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DEMO-0779-2021 Office Use Only DEMOLITION APPLICATION Permit#: ` -M�0 ZSfl21 Permit Fee: $ lQ J Town of Queensbury Invoice#: 742 Bay Road,Queensbury,NY 12804 P:518-761-8256 www.gueensbury.net Flood Zone? Y N Reviewed By: Demolition Location: Tax Map ID#: Zc\'+, **AN ASBESTOS REPORT IS REQUIRED WITH ALL DEMOLITION APPLICATION SUBMISSIONS** DEMOLITION INFORMATION: 1. Where will demoliti n material be disposed? . . �o r-� � �.�.�s � S�u,-�U,� o�o��al�ns01 2. Type of structure to be dembllshed: c ®O 30 RM Reside e d. Storage Building❑ b. Garage❑ e. Other: ��® c. Business ❑ a 3. What type of utilities are connected to the structure: a. Gas ❑ f. Well Water Pump❑ ,. b. Fuel Oil g. Public Sewer❑ c. Propane ❑ h. Other , d. Electric❑ i. None ❑ e. Public Water❑ 4. Have ALL utilities (water,relectric,.etc.) been disconnected? ,Yes No ❑ ADDITIONAL INFORMATION: 1. Two inspections may be required: an inspection to determine that utilities are disconnected, if necessary, and a final inspection, after the structure is removed an'd'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: fe- qy{ ©�S SIGNATURE: DATE: Z Demolition Application Revised December 2020 CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL • Applicant: Name(s): je(-6( ecGS Mailing Address, C/S/Z: 2257 Cat( WM' - , L,aa Lvgennny_j .Cell Phone: Email: 1ms5Cbn5qmc,1;bnlLL_c_ may(. cony • Primary Own r s • J i v _ ►ne�t- �-G��c �`U�'�Vi''�R , i�� 1, . �?���, ,' , . Mailing Address,; `C/S/Z: ?57 Oct(( Cell Phone: Land Line (ocl _Dyw Email: jf_rae(yvsS 2013 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: ��`� � Cell Phone: Land Line: Email: Demolition Application Revised December 2020 i 7 i 6 8 `i. OWNER: VLE Olt -- : 2' W E OCT 2 5 2021 TOWN OF OUEENSBURY BUILDING&CODES e0.AMIM SPECTRAq Sd)346- 3 4(123 e) (818)348-8374(Phone) Environmental flssa ates,Inc. (518)346-"2(>") TXCeeoiNS OV41 C4IENTS EXPPCTBT;0X5 OF E.YCBtMVCZ* www.4spectruni.com October 15,2021 Mr. Jerad Ross Moss Construction,LLC 2257 Call St. Lake Luzerne, NY 12846,NY 12308 (518) 681-0420 jrossconstructionllcn rnail.com 297-16-1-2.2 DEMO-0779-2021 RE: Asbestos Condition Inspection ROSE, 7erad 378 Queensbury Ave. 378 QUeensbury Ave Queensbury,NY 12804 Demolition of residence (fire damage) Spectrum Project#21-505 Dear Mr. Ross: Spectrum Environmental Associates, Inc. (Spectrum) performed a visual inspection of the areas identified in our report dated September 21,2021 at the residence located at 378 Queensbury Ave in Queensbury, NY on Wednesday October 13, 2021. The purpose of the inspection was to determine if there was any visual indication of the previously identified asbestos containing, materials (ACM)remaining that could pose a health concern. It was reported that all the identified suspect ACM from Apartment 2 &3 had been removed. Mr. William L. Massmann(Asbestos Inspector Cert# 90-15149)performed a visual inspection of the areas and confirmed that all previously identified ACM was removed and did not find any suspect asbestos materials that would require further attention. If you have any questions concerning this visual inspection, please do not hesitate to contact our office. Respectfully Submitted, JD�.P F c LE COPY Robert J DeRuyter VP of Operations Cc: file TOWN OF QUEENSBURY Attachments: Licensing and Certification(s) CODE DEPT. BUILDING & Reviewed y: Date: ! I Environmental Consulting&Management Services•Health&Safety Training•Laboratory Services P.0.Bar 1024 SPECTRVq Schenectady,NY 12301 : (518)346-63711(Phonre) Envi °ignmental dsSoclate�+s, Inc. (518)348-4062(FaY) 'EXCEEDING OVR CLIENTS EYPBCTBTIONS OP EjCELLENCE- t;vim4spectrum cam State of New York— Depailment of Labor Asbestos Certification )STATE OF NEW-Y(�R a•_. },� - � a>,�'y� i A`Ste)rFt'a1'�+rj NY��5 ASBflSfOS CERT}tCA'fE "`�;�;� ,'4 ," '�`�`�•�-, � 4 I�C�t �{!;}UVILLtAM �ASStVtAN f TA oii* VATEWQ 0Iz�ill, tNS�A ris till. - 1.�:�^T.a. " J �ii"••.�'r;-� r :CERT,CSOt�,S14�J`'_ v "ON0"97$s Jh fU5T1E Ci4RR{ED-:CQ 'i0.56EST S„P,RO:IEGiS" I "''= ''i '`� ' r - ;IIIIIII1tl101ltIgI111E1 IIIIIII llllllll#IIINIII l 111 IF FOUND RETURN TO: EYES BRO NYSDOL - L&C UNIT HAIR BRO ROOM 161A BUILDING 12 ,m a;9 HGT 6' 00" STATE OrricE CAMpUS $ ALBANY NY 12240 ' �n �o r: State of New York -- Department of Labor Codes Certification A Asbestos Handier B Restricted Handler - Allied Trades C Air Sampling Technician _D - Inspector _ E T �- Management Planner I Operations and Maintenance G _ S>pervisor 1-1 Project Nlonitor Project Desianel• ! fa:t�irnjl►�1 i11rticallsullingis-illanagellumlSt7rakas • lleallh lK.Sr:l�l}�'I':'tl}liili� • l.rabnrrjlnr} S�r9�icr�s �—New�York State Depar;�—eht�&Labor r` P 11 Division of- a(etyand Health �c. License and Certificate•lrif, } State Campus�Buildinig 12 Albany„NY 12240 �:,•.. " r "ASBESTOS HANDLING LICENSE . . .. ASpectrum Environmental Associates,Ines "�` i f� F E NUMBER: 99 0n1129 �: Y,�• ,, , LICENSE NUMBER:�2908=1 <:�i'` , PrO. Box1024 ' LICENSE CLASS: RESTRICTED d� kt ; / DATE OF ISSUE: 02/24/2021 . (• {Schenectady, NY 12'301 % �;tM:;ti\ +EXPIRATIQN DATE: 02/282022 t' ,.i j t,¢K I `: }mod"—_-_ _ _ . 2 tix QU Duly Authorized�,Representative {William{ tMassmann; �''... ,� rl �, 1Thishcense4hasbeen issuedin accordancetvith°a lieable .ro>vlsioxis oftA iele .Qbf`theLabor Law ofNewYork�Sfate-andof `'-. '.'c'""• 1 -� ft a��a t I 1 R , Jp .�,_:�_ +t17 cy �. thel(ewYor�StateCodes Rules a�iid,Regulations(12'N GRRPartS_6�Ztis,stbjecttosuispensionorrevocattonfora(1)j /' seiiousviolationof'state federalo local'laws t {re a'dt..." nd ofa' asLK-,bU ro;'e',ct or 2 demons°trat ed'laekvf i VA. 11 Ia 13 '1 ' ':I4= � y: lUr�a •- v�u+�' 3�sr P J, ( ) res onsibilit mthe.conductofan obinbolvtn asli'es is-br�a•sl'iestos�mV S �` z y y r- g� This lice sees alido u forthecontractor arriedabovean� hcenseo a= .hof'oco ._must e _ omirientl dis la ed'atfh°e asbesto projectworksite h'%liegnseverifzestha}allper�onsvemployedl y�helicenseeonan:asbestosproj tinN wYork -• r_• r State liavebeen issued nAsbestos Certificate;appropriate fothetypeofworktheyperfonn,by theNewYork State Departmento. abor. fix;;• : . r.,�^'' �. Amy Phillips,Director SH 432(8/12) For the Commissioner ofLabor 1 P.0.Box 1024 Sahenectadp,NY 1230t SPECTRVAf (518)346-6374(Phone) Environmental associates,.lnc. (518)346-4062(Fax) EXCEEDINC ODP.CLIENTS EXPEMITIONS OF EXCELLENCE wi m4spednnuCom ASBESTOS.PRE DEMOLITION SURVEY/INSPECTION BUILDING 378 QUEENSBURY RD. QUEENSBURY, NY 12804 SPECTRUM PROJECT NO.: 21-505 SEPTEMBER 21, 2021 PREPARED FOR: J ROSS CONSTRUCTION, LLC 2257 CALL ST. LADE LUZERNE, NY 12846 Environmental Consulting&Management Services•Health&Safety Training•Laboratory Services SECTION -INTRODUCTION, On September 14, 2021, Spectrum.Environmental,Associates,•Inc.:(Spectmm) conducted:a survey for the presence of asbestos containing materials at the building located at 378.Queensbury Ave in Queensbury, NY. Mr. Nate Martin (Asbestos Inspector #21-0486) conducted this inspection following procedures;and-guidelines,commonly used and;acc,epted by federal,and state regulations. The objective ofthe survey was,to identifythe.presenee and approximate.locations-and..quantities of suspect and/or confirmed asbestos containing.materials. An initial•walkthrough of.the•designated areas was,conducted by an experienced asbestos inspector to observe and record materials used in: e-construction,of the building. The inspector proceeded by assessing floors,'walls, ceilings, surfacing materials, thermal systems insulation, roofing materials and other miscellaneous materials, with..the;potential to contain asbestos. From observations; the,inspector•prepared-a listing of,building,materials that are suspecte1.d to;contain asbestos... The. inspector selected.:these materials for ;inclusion in the;inspection through professional experience; and an understanding of-.the: historical uses of.asbestos.. %Generally speaking,if a building material within a structure could contain asbestos,the.material was included in the inspection. Materials 'included in -the survey were identified and• 'recorded• with 'respect- to grouped homogeneous sampling areas. Representative bulk material samples were collected from locations within each homogeneous sampling area. Sampling information was recorded on chain of custody forms for documentation. Samples were individually preservedwithin a container and transported to.an independent laboratory for asbestos analysis. Laboratory analysis'of asbestoss samples'via polarized:h hi microscopy(PLM)and/or transrmssion electron microscopy(TEM)was conducted'by AmeASci of New York,New York(FLAP#11480; NVLAP#200546-0). Sample analysis was conducted as follows: • "Friable"Asbestos Samples—PLM e "Non-Friable" Organically Bound(NOB) Asbestos Samples—PLM and, if negative,TEM for confirmation as required under NYSDOH-ELAP regulations. SECTION II-LIMITATIONS The information provided in this report was compiled from field and laboratory data obtained during the site visit. Observations noted and recorded are intended to represent the conditions that existed at the subject site at the time and date that the observations were made. Spectrum has not conducted its own-analytical,but has utilized an independent NYS-DOH ELAP approved laboratory to provide the analytical results contained in this report. All discussions, findings, and conclusions are based on information that Spectrum received and understood to be factual. ATTACHMENTS TABLE I-ASBESTOSSAMPLINGRESULTS TABLE 2-ASBESTOS FINDINGS PHOTO ALBUM LOCAmNMAPS LABORA,TORYREPORTS LICENSINGAND.'CERTIFICATION TABLE 1 — ASBESTOS SAMPLING RESULTS 378 Queensbury Rd Spectrum Project#21-505 Date Sampled:September 14,2021 Tt;;: is ',;:' T'MR eslt :PI;MResul �s;:c,'..,, !. , , 4;�'a:Desci•i tioo..-� - ,,,. ati- ,.•.� P. P L`oc oiilAiea', _ - 17 Ceiling Tile Ceiling of Apt 2 NAD NA 18 Ceiling Tile Ceiling ofApt 2 NAD NA 19 Particle Board Walls Bedroom walls of Apt 2 NAD NA 20 Particle Board Walls Bedroom walls of Apt 2 NAD NA f37under Gie"S "eckled'12x12'. "':' r 31 Black 1VIastc sotile<0. /o 25 ''. Ch stile 1:4 ou'h'out� ,G � �'''S" `';•� A t 3 under"GreY', P e. cked122 :22 Black Mastic A.4- throuliout s yD.nr NAD NA7PS �`Gre�S'ec �e �l t:.; 0 y, p, kl d 2x1Zi,�- a�' ��A t3:under.iirioleum`�)?loorin� 24'= "Gre S eckled 12%'2`'y, 7 A f3"ariderrLinoleum,Flooriri 8c.1 a p et P ,s.': P g rP. :s ,,:y+' na'^ - "dr'r �n '•os ;;i",J":yj :. r .. _ .,r,d;.,r a,; ,'( ,,,Y' ,iibs ,.M•': ',%: ° .,kG.n'�°,r..-i: 25 Linoleum lay down flooring(Tan) Apt 3 flooring in Kitchen NAD NAD 26 Linoleum lay down flooring(Tan) Apt 3 flooring in Kitchen NAD NAD 27 Ceiling Tile Apt 3 ceilings NAD NAD 28 Ceiling Tile Apt 3 ceiling NAD NAD 29 Tar Paper RoofofBuilding NAD NAD 30 Tar Paper RoofofBuilding NAD NAD 31 Shingle RoofofBuilding NAD NAD 32 Shingle RoofofBuilding NAD NAD Note: Asbestos containing materials are greater than 1%asbestos. Trace is considered less than 1%asbestos. NAD-no asbestos detected,NA-not applicable,PS—Positive Stop,SF-square feet,LF—linear feet TABLE 2 - ASBESTOS FINDINGS 378 Queensbury Rd Spectrum Project#21-505 Date Sampled: September 14, 2021 Limitations: The following limitation/conditions were noted as part of the survey: • OSHA requires that an employer not expose its workers above the PEL and therefore specific training, work practices and/or respiratory protection may need to be'a consideration when handling materials that are less than one percent. • -The inspection was performed in accordance with,New York State Industrial-Code Rule 56 Section 5.1. A copy.of 56-5.1 is available upon request. It is the responsibility,of the owner or its agent to forward a copy of this report to the local,government entity charged with issuing a permit for such demolition,renovation;remodeling or repair work.under applicable State or local laws as well as.to the NYS Department,of Labor Asbestos Control Bureau. Spectrum will not send this report to the NYSDOL without written permission from its client;due,to the sensitive nature of the information present in this report. • This report reflects the conditions found at the date and time of the inspection(s). Conditions of the area and materials may change due to external events, forces or influences. Re-. inspection of the area may be required prior to the start of any work if an extended period of time has passed.or if.disturbances have occurred. •. If materials not sampled in the survey are uncovered during renovation/demolition,per ICR56 work should stop and those materials should be assessed before work-continues. Also per ICR 56, a copy of the survey report should be submitted to the local agency issuing the demolition permit and a copy should be kept on site during the demolition phase of the project. • This survey is for the future demolition of the structure. Per NYSDOL, if the project does not proceed within approximately.6 months,the stricture should be visually re-inspected to confirm that no addition materials have been added and that the,existing conditions of the identified ACM is still the same. • Spectrum did not inspect any exterior area below grade. Foundation sealers,buried piping and other items may exist below grade which may contain asbestos. SF—square feet,LF—linear feet,ea—each PHOTO ALBUM 21-505(9-14-21) 378 Queensbury Rd. Pre Demolition Bulk Sample Locations-NTS G1 9 20' 10'12'14 g Apartment 2 '29;30 !,32 Roofing Samples Of Ef fi a Structure' _.Apartment 7 27;28 _Apartment'3i ;21,23,25; ;33;34,) AmeriSci New York A4 117 EAST 30TH ST. MERI SCI NEW YORK, NY 10016 TEL:(212)679-8600• FAX:(212)679-3114 PLM Bulk Asbestos Report Spectrum.Environ mental,Associates, Inc. Date Received 09/.15/21 AmeriSci Job# 221092289 Attn: Bill-Massman :Date.Examined 09/1-6/21 P.O. # P.O.Box 1024 ELAP# 11480 - Page 1 Of 7 RE:21-505; 378 Queensbury.Rd.; Demo Survey Schenectady, NY 12301 Client No.] HGA Lab No. Asbestos Present Total %Asbestos 1 221092289-01 No NAD 1 Location:Apartment 1,2&3 Throughout-Joint Compound (by NYS ELAP 198.1) by Valeriu Voicu on 09/16/21 Analyst Description:White,Homogeneous, Non-Fibrous, Bulk Material Asbestos Types: Other Material: Cellulose Trace, Non-fibrous 100% 2 221092289-02 No NAD 1 Location:Apartment 1,2&3 Throughout-Joint Compound (by NYS ELAP 198.1) by Valeriu Voicu r: on 09/16/21 ' Analyst Description:White,Homogeneous,Non-Fibrous, Bulk Material Asbestos Types: Other Material: Cellulose Trace, Non-fibrous 100% 3 221.092289-03 No a NAD 2 Location:Apartment 1,2&3 Throughout-Sheetrock (by NYS ELAP 198.1) by Valeriu Voicu on 09/16/21 Analyst Description:Gray, Homogeneous, Fibrous, Bulk Material Asbestos Types: Other Material: Cellulose 3%, Non-fibrous 97% 4 221092289-04 No NAD 2 Location:Apartment 1,2&3 Throughout-Sheetrock (by NYS ELAP 198.1) by Valeriu Voicu on 09/1'6/21 Analyst Description:Gray/Brown, Heterogeneous, Fibrous, Bulk Material Asbestos Types: Other Material: Cellulose,7%, Fibrous glass 93% 5 221092289-05 No NAD 3 Location:Apartment 1 Throughout-Ceiling Tile (by NYS ELAP 198.6) by Valeriu Voicu on 09117/21 Analyst Description:White/Gray,Homogeneous, Non-Fibrous,Bulk Material Asbestos Types: Other Material: Non-fibrous 63.1% ' See Reporting notes on last page AmeriSci'Job#: 221092289 Page.3 of 7 Client Name:Spectrum Environmental Associates, Inc. PL_BbIkMbestbs Report • 21-505; 378 Queensbury Rd.; Derrlo"Survey Client.No. / HGA '.. Lab: No. Asbestos"Present Total °Io Asbestos 12 221�092289-12 No: NAD 6 Location:Apartment 2 Kitchen Under Lay Over Flooring-Self-Stick Tile 12 x 12(White) (by NYS ELAP 198.6) by Valeriu Voicu on 091.1:7/21 Analyst Description:Off-White/Gray, Homogeneous, Non-Fibrous, Bulk Material Asbestos Types: Other Material:.Non-fibrous,4.0% . . ,. 13 221092289-13 No NAD 7 Location:Apartment 2 Kitchen Flooring-Linoleum Lay Over Flooring(Beige) (by NYS ELAP 198.6) by Valeriu Voicu on 09/17/21.. , Analyst Description:Gray/Beige, Homogeneous, Nori-Fibrous, Bulk Material Asbestos Types: Other Material: Non-fibrous,2.8% . 14 291092289-14 No NAD 7 Location:Apartment 2 Kitchen Flooring-Linoleum Lay Over Flooring(Beige) (by NYSELAP 198.6) by Valeriu Voicu on 09/17/21.., Analyst Description:Gray/Beige, Homogeneous, Non-Fibrous,Bulk Material Asbestos Types: Other_Material: Non-fibrous.,1.8%. 15 221092289-15 Yes 6.8% 8 Location:Apartment 2 Bedroom Under Carpet-Self-Stick Tile 12 x 12(Beige) (by NYS ELAP 198.6) by Valeriu Voicu on 09/1.7/21., Analyst Description:Tan,.Homogeneous, Fibrous,Bulk Material Asbestos Types:Chrysotile 6.8% Other-Material: Non-fibrous.11.9,% 16 221092289-16 NA/PS 8 location:Apartment 2 Bedroom Under Carpet-Self-Stick Tile 12 x 12(Beige) Analyst Description:Bulk Material Asbestos Types: ' Other.Material,: 17 221092289-17 No NAD 9 Location:Ceiling Of Apartment 2 Ceiling Tile (by NYS ELAP 198.6) by Valeriu Voicu on 09/17/21 Analyst Description:White/Tan, Homogeneous, Non-Fibrous, Bulk Material Asbestos Types: Other Material:_Non-fibrous 14.8% See Reporting notes on last page AmeriSci Job#: 221092289 Page_5 of 7 Client Name:Spectrum Environmental Associates, Inc. PLM Bulk-A's"b`estos'Report 21-505; 378'&e'ensburyFtd.'; Demo Survey Client No: !HGA .. .._ . Lab:"_No: . Asbestos Present .. Total %Asbestos :. 24 221092289-24 NA/PS 12 Location:Apartment 3 Under Linoleum Flooring&Carpet-Gray Speckled 9 x 9 Analyst Description:Bulk Material Asbestos Types: Other Material: 25 229'092289-25 'No NAD 13 Location:Apartment 3 Flooring In Kitchen-Linoleum Lay Down Flooring'(Tan) (tiy NYS ELAP 198.6) by Valeriu Voicu on 09/17/21 Analyst Description:Tan, Homogeneous,Non-Fibrous,Bulk Material ti ' Asbestos Types: Other Material: Fibrous glass_1%, Non-fbrous 1;1% 26 221'092289-26 No NAD 13 Location:Apartment 3 Flooring,In Kitchen-Linoleum Lay Down Flooring(Tan) (by NYS ELAP 198.6) by Valeriu Voicu on 09/17,/21 , Analyst Description:Tan, Homogeneous,Non-Fibrous,Bulk Material Asbestos Types: Other Material: Fibrous glass 1%, Non-fibrous 1.4%. ` 27 221092289-27 No" NAD 14 Location:Apartment 3 Ceilings=Ceiling Tile (by NYS ELAP 198.6) by Valeriu Voicu on 09/17/21 Analyst Description:White/Brown, Homogeneous,'Non-Fibrous,Bulk Material Asbestos Types: Other,Material: Non-fibrous 24.3% ' 28 . .,.,. 221092289-28 _ No ' NAD 14 ,Location:Apartment 3 Ceilings-Ceiling Tile (by NYS ELAP 198.6) by Valeriu Voicu on 09/17/21 Analyst Description:White/Brown, Homogeneous,Non-Fibrous, Bulk Material Asbestos Types: " Other Material: Non-fibrous 16% 29 221092289-29 No NAD 15 Location:Roof Of Building-Tar Paper (by NYS ELAP 198.6) by Valeriu Voicu on 09/17/21 Analyst Description:Black, Homogeneous,Non-Fibrous, Bulk Material Asbestos Types: Other Material: Non-fibrous 1.6% See Reporting notes on last page AmeriSci Job#: 221092289 Page 7 of 7 Client Name:Spectrum Environmental Associates, Inc. PLM Bulk Asbestos .Report 21-505; 378 Queensbury Rd.; Demo Survey ,r , Reporting Notes: (1) Sample prepared for analysis by ELAP 198.6 method Analyzed by:Valeriu Voicu Reviewed by:Marik Peysakhov Date:9/16/2021 �f *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#:2299,15,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 M 221092289 .Page 2 of& Client Name: Spectrum Environmental Associates,Inc. ,Table l . Summary of'Bulk Asbestos Analysis;Results 21-505; 378 Queensbury Rd.; Demo Survey sample-! Heat Acid Insoluble AmeriSci HG . .. .. Weight_ 'Sensitive Soluble„ _Non-Asbestos !'.Asbesios.%.tiy ." ".Asbestos%by Sample# Client Sample# Area (gram) Organic_% Inorganic% Inorganic% PLM/DS" TEM 17 17 9 0.392 72.7 12.5 14.8 WAD NA Location: Ceiling OfApartmerit 2-Ceiling Tile 18 18 9 0.367 74.1 14.1 11.8 'NAD' NA Location: Ceiling Of Apartment 2-Ceiling Tile 19 19 10 - - - WAD . NA Location: Bedroom Walls Of Apartment 2-Particle Board Walls 20 20 10 - - - - WAD NA Location: Bedroom Walls Of Apartment 2-Particle Board Walls 21 . 21 11 0.099 70.3 15.6 12.7 Chrysotile<0.25 Chrysotile 1.4 Location:Apartment 3 Under Gray Speckled 9 x 9 Throughout-Black Mastic 22 22 11 0.087 86.5 7.0 6.4 WAD NAIPS Location: Apartment 3 Under Gray Speckled 9 x 9 Throughout-Black Mastic 23 23 12 0.366 25.6 47.3 23.6 Chrysotile 3.5 NA Location: Apartment 3 Under Linoleum Flooring&Carpet-Gray Speckled 9 x 9 24 24 12 0.273. 31.8 34.9 33.4 NA/PS NA Location: Apartment 3 Under Linoleum Flooring&Carpet-Gray Speckled 9 x 9 25 25 13 0.248 36.8 61.0 2.1 WAD WAD Location: Apartment 3 Flooring In Kitchen-Linoleum Lay Down Flooring(Tan) 26 26 13 0.226 40.4 57.3 2.4 WAD WAD Location: Apartment 3 Flooring In Kitchen-Linoleum Lay Down Flooring(Tan) 27, 27 14 OA89 70.7 5.0 24.3 WAD WAD Location: Apartment 3 Ceilings-Ceiling Tile 28 28 14 0.469 78.6 5.5 16.0 WAD WAD `Locafion::Apartment 3 Ceilings-Ceiling Tile 29j 29. 15 0.218. .95.4 3.0 1.6 WAD WAD Location::'Roof Of Building-Tar Paper: 30 30 15 0.185 95.3' 1.8:: 2.9 WAD WAD Location: Roof Of Building-Tar Paper 31 31 16 0.565 20.8 46.4 32.8 WAD ' WAD Location: Roof Of Building-Roofing Shingles 32 32 . 16 0.769 21.5 46.0 32.6 WAD WAD Location: Roof Of Building-Roofing Shingles See Reporting notes on last page f J� P.O.Box 1024 - s=SPECTRUM Schenectady.N!'12301 (518)846-6374(Phone) EnVftJ7Mentul dSSVdWeS.Inc. # 2 2 1 0 9 2 2 8 9 (518)346-4062(Pax) 'C.rrrromr Or;Ctn.rvt Cxrrcrrrrorr Vr Grrrrrrirr' Ivrvrv.4spectrum.cam t BULK SAMPLING CHAIN OF CUSTODY(a—ovw.12014) PR03I:C1'IN FORMATION' ram" p'21-505 b"n 37B Queensbury Rd. v(aiiis AnnlysisRequested Turnaround D-SM,kd: Arca7u naen: t 9-14-21 Demo Survey O Bulk ❑Paint 9'PLM-13LA111981 ©TrM-HLAP 195.4- ❑BUSH ❑24 Hour p'e`a1 or 3 Nate Martin ❑soil ❑Wipe : 0 PLM-FLAP 198.6 ❑7211our ✓ 5 Days SAMI'I,F.IDRNTIF(CATfON ' Sample ID 9: Group 9:t Material Sample Location V Condition/Commcnt 1 1 • Joint Compound Apartment 1,20 Throughout Poor QTY T.B.D 2 1 Joint Compound Apartment 1,20 Throughout Poor QTY T.B.D 3 2 Sheetrock Apartment 1,2&3 Throughout Poor QTY T.B.D 4 2 Sheetrock Apartment1,2&3 Throughout Poor QTY T.B.D 5 3 Ceiling Tile, Apartment 1 Throughout Poor QTY T.B.D 6 3 Ceiling Tile ,•Apartment.1Throughout Poor QTYT,B.D 7 4 Tile Grout Apartment 1 Throughout Poor QTY TB.D 8 4 Tile Grout Apartment 1 Throughout Poor QTY T.B.D 9 5 Self Stick Tile 12 x 12(Beige) ApartmenV2 Kitchen Under 12 x 12(White) Poor QTY T.B.D 10 5 Self Stick Tile 12 It 12(Beige) Apartment 2.Kitchen Under 12 x 12(White) Poor QTY T.B.D 11 6 Self Stick Tile 12 It 12(White) "Apartment.2.Kitchen Under Lay Over Flooring Poor QTY T.B.D 12 6 Self Stick Tile 12 x 12(White) Apartment'2;Kitchen Under Lay Over Flooring Poor QTY T.B.D 13 7 Linoleum Lay Over Flooring(Beige) Apartment 2 Kitchen Flooring Poor QTYT.B.D- 14 7 Linoleum Lay Over Flooring(Beige) Apartment 2 Kitchen Flooring Poor QTY T.B.D 15 8 Self Stick Tile 12 x 12(Beige) Apartment 2 Bedroom Under Carpet Poor QTY T.B.D 16 8 Self Stick Tile 12 x 12(Beige) Apartment 2 Bedroom Under Carpet Poor QTY T.B.D a Unless otherwise shoed plensu,mntyze each group to first(111)pnsitive remelt. amnsnhs; CHAIN OF CUSTODY liclidquishcd By Date 'Time Rcseivcd B"y Date Time Method orSubmiltal I Nate Martin 1,$ LI 1 2,oe n m t Environmental Consulting & Management Services Health & Safety rralafng Laboratory Services sPEcTRV G $ .s P.O.sex 1024 Schenectady,XY 12301 # 2 2 1 U 9 (518)346-6374(Phone) rye:Environmental Rswciates.Inc. (518)346-4062(Pax) �� 'Crrrrnrac Ore Ctuxts Ctrrerarrbrn tit CrrrlAkcrl" IVUwAspectrum con1 } BULK SAMPLING CHAIN OF CUSTODY(w.aa(mnal.tl PROJECI'INrOL NWHON r p"U.21-505 i1wddttie Name-378 Queensbury Rd. Matrix Analysis Requested Turnaround Ihie iainplcd: Ncatl.ncaGnn: 9-14-21 Demo Survey O 13ulk Cl Paint ©PLM—FLAP 198.1 7TM—"-LAP 198.4 ❑RUSH 10 24Hour 3 of 3 '-""s"°"-Nate Martin CM❑Soil ❑Wipc ✓ 5 Days 0 1' —GLAP 198.G ❑72 Hour SAIMI'L.r.1 DENTIFICATION Sample ID#: Croup#:• Material Sample Location Condition/Comment 33 17 Foundation Mortar Exterior Foundation Poor QTY T.13.1) 34 17 Foundation Mortar Exterior Foundation Poor CITY T.130 t`uldw uthcnvivcstated plcaac anuly<c mch g—.J.to First(Y)pasi0.result. ..tons.... CHALV or CUSTODY Relinquished By Date 'rime Received By Dale '1'imc Method orSubmiltdl i Nate Martin IS Zi l n w Environmental Consaltin.g & Alanagernent Services A!ealth & Safety Training Laboratory Services P.0.3ax 1024 SPECTRi- Schenectady,XV 12801 (518)346-63711(Phone) jvtvw.1SPe&vm.com Envl*rg9o?lmental.gssocl'ate4s9 Inc. (518)3,16-4062(Pax) �'� 'IEXCEEDIBCG DUR CaIENTS$XPECTfITIOYS OF�:CCELumccE State of. New.York'—De ai.,tmeut.4 Labor estos Cer-tif�catiox ' - � � '�.;,.w.,-:...�W,s jai�i3c'R-':q.:?�^.ra`^'^lr,sr:-f.a•s;�'nrnu+}.�ti!�-�:;,e �^`-;�",,..n'.`.;..,`."..`�"�.->�,.� =;STATE•OFN XORK-";DEPAR MEN7'Of ,fi; ��NJATiER4NIp�TIAf�= uNtt15T`QC412It1ED:QN:ASBEST )S.PItO�JECTSr :,t. i ,+....^'v'.?!L�.�=,aT";•rvI?Y'i.",K''�'ro..-.:+,E;•++b!+"t'^,.� ±=•��...Y�-.,s�'.r'.�.^-is.;w.«�..,a-'-_: . �, 1 y� •' _..II�I�I�II.'!.�'�I�II'I'I'll'I�IIi�'III� ,, - ��- i. --. . : ,• - IF FOUND RETURN TO: EYES BRO NYSDOL - L&C UNIT -te , o HAIR BRO.. ROOM 161P;,BUILDING 12 HGT 5' 11" STATE OFFICE CAMPUS - ALBANY NY 12240 • �m N State of New York— Department of Labor Codes,;,-. Certification A` Asbestos Handler B Restricted Handler -Allied Trades C Air Sainpling Technician D Inspector E Management Pleanner F I Operations and Maintenance G Supervisor H Project Momtor I Project Designer Enr!r,nnrnvntv]Cansu frog%&,fflanageln-pntSefwims „ Rvallb A,Safely 7`?Wning Lab•ora#o7TSM*vs NEW YORK STATE DEPARTMENT OF HEALTH WADSWORTH CENTER Expires.12:01 AM April 01,:2022 Issued April 01,2020 CERTIFICATE OF APPROVAL FOR LABORATORY SERVICE Issued in accordance with and pursuant to section 502 Public Health Caw of New York State MR.PAUL J.MUCHA NY Lab!d No:11480 AMERICA SCIENCE TEAM NEW YORK,INC f 1 7 EAST 30TH ST NEW YORK;NY 10016 is hereby APPROVED as an Environmental Laboratory for the category ENVIRONMENTAL ANALYSES SOLID AND HAZARDOUS WASTE All'approved subcategories and/or analytes are listed below: M1sceAaneouts Asbestos In Friable Material item 198.1 of Manual EPA 600/M41621020 Asbestos in N61-Fdable.Matedal-PIM Item 198.6 of Manual(NOB by PI.M) Asbestos in Non-Fdabia Material-TEM item 198.4 of Manual �eriai No.: 61903 Property of the NewYork Stets ovamnem of Heaw.Certificates are yaw only at the ad*m- shown,.must be eonspfarousty posted,and are printed on secure paper.con oo acneditation depends k. on suoces*l ongoing participation in the Program. Consumers are urged to ed(518)4W5570 to - wr9y the labomtoro aowedifaWn status. 9Pr1ge 1 Of 1 Kate Deck From: Sereena Coombes <sereenacoombes@yahoo.com> Sent: Tuesday, October 19, 2021 3:30 PM To: Kate Deck Subject: Change of builder Kate, Good afternoon I just wanted to reach out as we have had a change in our builder They should be finally starting the project next Monday, but Rozell will be doing the excavation and kevin Guilfoyle of.Ridgewood homes will be doing the rest of the construction. Please let me know if you need more information. Sereena Coombes 28 Tuthill road 5183213119 Sent from Yahoo Mail for iPhone This is an external email, D• not click links or ••- attachments unless you recognize the senderand know the content is safe. ' 1 024 SPECTRA P.O.Box anal St*enecWdy.XV 1230T (Sl8)340-6374(Phone Endronmental associates, Inc. (518)3484082(Fax 'ExcEmvc Oup CLmvrs Exrecrarro.vs or ExcrtLCxce• wu w.4sped?vm.com October 15, 2021 Mr. Jerad Ross JRoss Construction, LLC 2257 Call St. Lake Luzerne,NY 12846,NY 12308 (518) 681-0420 irossconstructionllc@p,mail.com RE: Asbestos Condition Inspection 378 Queensbury Ave. Queensbury,NY 12804 Spectrum Project#21-505 Dear Mr.Ross: Spectrum Environmental Associates, Inc. (Spectrum) performed a visual inspection of the areas identified in our report dated September 21,2021 at the residence located at 378 Queensbury Ave in Queensbury, NY on Wednesday October 13, 2021. The purpose of the inspection was to determine if there was any visual indication of the previously identified asbestos containing materials(ACM)remaining that could pose a health concern. It was reported that all the identified suspect ACM from Apartment 2 &3 had been removed. Mr. William L. Massmann (Asbestos Inspector Cert# 90-15149) performed a visual inspection of the areas and confirmed that all previously identified ACM was removed and did not find any suspect asbestos materials that would require further attention. If you have any questions concerning this visual inspection, please do not hesitate to contact our office. Respectfully Submitted, AMwt 67 May&o Robert J DeRuyter VP of Operations Cc: file Attachments: Licensing and Certification(s) FILE COPY Environmental Consulting&Management Services'Health&Safety Training'Laboratory Services r P.0.Bay 1024 SPECTRVA Schenectady.XF 12301 1 (518)346-6974(Phone) Environmental dsso ates9 Inc. (518)3,16-4062(Fay)'EXCEEDING OUe CLIENTS EXPfCTB7'10XS OF EXCELLENCE* www4spectrum com State of New York— Department of Labor Asbestos Certification STATE OF NE1N YORKf l DEPART`t�W`T OF lA80R ,}- asa OS CE2Tlf[CATE'R t'v ...,.,:.�_:,� .�-:�,�r.'t'.�,-�-_�;•` � =�. ""ram.-. t �i•,tr� 'S's, i FDt;rr1.0J2, 4 i s. CE4t ,9Q'' jj146 41 ';ifv#t151p�E CARRIED O,.ASBESTOS PROJEICT HIM 111111111111111111111 .: IF POUND RETURN TO: a BYES SRO NYSDOL - L&C UNIT "o HAIR BRO ROOM 161A BUXLD113G It � �o$N HGT 6' 00" STATE OFFICE CAMPUS o M AIMM NY 12240 N �O State of New York — Department of Labor Codes Certification A Asbestos Handler P _ Restricted Handler-Allied Trades C Air Sampling`l'e'chniciari — D Inspector {{ l'- _------ NAanagemeint Manner__ T' TAerations and Maintenance _--- _G _ _ Supervisor _--.- Project.Monitoi -_--.-- �_ 1--- } -- ----- — Pr ject Desig;Ze�-----'---- EarOrakra9a.mdul BeaPllaJK�sa9 ij,Trujifing labor"11,01-1,serl�ins York State 'De A ent:of.Labo� t Division of,ISafet`yy and Health License and Certiflcafe Uriit , State Campus;Building 12' ,. % Albany,.NY 12240 \., BESTOS HANDLING LICENSE� r� { Spectrum Environmental Associates,lnc h`, r S '1� 9'- - •FILE NUMBER 9~9=012i9 r i� E LICENSE NUMBER" 29081--' 66 ¢%PtO. Bo024:/' a4• LICENSE CLASS: RESTRICTED V Itr DATE OF ISSUE: 02/24/2021 Schenec/tady;�NY 12301 -� ;'�'' :;frs j EXPIRATION DATE: 02/28/2022 Duly Authorized Representative William'.L Mass:mann 4 � rl sTh�slicensehasbeenissuedinacMdancewtthapp,hcable:provisionsof lrGi¢e3U;oftheLaborLawofNewYork�St'ate-andof � � ec,,i, rd,;t.= s, a , I t o �; _ra sr WeNewYork State Codes Rules.MilRe lations, _1_2 gu ( :- Nl'CRRPart5.6 :=Itissu6jecttosuspensionorrevocationfora(1) seriousviolationof'state federal orlocaa'tawswith�regardtotheconduct:ofariasbestospr@e6, or(2)demonstrat�d'lackof ;k 14- U �. 1 18 t.: '• !~.t�ti --�!}��i�Cor .. 0%ri�'�41•i�Ci'`.F',' � -� I respo nstbility'in the eonductof anyjob tnvolvingasbe�stos or asbestos �. -��_ may, This licenseis,va�lidonly�fortheco� nK�rnamed-aboveand:Alas,hcenseo�raphotocopy.musttbe-prom' fit lydisplayedatthe asbestos ptojec�worksite.\This.1icense verifies th4allperson semp16yjed.byAhe licenseeon an;asbestos proja,t�New�'ork State have been1issued an Asbestos Certificate;appropriate fo thetype,of-'-'work they perform,by th6l ewYork-State t Departcnentof'abor, — Amy Phillips,Director SH 432(8/12) For the Commissioner ofLabor