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Home My WebLink AboutBLD2022-01217 DEMO - BLD Inspections - 8/9/2024 atih INSPECTION CARD y Mason County 615 W. Alder St. Bldg. 8, Shelton, WA 98584 360-427-9670 ext 352 www.co.mason.wa.us PERMIT# BLD2022-01217 PROJECT ADDRESS 172 E Lakeland Dr Allyn, WA 98524 PARCEL# 122205800021 PROJECT DESCRIPTION DEMO OF EXISTING SFR OWNER KITSAP COUNTY CONSOLIDATED ADDRESS 2244 NW BUCKLIN HILL RD PHONE 360.535.6100 CONTRACTOR ADDRESS PHONE CONTRACTOR LICENSE LENDER INSPECT19N INSP DATE Comments INSPECTION IP INSP DATE Comments Connection ha een verified by Demolition Final Inspection L Mason County Mason County - Division of Community Development 615 W. Alder St. Bldg.8 Shelton, WA 98584 360-427-9670 ext 352 www.co.mason.wa.us B DD2022-01217 DEMO PROJECT DESCRIPTION: DEMO OF EXISTING SFR ISSUED: 09/15/2022 SITE ADDRESS: 172 E LAKELAND DR ALLYN EXPIRES: 03/14/2023 PARCEL: 122205800021 APPLICANT: KITSAP COUNTY CONSOLIDATED HOUSING OWNER: KITSAP COUNTY CONSOLIDATED HOUSING AUTHORITY AUTHORITY 2244 NW BUCKLIN HILL RD 2244 NW BUCKLIN HILL RD SILVERDALE,WA98383 SILVERDALE,WA98383 360.535.6100 FEES: Paid Due Technology Flat Convenience $5.00 $0.00 Fee State Fee-Residential $6.50 $0.00 Demolition Fee $120.00 $0.00 Totals : $131.50 $0.00 REQUIRED INSPECTIONS Connection has been verified by Health or Utilities Demolition Final Inspection CONDITIONS • The Washington State Clean Air Act prohibits the burning of any construction or demolition debris in an outdoor fire. • OWNER/BUILDER acknowledges submission of inaccurate information may result in a stop work order or permit revocation. Acknowledgement of such is by signature below. I declare that I am the owner, owners legal representative, or contractor. I further declare that I am entitled to receive this permit and to do the work as proposed. I have obtained permission from all the necessary parties, including any easement holder or parties of interest regarding this project. The owner or authorized agent represents that the information provided is accurate and grants employees of Mason County access to the above described property and structure(s)for review and inspection. This permit/application becomes null & void if work or authorized construction is not commenced within 180 days or if construction work is suspended for a period of 180 days. PROOF OF CONTINUATION OF WORK IS BY MEANS OF INSPECTION. INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION. Printed by:Ariane Paysse on:09/15/2022 09:35 AM Page 1 of 2 Mason County I qua' Mason County - Division of Community Development 615 W.Alder St. Bldg.8 Shelton, WA 98584 360-427-9670 ext 352 www.co.mason.wa.us DEMO BLD2022-01217 * All construction and demolition debris must be removed from the beach after project completion. Proper disposal of construction debris must be on land in such a manner that debris cannot enter or cause water quality degradation of State waters. * All building permits shall have a final inspection performed and approved by Mason County Building Department prior to permit expiration. The failure to request a final inspection or to obtain approval will be documented in the legal property records on file with Mason County as being non-compliant with Mason County ordinances and building regulations. * The demolition and disposal of demolition debris must meet requirements as per Mason County regulations. it is unlawful for any person to cause or allow the demolition(or major renovation)of any structure unless all asbestos containing materials have been removed from the area to be demolished.work shall not commence on an asbestos project or demolition unless the owner or operator has obtained written approval from ORCAA @ 2490 B Limited Lane NW, Olympia WA 98502, 360-586-1044, 800-422-5623, www.orcaa.org * For public safety, it is the responsibility of the applicant to confirm through written verification all utility services(electric, gas, water, sewer,...) have been terminated prior to demolishing a structure. �(� y 4-7 - C/&-70 roc¢ L1,5 7 Jw1�hh, 1� 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/local law regulating construction or the performance of construction. Issued By: An iie Al a 2 Contractor or Authorized Agent: / Date: V c' 2 Printed by:Ariane Paysse on:09/15/2022 09:35 AM Page 2 0(2 MASON COUNTY PERMIT NO. 61 Z )� COMMUNITY SERVICES DEPARTMENT BUILDING• PLANNING• FIRE MARSHAL WWW.CO.MASON.WA.US (360)427-9670 Shelton ext.352 (�c �I i Mason County Bldg.#8, 615 W.Alder St (360)275-4467 Belfair ext.352 , \C.C Shelton,WA 98584 (360)482-5269 Elma ext.352 . DEMOLITION PERMIT APPLICATION SEP 5 ?nz2 _ 615 OWNER INFORMATION: CONTRACTOR INFORMATION: NAME: Housing Kitsap NAME: Housing kitsap MAILING ADDRESS: 2244 bucklin hill road MAILING ADDRESS:2244 bucklin hill rd CITY: Silverdale STATE:wA ZIP:98383 CITY:silverdale STATE:wa ZIP:98383 PHONE: 360-535-6100 CELL: 360-265-3693 PHONE:360-535-6100 CELL: 360-265-3693 EMAIL: gusemanj@housingkitsap.org EMAIL :gusemanj@housingkitsap.org L&I REG#N/A EXP. PARCEL INFORMATION: PARCEL NUMBER(12 DIGIT NUMBER) 12220-58-00021 FIRE DISTRICT CMF LEGAL DESCRIPTION (ABBREVIATED) SFR SITE ADDRESS 172.E.Lakeland dr. CITY Allyn DIRECTIONS TO SITE ADDRESS: IS PROPERTY WITHIN 200 FT: SALTWATER[] LAKE❑ RIVER/CREEK❑ POND[] WETLAND[] SEASONAL RUNOFF[] STREAM ❑ DOES PROPERTY HAVE SLOPE(S)WITHIN 300 FT Off'THE PROJECT-GREATER THAN 14% YES[]NO ❑o IF YOUR PROJECT IS LOCATED ADJACENT TO OR WITHIN AN AREA THAT IS LISTED ABOVE,PLEASE CONTACT THE PLANNING DIVISION OF COMMUNITY DEVELOPMENT PRIOR TO DEMOLITION TO ENSURE REDEVELOPMENT. USE OF STRUCTURE BEING DEMOLISHED(RESIDENCE,GARAGE ETC.) Residence HOW WILL THE DEBRIS BE DISPOSED OF?: dumpster to desposal facility PROVIDE A PLOT PLAN INDICATING LOCATION OF STRUCTURE TO BE DEMOLISHED OWNER/CONTRACTOR acknowledges submission of inaccurate information may result in a stop work order or permit revocation. Acknowledgement of such is by signature below. I declare that I am the owner,owners legal representative,or contractor. I further declare that I am entitled to receive this permit and to do the work as proposed. I have obtained permission from all the necessary parties,including any easement holder or parties of interest regarding this project.The owner or authorized agent represents that the information provided is accurate and grants employees of Mason County access to the above described property and structure(s)for review and inspection.This permit/application becomes null&void if work or authorized construction is not commenced within 180 days or if co traction work is suspended for a period of 180 days. PROOF OF CONTINUATION OF WORK IS BY MEANS OF INSPECT INACTIVI F THIS PERMIT APPLICATION OF 180 DAYS WILL IN ALIDATE THE APPLICATION. x %41S L 2_ Signature of Applicant Date xJoe Guseman 'OWNER/❑✓ REPRESENTATIVE /❑✓ CONTRACTOR Print Name DEPARTMENTAL REVIEW APPROVED DA1 DENIED DATE TAGS/NOTES/CONDITIONS BUILDING DEPARTMENT PLANNING DEPARTMENT 40s ZO P9 60 BOUNDARY LINE AGREEMENT PER R C W. 58 04.007 5677608'E 1 \ 1j J6.71 e::,.. I I � I I Detail \\ \ 1 =20 / 119 I I I I SURVEYOR'S NOTES N70.46'02'W I / 1 1— L———_—— Property corners and line stakes shown were the only points set during F_ T _ this survey. Except as shown, all property lines were not checked for 30 I I I I encroachments. _ g•33'37"E �?— I t— I I ——— I No title report was furnished to the surveyroc There may exist other 30' I I I I documents of record that would affect this parcel. 03, I N I ct �StTp I I I I Survey for use by original purchaser of survey only 1 ?V I I I This map is not Intended to show all matters related to the property + including, but not limited to easements,restrictions and encroachments. m I ;:i•,�� . I U ca I I I �' I�;, Encroachments(/cote, vegetation, improvements, driveways, etc.)may, at times, establish lines o1 ownership.property owner should seek legal Q I I I Found 5/8"Rebor - 11-. advice in these cases. m +l+B+i �&cop 'fiomton" 586�}•� n'^CI f I r Found 5/8" LEGAL DESCRIPTION 30 .,%ti't I 36.76'OB"£ I Reba&Ca � Sea Osta9 I I "fiomton See Boundary Line Agreement per A.Fj 21 7dO 77 $ o Found 5/8" y+ m 'P9 ; ,�,• L— I Rebor&Cap C ice". �' ��mF Lins a' I '� . 'Thornton' p"Q 01 —I---ir<— -------{------ + _ r ai `c ° ——J I;.. 9 .. UHLMAN AVK—— \� �Ngg'3536"W �c t PADCrDU1P�&&QUfPI®V!' Standard Field traverse with Leico 3" Total Station with j8 E 00 1 nt P°r I Found 5/8" — W.A.C.lectronic measurement. This survey meets minimum 5027122"W +50 1 1 a°m°63242 I Rebor&Cop standards as set forth in J32—I30-090. + i o 20.18' N�.3}'3g 11'I `/pFNs t7 L— i 'Thornton" 0 1 30\ ,.. 60.15 — LEGEND N86.33 \ r—J I • Set j2"rebar flush with ground with yellow cop imprinted"A.ES. 20795'with 2"x2" I white guard stake. 176 09 +oA 1 Found 5/8' } Rebor&Cap O Found survey point as noted. "fiO1^ton" —_ El So 2 x2"wood hub on property line. Found 5/8" 1—— ——1——— — (D) Deed measurement. + , Reb7Aornto0o" \ I i;�� I I (M) Measurement per this surety. o ` _I——J•r," ————_ R.O.S Record of Survey Mop. Found Brass cop in concrete u � —+ t ,2 4 --Ep F }2 GRAPHIC SCALE 'So n'tie. er 1 I m UNE / —Got cotot� r R`� 1 IE 1. i. P9 60 1 I rue) �d.2 I r Inch-Oo >t Wpm AUDITOR'S CERTIFICATE SURVEYOR'S CERTIFICATE E S Record of Survey/G ^::s Filed for record this /$+k'doy of Os• 20 s2�J_ This map correctly represents a survey mode by "E' JUAN A. GASPAR MARCOS SH T 00a^s me or under my direction in conformance with B_;.� of 1�]ew4 in Volume of Surrys, Pogo �_ the requirements of the Survey Recording Act of �bt s 4/y. �' ties AES CONSULTANTS INC. 1��k 1 1 -� +�a r7DK1� the request of CONSULTANTS, INC. SWN NEI!14 ri�P}. Auditor's Fie No. in MAY 2021. me.ogee:t of AES Consultants Inc. 4 il07111 ,�= P.O.801 M•savnoue a ee3ea (seotec2-ewo SEC. 20, TWP. 22N., OF s Dre— y c—xd sy RG. 1 W., W.M. B.J.M. S.£O. even mar Veto: ae No MASON COUNTY, WA DEPUTY COUNTY AUDITOR P.L.S. 20795 11103121 7487 P�122205066W8J- 12 / 121 LOT 4 T� ' / rn�2zz0se00m� � 6 ,•7099 SF LOT"3 ' r 7012 SF. ( ' LOT 5 "PN 1222M5005 /!7 _ _ 7199 SF Itlg LOT"2 a r SF 1222050§10 "h PN:122p5E00016 vn:,z2zOsasww 1 I r P NAVD EB P. 122zosoEsOos /. - ,�' Scale:1"=90' LOT 1 s SLOT 6 k 9156 SF 7252 5F _z /?�. WHEELWRIGHT BLAI / / - I Sole in Feel j �L /� LEGEND / P 122 ~ I `( • �, ..... �- ^•' L i - sY11841 DESCRIPPON PROJECT BOUNDARY LOT 7 9000 SF R a 1 - `\ �,_ .1a prr. zz2 1yY.16"2 \ —__—__— LOT LINE RIGHT O, AY LOT 9 9 vx:1233e5igpom ! - J / ——— EASEMENT e vN 122oMMIQ/ l I LOT 8 R / x 9632 SF 7548 SF / _ _ _ $� % \�i ROAD CENTER LINE i 12220so Mo. % PROPOSED DRIVEWAY ae•- °°' ————— '__ _— PROPOSED ASPHALT zzkk Barr xvvN' i ; 'I� Px.122205EOW19,.. i - - Px. 00a r '! LAKELAND 9-LOT A =O EYJSTING ASPHALT SHORT PLAT z2z0saTooT // I, / /j(E t- 1 err ,(-✓ PV1 2IIU50a700a tom / r--- -------- Ll P� REVISIONS D-TEI SITE PLAN FOR. HousingUsap 1"=40" Pere aY cesarnon nE9Gr,fD AXON .OIsoD&Associates,Inc. 32.7J�onhwct Hucklin Hill Rd J1.ne'a Jo== gum- Engineering,Planning and Surveying ALLYN I&2-SHORT PLAT SiWerdale,WA 98383 NH0" N cxacxEn 1Tem«+s...soo,ism,a2sssx' Phonc(360)535-6100 ow, 12055 r°—TED 2xsanW=1.x,rvv,.r,z.e�.an.lae u,wawa vasm Ponion ofScelion 20, Toss'nship 32 Nory Range I Nest W'.M.in Mason Counry.N'ashls�lon y� — K C B Environmental LLC CERTIFIED ASBESTOS CONTRACTOR #1639 PHONE#(360)830-5022 P.O. BOX 220 FAX#(360)830-5020 SEABECK,WA.98380 September 2, 2022 Housing Kitsap POC: Joel Klamp Job Site: 172 Lakeland Drive. WA. klcmpjLd housingkitsap.org 360-535-6138 CERTIFICATION OF COMPLETION AND COMPLIANCE FOR THE REMOVAL OF ASUESTOS-CONTAINING MATERIALS KCB abated the asbestos containing material that was identified in the required A.HERA Inspection at location 172 Lakeland Dr. it was removed in strict compliance to all regulations pertaining to asbestos remediation in local, State, and federal jurisdictions, pursuant to 40 CFR 61, PSCAA Regulation 111; VAC 296.62.077, The asbestos containing material(ACM)that was discovered and removed was: *Vinyl Asbestos Tile(VAT)approx. 470 sq. ft. The ACM was wetted wrapped or sealed into 2 layers of 6 mil poly bags, labeled and will be transported to a certified shipper who will dispose of it in an EPA approved landfill. All Asbestos has been removed from Structure. f. Cas'FayiW )ff anager for KC13,a *shington State Certified Asbestos Contractor#1639 WA STATE LICENSED GENERAL CONTRACTOR#KCBENEL831 KZ K C B Environmental LLC CERTIFIED ASBESTOS CONTRACTOR #1639 PHONE#(360)830-5022 P.O. BOX 220 QM FAX#(360)830-5020 SEABECK, WA. 98380 This amount is due upon receipt of this statement INVOICE September 2, 2022 Ilousing Kitsap POC: Joel Klamp Job Site: 172 Lakeland Dr.Allyn,WA. kleinpj@housingkitsap.org 360-535-6138 Completion of the Contract for the Asbestos removal at above Job Site location, Original Contract Price................................ ........$2,820.00 ORCAAPermit.................................................................................................$390.00 PrevailingWage...............................................................................................$310.00 TotalAmount Due...........................................................................................$3,520.00 "Thank you for your business" E V'IRNNMENT L KC B ENVIRONMENTAL SERVICES SERVICES Phone: (360)830-5022 Cell: (360)271-8252 P.O. BOX 829 Seabeck, WA 98380 Email: Skyler@kcbes.com CERTIFIED AHERA ASBESTOS INSPECTION MASON COUNTY March 251h,2022 172 Lakeland Drive Allyn,WA r a Prepared for: ATTN: Joel Klemp Housing Kitsap 2244 NW Bucklin Hill Rd Silverdale,WA 98383 1 TABLE OF CONTENTS 001. Regulatory Compliance.................................... 002. Asbestos Definition......................................... 003. Sampling Protocol........................................... '004. Survey Methodology/Limitations.......................... 005. Site Specifications........................................... 006. Summary...................................................... Attachments which may be included: * Site location maps * Photos * Notification forms * Lab analysis * Field reports * Chain of Custody forms * Certifications * Print outs * Miscellaneous information 2 001. ReEulatory Compliance This inspection satisfies the current regulation WAC 296-62-07707 that requires building owners to conduct an inspection before any repair, remodel, or demolition can be performed where asbestos may be disturbed(Chapter 49-17 RCW) and... Olympic Region Clean Air Agency(ORCAA)Regulations, Article 14 of the Asbestos Control Standards Section 14.05 Notification Requirement and Fees "It shall be unlawful for any person to cause or allow work on an asbestos project or demolition unless owner or the operator has obtained written approval from the control officer as follows: (1) A written "Application to Perform an Asbestos Project"or An application to Perform a Demolition; shall be submitted on Agency-provided forms by the owner or operator for approval by the Control Officer before any work on an asbestos project or demolition begins. It shall be unlawful for any person to cause or allow any false or misrepresenting information on either form. (2) The written application shall be accompanied by the appropriate Application fee and a certification that an asbestos survey has been conducted. (3) The written application for a demolition shall also include a Certification that there is no known,asbestos-containing materials remaining in the area of the demolition. (4) The duration of an asbestos project or demolition shall not exceed one year beyond the original starting date that is commensurate with the amount of work involved. (5) A copy of the approved application and asbestos survey shall be available For inspection at the asbestos project or demolition site. (6) Upon completion of an asbestos project or demolition, a written"Notice Of Completion" shall be filed with the Control Officer. (7) Submission of an"Application to Perform an Asbestos Project"shall be Prima facie evidence that the asbestos project involves ACM. (8) Application for multiple asbestos projects may be filed on one form, if Specific criteria are met(see ORCAA website for details). Notification is required for demolition's involving structures with a projected roof area greater.than 120 square feet, even if no ACM is present. Friable, asbestos-containing material need not be removed from a component if the component can be removed,stored, or transported for reuse without disturbing or damaging the asbestos. 3 It shall be unlawful for any person to cause or allow the burning of any facility for fire training without removing all asbestos-containing materials prior to burning. This includes both friable and nonfriable ACM. ----------------------------------------------------------------------------------------------------- Section 4.05 Procedures for Asbestos Projects. Training Requirements It shall be unlawful for any person to cause or allow any work on an asbestos project unless it is performed by persons trained and certified in accordance with the standards established by the Washington State Department of Labor and Industries, the federal Occupational Safety&Health Administration(OSHA), or the United States Environmental Protection Agency(whichever agency has jurisdiction) and whose certification is current. " This certification requirement does not apply to asbestos projects conducted in an owner-occupied, single family residence performed by the resident owner of the dwelling. AHERA (Asbestos Hazard Emergency Response Act) regulation requires this inspection to include the identification of Friable and Non-Friable ACM in (1) Surfacing Materials, (2) Thermal System Insulation, and (3) Miscellaneous Materials: to delineate homogeneous areas and to sample or "Presume"all materials located. Friable ACM is thought to release fibers into the air more readily, however,many types of Non-Friable ACM can become airborne if disturbed. Additionally, the condition of the material will be graded and the potential for future damage assessed. The number of samples required is specified in the AHERA Rule(40 CFR 763.86) as follows: Surfacing Materials: (SM) 3 samples per homo-geneous area of less than 1000 square feet, 5 samples for greater than 1000 but less than 5000 square feet, 7 samples for greater than 5000 square feet. Thermal System Insulation: (TSI) 3 samples from each homogeneous area that is not"Assumed" to be asbestos, 1 sample per each patched area and as determined by the inspector for tees, elbows or valves. Miscellaneous Materials: (MM) Sample in amounts determined sufficient by the inspector. 4 Friable asbestos is material that can be crumbled,pulverized or reduced to powder by hand pressure. Non-Friable asbestos can become Friable by sanding, grinding, sawing, or other mechanically induced means. EPA(Environmental Protection Agency)regulates asbestos above 1%, as determined using the method specified in Appendix A, Subpart F, 40 CFR(Code of Federal Regulations)Part 763, Section 1, by Polarized Light Microscopy(PLM). These agencies regulate asbestos in these counties: (Washington State) • Puget Sound Clean Air Agency(PSCAA)King,Kitsap,Pierce,Snohomish • Olympic Regional Clean Air Agency(ORCAA)Jefferson,Clallam,Mason,Thurston,Pacific,Grays Harbor • Southwest Clean Air Agency(SWCAA)Lewis,Clark,Wahkiakum,Cowlitz,Skamania • Yakima County Clean Air Authority(YCCAA)Yakima • Northwest Air Pollution Authority(NAPA)Whatcom,Skagit,Island • Douglas County Clean Air Commission,Douglas • Grant County Clean Air Authority. Grant • Tri Counties Air Pollution Control Authority,Benton,Walla Walla,Franklin • Spokane County Air Pollution Control Authority(SCAPCA)Spokane • Washington Department of Ecology,(DOE)Stevens,Ferry,Okanogan,San Juan,Chelan,Kittitas,Klickitat, Columbia,Garfield,Asotin,Adams,Lincoln,Pend Oreille A fee must be paid, and the Notice of Intent filed, and be submitted prior to renovation or demolition of a building. There is a required waiting period after filing a notification before work can begin. (Mandatory 10 days for all demolition's)Calendar or working day wait is stipulated by each regulatory agency's policy. Further information regarding compliance may be obtained at our office. It is unlawful for the owner or the owner's agent to remove asbestos in excess of 10 linear feet or 48 square feet per year,per structure,unless the building is an owner- occupied, single family private residence. Washington State law requires asbestos that is left in place, be in good repair and maintained at regular intervals. Maintenance should be documented. References: WA 296-62-077 Asbestos, Tremolite, An:hophlylite&Actinolite WAC 296-65-001 Asbestos Removal&Encapsulation NESHAP Asbestos Regulations 40 CFR 61 Sub Part M PSCCA Regulation III Article 4 AHERA Model Accreditation Plan/AHERA Final Rule 40CFR 763 OSHA 29 CFR Parts 1910 US EPA Guidance for Controlling Friable ACM in Buildings 5 US EPA ACM in School Buildings,A Guidance Document Part 1&2 US EPA Asbestos Waste Management Guidance (Office of Solid Waste)US EPA Reporting&Recordkeeping Requirements for Waste Disposal 11-90 US EPA Asbestos in the Home, A Homeowners Guide 6-88 United States Environmental Protection Agency; The Asbestos Informer All federally recognized Tribal Lands are not under the jurisdiction of a local air pollution control agency but must report to the US EPA when undertaking asbestos abatement. 6 002. Asbestos Definition "Asbestos" includes Chrysotile, Amosite, Crocidolite, Tremolite asbestos, Anthrophylite asbestos, Actinolite asbestos, and any of these minerals that have been chemically treated and/or altered. Chrysotile is the most commonly used type of asbestos in North America, known as"white asbestos", the only mineral in the serpentine group of asbestos minerals. The word"asbestos" (Greek-not extinguishable) was first recorded in the first century AD, although the substance was known as early as the second century BC. 75% of the world's asbestos is mined in Quebec. Exposure to asbestos fibers can cause asbestosis, various cancers and the deadly mesothelioma which is an inoperable cancer of the chest and abdominal linings. Because there is no known safe level of exposure to asbestos, all exposure should be avoided. Asbestos was used in the United States in over 3600 different building materials, and while it is possible to suspect that a material contains asbestos, actual determination can only be made by instrumental analysis. Sample List of Suspect Asbestos Containing Materials • Cement Siding/Wallboard/Cement asbestos pipes • Window putty • Vinyl Floor Tile/Vinyl Wall Coverings • Vinyl Sheet Flooring/backing and adhesives • Vermiculite attic insulation • Construction Mastics/Joint Compounds/Spackling/Caulking/Putty • Acoustical and Decorative Plaster • Textured Paints and Coatings • Ceiling Tiles and Lay-in Panels/"popcorn"ceiling texture • Spray-on Insulation/Duct&Boiler Insulation • Blown-in Insulation/Wiring Insulation • Fireproofing Materials/Cooling Towers/Base Flashing • Taping Compounds/Chalkboards/Roofing Shingles • Packing Materials(Walls/Floors) • Gaskets/Drywall/Roofing Felt • Laboratory Hoods/Gloves/Table Tops • Fire Blankets/Fire Curtains/Fire Doors • Heating&Electrical Ducts/Pipe Insulation 7 003. Sampling Protocol This survey addresses Friable and Non-friable suspect asbestos containing materials to meet NESHAP 40 CFR 61 (National Emissions Standards for Hazardous Air Pollutants)requirements for renovation and/or demolition activities. When suspect ACM is observed our technicians are trained and proficient in gathering samples by approved industry standards. All samples are then analyzed by an independent EPA approved NVLAP/NIST/AIHA accredited lab that participates in the PAT program according to 29 CFR 1910.1001, 0)(8)(ii)(A&B). The samples are analyzed using PLM with dispersion staining to estimate the percentage of asbestos composition by volume. Samples in which less than 1% of asbestos mineral is detected is designated as "None Detected"(ND) or"No Asbestos Detected" (NAD). Random samples are gathered of each homogeneous suspect ACM identified during a visual search. A series of samples are gathered(according to the 3-5-7 AHERA Rule) and are read at the lab for a positive result. If positive, no other samples are read of that material; if the sample is negative of asbestos content, the other samples are studied. All samples gathered must be reported negative for the material to be considered"None Detected". The laboratory analysis of all bulk sampling is included in this report and intended to be an integral part of the inspection data. Guidelines require laboratories reading asbestos samples to read all materials which are included in the submitted sample(tile, mastics, vinyls, adhesives, leveling compounds, etc). Because we frequently submit a "layered" sample, we may not sample mastics/adhesives separately as we feel this would be redundant and cause confusion in the interpretation for our clients and also result in costlier lab fees. Therefore, the number of samples gathered will not always result in the same number of sample results received from the lab. Not all laboratories are qualified to analyze asbestos. The lab must be NVLAP certified, participating in the PAT Program of the Federal government. 8 004. Survey Methodology/Limitations Site reconnaissance was conducted by a Certified AHERA Building Inspector, in accordance with 40 CFk..Part 763 Appendix C,who is familiar with the probable uses and locations of suspected Asbestos Containing Building Materials (ACBM). In addition to a visual walk through, effort is expended to disclose prior uses of the facility, age, and characteristics of construction, and other information which helps determine the potential presence of suspected ACBM. This inspection report is the written opinion of a qualified Certified AHERA Building Inspector and is based on conditions visible at the time of the site visit. This report does not constitute a warranty of any kind. Although extensive searches are conducted, there remains a remote possibility that asbestos in some form may lie undetected within the structure;under a floor, inside a duct,behind a wall, or buried in the ground. No degree of demolition was authorized or performed. Some printed materials may be included in this report strictly for educational purpose. Estimated dimensions quoted in this report are approximate estimates for location awareness of the materials and are not intended to be accurate for bidding. The Abatement Contractor should check all measurements by site visit. No portion of this report should be removed from its entirety; copies can be made by folding back the pages. This report should remain on file for future reference regarding this structure. In older structures, it should be noted for personal safety that most window putty did contain asbestos, and that in the process o 17 removing the putty to repair a pane, some individual contamination would most likely occur. Such windows should be removed with the glass intact, and disposed of as a unit. When flooring is considered suspect of asbestos content, the mastic should always be treated as suspect as well,and should never be chipped, sanded or scraped until tested to determine if asbestos is present. All questions pertaining to this report should be directed to our office for immediate response. Field notes are included in this report for their interpretive value. Photo's if taken are included for identification. Sample readings resulting in less than one percent(<1%) will not be recorded as asbestos because this amount in unregulated, therefore not considered asbestos (ACM). 9 Our services have been executed in accordance with generally accepted practices within the limitations of scope, schedule, and budget; no other conditions are expressed or implied. This report does not expire as long as all repairs and remodeling activities after the inspection has been performed are conducted using new materials (not inventoried or used) certified asbestos free; and this action is carefully documented. Because materials are being imported into the United States from China, which can contain asbestos, all suspect materials must be tested to ascertain whether or not asbestos fibers are present. There no longer is a"cut off'date from the year that the U.S. stopped the manufacturing of ACM for residential use that we can rely on. This document is protected by the Copyright Act of 1979 under Title 17 of the United States Code. Under no circumstances can this report be used unless it has been financially compensated for,nor can it be re-printed without express authorization from this firm. 10 005. Site Suecif cation: This Certified AHERA Building Inspection has been authorized by the owner, Housing Kitsap at 172 Lakeland Drive in Allyn. The site investigation was performed on March 25th, 2022 of this single-family home. It has a composition roof, metal siding. It is planned for demolition. (7) samples were collected on site of materials that were suspect of containing asbestos fibers: -Vinyl Tile -Linoleum -Texture -Drywall with Joint Compound -Window Glaze Suspect materials are collected wet and sealed into 2mil poly lab pouches and were shipped by Priority Mail to our preferred asbestos-specific NVLAP laboratory for analysis using Polarized Light Microscopy. "Suspect Material" is defined as any building material that has ever been documented as containing asbestos fibers or materials that closely resemble those that have. The base amount of asbestos that is regulated is more than one percent. This report was prepared for the exclusive use of Housing Kitsap and its agents or representatives for specific application to this site. If new information is developed through excavations, borings or other studies, this inspector should be retained,to re-evaluate the conclusions of this report and provide amendments as needed. 11 006. Summary: The local Clean Air Agencies require a 10 day wait prior to asbestos abatement of a commercial or other than owner-occupied structures; and requires the 14 day wait for all demolitions. A demolition permit must be purchased from ORCAA whether or not asbestos was identified attached to your structure. It is required to file your Notice of Intent with Olympic Region Clean Air Agency online at wwworcaa.ora and you may phone them for more information at; 360.539.7610. Payment of the Notice of Intent will be accepted by credit/debit card. We suggest you retain this document for as long as you own this property(or hold contract to work on it)to verify your compliance to the asbestos standards in place at this time. If there are any questions, please feel free to contact this inspector: Skyler Taylor, Certified AHERA Building Inspector#BI-rrss-08-21-14-01 12 KCB ENVIRONMENTAL SERVICES P.O. Box 829—Seabeck,WA 98380 360.2171.8252 COMPENDIUM OF LOCATED ASBESTOS-CONTAINING MATERIALS 172 Lakeland Drive Allyn, WA After due diligence was exercised in the investigation of this single- family home, this was the material identified to contain asbestos: Sample #1. Approximately 470 Sq. Ft. of Tan Vinyl Tile in throughout the home. A t "ey Skyler Taylor, Certified AHERA Building Inspector#BI-NES-08-21-14-01 13 FIELD REPORTS - LABORATORY FINDINGS K C B Environmental Services 14 FIELD REPORT Page t ofi Kc KCB Environmental Services PROJECT NAME: c� ct 1 Xrr-,<�-je f E IRONME L P.O. Box 829 INSPECTOR: Skyler Taylor#BI/R-NES-08-13-15-01 31 RV€t:1=,-, Seabeck, WA 98380 Site Address: 1-22- no?- 4 Phone: (360) 830-5022 Mobile: (360) 271-8252 Email: Skyler@kcbes.com SIGNATURE: DATE: DESCRIPTION: , Glt€7ot> g2jr.} ', �. ,,m o avor-, t!I—Jt-- I�+ ` CONTRACTOR: SAMPLE FUNCTIONAL HOMO AHERA MATERIAL FRIABLE MATERIAL CONDITION POTENTIAL REASON MATERIAL. OTHER COMMENTS IDENTIFICATION SPACE AREA CAT TYPE YES/NO AMOUNT G/D/SD DAMAGE DAMAGF COLOR LOCATION Lft { � PL W tx.D / 112 I✓ fII-t '- l J"�" �' 1 ( T —o C, -C-a p- s si-1 f34,Nrz �, j,IVIAj6, M AArr tot i `Z. I `I`>(r'lJt.i•. Llw+nJ� �`f Ain s A 1,L --- GAL t i`�MG l + t r *FUD=Friable Upon Demolition -SM=Surfacing Material - MM=Miscellaneous Material-TS1=Thermal System Insulation -SV=Sheet Vinyl-VT=Vinyl Tile -CT=Ceiling tile Housing Kitsap gym - magi 172 East Lakeland Drive,98524,Washington,United States SUBMITTED BY KCB Environmental Services TOTAL AREA: 1278.29 sq ft•LIVING AREA: 1278.29 sq ft•FLOORS:2•ROOMS: 5 skyler@kcbes.com ♦ Ground Floor TOTAL AREA: 928.95 sq ft-LIVING AREA:928.95 sq ft,�,000,E 3 3 i I Workshop 293.80 sq ft � 1721/8"•17'11/2, t. L undry R]x,Lvirgfioan 227.07 sq ft 1 14'7 1.'8"x 15 6 3/4" S Ra roo 30 s '12 €3"• Outbuilding Outbuilding 327.16 sq ft 145.62 sq ft 16 2 3/8's 20 2 3/8' 3 r_, IF,2 s:"W ♦ 1st Floor TOTAL AREA: 349.34 sq ft,LIVING AREA: 349.34 sq ft-ROOMS:2 Closet :15117A'•g y 7 Bedroom 96.06sqft so tt 78/8' ka!i '7114' THIS FLOORPLAN IS PROVIDED WITHOUT WARRANTY OF ANY KIND.SENSOPIA DISCLAIMS ANY WARRANTY INCLUDING, O. 81 16' 24' WITHOUT LIMITATION,SATISFACTORY QUALITY OR ACCURACY OF DIMENSIONS. 1:1 87 Pagel/1 CHAIN OF CUSTODY �,,. V+tEATF R IF, Raw �{? S�Eou��T c s RVICE vta.ENLa#PC.c9r upaaroblR m I t".aJltt jow � pYl7ac Requests N1: te�lt � 71t?8ASteAa ) C axltor, ' ° 61 6511d E Hl " Ptverdx,AZ. 1601 Wm Knaid Or te tYd1 a'GYin SSF,CA;60M ShOrelrft 0,Sto.2175 S bars FrB o%w� CA 144CM'3 `tbfh"t 888-6654 CONTACT INFORMATION halt 'eta ,>mE�=rtrl a8�ak�1� 1i°af 4S9C1ta .Pohi�€- ScaEN'nk< WA IS0 t"°CaaYiPAnY . fds�tt.�4t; '_1�.4fGl sal+'f.H PROJECT I�IFQRAIlAXION TUI'3N AftoUt4;0 WE CODES-(TAT) _ 5TO.starr»°r3 tnetaull RixOas t cower,'OtOf 23n' a ' N a t m, SR w qs�m Buts nos a pay s t tt od fecul t qqee ar�ct FYe�IN,ir { f W' ASr I' blrf�+its«5�qdv a ur tai ' r4elrl I'lb+7aAr!oS�l"I� ..y tit"Af1 LaI Ip Glt ! f WN-Neeh+�rattz#30Itctrzy werkettal;ar4y..nPO Nw4w' en Sample TAT Total NOTES �E I#I DE-CRIPT"D Type (Abowt Va It�rntJAraata IT€me at day.7r mp,Itti,•ac.} Ik3stnev rya npPt;tas>te� °..�...,� ,.,...._... — .w.�..�... -_ AJ J " � I i SAMPLE TYPE CODES RELINOItI9IIED By DATE&TIME RECEIVED BY DATEIt TIME 1 G BaaGasa }pt 1 Y � 0-?',thpr CP t'r~td CiRR T Tape, A1$. �Aat i� j C t, -• LI ztx .? f`J"�. `G +r F � z SiT_,xpcar�I`rbTa �i±1I_Svs°ala ,a{ SAS-Sudace Aar Si»'rTlh-V B Buth 4 >rnl A NP-Ntrn klie 1�`atetP•P r d Yaathat„-haih trI:a+ telt t' yxrc{re to Y�y"tba Ieb€errl C4rKfi;inn#set hlrthe - e Tay ht ?iJt Eurcrtras FTALsakS Paf� parr..#EhT•�;* F-1192,Rev.33,R0Vt fV15r'49,I is 1 Of 1 ti' euo� r fins �. _ E Y(RONMENT L a„<_x€i_-sera P K _ Report for: Skyler Taylor KCB Environmental Services 9916 NW Pioneer Road Seabeck, WA 98380 Regarding: Project: Housing Kitsap; 172 Lakeland Dr EML ID: 2885328 Approved by: Dates of Analysis: Asbestos PLM: 03-31-2022 Approved Signatory David Andrews Service SOPs:Asbestos PLM (EPA 40CFR App E to Sub E of Part 763&EPA METHOD 600/R-93-116, SOP EM-AS-S-1267) NVLAP Lab Code 600266-0 All samples were received in acceptable condition unless noted in the Report Comments portion in the body of the report.The results relate only to the samples as received and tested.The results include an inherent uncertainty of measurement associated with estimating percentages by polarized light microscopy. Measurement uncertainty data for sample results with>1%asbestos concentration can be provided when requested. Eurofins EMLab P&K("the Company")shall have no liability to the client or the client's customer with respect to decisions or recommendations made,actions taken or courses of conduct implemented by either the client or the client's customer as a result of or based upon the Test Results. In no event shall the Company be liable to the client with respect to the Test Results except for the Company's own willful misconduct or gross negligence nor shall the Company be liable for incidental or consequential damages or lost profits or revenues to the fullest extent such liability may be disclaimed by law,even if the Company has been advised of the possibility of such damages, lost profits or lost revenues. In no event shall the Company's liability with respect to the Test Results exceed the amount paid to the Company by the client therefor. Eurofins EPK Built Environment Testing,LLC EMLab ID: 2885328, Page 1 of 3 Eurofins EMLab P&K 19515 North Creek Pkwy N,#100, Bothell, WA 98011 (866) 888-6653 Fax(623) 780-7695 www.emlab.com Client: KCB Environmental Services Date of Sampling: 03-25-2022 C/O: Skyler Taylor Date of Receipt: 03-28-2022 Re: Housing Kitsap; 172 Lakeland Dr Date of Report: 03-31-2022 ASBESTOS PLM REPORT Total Samples Submitted: 7 Total Samples Analyzed: 7 Total Samples with Layer Asbestos Content> M 1 Location: 1-172 Lakeland,Vinyl tile Lab ID-Version$:13843479-1 Sample Layers Asbestos Content White Leveling Compound ND Semi-Transparent Mastic ND Tan Floor Tile 2%Chrysotile Composite Non-Asbestos Content: 3%Cellulose Sample Composite Homogeneity: Poor Location: 2-172 Lakeland,Linoleum Lab ID-Version$: 13843480-1 Sample Layers Asbestos Content Light Brown Linoleum with Fibrous Backing ND Composite Non-Asbestos Content: 20%Cellulose 10%Synthetic Fibers Sample Composite Homogeneity: Good Location: 3-172 Lakeland,Texture Lab ID-Version$: 13843481-1 Sample Layers Asbestos Content .White Texture with Paint ND Sample Composite Homogeneity: Good Location: 4-172 Lakeland,Texture Lab ID-Version$:13843482-1 Sample Layers Asbestos Content White Texture with Paint ND Sample Composite Homogeneity: Good The test report shall not be reproduced except in full,without written approval of the laboratory.The report must not be used by the client to claim product certification,approval,or endorsement by any agency of the federal government.Eurofins EMLab P&K reserves the right to dispose of all samples after a period of thirty(30)days,according to all state and federal guidelines,unless otherwise specified. Inhomogeneous samples are separated into homogeneous subsamples and analyzed individually.ND means no fibers were detected.When detected,the minimum detection and reporting limit is less than 1%unless point counting is performed.Floor the samples may contain large amounts of interference material and it is recommended that the sample be analyzed by gravimetric point count analysis to lower the detection limit and to aid in asbestos identification. $A"Version"indicated by--"x"after the Lab ID#with a value greater than I indicates a sample with amended data. The revision number is reflected by the value of"x". Eurofins EPK Built Environment Testing,LLC EMLab ID:2885328,Page 2 of 3 Eurofins EMLab P&K 19515 North Creek Pkwy N,#100,Bothell,WA 98011 (866) 888-6653 Fax(623) 780-7695 www.emlab.com Client: KCB Environmental Services Date of Sampling: 03-25-2022 C/O: Skyler Taylor Date of Receipt: 03-28-2022 Re: Housing Kitsap; 172 Lakeland Dr Date of Report: 03-31-2022 ASBESTOS PLM REPORT Location: 5-172 Lakeland,Texture Lab ID-Version$:13843483-1 Sample Layers Asbestos Content White Texture with Paint ND Sample Composite Homogeneity: Good Location: 6-172 Lakeland,DrywalUJC Lab ID-Version$:13843484-1 Sample Layers Asbestos Content White Drywall with Brown Paper ND White Joint Compound ND Cream Tape ND White Texture with Paint ND Composite Non-Asbestos Content: 15%Cellulose 2%Glass Fibers Sample Composite Homo enei : Poor Location: 7-172 Lakeland,Window glaze Lab ID-Version$:13843485-1 Sample Layers Asbestos Content Tan Window Glazing ND Sample Composite Homogeneity: Good The test report shall not be reproduced except in full,without written approval of the laboratory.The report must not be used by the client to claim product certification,approval,or endorsement by any agency of the federal government.Eurofins EMLab P&K reserves the right to dispose of all samples after a period of thirty(30)days,according to all state and federal guidelines,unless otherwise specified. Inhomogeneous samples are separated into homogeneous subsamples and analyzed individually.ND means no fibers were detected.When detected,the minimum detection and reporting limit is less than 1%unless point counting is performed.Floor tile samples may contain large amounts of interference material and it is recommended that the sample be analyzed by gravimetric point count analysis to lower the detection limit and to aid in asbestos identification. $A"Version"indicated by=Y'after the Lab ID#with a value greater than I indicates a sample with amended data. The revision number is reflected by the value of"x". Eurofins EPK Built Environment Testing,LLC EMLab ID:2885328,Page 3 of 3 j �vt •�� ;,. awn.Ycw'ry`� ,,,"`^ pert �t ,rs"-. ..---'K-- .. l,,. •uv„ fi �,„. ��, .f 1 _ •e r < F IJ BUILDING INSPECTOR j REFRESHER CERTIFICATE ` ` : fi This is to certify that , Skyler Taylor ✓ f ;f has attended and satisfactorily completed all requirements to maintain accreditation as an AHEF�A Building Inspector in accordance with the Toxic Substance Control Act Title (Section 206) and 40 CFR 763. Accreditation No. BI1R-NES-10-15-2021-01 I i Course Date: Oct. 15, 2021 — --- --- Valid through: Oct. 15, 2022 l-nstruet6r: Patricia "PX Journey NOW Environmental Services, Inc. . 34004 — 9t'' Avenue South, Suite # 12 Federal Way, Washington 98003 � (253) 927-5233 , hi i{ t.J .,?'�p `arz-!� .,+T1��•:.� i �u-' 4"`«-_....,._..-, ``• "'-.mx� � :, .'�ye>,g�.*ffi!^.mERZO*�:'" `+y �.. .tee-^M1'/ �ti 1"� " r•u F'-1 *u-s \.� a< S � Joe Guseman From: permits@orcaa.org Sent: Tuesday, August 23, 2022 10:13 AM To: Joe Guseman Subject: Demolition Notification Follow Up Flag: Follow up Flag Status: Flagged CAUTION: This email originated from outside your organization. Exercise caution when opening attachments or clicking links, especially from unknown senders. - 2940 Limited Lane NW Olympia, WA 98502 360-539-7610 This is your OFFICIAL CONFIRMATION of NOTIFICATION to ORCAA of your planned DEMOLITION Project. If required, present this Confirmation of Notification certificate, along with your receipt of payment, to your local city or county permitting agency as evidence of completion of ORCAA's Notification Process. This Notification is not valid until fees are paid and a full asbestos survey has been submitted. Notification fee non-refundable. Name: housing kitsap Mailing address: 2244 nw Bucklin hill road City: silverdale State: washington ZIP: 98383 Phone number: 3602653693 Email address: gusemanj@housingkitsap.org Is the property owner also the Yes demolition contractor?: Project Size: 928 Is asbestos present?: Yes i .' Number of structures being 1 demolished?: Start date: 09/24/2022 Upload your asbestos survey: 172Lakeland-HousingKitsapSurvey-4_6_2022.pdf Site address: 172 lakeland drive City: allen ZIP: 98524 This structure is:: Built on-site Has all identified asbestos been Yes removed?: What year was the structure initially 1947 built?: Category options: Training fire Fire protection agency name, point of central mason fire and ems, Dan eldridge, 360) 426-5533 contact,and phone number: Fee: Single family residence - Notification fee: $42.00- 14 day waiting period - Nonrefund What email address should we send gusemanj@housingkitsap.org the application confirmation to?: Submitted On: 2022-08-23 10:12:40 IP Address: 174.204.75.45 2