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DEMO-0082-2023 Office Use Only '•,-_---�.., pC-�t© - ��� 2— 202� DEMOLITION APPLICATION Permit#: Permit Fee:$ 10 S r —Li Town of Queensbury Invoice#: 17_�S 742 Bay Road,Queensbury,NY 12804 P:518-761-8256 www.gueensbury.net Flood Zone? Y N Reviewed B . L__11 V Demolition Location: i5-ff i r3 y Rid Tax Map ID#: **AN ASBESTOS REPORT IS REQUIRED WITH_.ALL DEMOLITION APPLICATION SUBMISSIONS** DEMOLITION INFORMATION: 1. Where will demolition material be disposed? Chi S�- 2. Type of structure to be demolished: _ 1 a. Residence_ d. Storage Building b. Garage— — e. Other: c. Business MAR O 2 3. What type of utilities are connected to the structure: TOWN a. Gas f. Well-Water Pump BUI`Oi� LC7�1���Y b. Fuel Oil g. Public Sewer w c. Propane h. Other d. Electric i. None e. Public Water 4. Have ALL utilities (water, electric, etc.) been disconnected? Yes No ADDITIONAL INFORMATION: 1. Two inspections are required: an inspection to determine that utilities are disconnected, and a final inspection after the structure is removed and the site is cleaned up and graded. 2. Twenty-four (24) hour notification is required for inspections. 3. Workers' Comp insurance information is required to be submitted with this application. Declaration: I acknowledge that no structure(s)will be removed from the parcel until the demolition application has been reviewed and approved by the Town of Queensbury Building&Code Enforcement and Zoning Departments and a permit has been issued. I have read and agree to the above: PRINT NAME: Cfl/fEL 0 cd&eL !` SIGNATURE: / DATE: 3 /3 /,1 Demolition Application Revised June 2022 CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL • Applicant: Name(s): 1111Clf14EL Mailing Address, C/S/Z: K- Cell Phone: Land Line: Email: NO e6G- G/YlLiL ,c �,A • Primary Owner(s): _ Name(s): 5, � 4 Mailing Address, C/S/Z: Cell Phone: Land Line: Email: 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: «&Y,v Cell Phone: Land Line: Email: Demolition Application Revised June 2022 • 1 FILE Copy TOW OF QUEENSBURY BUILDING & CODES DEPT. Reviewed By: V�S .Date: 16 Asbestos Survey Michael Canale 1581 Bay Rd Lake George, NY 12804 inspection-date: 2/11/2023 (33 CD CD CD-0 CD �U p �QG)p �0) CD 00 �m o 5'XZ LF-,' f�+ MEN• i LU, � l F,5 C, m e cQ°' o Z�7 FMAR 0 1 2023 CD Tom Callahan /TC Inspections o 1 Knolls Dr TOWN' OF: QU ys,.�� .ii�Y Oueensbury,NY 12804 `BUS`�'i's�� �J`'e �= Inspector# 17-42926/Contractor# 109425 cell# 518-832-9750 265.4-29 DEMO-0082-2023 Canale, Mike 1581 Bay Rd Demolition of garage Summary of Inspection At the request of Michael Canale an asbestos survey was performed at 1581 Bay Rd Lake George, NY. Scope of the Inspection/Survey is to determine if the garage structure contains any asbestos prior to demolition. Suspected Asbestos containing materials were.removed and sent out for sampling.The following samples were-removed and sent out for testing. Homogeneous area 1( nonfriable) Roof Shingle (No asbestos detected) Homogeneous area 2( nonfriable) Siding (No asbestos detected) Homogeneous area 3( nonfriable) Foundation sealer (5.3% Chrysotile asbestos detected) approximately 40 sq ft Things to note THIS REPORT SHOULD BE MADE AVAILABLE TO ANY NEIGHBORS. NYS DEPT OF LABOR SHOULD BE NOTIFIED THIS REPORT SHOULD ALSO BE READILY AVAILABLE AT THE LOCATION OF THE DEMOLITION/RENOVATION FOR ANY TRADES PEOPLE ENGAGED TO CARRY OUT REPAIRS OR DEMOLITION OF THE PROPERTY. Conclusion The foundation sealer was.identified as containing more than 1% asbestos material. Therefore asbestos abatement is required. A copy of this report should be kept at the work site. . A copy of the sample analysis is.attached to this report Update 2/28/23- The project was reinspected and the homeowner has removed the foundation material that contained asbestos. After abatement and removal of,asbestos-containing materials, homeowners should contact their solid waste hauler for pickup or bring small amounts double-bagged and wetted to a landfill or transfer facility. Landfills and,transfer facilities that accept asbestos-containing materials may be found via the links in the Transportation and Disposal section below, but should be contacted for specific handling requirements prior to delivery. WE ARE YOUR DOL ro" Department ATE I of Labor DIVISION OF SAFETY&HEALTH LICENSE AND CERTIFICATE UNIT,STATE OFFICE CAMPUS,BLDG..12,ALBANY,NY 12226 ASBESTOS HANDLING LICENSE Thomas M. Callahan dba TC inspections 1 Knolls Drive, Queensbury, NY, 12804 . S , License Number: 109425 License Class: RESTRICTED Date of Issue: 01/25/2023 Expiration Date: 01/31/2024 Duly Authorized Representative: Thomas Callahan 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. -STA E OO NE1N'YORK`,)EPARTMENT Of.tABOR,"k,• ,' jam, c .•.• hl.:ASBESTOS CERTIRCATE / Gjv THOMAS-MpCALLAHANr ` CIASS(EXPIRFS).: Amy Phillips, Director For the Commissioner of Labor = •;,, .{ �s_.:;�,_, ceHis 7z a2szd:.. EMSL Analytical, Inc. EMSLOrder: 062302744 528 Mineola Avenue Cade Place,NY 11514 Customer ID: TCNS29 Tel/Fax:(516)997-7251/(516)997-7528 Customer PO: http://Www.EMSL,comicadeplacelab@emsl.com Project ID: Attention: Tom Callahan Phone: (518)832-9750 TC Inspections Fax: 1 Knolls Drive Received Date: 02/14/2023 11:38 AM Queensbury,NY 12804 Analysis Date: 02/15/2023-02/16/2023 Collected Date: 02/11/2023 Project: 1581 Bay Rd Queensbury NY Test Report:Asbestos Analysis of Bulk Material Analyzed Non-Asbestos - Test Date Color Fibrous Non-Fibrous Asbestos ' SomplolD 1-RS1 Description Roof Shingle 062302744-0001 Homogeneity Heterogeneous PLM NYS 198.1 Friable Not Analyzed PLM NYS 198.6 VCM Not Analyzed PLM NYS 198.6 NOB 0211612023 Black 1D0.00%Other Inconclusive:None Detected TEM NYS 198.4 NOB 02/16/2023 Black 100.00%Other None Detected Sample ID 1-RS2 Description Roof Shingle' 062302744-0002 Homogeneity Heterogeneous PLM NYS 198.1 Friable Not Analyzed' PLM NYS 198.6 VCM Not Analyzed PLM NYS 198.6 NOB 02/16/2023 Black 100.00°%Other Inconclusive:None Detected TEM NYS 198.4 NOB 0 211 6/2 0 2 3 Black 100.00%Other None Detected Sample ID 2-S1 Description Siding 062302744-0003 Homogeneity Homogeneous _ PLM NYS 198.1 Friable 02/15/2023 Brown 95.00%Cellulose 5.00%Non-fibrous(other) Nona Detected PLM NYS 198.6 VCM Not Analyzed PLM NYS 198.6 NOB Not Analyzed TEM NYS 198.4 NOB Not Analyzed Sample ID 2-S2 Description Siding 062302744-0004 Homogeneity Homogeneous ' PLM NYS 198.1 Friable 02/15/2023 Brown 96.00%Cellulose 4.00%Non-fibrous(other) None Detected PLM NYS 198.6 VCM - Not Analyzed PLM NYS 198.6 NOB Not Analyzed TEM NYS 198A NOB Not Analyzed Sample ID 3-FS1 Description Foundation Sealer 062302744-0005 Homogeneity Heterogeneous PLM NYS 198.1 Friable Not Analyzed PLM NYS 198.6 VCM Not Analyzed PLM NYS 198.6 NOB 02/1612023 Black None 95.20%Other 4.80%Chrysogle TEM NYS 198A NOB Not Analyzed Initial report from:02/16/2023 13:42:27 ASB_f98x_0009_0001 Printed 2/16/2023 1:42:30PIM Page 1 of r 1 EMSLAnalytical, Inc. EMSLOrder: 062302744 528 Mineola Avenue Cade Place,NY 11514 Customer ID: TCNS29 Tel/Fax:(516)997-7251/(516)997-7528 Customer PO: http:lAvww.EMSL.com/cadeplacelab@emsl.com Project ID: Test Report:Asbestos Analysis of Bulk Material 2 Non-Asbestos Analyzed Test Date Color Fibrous Non-Fibrous Asbestos Sample ID -3-FS2 Description Foundation Sealer 062302744-0006 Homogeneity Heterogeneous PLM NYS 198.1 Friable Not Analyzed PLM NYS 198.6 VCM Not Analyzed PLM NYS 198.6 NOB 0211612023 Black None .94.70%Other 5.30%Chrysotlie TEM NYS 198.4 NOB - Not Analyzed Initial report from:02/1612023 13A2:27 ASB_198x 0009_0001 Printed 2/1612023 1:42:30PM Page 2 of 3 OrderID: 062302744 UPS Asbestos Chain of CustodyEMSL ANALYTICAL.INC. ® 528 MINEOL AVENUE EMSL Order f11b r eb US On! : � CARLE PLACE,.NY 11514 PHONE,(516)997-7251 iMiIANALYTICA41HC. FAX:(516)997-T528 u�w-.vn.,cwrn.tioa EMSL Customer ID: TCIN50 Company Name:TC Inspections Street:I Knolls Drive City: Queensbury State/Province:NY ZlplPostal Code:12804 Country:USA Telephone#: 518-832.9750 Fax#: Report To(Name): Tom Callahan Please Provide Results: El Fax 9 Email Email Address:tc Purchase Order:lns eetlonservice Project NamelNumber.I I f� EMSL Project ID(internal Use Only): U.S.State Samples Taken:NY CT Samples:U Commercialfraxable LJ Residentiairrax Exempt EMSL-Bill to:El Ssme 9DIfferent-If Bill to Is Different note mstnrctions In Comments Third Party BilMag mquires wnaen authorization from third a Turnaround Time A O tions•-Please Check' 3 Hour 6 Hour 24 Hour 48 Hour I LJ 72 Hour 10 96 Hour 1 Week I C1 2 Week 'For TEM Air 3 hr through 6 h,please call ahoad to schedule.Thera Is a promlum charge for 3 HourTEMAHERA ortcPALevel If TAT, You wID he asked Io sign an authodzaGon form for this sorviee. Analysis completed In accordance with ENSL's Terms and Cond+llons/oeafedin the Anal 'ea/Prlce Guide. PCM-Air Check if samples arLi e from NY TEM-Air 4.4.5hr TAT(AHERAonly) TEM-Dust , ❑ NIOSH 7400 ❑ AHERA 40 CFR,Part 763 ❑Microvac-ASTM D 5755 ❑w/OSHA 6hr.TWA ❑ NIOSH 7402 ❑Wipe-ASTM D6480 PLM-Bulk(reporting limit) ❑ EPA Level 11 ❑Carpet Sonication PA 600/J-93116-' El PLM EPA 6001R-93/116(<1%) ❑ ISO10312 SoilfRockfVermlculite 0L� ❑PLM EPA NOB(<t%) TEM-Bulk ❑PLM EPA 600111931116 wittl6tnipiep(<7%) Point Count ❑TEM EPA NOB ❑PLM EPA 600/R-931116 witlg tilfr(g asp(<0.25%) ❑400(<0.25%)❑1000(<0,1%) 0 NYS NOB 198.4(non-friable-NY) ❑TEM EPA 6001R-93/116 withmilling prep Point Count w/Gravimelde K❑Chatfield SOP ❑TEM Qualitative via Flltrat)ofR�rep,_ r ❑400(<0.25%)❑1000(<0.1%) TEM Mass Analysis-EPA 600 sec.2.5 ❑TEM Qualitative via Drop Mont PFeep3.- Q- ElCincinnati Method EPA 6001R-04100a—SPLMREM NYS 198.1(fr)eble in NY). TEM-Water:EPA 100.2 ' BC only) = =7- ff-NYS 198.6 NOB(non-friable-NY) Fibers>1DNm ❑Waste ❑Drinking Other: U.; ` ❑ NYS 198.8 SOF-V c� Ali Fiber Sizes ❑Waste El NIOSH 9002 <1% Drinking ' Check For Positive Stop-Clearly Identify Homogenous Group Filter Pore Size(Air Samples): ❑'O.Bpm. 0.45pm Samplers Name: -a rt n Samplers Signature: y Voiuma/Area(AU) Date/fime Sample# Sample Description HA# Bulk Sam led S S w t it 13 f 5 f't _ c° r AA F � for 5e�`�� 1aA3 fr Client Sample#(a):_ Total#of Samples: Relinquished(Ciient)Iorv% G Dater 13 Time: Received L-b: sonayw, Date: '2_ktLJJTJ Time: 1 "Stool) CommentstSpecial Instructions: caraeeoam..a-w,e.,m,eoc-aro-owmre Page 1 of-DL pages Q � f r: 11111I i AV MY a'' •.. i�rdti. 1 ti ���{�1C VSG�� II •I_ �___ I fa Mi W}13 ,•�: .��.''`�� � �r.�1 i�•�' `''z , - ��' �-+�, soy' ', d / �� t�,,�'�•H .bye rtY '�d" .1 `•l •�•�). .n ., ., $$��1^(�•�.r7_�=f���jjjj!!,,''4'��4ryryi. �M4 �y p 1 S .j pit " Caw tYl '$ R \�Itfys) r ti • i •,may WASTE SHIPMENT RECORD 1. Owner's name and m Iling address Project name and location Owner's r ( a 6 f S�j q �� telephone no. 0/17 2. perator's n a d address �® �� Project number Operator's qgq `�r� telephone no. 3. Waste Di po al Site DS / /� WDS Name l O f 4 LQ gl telephone no. Mailing Address 2 Additional Information 22 OK Physical /a A A5 � Site Location f�'/ICJ a 4. Name and a dress of responsible agency �aa 2 !* tr EPA+ eft o� �t z are A5be5fV5 PGLU �- lrr- - 5. Descc�ri�ption o materials 6. Containers 7. Total quantity t/�cl ri` ,til' or, alo'ck No. Type m'(Yd3) Friable on-Friable 8.--SpftW1iindIIng instructions and additional Information 9. OPERATOR'S CERTIFICATION: . I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified,packed,marked,and labeled,and are in all respects In proper condition for transport by highway according to applicable international and government regulations. Printe typed name&title nature Month Day Year q4da It Itl 10. Transporter 1 (Adicnowledgment of receip f materials) Printed/ ped name&title Signature Month. Day Year a4 �� P�`�cadcr e qqq t#,g_Addre and t' epho a no. Ix Cn 11. Transporter 2(Acknowledgment of receipt of materials) z Printed/typed name&title Signature Month Day Year Address and telephone no. FW.. 12. Discrepancy indication space Q 13. Waste disposal site owner or operator: Certification of receipt of asbestos Grid Coordinates N materials covered by this manifest except as noted in Item 12. a East North El to Printed/typed name&title Signature Month Day Year G Copy 1-Generator Copy 2-Operator Copy 3-Waste Disposal Site 1 Inc) 00'b-2.- 2023 USecology.com I us ecology Randall Brown Project Manager ' 0 518.355.0197 4240 Albany Street m 518.844.7722 Albany, NY 12205 f 518.355.3256 randall.brown@usecology.com