogeneous, Fibrous, Bulk Material
Asbestos Types:
Other Material: Cellulose 12 %, Fibrous glass 2 %, Non-fibrous 86%
#2 218092222-02 No NAD
Location: Bedroom 1 Wall- Drywall/Compound (by NYS ELAP 198.1)
by Ivan H. Reyes
on 09/17/18
Analyst Description: OffWhite/Tan/White, Heterogeneous, Fibrous, Bulk Material
Asbestos Types:
Other Material: Cellulose 10 %, Fibrous glass 2%, Non-fibrous 88%
#3 218092222-03 No NAD
Location: Bedroom 1 Ceiling- Drywall/Compound (by NYS ELAP 198.1)
by Ivan H. Reyes
on 09/17/18
Analyst Description: OffWhite/Tan/White, Heterogeneous, Fibrous, Bulk Material
Asbestos Types:
Other Material: Cellulose 12 %, Fibrous glass 2 %, Non-fibrous 86%
#4 218092222-04 No NAD
Location: Bedroom 1 Ceiling-Drywall/Compound (by NYS ELAP 198.1)
by Ivan H. Reyes
on 09/17/18
Analyst Description: OffWhite/Tan/White, Heterogeneous, Fibrous, Bulk Material
Asbestos Types:
Other Material: Cellulose 15%, Fibrous glass 2%, Non-fibrous 83
#5 218092222-05 No NAD
Location: Bedroom 2 Wall- Drywall/Compound (by NYS ELAP 198.1)
by Ivan H. Reyes
on 09/17/18
Analyst Description: OffWhite/Tan/White, Heterogeneous, Fibrous, Bulk Material
Asbestos Types:
Other Material: Cellulose 8%, Fibrous glass 2 %, Non-fibrous 90 %
See Reporting notes on last page
AmeriSci Job#: 218092222 Page 2 of 5
Client Name: Michael J. Stevens
PLM Bulk Asbestos Report
43; 43 Country Club; 43 Country Club Rd, NY
Client No. ! HGA Lab No. Asbestos Present Total % Asbestos
#6 218092222-06 No NAD
Location: Bedroom 2 Wall-Drywall/Compound (by NYS ELAP 198.1)
by Ivan H. Reyes
on 09/17/18
Analyst Description: OffWhite/Tan/White, Heterogeneous, Fibrous, Bulk Material
Asbestos Types:
Other Material: Cellulose 15%, Fibrous glass 2 %, Non-fibrous 83%
#7 218092222-07 No NAD
Location: Bedroom 2 Ceiling-Drywall/Compound (by NYS ELAP 198.1)
by Ivan H. Reyes
on 09/17/18
Analyst Description: OffWhite/Tan/White, Heterogeneous, Fibrous, Bulk Material
Asbestos Types:
Other Material: Cellulose 18°A), Fibrous glass 2 %, Non-fibrous 80%
#8 218092222-08 No NAD
Location: Bedroom 2 Ceiling-Drywall/Compound (by NYS ELAP 198.1)
by Ivan H. Reyes
on 09/17/18
Analyst Description: OffWhite/Tan/White, Heterogeneous, Fibrous, Bulk Material
Asbestos Types:
Other Material: Cellulose 12%, Fibrous glass 2%, Non-fibrous 86%
#9 218092222-09 No NAD
Location: Bedroom 3 Wall-Drywall/Compound (by NYS ELAP 198.1)
by Ivan H. Reyes
on 09/17/18
Analyst Description: OffWhite/Tan/White, Heterogeneous, Fibrous, Bulk Material
Asbestos Types:
Other Material: Cellulose 15%, Fibrous glass 2 %, Non-fibrous 83%
#10 218092222-10 No NAD
Location: Bedroom 3 Wall-Drywall/Compound (by NYS ELAP 198.1)
by Ivan H. Reyes
on 09/17/18
Analyst Description: OffWhite/Tan/White, Heterogeneous, Fibrous, Bulk Material
Asbestos Types:
Other Material: Cellulose 15%, Fibrous glass 2 %, Non-fibrous 83%
#11 218092222-11 No NAD
Location: Bath Ceiling-Ceiling Tile (by NYS ELAP 198.6)
by Ivan H. Reyes
on 09/17/18
Analyst Description: White, Homogeneous, Fibrous, Bulk Material
Asbestos Types:
Other Material: Non-fibrous 35.5
See Reporting notes on last page
AmeriSci Job#: 218092222 Page 3 of 5
Client Name: Michael J. Stevens
PLM Bulk Asbestos Report
43; 43 Country Club; 43 Country Club Rd, NY
Client No. / HGA Lab No. Asbestos Present Total % Asbestos
#12 218092222-12 No NAD
Location: Bath Ceiling-Ceiling Tile (by NYS ELAP 198.6)
by Ivan H. Reyes
on 09/17/18
Analyst Description: White, Homogeneous, Fibrous, Bulk Material
Asbestos Types:
Other Material: Cellulose 37.4
#13 218092222-13 No NAD
Location: Kitch/Living Room Wall-Drywall/Compound (by NYS ELAP 198.1)
by Ivan H. Reyes
on 09/17/18
Analyst Description: OffWhite/Tan/White, Heterogeneous, Fibrous, Bulk Material
Asbestos Types:
Other Material: Cellulose 8%, Fibrous glass 2 %, Non-fibrous 90
#14 218092222-14 No NAD
Location: Kitch/Living Room Wall-Drywall/Compound (by NYS ELAP 198.1)
by Ivan H. Reyes
on 09/17/18
Analyst Description: OffWhite/Tan/White, Heterogeneous, Fibrous, Bulk Material
Asbestos Types:
Other Material: Cellulose 10 °A), Fibrous glass 2 %, Non-fibrous 88%
#15 218092222-15 No NAD
Location: Kitch/Living Room Ceiling-Ceiling Tile (by NYS ELAP 198.6)
by Ivan H. Reyes
on 09/17/18
Analyst Description: White, Homogeneous, Fibrous, Bulk Material
Asbestos Types:
Other Material: Non-fibrous 40
#16 218092222-16 No NAD
Location: Kitch/Living Room Ceiling-Ceiling Tile (by NYS ELAP 198.6)
by Ivan H. Reyes
on 09/17/18
Analyst Description: White, Homogeneous, Fibrous, Bulk Material
Asbestos Types:
Other Material: Non-fibrous 39.9
#17 218092222-17 No NAD
Location: Outside Wall North Side-Vinyl Siding (by NYS ELAP 198.6)
by Ivan H. Reyes
on 09/17/18
Analyst Description: Grey, Homogeneous, Non-Fibrous, Bulk Material
Asbestos Types:
Other Material: Non-fibrous 10°A,
See Reporting notes on last page
AmeriSci Job#: 218092222 Page 4 of 5
Client Name: Michael J. Stevens
PLM Bulk Asbestos Report
43; 43 Country Club; 43 Country Club Rd, NY
Client No. / HGA Lab No. Asbestos Present Total % Asbestos
#18 218092222-18 No NAD
Location: Outside Wall South Side-Vinyl Siding (by NYS ELAP 198.6)
by Ivan H. Reyes
on 09/17/18
Analyst Description: Grey, Heterogeneous, Non-Fibrous, Cementitious, Bulk Material
Asbestos Types:
Other Material: Non-fibrous 10.3%
#19 218092222-19 No NAD
Location: Outide Wall East Side-Vinyl Siding (by NYS ELAP 198.6)
by Ivan H. Reyes
on 09/17/18
Analyst Description: Grey, Homogeneous, Non-Fibrous, Bulk Material
Asbestos Types:
Other Material: Non-fibrous 9.4%
#20 218092222-20 No NAD
Location: Roof North Side-Asphalt Shingle (by NYS ELAP 198.6)
by Ivan H. Reyes
on 09/17/18
Analyst Description: Black, Homogeneous, Fibrous, Bulk Material
Asbestos Types:
Other Material: Fibrous glass Trace, Non-fibrous 39.2%
#21 218092222-21 No NAD
Location: Roof South Side-Asphalt Shingle (by NYS ELAP 198.6)
by Ivan H. Reyes
on 09/17/18
Analyst Description: Black, Homogeneous, Fibrous, Bulk Material
Asbestos Types:
Other Material: Fibrous glass Trace, Non-fibrous 33.1 %
#22 218092222-22 No NAD
Location: Roof West Side-Asphalt Shingle (by NYS ELAP 198.6)
by Ivan H. Reyes
on 09/17/18
Analyst Description: Black, Homogeneous, Fibrous, Bulk Material
Asbestos Types:
Other Material: Fibrous glass Trace, Non-fibrous 33.9
#23 218092222-23 No NAD
Location: Bath Floor-Vinyl Flooring (by NYS ELAP 198.6)
by Ivan H. Reyes
on 09/17/18
Analyst Description: Brown, Homogeneous, Fibrous, Bulk Material
Asbestos Types:
Other Material: Fibrous glass Trace, Non-fibrous 6.8
See Reporting notes on last page
AmeriSci Job#: 218092222 Page 5 of 5
Client Name: Michael J. Stevens
PLM Bulk Asbestos Report
43; 43 Country Club; 43 Country Club Rd, NY
Client No. / HGA Lab No. Asbestos Present Total % Asbestos
#24 218092222-24 No NAD
Location: Bath Floor-Vinyl Flooring (by NYS ELAP 198.6)
by Ivan H. Reyes
on 09/17/18
Analyst Description: Brown, Homogeneous, Fibrous,Bulk Material
Asbestos Types:
Other Material: Fibrous glass Trace, Non-fibrous 3.6
Reporting Notes:
(I) This job was-Analyzed u g Motic 310 Pol Scope S/N 1190000326
Analyzed by:Ivan H.Reyes
'NAD/NSD=no asbestos detected;NA=not ana edt NAPS=not analyzed/positive stop,(SOF-V)=Sprayed On Fireproofing containing Vermiculite;
(SM-V)=Surfacing Material containing Vermiculite;PLM Bulk Asbestos Analysis by Appd E to Subpt E.40 CFR 763(NVLAP 200546-0),ELAP PLM
Method 198.1 for NY friable samples,which includes the identification and quantitation of vermiculite or 198.6 for NOB samples or EPA 400 pt ct by
Appd E to Subpt E,40 CFR 763(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 lab.This PLM report relates ONLY to the items tested.AIHA-LAP,LLC Lab ID 102843,RI Cert AAL-094,CT Cert PH-0186,Mass Cert
AA000054.
Reviewed By: END OF REPORT
AmeriSci Job#: 218092222 Page 1.of 2
Client Name: Michael J. Stevens
Table I
Summary of Bulk Asbestos Analysis Results
43; 43 Country Club; 43 Country Club 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: Bedroom 1 Wall-Drywall/Compound
02 #2 ---- ---- ---- ---- NAD NA
Location: Bedroom 1 Wall-Drywall/Compound
03 #3 ---- --- ---- ---- NAD NA
Location: Bedroom 1 Ceiling-Drywall/Compound
04 #4 ---- ---- ---- ---- NAD NA
Location: Bedroom 1 Ceiling-Drywall I Compound
05 #5 ---- ---- ---- ---- NAD NA
Location: Bedroom 2 Wall-Drywall/Compound
06 #6 ---- ---- ---- ---- NAD NA
Location: Bedroom 2 Wall-Drywall I Compound
07 #7 ---- ---- ---- ---- NAD NA
Location: Bedroom 2 Ceiling-Drywall/Compound
08 #8 ---- ---- ---- ---- NAD NA
Location: Bedroom 2 Ceiling-Drywall/Compound
09 #9 --- ---- --- ---- NAD NA
Location: Bedroom 3 Wall-Drywall/Compound
10 #10 ---- ---- ---- ---- NAD NA
Location: Bedroom 3 Wall-Drywall/Compound
11 #11 0.169 21.3 43.2 35.5 NAD NAD
Location: Bath Ceiling-Ceiling Tile
12 #12 0.171 19.9 42.7 37.4 NAD NAD
Location: Bath Ceiling-Ceiling Tile
13 #13 ---- ---- ---- ---- NAD NA
Location: Kitch/Living Room Wall-Drywall I Compound
14 #14 --- ---- ---- --- NAD NA
Location: Kitch/Living Room Wall-Drywall/Compound
15 #15 0.215 20.5 39.5 40.0 NAD NAD
Location: Kitch/Living Room Ceiling-Ceiling Tile
16 #16 0.178 20.2 39.9 39.9 NAD NAD
Location: Kitch/Living Room Ceiling-Ceiling Tile
See Reporting notes on last page
AmeriSci Job#: 218092222 Page 2 of 2
Client Name: Michael J. Stevens
Table I
Summary of Bulk Asbestos Analysis Results
43; 43 Country Club; 43 Country Club 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 0.130 88.5 1.5 10.0 NAD NAD
Location: Outside Wall North Side-Vinyl Siding
18 #18 0.126 86.5 3.2 10.3 NAD NAD
Location: Outside Wall South Side-Vinyl Siding
19 #19 0.117 89.7 0.9 9.4 NAD NAD
Location: Outide Wall East Side-Vinyl Siding
20 #20 0.316 20.9 39.9 39.2 NAD NAD
Location: Roof North Side-Asphalt Shingle
21 #21 0.357 21.0 45.9 33.1 NAD NAD
Location: Roof South Side-Asphalt Shingle
22 #22 0.322 21.1 45.0 33.9 NAD NAD
Location: Roof West Side-Asphalt Shingle
23 #23 0.278 34.5 58.6 6.8 NAD NAD
Location: Bath Floor-Vinyl Flooring
24 #24 0.222 32.0 64.4 3.6 NAD NAD
Location: Bath Floor-Vinyl Flooring
Analyzed by:Aleksandr BarengoltsC-47
;Date Analyzed 9/17/2018
**Quantitative Analysis(Semi/Full);Bulk Asbestos Analysis-PLM by Appd E to Subpt E,40 CFR 763 or ELAP 198.1 for New York friable samples or ELAP 198.6 for New York NOB samples;TEM
(Semi/Full)by EPA 600/R-93/116(or ELAP 198.4;for New York samples; 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,AIHA-LAP, LLC(PLM)Lab ID 102843.
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).
Reviewed By:
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Pre-Demolition Asbestos Building Survey
43 COUNTRY CLUB ROAD
QUEENSBURY NY 12804
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 State or local
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 appropriate Asbestos Control Bureau district
office.
3) Due to a fire in the garage and the possibility of ACMS it should be
abated by a qualified abatement company
Pre-Demolition Asbestos Building Survey
43 COUNTRY CLUB R
QUEENSBURY NY 12804
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 SEPTEMBER 8 2018 which included both the interior and exterior
portions of the residence.
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
rooms, utility rooms, and crawl spaces.
During the survey, the inspector classified each suspect ACM 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 walls, 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.
Areas that were not accessible without significantly destructive
methods (e.g. fire doors) or that were contained within non-functional
building spaces or where part of energized equipment (heating
equipment, air handlers, electrical wiring, etc.) were not inspected. ACM
in non-functional spaces wound not typically be expected to pose a
hazard to human health or the environment as long as these materials
remain enclosed, are not part of the circulating air system and are
inaccessible to the building occupants.
Not all piping was able to be visually assessed in wall cavities.
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.
•
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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
Michael J Stevens FILE NUMBER: 13-72900
LICENSE NUMBER: 72900 `
PO Box 2202 LICENSE CLASS: RESTRICTED
DATE OF ISSUE: 09/28/2017
Glens Falls, NY 12801 EXPIRATION DATE: 09/30/2018
Duly Authorized Representative—Michael Stevens:
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.
rays:L.
Eileen M.Franko, Director
SH 432(8/12) For the Commissioner of Labor
STATE OF NEW YORK-DEPARTMENT OF LABOR - -
ASBESTOS CERTIFICATE
MICHAEL J STEVENS
'CLASS(EXPIRES)
D INSP(08/18)
MUST BE CARRIED ON ASBESTOS PROJECTS
IaItt11NI111�IHI1 I
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
Michael J Stevens FILE NUMBER: 13-72900
LICENSE NUMBER: 72900
PO Box 2202 LICENSE CLASS: RESTRICTED
DMTF OF ISSUE 10 04 2O 8
Glens Falls, NY 12801 EX117,..A,TION DATE: 10,31 2)19
Duly Authorized Representative—Michael Stevens:
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 isAralid 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.
SH 432(8/12) Eileen M.Franko, Director
For the Commissioner of Labor
STATE OF NEW YORK-DEPARTMENT OF LABOR —
ASBESTOS CERTIFICATE
MICHAEL J STEVENS
CLASS(EXPIRES)
D<INSP(08/I s)
MUST BE CARRIED ON ASBESTOS PROJECTS