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14-101256 • • Demolition City of Federal Way .//.� 14-101256-00-DE Community&Econ.Dev.Services Permit #: 33325 8th Ave S Federal Way,WA 98003 Ph:(253)835-2607 Fax:(253)835-2609 Inspection Request Line: (253) 835-3050 Project Name: HABITAT FOR HUMANITY Project Address: 30064 MILITARY RD S Parcel Number: 042104 9075 Project Description: Demolish existing single family residence and accessory detatched shed. Owner Applicant Contractor HABITAT FOR HUMANITY- HABITAT FOR HUMANITY- OWNER IS CONTRACTOR SEATTLE/SOUTH KING COUNTY SEATTLE/SOUTH KING COUNTY PO BOX 88337 PO BOX 88337 TUKWILA WA 98138 TUKWILA WA 98138 Additional Permit Information Demolition Valuation 8000.00 PERMIT EXPIRES Friday, March 18, 2016 Permit Issued on Wednesday, March 19, 2014 I hereby certify that the above information is correct and that the construction on the above described property and the occupancy and the use will be in accordance with the laws, rules and regulations of the State of Washington 9 he Ci of Federal Way. Owner or agent: G Date: Y '" /7f/` THIS CARD IS TO MAIN ON-SITE "TM OF '�,,41 ...... • Construction In ection Record Federal Way INSPECTION REQUE TS: (253) 835-3050 PERMIT#: 14-101256-00-DE Address: 30064 MILITARY RD S Project: HABITAT FOR HUMANITY - SEATT FEDERAL WAY, WA 98003-4230 Scheduled inspections may be failed if this card is not on-site. DO NOT LOSE THIS CARD. Inspections are listed as close to sequential order as possible(read left to right,top to bottom). Please schedule inspections as appropriate. Work must not be covered until it is approved. Check with your inspector if you are unsure about any of the inspections or the inspection sequence. On-going inspections are logged on the back of this card. ❑ Final-Building(4050) Approved By P Date l , -3t ) S ❑ Rough Electrical111 Final Electrical El Right of Way Approved Approved Approved By Date By Date By Date i lit CITY OF • PERMIT„ PLICATION Federal Way MAR 19 2014 421(1)" PERMIT NUMBER 14 _ i 0 ( 2 5- 6 _ CITY OF FEDERAL WAYN/A- _ _ TARGetgATE SITE ADDRESS SUITE/UNIT# 300(01'+ H 1 La-n g ( 12\D S ) 4OE:RA. VI)A'`-t PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL# $ 0 I+ .Z 1 Q LI - 1 0 5 TYPE OF PERMIT ❑ BUILDING 0 PLUMBING ❑ MECHANICAL SOEMOLITION 0 ENGINEERING ❑ FIRE PREVENTION NAME OF PROJECT M t 1 1v-d R8 'ReMd� 1 sof: but-5Q �t Smoujk h - b 8rrtc7 PROJECT DESCRIPTION ;�„ L Detailed description of work to 1?tt Vfl Ot - l`J\1✓1C( Serie__ s l%cte.tYl " ;(/'�c.,\tAcV v7 C'( drat it be included on this permit only {_tel`� ti � Q �•' _-v'4;c ' i„ m Q '`-, �,1 � QLA, T►C� 'tC� Fad ( � �.w � . - NAME ...._ . PHO PROPERTY OWNER V i"+c(,•i Nierrun(u -- C KC. I PRIMARY-Li (cc4 t MAILING ADDRE ��''��11 v Y~ E-MAIL�C' 5(DO I/ctc 5 vt.' 5 w`fe 1 I 0 Korn U Y`c. col STATE NAME PHONE Pro pf er 0 0 (\� MAILING AD SS E-MAIL CONTRACTOR CITY STATE ZIP FAX WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE# 1-4 PoiTTHg3. 2_ D 09 iZ5 i15ICI (;?0 --!CI32a_OO-131. NAME PRIMARY PHONE Pro pe k-i t. Ow(' e' APPLICANT MAILING ADDRESS E-MAIL CITY STATE ZIP FAX N - PRIMARY PHONE PROJECT CONTACT I l.I I_ t O1 Rif\ alp`4HO✓(o 4o The individual to receive and MAILING SS E-MAIL Ort. respond to all correspondence 5(00 �ac v >`-s �* 6\J Su ' h 0 `V1Ct to t trt ,:m. r concerning this application) STATE ZIP FAX PROJECT FINANCING NAME PeAr Ow n et- Nr OWNER-FINANCED Required value of$5,000 or more MAILING ADDRESS,CITY,STATE,ZIP PHONE (RCW 19.27.095) I certify under penalty of perjury that I am the property owner or authorized agent of the property owner.I certify that to the best of my knowledge, the information submitted in support of this permit application is true and correct.I certify that I will comply with all applicable City of Federal Way regulations pertaining to the work authorized by the issuance of a permit. I understand that the issuance of this permit does not remove the owner's responsibility for compliance with local, state, or federal laws regulating construction or environmental laws. I further agree to hold harmless the City of Federal Way as to any claim(including costs,expenses, and attorneys'fees incurred in the investigation and defense/rf such clai»„ which may be made by any person,including the undersigned, and filed against the city, but only where such ciai rrs- out .f he reliance of the city, including its officers and employees, upon the accuracy of the information supplied to t ty i a .., oft s application. SIGNATURE: 0 DATE 3- /?-- // PRINT NAME: /a ' 44:,, It/ _ _ Bulletin#100—January 1,2013 Page 1 of 3 kAllandouts\Pelmit Application • 0 COMMUNITy&ECONOMIC DEVELOPMENT DEPARTMENT 33325 8'b Avenue South 4 ,14•A, ,,,,,.,.. Federal Way,WA 98003-6325 _ ''"•-k.,,,,'"t.. , CITY OF 253-835-2607;Fax 253-835-2609 Fed,,,,i,„ Al. jue,,,„„vzv,/ www.citvofTederalway.com ,,,,,-- DEMOLITION PERMIT REQUIREMENTS A demolition permit is required to remove any structure or structures on a subject property. Check with the City's Planning Division to see if the proposal exceeds thresholds that trigger an environmental review. An environmental review and submittal of an environmental checklist may be required,which will extend the time period before a demolition permit can be issued. 0 Prior to submitting a demolition permit,the following items(as applicable) must be signed by the respective agency(see attached Demolition Permit Contact List). NOTE ro AtIVEANT: Utilities shall he disconnected and services performed, if applicable,prior to issuoiree of the demolition permit.,III applicable items below are to be kgited and dakdby the respective agency representatives, S 0 0(0 4— NAkLA-KIX(2,C{ 1.ASBESTOS ABATEMENT 6. ELECTRICITY ... (Copy of iroval form and asbestos survey f .m Puget Sound Clean Air (E 'city to be shut If ter i', o d - Ag-• pr ;., i /2 - ('W-1 (Puget Sound Energy dr (City of Federal Way Buil.,* icial) / 2.GAS SUPPLY 7. FUEL STORAGE TANKS , (Gas to be/.ut off,Mr r, oved and final bill paid) (Above or belo, gr.'eAuel tanks, have been pumped or removed under Fire DPa en( ermit prior to any dismantle/excavation) , 1 (Puget Sound Energy) (1-. re CQ -J' 4‘,...4 i c...,0,a. %I/ ) 11 / (South King Fire and Rescue) 3.SEPTIC SYSTEM 8.WATER- Public Source (Check applicable box) (Tank to be removed or tank to be drained and filled) a Meter to be removed and final utility bill paid )".Meter to remain and be protected ' -----(King County Environmental Services) (Water Sapplier) 1 4.SANITARY SEWER ( 9.WATER- Private WlerChecli applicable box) (Check apI.;,(cable box) o Sewer line capped at prope line ,\.., a Private well filled a49tapflIt a Existing sewer line to remain an. so Vsed by proposed new structure a Private well to be s f6 her purposes (Laic- aven Utility District) 9 County Environmental Services) /7 n 5.GARBAGE (All household garbage disposed off and final bill paid) (Waste Management/Other Company) 0 Completed Construction Permit Application form ID Provide the following fees: I. Demolition Permit Fee Based on valuation.See table on pg 4 ofthe construction permit application. 2.Automation Fee $20.00 3. WA State Surcharge S4.50 Bulletin 1/122—February 14,2013 Page 1 of 1 1:,11inncioutalemolition Permit Requirements • P.O. Box 81005 M CAN Seattle, WA 98108- 1005 Environmental Construction LLC Phone: (206) 267-0746 Asbestos- Lead - Mold- Demolition Fax: (206)267-0753 February 6, 2014 Name: Habitat for Humanity Seattle-King Co. Attn: Kelly Morgan 560 Naches Ave SW, Suite 110 Renton, WA 98057 Email: kmorgan@habitatskc.org --- Letter of Completion --- (14034) Re: Asbestos Abatement Services at: 30064 Military Rd. S Federal Way, WA 98003 This is to certify that American Environmental Construction LLC has removed the asbestos containing material from the above referenced address per our Proposal & Contract dated January 17, 2014. Clearance Air Monitoring (Sample Type=CL) as reported on the Air Sample Data Sheet (available upon request) indicates that the airborne asbestos level is below the EPA established standard of .01 fibers/cubic centimeter for clean air after an abatement project. Accordingly, the work area is safe, in regard to asbestos exposure, for re- occupancy. Please call me at 206-267-0746 if you have any questions or comments regarding this Letter of Completion. Respectfully submitted, American Environmental Construction. LLC Dee Surface-Office Manager • Approved Transaction Page 1 of 1 psdeanair.org Puget Sound Clean Air Agency Notification Case #: 201400266 This page must be printed.A printout of the notification,all amendments to the notification, and the asbestos survey shall be available for inspection at all times at the asbestos project or demolition site(Reg III,4.03(a)(6)). Fee Amount Paid $210.00 Credit Card Transaction#VXHFB6CD4CB8 Transaction Date 01/24/14 Owner's Name Habitat for Humanity Phone (206)456-6871 Project Street Address 30064 Military Rd.S AEC Job#14034 City Federal Way Zip 98003 ' Contact Person Kelly Morgan Phone (206)830-8267 Mailing Address 560 Naches Ave SW Renton,WA98003 This project includes asbestos removal. Project Size linear feet / 374 square feet Project Start Date 02/04/14 Completion Date 02/28/14 Asbestos will be removed by a licensed asbestos abatement contractor Contractor American Environmental Construction, LLC Contractor Job# 14034 Contact Dee Surface Phone (206)267-0746 Mailing Address P.O. Box 81005 Seattle,WA98108-1005 (1)I certify that the information I have provided is to the best of my knowledge true and accurate. (2)I understand that I must file an Amendment to this Notification if: • The type of project has changed.The project types are asbestos and demolition. • The quantity of friable asbestos to be removed meets a larger project category. • The projects start or completion date has changed. (3) I understand one Notification must be filed for each structure. The only exception is for a single-family residence that includes multiple ancillary structures, such as a detached garage or other outbuildings having the same street address. If there is no street address, I have used a building number. (4) I understand the fees for this Notification are nonrefundable. Create Another Notification View History Log Out If you have questions,contact us at asbestos@pscleanair.org or 206.689.4058. blips://secure.pscleanair.org/Asbestos/Approved.aspx 1/24/2014 ~ II • `h Habitat for Humanity November 10 2013 Residence#30064—Military Road South,Federal Way,WA Lee Brannam Director of Site Acquisition& Development Habitat for Humanity 560 Naches Way, Suite 110 Renton,WA 98057 INSPECTION FOR ASBESTOS AND LEAD CONTAINING MATERIALS, RESIDENCE #30064—MILITARY ROAD SOUTH, FEDERAL WAY, WA Dear Lee, At your request, on October 21St 2013 Ewing Environmental performed a Good Faith Inspection of the Residence, in Federal Way, Washington, to determine the presence of Asbestos and Lead in building materials prior to a possible demolition of the Residence Samples were collected from multiple materials, including the Vapor Barrier, Flooring, Roofing, sheet rock tape and mud, and Attic Insulation. There might be floor tile or sheet vinyl under the existing carpet, or unknown piping in the walls and ceilings with suspect insulation that was not detected, so if the carpet is removed or walls and ceilings may be demolished some exploratory demolition would be advised. The light fixtures should be inspected upon removal for PCB Ballast's, and if any are found they are to be disposed of appropriately. Fluorescent light tubes shall be collected and disposed of properly. If there are any Lead Collars on the roof, they will need to be removed and disposed of properly. 1 • 1110 Habitat for Humanity November 10th 2013 Residence#30064—Military Road South,Federal Way,WA Sampling Methods: Samples were analyzed by Seattle Asbestos Test a NVLAP accredited laboratory (NVLAP #102063), located in Lynnwood, Washington. Examination of the samples for asbestos was conducted using polarized light microscopy (PLM) with dispersion staining in accordance with US EPA method 600/M4-82-020 as specified in 40 CFR Chi. I (1-1-87 edition) Pt 763, Subpart. F App. A, pages 293-299 or its current edition. Lead Paint Samples were analyzed by RGA Environmental,NVLAP accredited laboratory located in Seattle Washington. For samples containing more than one separable layer of materials, the asbestos in each layer was reported separately. Asbestos sample results from this round of testing are reported in Table I. Lead Paint sample results are located in Table II. 2 Habitat for Humanity November 10th 2013 Residence#30064—Military Road South,Federal Way,WA Table I Asbestos Results IDENCE 30064 - Military Road South, Federal ay Sample Number Location Asbestos Fiber Analysis INSUL - 1 Exterior Insulation under Siding Negative INSUL- 2 Utility Room Roof Insulation Negative INSUL - 3 Wall Insulation Negative SR-1 Hallway Sheetrock Tape and Mud Less than 1% as a Composite SR- 2 Utility Room Sheetrock Tape and Negative Mud SR- 3 Bedroom Sheetrock Tape and Negative Mud SV - 1 Kitchen Sheet Vinyl Negative WP - 1 Utility Room Only, Window Negative Putty TP - 1 Back Bedroom Textured Paint Negative SU - 1 Black Kitchen Sink Under 3% Chrysotile Coating Asbestos 3 • Habitat for Humanity November 10th 2013 Residence#30064—Military Road South,Federal Way,WA Table I Asbestos Results RES/BENCE #1 30064 -__ Military Road South, Federal Way Sample Number Location Asbestos Fiber Analysis CAB - 1 Exterior CAB Siding 15% Chrysotile Asbestos VB- 1 Back Bedroom Floor Vapor Negative Barrier VB - 2 Exterior Vapor Barrier Negative KITCHEN FLOOR 2 Layers of Wood Sub Floor with Negative Vinyl COMP - 1 House Composition Roofing, 2 Negative Layers 4 • Habitat for Humanity November 10th 2013 oo Residence 3 64 Military Road South, Federal Way,WA • Results of testing: RESIDENCE ) F ,r. 14 364 Milicary Load ,sout „ cdc All materials were analyzed and found to be negative for asbestos with the exception of: Black Kitchen Sink under Coating which is 3% Chrysotile Asbestos Exterior CAB Siding which is 15% Chrysolite Asbestos. this was identified as some or the exterior 5 • • Habitat for Humanity November 10th 2013 . Residence#30064—Military Road South,Federal Way,WA Table II Lead Paint Results RESIDENCE 3 �4 — Military Road South, Federal ay Sample Number Location Percent Lead P - 1 Tan Interior Wall Paint 0.037% P - 2 White Exterior Trim Paint 0.210 % P - 3 Tan Exterior Body Paint 0.030 % Results: The lead paint chips were analyzed according to EPA method 7420 and all samples were found to be below the HUD (Housing and Urban Development) action level of 0.5% lead. 6 • • Habitat for Humanity November 10`h 2013 • Residence#30064—Military Road South,Federal Way,WA Conclusion: Prior to the demolition of any portion of RESIDENCE # 30064 _- Military 4. Road South., Federal Way mo . the following must be abated: Black Kitchen Sink under Coating which is 3% Chrysotile Asbestos Exterior CAB Siding which is 15% Chr,sotile Asbestos Please use plenty of water during the demolition, NO VISIBLE EMISSIONS, and respiratory protection shall be provided to the operator and the grounds crew. • Habitat for Humanity November 10th 2013 1 Residence#30064—Military Road South,Federal Way, WA Thank you for this opportunity to be of service. Please call (206) 399-1002, with any questions which you might have. Yours sincerely, Thea Ewing, IHT Ahera Certified Building Inspector/Management Planner exp. 3/22/14 WAMOA-0102-04 NIOSH 582 Lead Inspector 8 �� SEATTLE ASBESTOS TEST w��aw ��om="amnm�*�0876 1ornScriber Lake Road,Suite o,Lynnwood,wmouoov'na*uo.am.omsn.pw',*ux.nrn.mV10 1272Northup Way,Suite 1,Bellevue,WA 98005,nm:4zoum.1111.pox:*u .861.1118 ---Website.www.seattleasbestostest.com,Emaitadmin@seattleasbestost~~~~.. PLM y Point Coo t(400 Poi ts) Client Job 4: Good Faith Attention: Ms.Thea Ewing Laboratory a��»#: 20131534e Client: swingeoximnmenm/ oauoReoeived: 11e//2013 Address: 9710 LowellLarimer Road Everett,WA 98208 Samples Received: 1 Date Analyzed: 11/6/2013 Project: #30064 Military Rd.S. Sample Requested for Point Count TP-1 Previous Analytical!nfomiation Previously Analyzed by; Ryan Antolock Previous Batch#: 201315104 Previous Lab ID: 9 Previous Description: Offwhite/white powdery material Layer to be Point Counted; 2 Asbestos Type Found: Chrysotile Asbestos Percentage Found: 2 Point Count Analytical Procedures New Lab ID; 1 Asbestos Points NonAngostos Points Total Points Slide 0 50 50 e S!id2 1 49 5O Slide 0 50 - -- 50 Slide 0 50 50 Slide 0 50 50 Slide 1 49 50Slide 7 149 0�e8 O ---- 50 50 Total 3 397 400 Point Count Summary Results Type of Asbestos: Chrysotile Percentage of Asbestos: 075% __ Analyzed By: RvanAn¢`|nck Reviewed by: Steve(Fanyao)Zhang, President 1 • • M( ( ezi Change Order Estimator: Mike Fonseca Date. February 4, 2014 Job Number. 14034 Single Family Residence 30064 Military Rd S Federal Way, WA 98003 Contractor Habitat for Humanity Kelly Morgan 560 Naches Ave SW Suite 110 Renton, WA 98057 206-830-8267 Scope of Work: - Contact for this project will be: Kelly Morgan=206-830-8267 American Environmental Construction LLC proposes to provide the following: • Remove and properly dispose of 800 sq ft of cement asbestos board from the 3 sides of the home. • We will remove the wood siding to access the cement asbestos board material. The wood siding will be left onsite. • We will need to demo some of the south side carport and wood deck, so that we can access the cement asbestos board material. The carport and deck wood materials will be left onsite. Change Order Price: $1,800.00 Plus Applicable Tax Respectfully submitted, American Environmental Construction, LLC ,3,"): ,- - 7". Mike Fonsec. -- Project Estimate I' /er a/ Kell Morgan- Habitat for Humanity W:\2-Bids\5-Bids Sent\Bids_G-L\Habitat for Humanity-30064 CO.doc 0 • i . , . , t, , 1 i''I 'I ' .„ -,_:':o r 5, (,E•., 1 cyz..). tv IN c; L a e Fri VNI RONI 11„" NI' Al i 47 10 Lo ,e11w - IUnr Road =Z:,1, Everett Vc a 98108 Industrial Hygiene_ and ),:,99-ic K12 Environmental Consultants tiv, 4425)385-8849 CHAIN OF CUSTODY SAMPLE LOG / Client Habitat for Humanitv Project Good Faith Inspector T t . Ewino- Phone Number (206)399-1002 ii Number oeSam ties i Fax Number (425)385-8849 . 0. .. _ . • •. yuRN ARNIM:Er 0 , ..• irricm(air) El Paint ChipsO Air , 'PLM(bulk 0 Soil 0 TCLP 0 1 hour U 24 hours k ,3 k Other 0 Dust/wipe 0 4 hours 0 48 hours''T'2 5 days Seq.# Lab ID 1 Sample# / AIRi , Seq.# Lab ID Sample# AIR 4 4. 4(c6,„,44/ t•-•1121-- 1 , iii , 1 i _ , ii tst-45,frt..44.- ,,,,.,..e.....le ,,,- -k-C 2 Ibickti"t- ----/ I'00541-4.114 , 7 alf 11;-4 gt., ig- -; -*It.24:1:1,1,----. .,'" :.;' 3 i - - 1, , ''''''Ce 3 Ifa iisf,14,144 13 *(1 , , ''''' ..f, „...,'1,..' 1 „/""i / 14 :4 : - V , ,,,z,"„:,,,,,, , ),.. // r/dtry" ' - - ,.... • ;l .... I - 15 • b..91,---'ti. .___67;i7 -- , — - - 616 , tlY/ 7 ).7/1•••--1 • 'Li ' 9-4---- 17 11.11 18 8 .14/4, ."—,ir 19 • 9 oLs.44 „4-1 p , .0.;.. •, :•• -- .4! , w 4 4 . I/* 10 .1. .. - S-;(,e ...-- 4-.1 `"- • ' 4. . • 4 i D4ri T I IVi, / „, a5 Sampled By: 4/1 10/01 113 ii, Relinquished By: / .;-i. „.•----- I 1------e f i 13 ")/ - DELIVERED BY: j 10/ 1 Z /13 Received Bv: (734 ;: -4-7 --- " 5S: . Q.1/4,(...',:, _. .. .,„ st,.4 0',/2:: I :7) Analyzed By: "Mr' "Zip tril 43 • ,i 1.-.1 id/ .., i„, Results called in by: _ Results faxed by: SPECIAL INSTRIJC"FHINS: Please email copy of C.O.C.with resuilts to Kharnerorii;AOLeont ----- .._.......... • 0 SEAITLE ASBESTOS TES1 NVLAP Awreditadon Lab Codes:Bellevue-,200876,Lynnwood-200788 Lynnwood Laboratory:19701 Scriber Lake Road,Suite 103, Bellevue Laboratory.12727 Northup Way,Suite 1,Bellevue, Seattle Laboratory:4500 9th Ave.NE,Suite 300,Seattle,WA 98105, Lynnwood,WA 98036,Tel:425.673.9850,Fee:425.673.9810 WA 98005,Tel:425861.1111,Fax 425861.1119 Tel:206.633.1111,Fax:206.633.4747 ANALYTICAL LABORATORY REPORT PLM by Method EPA/600/R-93/116 Atm:: Ms.Thea Ewing cilene Ewing Environmental Address: 9710 Lowell-Larimer Road,Everett,WA 98208 Jo t:lk Good Faith Batch& 201315104 Date Received: 10124/2013 Revision Date:11/512013 Samples Reed: 15 Data Analyzed: 10/28/2013 Samples Analyzed: 15 By:R.Antolock Protect I-0c.: #30064 Military Rd.S. . . - ' ,v,t t r Analyzed by: it .n Antolock Reviewed by Steve(Fanyao)Zhang,President Lab ID Client Sample ID Layer Description % Asbestos Fibers Non-fibrous Components % Non-asbestos Fibers Yellow fibrous None Filler, Glass 1 Insul-1 1 material with beads, Fine 89 Glass fibers, detected Cellulose debris particles, Debris Yellow fibrous Filler, Glass None Glass fibers, 1 material with beads, Fine 91 detected Cellulose 2 Insul-2 debris particles, Debris Black asphaltic None Asphalt/binder, 2 68 Cellulose fibrous material detected Binder/filler None 1 Silver foil detected Foil/binder None detected Tart paper with None Filler, 3 Insul-3 2 70 Cellulose black mastic detected Asphaltic/binder Pink fibrous None 3 material detected Filler, Glass beads 87 Glass fibers Off-white/white powdery material SR-1 1 2 ChrysotIle Binder/filler, Paint 33 Cellulose with paint and 4 paper Composite White chalky None Binder/filler, result<1°/o 2 material with a•er detected G psum/binder 27 Cellulose II Gray fibrous None 5 SR-2 material with paint detected White soft/elastic material detected None Paint, Filler, Perlite 72 Cellulose Binder, Filler 4 Cellulose White powdery None Binder/filler, material with paint detected Paint 5 Cellulose 6 SR-3 White chalky None Binder/filler, 2 material with paper detected Gypsum/binder 26 Cellulose White/beige sheet None 1 vinyl detected Vinyl/binder None detected Gray fibrous 7 SV-1 material with None Binder/filler, 2 mastic and brittle detected Mastic/binder 69 Cellulose material None 8 WP-1 1 Tan brittle material detected Filler,Binder 3 Cellulose White powdery None 1 Binder/filler, Paint 4 Cellulose material with paint detected 9 -TP-1 Off-white/white 2 powdery material Chrysotile Filler, Binder 3 Cellulose 10 Black asoft/loose Chi- Ie Filler, Fine SU-1 1 ysol5 Cellulose materil •articles 11 CAB-1 iGrayrci ael mwei tnhti tsi oa iunst Chrysotile Cement/binder, 4 Cellulose Paint Off-white/beige soft/elastic None III Binder, Filler Cellulose material with detected 12 VB-1 1 fiatter 2 Black asphaltic None Asphalt/binder,fibrous material detected Binder/filler 70 Cellulose 1 S • .' SEATTLE ASBESTOS TEST NO/LAP Accreditation Lab Codes:Beilevue-200876,Lynnwood-200768 Lynnwood Laboratory:10701 Scriber Lake Road,Suite 103, Bellevue Latwatory:12727 Northup Way,Sutte 1,Bellevue, Seattle Laboratory:4500 gth Ave.NE.Suite 300,Seattle,WA 98105, Lynnwood,WA 08036,Tel:425.673.9850,Fax:425.673.9810 WA 98005,Tel.425.861.1111,Fax:425.861.1116 TeL 2066311111,Fax:206.633.4747 ANALYTICAL LABORATORY REPORT PLM by Method EPA/600/R-93/116 Atm; Ms.Thea Ewing client Ewing Environmental Address: 9710 Lowell-Larimer Road,Everett,WA 98208 Jotok Good Faith Satthlk 201315104 Date Received: 10/24/2013 Revision Date:11/5/2013 Samples Ftec'd: 15 Date Analyzed: 10/28/2013 samples Analyzed: 15 By:R.Antolock c---- $ Project Loc.: #30064 Military Rd.S. / I — Analyzed by: -yr Ar ,tolock RevIewed by: Steve(Fanyao)Zhang,President Lab ID Client Sample ID Layer Description % Asbestos Fibers Non-fibrous Components % Non-asbestos Fibers Brown brittle None 3 material detected Filler, Binder 2 Cellulose None 4 Brown wood block detected Wood aggregates 4 Cellulose Black asphaltic None Asphalt/binder, 13 VB-2 1 fibrous material detected Binder/filler, Fine 73 Cellulose with debris particles, Debris White/beige sheet None 1 vinyl detected Vinyl/binder None detected Gray fibrous material with None Binder/filler, 14 Kitchen Floor 2 68 Cellulose mastic and brittle detected Mastic/binder material None 3 Brown wood block detected Wood aggregates 4 Cellulose Black asphaltic None Asphalt/binder, 1 material with white 28 Glass fibers detected Sand sand Black asphaltic None , 2 material with gray 30 Glass fibers tected S 15 Comp-1 sand deand - None 3 White/blue paint Paint/binder 2 Cellulose detected Multi-layered black Noce Asphalt/binder, 4 asphaltic fibrous ted 72 Cellulose detecBinder/filler material 2 • • Public Health II0 Seattle & King Count - REPORT OF WASTEWATER TANK ABANDONMENT Return completed form to Public Health—Seattle&King County,Environmental Health Division, 14350 SE Eastgate Way, Bellevue,WA,98007,Tel.e (206)296-4932. Faxed co ies will not be accepted due to data entry purposes. PARCEL(APN): 0 q 2- ( l0 1A Q 0 , 5 DATE:3 / 15 / ici Instructions for completing form: This form is to be completed by any persons permanently removing a septic tank, seepage pit, cesspool, or other on-site sewage system wastewater tanks from service. Complete and submit this report to the health officer within thirty (30) days of the abandonment. Authority: Chapter 13.04.054, the Code of King County Board of Health, Title 13. General Information (Please print): L `Ce Name of Owner/Occupant of Property: • • • ,,- %t J ' t_ .-Pi �'�,0C Address: 3CO(� ti t• • k S f cA€r tai q qs Wastewater Tank Data: Type of Sewage Tank: )X Septic Tank Pump Tank Holding Tank Other: Number of Compartments Pumped: / Number of Gallons Pumped: Co D Checklist Item Yes No Not Applicable Comments Septage removed by an approved pumper?* A Tank lid removed or destroyed? Tank void filled with compacted soil or gravel? *OSS Pumper Name: %/(S .49/2/4e-- s�.'v,e P %• /1 S, .,� King County Certification Number: .C -77S Reason for wastewater tank abandonment: Property being served by public sewers Property being served by replacement tank , XStructure being demolished Comments: Report of Wastewater Tank Abandonment Revised 11/9/2012