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2006, 01-18 Permit App: 06000136 Demo Mobile Homecar, �� Permit Center Spokane 11707 E Sprague Ave, Suite 106 Valley Spokane Valley, WA 99206 (509)688-0036 FAX: (509)688-0037 Community Development www.spokanevalley.org.com Manufactured Home Permit Application SITE ADDRESS e- /72, D e Cc 7G,/ 0/2.-///e , S/0I714C/✓e t/ //8yr /1/A- . 9.9046 ASSESSORS PARCEL NO: 5 j t cl • f OO 1 LEGAL DESCRIPTION: Building owner Name: Zervr ta-2.ci ` Address j726 —( Gj dyrl/F' City: 9dk J,IJ Milo)/ UM, Zip: i6V. Phone:7,2g -7433 Fax: Coin'tact Person'? Name: LMd A 1,3c..Q i,-,/ Phone: #jj 91 2 211 13 )1 Describe the scope of work in detail: eMO/if/ON of a4 x ?6' Ale b, Ce I -Jenne - Contractor` Name: Address: City: Zip: Phone: Fax: Lic No: Exp. Date: City Business Lic No: MANUFACTURED HOME Width: �f Manufacture: T/ raN Length: 7 ° Year: /Tr Pit Set: ,(/Q Previous Address: Proposed Use: ,V4 DISCLAIMER A14 The permitee verifies, acknowledges and agrees by their signature that: 1) If this permit is for construction of or on a dwelling, the dwelling is/will be served by potable water. 2) Ownership of this City of Spokane Valley Permit inure to the property owner. 3) The signatory is the property owner or has permission to represent the property owner in this transaction. 4) All construction is to be done in full compliance with the City of Spokane Valley Development Code. Referenced codes are available for review at the City of Spokane Valley Permit Center. 5) This City of Spokane Valley Permit is not a permit or approval for any violation of federal, state or local laws, codes or ordinances. 6) Plans or additional information may be required to be submitted, and subsequently approved before this application can be processed. Date C7/- /8- o..6 Method of Payment: (Faxed permit applications will only be accepted with major bankcard) JO Cash ❑ Check 0 Mastercard 0 VISA Bankcard #: Expires: VIN#: Authorized Signature: REVISED 6/23/2005 0 Other 17208 E COACH DR., SPOKANE VALLEY PRE -DEMOLITION ASBESTOS SURVEY PRE -DEMOLITION ASBESTOS SURVEY FOR THE SUSPECT BUILDING MATERIALS ASSOCIATED WITH THE PRIVATE RESIDENTIAL STRUCTURE ADDRESSED 17208 EAST COACH DRIVE, SPOKANE VALLEY, WASHINGTON 1.0 INTRODUCTION Mr. & Mrs. Lenard Benthien, contracted MCS Environmental, Inc. (MCS), to conduct a pre - demolition asbestos survey of the suspect building materials associated with private residential structure addressed 17208 East Coach Drive in Spokane Valley, Washington. Mr. Chris Bennett, EPA -accredited AHERA building inspector, conducted a field survey of the identified residential manufactured home on December 16, 2005. [Refer to Appendix A for inspector certifications and laboratory accreditations]. SITE DESCRIPTION The structure is a single story; wood framed private residence manufactured home with wood siding and 3 -tab composite roofing. The interior consists of gypsum wallboard, wood paneling, carpeting and vinyl flooring. This structure has sustained recent fire damage to the interior and to the roof and is scheduled for demolition. The property is bounded by residential properties to the north and east. East 3rd Avenue borders the property to the south and Coach Drive borders the property to the west. [Refer to Appendix D for site drawings]. 2.0 SCOPE OF WORK The scope of work was designed to meet the requirements for asbestos inspection and due diligence notification in the Occupational Safety and Health Administration (OSHA) Asbestos Standard (29 CFR 1926.1101), Washington Industrial Safety & Health Act (WISHA) standards (WAC 296-62- 077), the National Emission Standards for Hazardous Air Pollutants (NESHAP; 40 CFR 61), and applicable portions of the Asbestos Hazardous Emergency Response Act (AHERA) and regulations in 40 CFR 763. The survey was conducted through visual evaluation, classification and analysis of suspected asbestos -containing materials (ACMs) used in the construction or remodeling of the surveyed manufactured home. The survey included the following tasks: • Visual survey and assessment of the location and condition of suspected materials. December 21, 2005 PAGE 1 MCS Environmental, Inc. 17208 E COACH DR., SPOKANE VALLEY PRE -DEMOLITION ASBESTOS SURVEY • Collection and analysis of bulk samples from suspected asbestos containing materials. • Preparation of a report summarizing the identification and assessment of any asbestos containing materials and material found not to contain asbestos. 3.0 ASSESSMENT SURVEY PARAMETERS 3.1 HOMOGENEOUS AREAS Homogeneous materials are those considered to be consistent throughout an area based on color, texture, and construction era. For the purpose of this survey, homogeneous areas were delineated using the construction era, material composition, and material location as the primary considerations. Material appearance, texture, size, color, and analytical results may support assumptions about each material's homogeneity. 3.2 BULK SAMPLING Suspected ACMs were collected according to guidelines in 40 CFR 763.85 and were sampled to determine the type and percentage of asbestos by volume. At least one sample was collected from selected miscellaneous materials and at least three samples from thermal system insulation materials. Suspect surfacing materials were sampled according to the AHERA "3/5/7 rule." For other types of suspect materials, or materials assumed to be non -ACM, regulations require the on-site AHERA building inspector to determine the appropriate number of samples. The quantity of material present, manufacturer's labels, appearance, construction or renovation era, and inspector's expertise were used to determine the number of samples. A homogeneous material is considered to be an ACM if one or more sample results are equal to or greater than 1% asbestos. The EPA recommends that at least three samples be analyzed by polarized -light microscopy (PLM) for the following types of materials in order to prevent false negative results (less then <1 % asbestos): • Materials that contain low concentrations of asbestos fibers (less then 10%); • Materials with asbestos fibers tightly bound in a matrix; • Materials with milled asbestos fibers (fine fibers); • Materials with hand -mixed asbestos fibers; and • Materials with a combination of these characteristics. December 21, 2005 PAGE 2 MCS Environmental, Inc. 17208 E COACH DR., SPOKANE VALLEY PRE -DEMOLITION ASBESTOS SURVEY All bulk samples must have results below 1% asbestos before the material may be classified in accordance with AHERA rules as not being ACM. However, if asbestos is detected in the material at less than <1%, OSHA and WISHA worker health and safety regulations still apply. 3.3 LABORATORY AND ANALYTICAL METHODS MCS collected 6 samples of suspected ACM from 8 different homogeneous materials identified during this survey. Lab analysts sub -divided 1 sample into 2 individual samples making a total number of 9 samples analysed. All samples were submitted for analysis to Mountain Laboratories of Spokane, Washington using chain of custody procedures. Mountain Laboratories participates in the national voluntary laboratory accreditation program (NAVLAP) and is a NAVLAP accredited asbestos testing laboratory, NAVLAP code: 101890-0. All samples were analyzed to determine asbestos type and content using PLM with dispersion staining in accordance with the following methods: EPA EPA 600/R-93/116, "Method for the Determination of Asbestos in Bulk Building Materials" (July 1993). EPA "Interim Method for the Determination of Asbestos in Bulk Insulation Samples" (40 CFR Part 763, Subpart F, Appendix A; May 27, 1982). ASTM Draft "Standard Method of Testing for Asbestos Containing Materials by Polarized Light Microscopy" (ASTM Committee D22.05; January 14, 1988). 4.0 RESULTS This section describes suspect materials that were found to be or assumed to be asbestos containing. [Refer to the bulk sample analysis report in Appendix B for specific sample composition and the sample log in Appendix C for sampling locations]. 4.1 MATERIAL CONTAINING 1% OR MORE ASBESTOS ACMs are materials proven to contain at least 1% asbestos or greater. AHERA and NESHAP regulations distinguish between friable and nonfriable forms of ACM. A friable material is defined as one that can be "crumbled, pulverized, or reduced to powder by hand pressure when dry." Friability is an indication of a material's ability to release asbestos fibers into the air. PAGE 3 MCS Environmental, Inc. December 21, 2005 17208 E COACH DR., SPOKANE VALLEY PRE -DEMOLITION ASBESTOS SURVEY Regulated ACMs are defined by NESHAP as all friable ACM and nonfriable ACM that may be disturbed by renovation or demolition. The following homogeneous material was found to be a regulated ACM, by laboratory analysis: • Approximately 700 square feet (ft2) of Orange Vinyl Sheet Flooring (VSF) was identified in the bathrooms, kitchen, hallway and closets. This category I, non -friable material contains between 20% and 25% chrysotile asbestos. 4.2 MATERIALS ASSUMED TO CONTAIN ASBESTOS No suspect materials were Assumed to contain asbestos during this survey. 4.3 MATERIALS WITH ASBESTOS CONCENTRATIONS OF LESS THAN <1% No sampled materials were proven to contain less than one percent (<1 %) asbestos by laboratory analysis. 4.4 NON -ACM MATERIALS Microscopic examination of samples from the following suspect materials collected from the retail spaces did not detect the presence of asbestos -containing minerals: • Gypsum Wallboard • Ceiling Texture • Gray Ceiling Panel (above wood stove) • Tan Ceiling Tile (above wood stove) • Gray 3 -Tab Composite Roofing • Black Roofing Paper 4.5 MATERIALS ASSUMED NOT TO CONTAIN ASBESTOS The following materials were assumed not to contain asbestos, based on manufacturers' labels, age, appearance, or inspector's expertise: • Wood components — framing, walls, and cabinets. • Glass — exterior and interior. • Metal — structural support, furnace/ducting, piping, and tanks. December 21, 2005 PAGE 4 MCS Environmental, Inc. 17208 E COACH DR., SPOKANE VALLEY PRE -DEMOLITION ASBESTOS SURVEY • Fiberglass insulation — attic, walls, and pipes. • Concrete — foundations, columns, and walls. 5.0 CONCLUSIONS AND RECOMMENDATIONS Our findings are based strictly on information obtained from our site observations and from sample analysis during survey activities. Consistent with our knowledge and understanding of environmental regulations, particularly as they apply to the potential liabilities associated with asbestos -containing building materials, we present the following conclusions and recommendations. 5.1 CONCLUSIONS MCS identified one (1) non -friable ACM: Orange vinyl sheet flooring. This class I ACM appeared to be in good condition, with no areas gouged, abraded or missing. It should be noted that VSF materials that are intact are considered non -friable however during removal these materials become friable during the forces of abatement. In accordance with regulatory protocol, all suspect materials identified as, or assumed to be, asbestos containing must be managed as ACM until further sampling documents otherwise. The owner may refute, by additional point -count analysis, the ACM status of materials found to contain less than 10% asbestos. However, for materials such as vinyl tile and adhesive with concentrations between 1% and 10%, reanalysis by point counting typically does not decrease estimated concentrations enough to justify non -ACM classification. The materials proven not to contain asbestos require no further action in regard to asbestos regulations. These materials may be disposed of in a landfill that accepts standard construction debris. 5.2 RECOMMENDATIONS 1% or Greater, Regulated ACM Materials: Properly trained workers employed by a certified asbestos -abatement contractor may work on, remove, or dispose of ACM materials using wet methods, appropriate work practices, and proper engineering controls. Depending on type of material (category I or category II, friable or non -friable) and engineering controls used (mechanical or manual), workers need either 8 or 32 hours of initial training and must be supervised by a competent person with 40 hours of training. December 21, 2005 PAGE 5 MCS Environmental, Inc. 01/15/2005 15:15 5094847258 FAX COVER SHEET Summit Environmental, Inc PO Boz 141144 Spokane, WA 99214-1144 Office: (509) 483-0376 Fax: (509) 921-6486 SUMMIT ENJIRLNMENTAL PAGE 01 SEND TO: Linda Benthien FROM: Cathy Smith ATTENTION: DATE: 01/16/2006 FAX NUMUMBER: 533-8681 COMMENT: Linda, I finally got to my billing today — I have faxed a copy of the invoice to Foremost Insurance as you asked. Following you will find invoice # 6001 along with the waste shipment record for your file_ Please let me know if you need anything else_ Total Pages including cover sheet:.' Y (IP YOU DO NOT RECEIVE ALL PAGES, PLEASE CALL (509) 483-0376) 01/18/2005 15:16 5094847288 SUMMIT ENS/IRUNMENTAL PAGE 02 Summit Environmental, Inc PO Box 141 144 Spokane, WA 99214-1411 Office: (509) 483-0376 Fax: (509) 921-6486 January 16, 2006 Ben & Linda Benthien 17208 E. Coach Spokane, WA RE: Residence located at 17208 E. Coach in Spokane Valley, WA Summit Environmental, Inc has completed asbestos abatement on the project located at the above-mentioned location per survey. Enclosed you will find the following documents to close this project. Invoice # 6001 Waste Shipment Record Please let me know if you need additional information to close this project. We have enjoyed working with you on this project and sincerely hope to work with you again in the near future. Sincerely, Cathy Smith Enclosures 111/16/20F16 15:15 50948472SP Summit Environmental, Inc. PO Box 141144 Spokane, WA 99214-1144 BILL TO Ben & Linda Deo thien 17208 PL Coach Dr Spokane, WA 99216 SUMMIT ENJIRONMENTAL PAGE 03 Invoice DATE INVOICE * 1/16!2006 6001 Project Location Residence 17208 E. Coach Drive Spokenc, WA P.O_ NO. TERMS PROJECT C1#7652506N/30 , DESCRIPTION QTY RATE AMOUNT Remove) of /Asbestos containing materials completed per proposal WA St Sales Tax 1,155.18J 8.50% 1.155 OOT 98.18 We appreciate your business Tota I 61253.18 01/16/2006 15:15 5094547288 SI_IMMIT ENVIRONMENTAL PAGE e4 WASTE SHIPMENT RECORD 1_ Work Site Name & Mailjng Address: B i a'j . t �7 a c 6`✓-��.9 a� County: �t.,y �� Kms•• t Operator's Name & Address: Summit Environmental, Inc PO Box 141144 Spokane, WA 99214 Owner's Name: Ger, ,1 . i$4i.'zn Telephone No.: j 3 3 . 'o o �- Telephone No.: (509) 483-0376 3_ Disposal Site Name: Graham Rd Disposal Mailing Address: 1820 S. Graham Rd — Medical Lake, WA Site Address: Same Telephone No: 244-0151 4. Name & Address of Responsible Agency: SCAPCA 1101 W. College Spokane, WA 99201 Telephone No.477-4727 5. Description of Materials: 401PAZ /N 8. Special 6. Containers No: Type udling Instructions and Information: 7. Total Quantity Cubic Yards: 9. Operators Certification: I hereby certify that the above listed materials(s), is (are) not hazardous waste as defined by 40 CFR part 261 or any applicable state law. I hereby declare that the contents of this consignment are full and accurately described above by proper shipping name and arc classified. packed,. marked and labeled and are in all respects in proper condition for transport by highway according to applicable international and government regulations. Printed/Typed Name & C.? -4014" Signature: .- Date: 12 -- (7 - p 10_ Transporter 1 (Acknowledgement of receipt of +naJeriais) Printed/Typed Name & title: "(-EvC /Hi Address & Telephone No: /tg.O 1 4-A.) N� Signature: Q Date: / (1 - (53 Coe 11. Transporter 2 (Acknowledgement o of materials) Printed/Typed Name & title: Address & Telephone No: Signature: Date: 12. Discrepancy Indication Space: 13. Disposal Site Owner or Operator: Certification of receipt of asbestos materials covered by this manifest except as noted in itein 12 Printed/Typed Na 8c Title: Lam-, t % signature: ✓- "/ �Y� 1 11 / B>�