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HomeMy WebLinkAboutBLD-2016-1252 - DECONSTRUCTION & DEMOLITION �G1 City of Anacortes Invoice/Permit#: BLD-2016-1252 904 6th Street Applied date: 05/16/2016 P.O.Box 547 Issue date: 05/16/2016 $" 04 . Anacortes, WA 98221-0547 Expire date: 05/11/2017 (360) 293-1901 wog . Job Address: 1010 23RD ST Permit Type: Demolition Permit ANACORTES WA 98221-2524 Project: APN: P57199 Remarks: Demo house and grade lot for future new construction. Owner: FRANK HANSEN Contractor: KNUTSON HOMES Address: 1010 23RD ST Address: ANACORTES WA98221-2524 / 11C Phone: Phone: 293-3409 -770 License#: SUNSEPC936MA General Information: Fees: Total Calculated: Adjustments: Deposits/Receipts: Total Due: d- 16-16 /VO luspe,fIO j N eU-) bur (CQt , l� THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANYTIME AFTER WORK IS COMMENCED, I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT,ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT, THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. kV--lez }ck2> UP o3.1b•t�, SIGNATURE OF OWNER OR AUTHORIZED AGENT ISSUED B City of Anacortes Invoice/Permit#: BLD-2016-1252 904 6th t Street Applied date: 0 511 6/2 0 1 6 P.O.BOX 547 Issue date: 05/16/2016 Anacortes, WA 98221-0547 Expire date: 05111/2017 (360)293-1901 Jab Address: 1010 23RD ST Permit Type: Demolition Permit ANACORTES WA98221-2524 Project: APN: P57199 Remarks: Demo house and grade lot for future new construction. Owner: FRANK HANSEN Contractor: KNUTSON HOMES Address: 1010 23RDST - Address: ANACORTES WA98221-2524 Phone: Phone: . 293-3409 License#: SUNSEPC936MA General Information: Fees: Total Calculated: Adjustments: Deposits/Receipts: Total Due: THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED. I HEREBY CERTIFY THAT I HAVE READAND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUEAND CORRECT.ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED.HEREIN OR NOT, THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE SIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. SIGNATURE OF OWNER ORAUTHORIZED AGENT ISSUED B Environmental Abatement Services Inc 4/26/2016 Forbes Hansen Asbestos Abatement Project Completed at: 1010 23rd St, Anacortes, WA Per the Asbestos Survey conducted by Dave Phillips, (certification #154454), EAS (contractor #ENVIRAS014RA, asbestos certification #01279) removed asbestos containing material from the above address specifically, 206 SF of sheet vinyl. According to local state and federal regulations, materials containing more than one percent (1%) asbestos must be removed prior to any remodel, renovation or demolition activity. The material was removed by Certified Asbestos Workers under the direct supervision of a Certified Asbestos Supervisor in accordance with all applicable local, state and federal regulations on 3/10/2016. The materials collected were packaged for final disposal in compliance with all applicable federal, state and local laws. If materials are identified less than 1% asbestos on the survey work practices and worker protection must be in compliance with WAC 2962-62-077. Additional information is available with directive WRD 23.30 available on the Washington State Department of Labor and Industries website. The building surveyed, the materials found to contain more than 1% asbestos removed and properly disposed of in accordance with all applicable regulations. A copy of the survey with laboratory report, and this letter, may be used as documentation of the completion of asbestos identification and removal. Any planned remodeling, renovation, or demolition activities should be approved to proceed. Sincerely, CATHERINE D MARQUEZ OWNER PO Box 2503/18365 W Lincoln St. Phone(360)755-1085 Mount Vernon,WA 98273 Fax(360)588-4180 Asbestos Notification For Agency Use Only _ Clean❑Ur[hWi'Sl 160U snuu,`r•cood Stu•.n I V--U -7 110 /� n 1' Contractor Form Case#: Air II MunN Vernon•WA 9s2T.N;U2 agency 160 428.1617 This notification must be present or posted For revisions to this information use Stiaaza.ioto _A_mendment_(o Perform Asbestos Project at all times at the asbestos project site trNw.nwcicanaicorg NWCAA Reg No.570,4(a)(6) (NWCAA Form No.570.5) Type of Project Project Category(Mark all that apply) Advance Notification Period NWCAA Fee Renovation ❑ Residential(Single family/owner-occupied one/any size) Prior Notification $31.00 Maintenance ❑ 10-259 linear ft.,46-159 square ft. 3 Working Days $204.00 F] Other(specify): 10 Working Days $356.00 260-1,000 linear h.,160-5,000 square h. M Demolition*,> 1 fee) More than 1,000 linear ft.,More than 5,000 square ft. 10 Working Days 5662.00 Permitting authority: (�City ❑ Emergency(Call NWCAA immediately for notification period waiver) $51.00 ( County Demolition start date: *Demolition start date must be after asbestos removal end date. $51.00 Workshift Days: Quantity to be removed/encapsulated: 206 square ft. linear ft. ❑M T W ©THE]F sA sU Project start date: 3/10/2016 Completion Date: 3/10/2016 Workshift Hours: 7am-3:30pm Site Address: 1010 23rd St City:AnacorteS zip: 98221 County:Skagit Location of asbestos: kitchen and bathroom Project Description:K-12 School? Yes Q No School Name: Federal facility or marinevessel?❑ Yes Q No Complete demolition of structure? ✓Q Yes 0 No Facility type: SFR Age: 116 Size:.1248 #Floors:1 Asbestos survey conducted? ❑✓ Yes 0 No if yes,include results summary page. If no,reason: AHERA Inspector; Dave Phillips Certiication#: 154454 MATERIAL TO BE REMOVED; CONTROL METHODS: Class 1(TSI/Surfacing) Class 11(Non-TSI/Surfacing) Pipe Lagging F Fireproofing Cement Board(CAB) Floortile(VAT) Q Water Applicator ❑✓ Full Enclosure Boiler Insulation ❑ "Popcorn'Surfacing Cement Pipe Mastics ❑✓ HEPAVac Decon area Duct Paper Decorative/Acoustic Plaster Wallboard Siding Glove bag Wrap&cut ❑✓ Sheeting Putty/Sealant Q✓ Neg Air Machine# Q Critical Barriers Other surfacing/TSI O Roofing E] Other Other(specify) Asbestos Abatement contractor:Enyironmental Abatement Serviceg, Contractorjob#;A16049 Contractor#:ENVIRAS01 4RA Mailing Address: PO Box 2503 city: Mount Vernon zip: 98273 County:Skagit Supervisor/competent person:Catherine Marquez Competentperson phone:360-755-1085 Certfficate4:1279 owner/CEO: Catherine Marquez Business Phone: 360-755-1085 FAX: 360-588-4180 Property owner: Frank Hansen Phone: 360-507-5175 Mailing address: 11629 Pointe Rd city: Anacortes State: WA zip: 98221 Forlq Asbestos disposal site; Northern Wasco County Landfill Estimated cost of ashqtos abatement project: I DO HE CER I YTH T THE INFORMATION CONTAINED IN THIS APPLICATIO IS,TOTHEBESTOF MAR - 3 2016 MY GE CU PLETE. _ / //�� C,Signat HWt5f Title Representing Print Form PHILLIPS ENVIRONMENTAL SERVICES 29354 BACUS RD. SEORO WOOLLEY,WA 98284 360-854,7900 FAX 360.854,7731 February 8,2016 Survey No. 16028 Forbes Hansen 11629 Pointe Place Anacortes,WA 98221 360-507-5175 forbesahansen ail.com RE: Asbestos Survey: 1010 23rd. Street, Anacortes, WA 98221 On February 4, 2016, I inspected a single family residence along with detached shed and garage located at the above referenced address for the purpose of determining the presence or absence of building materials that might contain asbestos. Title 40 Code of Federal Regulations(40 CFR), subpart M, section 61.141, established the allowable limit of asbestos in building materials at 1%by weight. Materials containing more than 1% asbestos are regulated and must be handled in accordance with Federal, State, and Local regulations. Surveys are based on'visible and accessible materials' and although reasonable effort was made to locate and test all suspect materials, some suspect materials may remain hidden in walls or below floor underlayment or other areas until demolition or renovation work makes them accessible.If other suspect materials are discovered during the course of demolition or remodel activities they will require testing prior to continuing work. Sixteen bulk samples were collected and subsequently analyzed for asbestos content by Polarized Light Microscopy with Stain Dispersion. Samples#1, 5, and 6 were found to contain more than 1 % asbestos. These materials will require handling/removal by trained asbestos workers prior to any remodeling,renovation, or demolition that will lead to the disturbance or removal of asbestos. Prior to removal of these materials, ten- day notices must be filed with the local Clean Air Agency and the State Department of Labor&Industries. This letter along with the attached material list and lab report will comprise the `Asbestos Survey'. Please call us if you have any questions. Sincerely, Qom-- 0. ,- Dave B. Phillips AHERA Bldg. Insp. Cert.# 154454 (expires 12-8-16) enclosure PHILLIPS ENVIRONMENTAL SERVICES 29354 BAcus RD. SEDRO WOOLLEY,WA 98284 360Z54.7900 FAX 360-854.773 t Client: Forbes Hansen Asbestos Survey- 1010 23rd. Street Survey#: 16028 11629 Pointe Place Anacortes, WA 98221 Anacortes, WA 98221 360-507-5175 Survey date: 2-5-16 Homogeneous Material List Material # & Description I Location (homog.area) I Typal F riaq Cond I City. I Sample# & Location Asbestos 11 Vinyl sheet I Kitchen floor Misc N F 150sf 1 Kitchen floor Chry.40°/a 21 Vinyl tile&mastic I Master bath floor Misc N F 2 Master bath floor N/D 3 1 2 layers vinyl sheet Utility room floor Misc N F 3 Utility room floor N/D 141 Vinyl file I Main bath floor,top layer Misc N F 4 Main bath floor,top layer N/D 5 Vinyi Sheet Main bath, below Misc N I F I 30sf 5 Main bath, below Chry.40% underlay underlay 6 Vinyl sheet Kitchen counter top & Misc N I F I 20sf 1 6 1 Kitchen counter top Chry. backs lash 7 1 Acoustical tile Living room ceiling Misc N F 7 1 Living room ceiling N/D 8 Vermiculite Attic Tsi N F 8a Attic Trem <1% r8b Attic Trem.<1% 8c Attic N/D 9 1 Mastic Main bath,tub sunound Misc N F 1 9 Main bath,tub surround N/D 101 Drywall&jt.comp Main bath wall Misc N F 10 Main bath wall N/D 111 Drywall &it.comp. Master bedroom wall Misc N F 11 Master bedroom wall N/D t2l Asphalt roof w/sand House roof Misc N F 12 House roof N/D 1131 Asphalt roof w/sand I Shed roof IMiscl N I F 1 1 13 1Shed roof N/D 1141 Asphalt roof w/sand I Garage roof I Misc I N I F 14 1 Garage roof N/D Also observed is one mercury switch thermostat in the hallway N/D=None Detected Note: Friability assessments were made on these materials in their present undisturbed condition, N/T=Not Tested-previous sample tested positive damage or disturbance of any kind may cause some non-friable materials to become friable. Quantities shown are approximate-field verification recommended PHILLIPS ENVIRONMENTAL SERVICES 29354 BACuB RD. SEDRO WOOLLEY,WA 98284 360-854.7900 American Industrial Hygiene Association Lab I.D.#102950 FAX 360-854.773 f ASBESTOS BULK SAMPLE ANALYSIS Client Name: Forbes Hansen 11629 Pointe Place Survey#: 16028 Anacortes, WA 98221 360-507-5175 forbesahansen@ mail.com Source of Samples: 1010 23rd.Street, Anacortes, WA 98221 Date Rec'd:2-5-16 Analytical Method:Polarized Light Microscopy with Dispersion Staining(PLM-DS Method) Sample#: I Lab No.: 80974 Location: Kitchen floor Layers Description: Non-Fibrous Material: Other Fibrous Mat'l:% Asbestos Type: % Layer of Off white&brown vinyl sheet Vinyl/Binder None detected None detected Layer 2 of 3 Grey fibrous paper-like material Binder/Fine particles Cellulose 20% C h rysotlle 40% Layer of Yellow mastic Mastic/binder Cellulose trace None detected Sample#: 2 Lab No.: 80975 Location: Master bathroom floor Layers Description: Non-Fibrous Material: Other Fibrous Mat'l: % Asbestos Type: % Layer Iof4 Off white&brown vinyl tile Vinyl/Binder None detected None detected Layer 2of4 Clem mastic mastic Cellulose trace None detected Layer 3 of 4 Grey leveling compound Binder/Fine particles Cellulose trace None detected Layer 4 of 4 White leveling compound Binder/fine particles Cellulose trace None detected Sample#: 3 Lab No.: 80976 Location: Utility room floor Layers Description: Non-Fibrous Material: Other Fibrous Mat'l: % Asbestos Type: % Layer of Off white vinyl w/foam backing Vinyl/Binder - - None detected None detected Layer 2 of 5 Yellow mastic Mastic/binder Cellulose trace None detected Layer of Off white vinyl sheet Vinyl/Binder None detected None detected Layer of Black fibrous paper-like material Binder/Fine particles Cellulose 60% None detected Layer 5of5 Brown mastic Mastic/binder Cellulose trace None detected Sample#: 4 Lab No.: 80977 Location: Main bath floor,top layer Layers Description: Non-Fibrous Material: Other Fibrous Mat'l: % Asbestos Type: % Layer oft Off white&brown vinyl tile Vinyl/Binder None detected None detected Layer oft Clear mastic mastic Cellulose trace None detected Sample#: 5 Lab No.: 80978 Location: Main bath floor,below underlay Layers Description: Non-Fibrous Material: Other Fibrous Mat'1: % Asbestos Type: % Layer of Off white pebble pattern vinyl sheet Vinyl/Binder None detected None detected Layer 2 of 3 Grey fibrous paper-like material Binder/Fine particles Cellulose 20% C h rysotile 40% Layer of Yellow mastic Mastic/binder Cellulose trace None detected Analyst:_Q''_ e, I` k- Date: 2-7-16 Dave B.Phillips Samples retained for 2 weeks unless otherwise requested in writing. Lab results are completely confidential. Written permission is required to release results to another party. PHILLIPS ENVIRONMENTAL SERVICES 29354 BACus RD. SEDRO WOOLLEY,WA 98284 360-854-7900 American Industrial Hygiene Association Lab I.D.#102950 FAX 360-854.7731 ASBESTOS BULK SAMPLE ANALYSIS Sample#: 6 Lab No.: 80979 Location: Kitchen counter to Layers Description: Non-Fibrous Material: Other Fibrous Mat'l: % Asbestos Type: % Layer l of Off white pebble pattern vinyl sheet Vinyl/Binder None detected None detected Layer 2 of 3 Grey fibrous paper-like material Binder/Fine particles Cellulose 20% C h rysotile 40% Layer of Yellow mastic Mastic/binder Cellulose trace None detected Sample#: 7 Lab No.: 80980 Location: Living room ceiling Layers Description: Non-Fibrous Material: Other Fibrous Mat'l:% Asbestos Type: % Layer 1 of 1 Tan acoustical tile Binder Cellulose80% None detected Sample#: 8a Lab No.: 80981 Location: Attic Layers Description: Non-Fibrous Material: Other Fibrous Mat'l:% Asbestos Type: % Layer 1 of 1 VermiculiteVermiculite/debris Cellulose trace Tremolite <1% Sample#: 8b Lab No.: 80982 Location: Attic Layers Description: Non-Fibrous Material: Other Fibrous Mat'l:% Asbestos Type: % Layer l of l Vermiculite Vermiculite/debris Cellulose trace Tremolite<1% Sample#: 8c Lab No.: 80983 Location: Attic Layers Description: Non-Fibrous Material: Other Fibrous Mat'l:% Asbestos Type: % Layer I of 1 Vermiculite Vermiculite/debris Cellulose trace None detected Sample#: 9 Lab No.: 80984 Location: Main bath,tub surround mastic Layers Description: Non-Fibrous Material: Other Fibrous Mat'l: % Asbestos Type: % Layer 1 of 1 Yellow mastic Mastic/binder Cellulose trace None detected Sample#: 10 Lab No.: 80985 Location: Main bathroom wall Layers Description: Non-Fibrous Material: Other Fibrous Mat'l: % Asbestos Type: % Layer l of White compacted powdery material Binder/fineparticles Cellulose trace None detected Layer 2of2 Drywall Gypsum/fineparticles Cellulose 20% None detected Sample#: 11 Lab No.: 80986 Location: Master bedroom wall Layers Description: Non-Fibrous Material: Other Fibrous Mat'l: % Asbestos Type: % Layer l of White compacted powdery material Binder/fine particles Cellulose trace None detected Layer 2of2 Drywall Gypsum/fineparticles Cellulose 20% None detected Sample#: 12 Lab No.: 80987 Location: House roof Layers Description: Non-Fibrous Material: Other Fibrous Mat'l: % Asbestos Type: %u Layer of Asphalt roofw/sand Asphah/sand Glass 20% None detected Layer 2of2 Asphalt roofw/sand Asphalt/sand Glass 20% None detected Qk- Analyst: Qd'''"- e, Date: 2-7-16 Dave B.Phillips Samples retained for 2 weeks unless otherwise requested in writing. Lab results are completely confidential. Written permission is required to release results to another party. PHILLIPS ENVIRONMENTAL SERVICES 29354 BAcus RD. SEDRO WOOLLEY,WA 98284 360-854.7900 American Industrial Hygiene Association Lab I.U.#102950 FAX 360-854,7731 ASBESTOS BULK SAMPLE ANALYSIS Sample#: 13 Lab No.: 80988 Location: Shed roof Layers Description: Non-Fibrous Material: Other Fibrous Mat'l: % Asbestos Type: % Layerlof2 Asphalt roofw/sand Asphalt/sand Cellulose20% None detected Layer 2of2 Asphalt roofw/sand Asphalt/sand Cellulose20% Nonedetectetl Sample#: 14 Lab No.: 80989 Location: Garage roof Layers Description: Non-Fibrous Material: Other Fibrous Mat'l: % Asbestos Type: % Layer lof2 Asphalt roofw/sand Asphalt/sand Glass20% None detected Layer 2of2 Asphalt roofw/sand Aspbah/sand Glass20% None detected Analyst:_Q'_ el w Date: 2-7-16 Dave B.Phillips Samples retained for 2 weeks unless otherwise requested in writing. Lab results are completely confidential, Written permission is required to release results to another party. City of Anacortes Invoice/Permit#: BLD-2016-1252 904 6th t Street Applied date: 0 511 6/2 0 1 6 P.O.BOX 547 Issue date: 05/16/2016 Anacortes, WA 98221-0547 Expire date: 05111/2017 (360)293-1901 Jab Address: 1010 23RD ST Permit Type: Demolition Permit ANACORTES WA98221-2524 Project: APN: P57199 Remarks: Demo house and grade lot for future new construction. Owner: FRANK HANSEN Contractor: KNUTSON HOMES Address: 1010 23RDST - Address: ANACORTES WA98221-2524 Phone: Phone: . 293-3409 License#: SUNSEPC936MA General Information: Fees: Total Calculated: Adjustments: Deposits/Receipts: Total Due: THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED. I HEREBY CERTIFY THAT I HAVE READAND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUEAND CORRECT.ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED.HEREIN OR NOT, THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE SIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. SIGNATURE OF OWNER ORAUTHORIZED AGENT ISSUED B Environmental Abatement Services Inc 4/26/2016 Forbes Hansen Asbestos Abatement Project Completed at: 1010 23rd St, Anacortes, WA Per the Asbestos Survey conducted by Dave Phillips, (certification #154454), EAS (contractor #ENVIRAS014RA, asbestos certification #01279) removed asbestos containing material from the above address specifically, 206 SF of sheet vinyl. According to local state and federal regulations, materials containing more than one percent (1%) asbestos must be removed prior to any remodel, renovation or demolition activity. The material was removed by Certified Asbestos Workers under the direct supervision of a Certified Asbestos Supervisor in accordance with all applicable local, state and federal regulations on 3/10/2016. The materials collected were packaged for final disposal in compliance with all applicable federal, state and local laws. If materials are identified less than 1% asbestos on the survey work practices and worker protection must be in compliance with WAC 2962-62-077. Additional information is available with directive WRD 23.30 available on the Washington State Department of Labor and Industries website. The building surveyed, the materials found to contain more than 1% asbestos removed and properly disposed of in accordance with all applicable regulations. A copy of the survey with laboratory report, and this letter, may be used as documentation of the completion of asbestos identification and removal. Any planned remodeling, renovation, or demolition activities should be approved to proceed. Sincerely, CATHERINE D MARQUEZ OWNER PO Box 2503/18365 W Lincoln St. Phone(360)755-1085 Mount Vernon,WA 98273 Fax(360)588-4180 Asbestos Notification For Agency Use Only _ Clean❑Ur[hWi'Sl 160U snuu,`r•cood Stu•.n I V--U -7 110 /� n 1' Contractor Form Case#: Air II MunN Vernon•WA 9s2T.N;U2 agency 160 428.1617 This notification must be present or posted For revisions to this information use Stiaaza.ioto _A_mendment_(o Perform Asbestos Project at all times at the asbestos project site trNw.nwcicanaicorg NWCAA Reg No.570,4(a)(6) (NWCAA Form No.570.5) Type of Project Project Category(Mark all that apply) Advance Notification Period NWCAA Fee Renovation ❑ Residential(Single family/owner-occupied one/any size) Prior Notification $31.00 Maintenance ❑ 10-259 linear ft.,46-159 square ft. 3 Working Days $204.00 F] Other(specify): 10 Working Days $356.00 260-1,000 linear h.,160-5,000 square h. M Demolition*,> 1 fee) More than 1,000 linear ft.,More than 5,000 square ft. 10 Working Days 5662.00 Permitting authority: (�City ❑ Emergency(Call NWCAA immediately for notification period waiver) $51.00 ( County Demolition start date: *Demolition start date must be after asbestos removal end date. $51.00 Workshift Days: Quantity to be removed/encapsulated: 206 square ft. linear ft. ❑M T W ©THE]F sA sU Project start date: 3/10/2016 Completion Date: 3/10/2016 Workshift Hours: 7am-3:30pm Site Address: 1010 23rd St City:AnacorteS zip: 98221 County:Skagit Location of asbestos: kitchen and bathroom Project Description:K-12 School? Yes Q No School Name: Federal facility or marinevessel?❑ Yes Q No Complete demolition of structure? ✓Q Yes 0 No Facility type: SFR Age: 116 Size:.1248 #Floors:1 Asbestos survey conducted? ❑✓ Yes 0 No if yes,include results summary page. If no,reason: AHERA Inspector; Dave Phillips Certiication#: 154454 MATERIAL TO BE REMOVED; CONTROL METHODS: Class 1(TSI/Surfacing) Class 11(Non-TSI/Surfacing) Pipe Lagging F Fireproofing Cement Board(CAB) Floortile(VAT) Q Water Applicator ❑✓ Full Enclosure Boiler Insulation ❑ "Popcorn'Surfacing Cement Pipe Mastics ❑✓ HEPAVac Decon area Duct Paper Decorative/Acoustic Plaster Wallboard Siding Glove bag Wrap&cut ❑✓ Sheeting Putty/Sealant Q✓ Neg Air Machine# Q Critical Barriers Other surfacing/TSI O Roofing E] Other Other(specify) Asbestos Abatement contractor:Enyironmental Abatement Serviceg, Contractorjob#;A16049 Contractor#:ENVIRAS01 4RA Mailing Address: PO Box 2503 city: Mount Vernon zip: 98273 County:Skagit Supervisor/competent person:Catherine Marquez Competentperson phone:360-755-1085 Certfficate4:1279 owner/CEO: Catherine Marquez Business Phone: 360-755-1085 FAX: 360-588-4180 Property owner: Frank Hansen Phone: 360-507-5175 Mailing address: 11629 Pointe Rd city: Anacortes State: WA zip: 98221 Forlq Asbestos disposal site; Northern Wasco County Landfill Estimated cost of ashqtos abatement project: I DO HE CER I YTH T THE INFORMATION CONTAINED IN THIS APPLICATIO IS,TOTHEBESTOF MAR - 3 2016 MY GE CU PLETE. _ / //�� C,Signat HWt5f Title Representing Print Form PHILLIPS ENVIRONMENTAL SERVICES 29354 BACUS RD. SEORO WOOLLEY,WA 98284 360-854,7900 FAX 360.854,7731 February 8,2016 Survey No. 16028 Forbes Hansen 11629 Pointe Place Anacortes,WA 98221 360-507-5175 forbesahansen ail.com RE: Asbestos Survey: 1010 23rd. Street, Anacortes, WA 98221 On February 4, 2016, I inspected a single family residence along with detached shed and garage located at the above referenced address for the purpose of determining the presence or absence of building materials that might contain asbestos. Title 40 Code of Federal Regulations(40 CFR), subpart M, section 61.141, established the allowable limit of asbestos in building materials at 1%by weight. Materials containing more than 1% asbestos are regulated and must be handled in accordance with Federal, State, and Local regulations. Surveys are based on'visible and accessible materials' and although reasonable effort was made to locate and test all suspect materials, some suspect materials may remain hidden in walls or below floor underlayment or other areas until demolition or renovation work makes them accessible.If other suspect materials are discovered during the course of demolition or remodel activities they will require testing prior to continuing work. Sixteen bulk samples were collected and subsequently analyzed for asbestos content by Polarized Light Microscopy with Stain Dispersion. Samples#1, 5, and 6 were found to contain more than 1 % asbestos. These materials will require handling/removal by trained asbestos workers prior to any remodeling,renovation, or demolition that will lead to the disturbance or removal of asbestos. Prior to removal of these materials, ten- day notices must be filed with the local Clean Air Agency and the State Department of Labor&Industries. This letter along with the attached material list and lab report will comprise the `Asbestos Survey'. Please call us if you have any questions. Sincerely, Qom-- 0. ,- Dave B. Phillips AHERA Bldg. Insp. Cert.# 154454 (expires 12-8-16) enclosure PHILLIPS ENVIRONMENTAL SERVICES 29354 BAcus RD. SEDRO WOOLLEY,WA 98284 360Z54.7900 FAX 360-854.773 t Client: Forbes Hansen Asbestos Survey- 1010 23rd. Street Survey#: 16028 11629 Pointe Place Anacortes, WA 98221 Anacortes, WA 98221 360-507-5175 Survey date: 2-5-16 Homogeneous Material List Material # & Description I Location (homog.area) I Typal F riaq Cond I City. I Sample# & Location Asbestos 11 Vinyl sheet I Kitchen floor Misc N F 150sf 1 Kitchen floor Chry.40°/a 21 Vinyl tile&mastic I Master bath floor Misc N F 2 Master bath floor N/D 3 1 2 layers vinyl sheet Utility room floor Misc N F 3 Utility room floor N/D 141 Vinyl file I Main bath floor,top layer Misc N F 4 Main bath floor,top layer N/D 5 Vinyi Sheet Main bath, below Misc N I F I 30sf 5 Main bath, below Chry.40% underlay underlay 6 Vinyl sheet Kitchen counter top & Misc N I F I 20sf 1 6 1 Kitchen counter top Chry. backs lash 7 1 Acoustical tile Living room ceiling Misc N F 7 1 Living room ceiling N/D 8 Vermiculite Attic Tsi N F 8a Attic Trem <1% r8b Attic Trem.<1% 8c Attic N/D 9 1 Mastic Main bath,tub sunound Misc N F 1 9 Main bath,tub surround N/D 101 Drywall&jt.comp Main bath wall Misc N F 10 Main bath wall N/D 111 Drywall &it.comp. Master bedroom wall Misc N F 11 Master bedroom wall N/D t2l Asphalt roof w/sand House roof Misc N F 12 House roof N/D 1131 Asphalt roof w/sand I Shed roof IMiscl N I F 1 1 13 1Shed roof N/D 1141 Asphalt roof w/sand I Garage roof I Misc I N I F 14 1 Garage roof N/D Also observed is one mercury switch thermostat in the hallway N/D=None Detected Note: Friability assessments were made on these materials in their present undisturbed condition, N/T=Not Tested-previous sample tested positive damage or disturbance of any kind may cause some non-friable materials to become friable. Quantities shown are approximate-field verification recommended PHILLIPS ENVIRONMENTAL SERVICES 29354 BACuB RD. SEDRO WOOLLEY,WA 98284 360-854.7900 American Industrial Hygiene Association Lab I.D.#102950 FAX 360-854.773 f ASBESTOS BULK SAMPLE ANALYSIS Client Name: Forbes Hansen 11629 Pointe Place Survey#: 16028 Anacortes, WA 98221 360-507-5175 forbesahansen@ mail.com Source of Samples: 1010 23rd.Street, Anacortes, WA 98221 Date Rec'd:2-5-16 Analytical Method:Polarized Light Microscopy with Dispersion Staining(PLM-DS Method) Sample#: I Lab No.: 80974 Location: Kitchen floor Layers Description: Non-Fibrous Material: Other Fibrous Mat'l:% Asbestos Type: % Layer of Off white&brown vinyl sheet Vinyl/Binder None detected None detected Layer 2 of 3 Grey fibrous paper-like material Binder/Fine particles Cellulose 20% C h rysotlle 40% Layer of Yellow mastic Mastic/binder Cellulose trace None detected Sample#: 2 Lab No.: 80975 Location: Master bathroom floor Layers Description: Non-Fibrous Material: Other Fibrous Mat'l: % Asbestos Type: % Layer Iof4 Off white&brown vinyl tile Vinyl/Binder None detected None detected Layer 2of4 Clem mastic mastic Cellulose trace None detected Layer 3 of 4 Grey leveling compound Binder/Fine particles Cellulose trace None detected Layer 4 of 4 White leveling compound Binder/fine particles Cellulose trace None detected Sample#: 3 Lab No.: 80976 Location: Utility room floor Layers Description: Non-Fibrous Material: Other Fibrous Mat'l: % Asbestos Type: % Layer of Off white vinyl w/foam backing Vinyl/Binder - - None detected None detected Layer 2 of 5 Yellow mastic Mastic/binder Cellulose trace None detected Layer of Off white vinyl sheet Vinyl/Binder None detected None detected Layer of Black fibrous paper-like material Binder/Fine particles Cellulose 60% None detected Layer 5of5 Brown mastic Mastic/binder Cellulose trace None detected Sample#: 4 Lab No.: 80977 Location: Main bath floor,top layer Layers Description: Non-Fibrous Material: Other Fibrous Mat'l: % Asbestos Type: % Layer oft Off white&brown vinyl tile Vinyl/Binder None detected None detected Layer oft Clear mastic mastic Cellulose trace None detected Sample#: 5 Lab No.: 80978 Location: Main bath floor,below underlay Layers Description: Non-Fibrous Material: Other Fibrous Mat'1: % Asbestos Type: % Layer of Off white pebble pattern vinyl sheet Vinyl/Binder None detected None detected Layer 2 of 3 Grey fibrous paper-like material Binder/Fine particles Cellulose 20% C h rysotile 40% Layer of Yellow mastic Mastic/binder Cellulose trace None detected Analyst:_Q''_ e, I` k- Date: 2-7-16 Dave B.Phillips Samples retained for 2 weeks unless otherwise requested in writing. Lab results are completely confidential. Written permission is required to release results to another party. PHILLIPS ENVIRONMENTAL SERVICES 29354 BACus RD. SEDRO WOOLLEY,WA 98284 360-854-7900 American Industrial Hygiene Association Lab I.D.#102950 FAX 360-854.7731 ASBESTOS BULK SAMPLE ANALYSIS Sample#: 6 Lab No.: 80979 Location: Kitchen counter to Layers Description: Non-Fibrous Material: Other Fibrous Mat'l: % Asbestos Type: % Layer l of Off white pebble pattern vinyl sheet Vinyl/Binder None detected None detected Layer 2 of 3 Grey fibrous paper-like material Binder/Fine particles Cellulose 20% C h rysotile 40% Layer of Yellow mastic Mastic/binder Cellulose trace None detected Sample#: 7 Lab No.: 80980 Location: Living room ceiling Layers Description: Non-Fibrous Material: Other Fibrous Mat'l:% Asbestos Type: % Layer 1 of 1 Tan acoustical tile Binder Cellulose80% None detected Sample#: 8a Lab No.: 80981 Location: Attic Layers Description: Non-Fibrous Material: Other Fibrous Mat'l:% Asbestos Type: % Layer 1 of 1 VermiculiteVermiculite/debris Cellulose trace Tremolite <1% Sample#: 8b Lab No.: 80982 Location: Attic Layers Description: Non-Fibrous Material: Other Fibrous Mat'l:% Asbestos Type: % Layer l of l Vermiculite Vermiculite/debris Cellulose trace Tremolite<1% Sample#: 8c Lab No.: 80983 Location: Attic Layers Description: Non-Fibrous Material: Other Fibrous Mat'l:% Asbestos Type: % Layer I of 1 Vermiculite Vermiculite/debris Cellulose trace None detected Sample#: 9 Lab No.: 80984 Location: Main bath,tub surround mastic Layers Description: Non-Fibrous Material: Other Fibrous Mat'l: % Asbestos Type: % Layer 1 of 1 Yellow mastic Mastic/binder Cellulose trace None detected Sample#: 10 Lab No.: 80985 Location: Main bathroom wall Layers Description: Non-Fibrous Material: Other Fibrous Mat'l: % Asbestos Type: % Layer l of White compacted powdery material Binder/fineparticles Cellulose trace None detected Layer 2of2 Drywall Gypsum/fineparticles Cellulose 20% None detected Sample#: 11 Lab No.: 80986 Location: Master bedroom wall Layers Description: Non-Fibrous Material: Other Fibrous Mat'l: % Asbestos Type: % Layer l of White compacted powdery material Binder/fine particles Cellulose trace None detected Layer 2of2 Drywall Gypsum/fineparticles Cellulose 20% None detected Sample#: 12 Lab No.: 80987 Location: House roof Layers Description: Non-Fibrous Material: Other Fibrous Mat'l: % Asbestos Type: %u Layer of Asphalt roofw/sand Asphah/sand Glass 20% None detected Layer 2of2 Asphalt roofw/sand Asphalt/sand Glass 20% None detected Qk- Analyst: Qd'''"- e, Date: 2-7-16 Dave B.Phillips Samples retained for 2 weeks unless otherwise requested in writing. Lab results are completely confidential. Written permission is required to release results to another party. PHILLIPS ENVIRONMENTAL SERVICES 29354 BAcus RD. SEDRO WOOLLEY,WA 98284 360-854.7900 American Industrial Hygiene Association Lab I.U.#102950 FAX 360-854,7731 ASBESTOS BULK SAMPLE ANALYSIS Sample#: 13 Lab No.: 80988 Location: Shed roof Layers Description: Non-Fibrous Material: Other Fibrous Mat'l: % Asbestos Type: % Layerlof2 Asphalt roofw/sand Asphalt/sand Cellulose20% None detected Layer 2of2 Asphalt roofw/sand Asphalt/sand Cellulose20% Nonedetectetl Sample#: 14 Lab No.: 80989 Location: Garage roof Layers Description: Non-Fibrous Material: Other Fibrous Mat'l: % Asbestos Type: % Layer lof2 Asphalt roofw/sand Asphalt/sand Glass20% None detected Layer 2of2 Asphalt roofw/sand Aspbah/sand Glass20% None detected Analyst:_Q'_ el w Date: 2-7-16 Dave B.Phillips Samples retained for 2 weeks unless otherwise requested in writing. Lab results are completely confidential, Written permission is required to release results to another party.