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09-100302
40 Demolition - City of Federal Way Community Development Services Permit #: 09-100302-00-DE P.O.Box 9718 Federal-260, Fax (253 9718 835- Inspection Request Line: (253) 835-3050 Ph:(253)835-2607 Fax:(253)835-2609 � p q Project Name: ST LUKE'S-FD TRAINING HOUSE ..5) ). \,60);,, Project Address: 31412 4TH AVE S Parcel Number: 082104 9153 Project Description: Controlled training burn of house for demolition,including removal of debris and abatement of utilities. , Owner Applicant Contractor COMMUNITY OF CHRIST ST LUKE'S COMMUNITY OF CHRIST ST LUKE'S FIRE DEPARTMENT TRAINING CREW 515 SW 312TH ST 515 SW 312TH ST FEDERAL WAY WA 98003-4033 FEDERAL WAY WA 98003-4033 PERMIT EXPIRES Saturday, January 22, 2011 Permit Issued on Thursday, January 22, 2009 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 and the City of Federal Way. Owner'or agent. V/ --/L Date: /Z/40�' • THIS CARD IS T MAIN ON-SITE • CITY OF Community Develop ent Inspection Record Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050 PERMIT#: 09-100302-00-DE Owner: COMMUNITY OF CHRIST ST LUKE'S Address: 31412 4TH AVE S FEDERAL WAY, WA 98003-5204 This card is part of your required inspection documents. 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. 0 Final-Building(4050) Approved By � Date3- "0511. For inspector reference only ❑ Rough Electrical ❑ FINAL-Electrical Approved Approved By Date By Date Status _..,.:,.„:„..,„..,„:„....„,..,,,,„,,,,r,15,4v!,....,y,:-H-:...:.:,!:..:,.•,,,,i:::,!,..::„......i,,-:!,!:-] !] ..",....,.....„:„..,:,,,,,4,,,,r,,,,,,,,mmg,: rrit.t.o-.k.t..L.i,,,:..,:-:,:.•.::N.,,,,:- ..------ ' Cen. Yr. Sequence 00 DE Type r-7.,„...: Demolition Number li,:4:'E>: :,:ppA loppppa,k,,....:„..::::::,,, Unit .,,,.;,„:!!,,:::.,,,pmatoic:aIIE:lVelgkc,L;jntRidNtelltlllEitp,,rltatdfig6O661SOVtOPPIPTArfottl:3 Violations Propertyge0at,6etwaanEsegN4P ,ArAiomasv:iu5anrm), 811.1400040Ammool ,,i rt46iigitailP*I*MlfStlfit'' :",Oiltzntiai,2Rfcii„i::AnraRuH f.,,. .:R. tiiz 46 lijP':llHtioeNoIA!'A,T:rzz, .;itli5;:,!owtYTmoqi!'ttzztzqf.',vgimtaaigiawiEaiof!"!ft)! :: aoi Parent --:''AddfOj$:ss,;attl:glo,, ' .'ftziioiizfpf ;ig.165derrtm!!fijaRAtePamo, ;;ojiikstc,WACI:;'t:Rwi '''it,-.rAtruilgillifigirlig R. o,t:,I1,1o,tz,J.,,::,:,.:gllsg,uipagivsntf.4itipoomlif"tt,,1Lr-iMIbfiitj4PriotsagiliiSRtg!R!litz2a .alzgj lth*forotilliallkIEZE mi',t5..'fagllqalairq:firloigegiai,iiq Iwypottg!y7eitvziigtiishrozo'''"'''''''''''''''''' -114 OF iii59yviyigkm , ;:gt,z41,111.k.i.F411Gititrn -4..F8,-- e,,, ,, '' ''''Y ''' '',i'5'35' VV.-330 FT OF N 1/2 OF S 1/2 OF NE 'J ill,*.119iiii STR 082104 TAXLOT -ititii,rnmr.1.4 SW 1/4 Expires Pan 22, 2011 In Date Jan 22, 2009 Issue/ApprovayliProabnin22,bFinal Date IMar 23, 2009 2009 Reference File#1 B SubType Residential 1ST ' ' ' - .._ Priority Iml,r77.7r5itl"Z\iS'''17,1';151;lfr4ri -LUKE'S-ED TRAINING HOUSE Name .,-,r.: ,,,..-- lotiT:-.-tratiZ iVii,t.7rt. 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RSN t Folder i„. _,,,,,,,,,,,,,,,,,,,,,,,,,,,, ParentR 1!).-;:,41,*.4- ,,1„7;p7 Group!Permits ril,;, 14., , , 1i121211!!ifiiP: 77 7- 7 ...) c/ , .r., x , t t) f ( 3 2 Ii09. c kit' v A,:: /14,,.. i..." 40.44- .Q'' (.7,., „,17//..„ $ 0 Co Lee Bailey From: NoReply.FORMS©cityoffederalway.com Sent: Saturday, December 04, 2010 9:22 AM To: Lee Bailey Subject: Community Development-Code Action Request Form response 1. Your name : Richard Elofson 2. Your Address : 30908 5th P1 S 3. City, State, Zip Code: Federal Way, WA 98003 4. Phone number to reach you during the day: 2536530425 5. E-mail: dickelofAgmail.com 6. Do you want your request to remain anonymous? Yes 7. Location of violation:(Please provide complete street address if possible) Abandoned dwelling site of demolished home east of the corner of 4th Ave S and 314th P1: Geo coordinates 47degrees 19 min 12.32N; 122 degrees 19 min 42.58 W. Ownership unknown but may be St Luke Lutheran Church. 8. Please provide detailed description of violation: Hazardous open well which is only covered by a broken piece of plywood. A child could easily open this cover and slip in. 9. Would you like us to contact you with an update? Yes 1 i Federal prat Wad PE, A, ECEliE • .,.(sit k _0/ - I_ d 0 3 o d" JAN 2 2 2an IT G3258nMVENUE O1117ENT 1•POBVICSS SF MF CO ME EL PL EN FP 33325 8m AVENUE UTTf•FO 972 9718 FEDERAL WAY,WA 98063-9718 O VIPT AT r T 253.83& �� fEgli) I O 2607•PAX 253.835. 1\�11 '�'� / / The following is required information-an incomplete application will not be accepted. Pleaserint P legibly(in ink)or type. M PROPERTY INFORMATION SITE ADDRESS -31 1-/J Z- y fry 5 , SUITE/UNIT# ASSESSOR'S TAX/PARCEL# L / .0 q - L!•j / 2 � 9 g1 3 �Z ( LOT SIZE s /b LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) elm • PROJECT INFORMATION TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL DEMOLITION 0 ELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION SYSTEM PROJECT DESCRIPTION(Provide detailed description of work include_d on this aennitonit) PC/110 1-1770..1 g "y :r3 vic"i/! /r/ g LsS-C VC f 5 fry-d s TLscvii, c,4 4.- Lo 1/6-6 6,- PROJECT PROJECT NAME(Name of Business or Owner Last Name) 5 1. L i"x 6S ® PEOPLE INFORMATION PROPERTY /^NAME OWNER Wr,,I�7 Ui Jl it,7 Oa.",..1,5,- PRIMARY PHONE MAILING ADDRESS / _3000 Sl CITY,STATE,ZIP 10 4903 E-MAIL ADDRESS s• 3/z Sty-*Ej tC9£ L W -7, II%, CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE MAILING ADDRESS CITY,STATE,ZIP ( ) (CELL PHONE CITY OF FEDERAL,WAY BUSINESS LICENSE NUMBER ( ) - EXPIRATION DATE FAX NUMBER CONTRACTOR'S REGISTRATION NUMBER EXPIRATION DATE E-MAIL ADDRESS APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE 5T 40ir-L 7-F,L,-f Al ES-rax. (z.....0) 9`4,/ - 30 4,0 MAILING ADDRESS ES-rem—Jr-4 �� r CITY,STATE,ZIP CELL PHONE REL ATIONSHI O PR, 57" 7 r WAQI$Do ( ) _ a Architect 0 Tenant 0 Agent �/ FAX NUMBER �Othe� t 4 4 /si I../is6 4.1-- (z S3 )9y/ - y9 3'/ PROJECT '_/ CONTACT r k4,c cr6, . o.�-y-7 t PRIMARY PHONE E-MAIL ADDRESS LENDER NAME � g-53 WY/ -,3vo v Per RCW 19.37.095: MAILING ADDRESS � er Information is required if project value exceeds$5,000 CITY,STATE,ZIPPHONE 1 ( _ R DETAILED BUILDING INFORMATION EXISTING USE ST/2Z - 144-C/974(1- PROPOSED IISE EXISTING ASSESSED/APPRAISED VALUE$ VALUE OF PROPOSED WORK $ SPRINKLERED BUILDING? ❑ YES P NO FIRE SUPPRESSION SYSTEM PROPOSED /REQUIRED?/REQIIIRED? ❑YES �NO WATER SERVICE PROVIDER aRI VEN ❑ HIGHLINE SEWER SERVICE PROVIDER 'L ❑ TACOMA ❑ PCIVATE(WELL) AKEFiAVEN ❑ BIGHLINE 0 PRIVATE(SEPTIC) e PROJECT FLOOR AREAS AREA DESCRIPTION EXISTING PROPOSED TOTAL SQ.FT. SQ.FT. SQ.FT. BASEMENT ✓"- 5,1-5 31577 1/U' —e'-- FIRST /'p $, SECOND H Ail. r1 oo/i. ;I'd THIRD i4 A- ADDITIONAL FLOORS(DESCRIBE) N A, DECK(0 COVERED OR 0 UNCOVERED?) GARAGE 0 CARPORT 0 Eatseata PROPOS= TOTAL TOTAL Sinn=ZIP TOTAL PROPOSED Br SClAL Sr NUMBER OF FLOORSp $/D *+NEW HOMES ONLY"* NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $ ®; FIXTURES Indicate number of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to remain. MECHANICAL l A Value of Mechanical Work$ /V/ I (A COPY OP BID OR ESTIMATE MUST BE INCLUDED WITH APPLICATION) AIR HANDLING UNITS EVAPORATIVE COOLERS GAS PIPE OUTLETS WOODSTOVES BBQSFANG GAS WATER HEATERS MISC(Describe) BOUERS FIREPLACE INSERTS HOODS( COMPRESSORS FURNACES RANGES DUCTS GAS LOG SETS REFRIG.SYSTEMS PLUMBING BATHTUBS IorTub/Shower comb* LAVS(mamma Siok4 URINALS MISC(Describe) DISHWASHERS RAINWATER SYST VACUUM BREAKERS DRINKING FOUNTAINS SHOWERS WATER CLOSETS maw ELECTRIC WATER HEATERS SINKS WASHING MACHINES HOSE BIBBS SUMPS SIGNATURE 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 eert(fij that I will comply with all applicable City of Federal Way regulations pertaining to the work authorised 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 taws regulating construction or environmental laws. I further agree to hold harmless the City of Federal Wag as to any claim(including costs, expenses, and attorneys'fees incurred in the investigation and defense of such claim), which may be made by any person, including the undersigned, and filed against the city, but only where such claim arises out of the reliance of the city,including its officers and employees,upon the accuracy of the information supplied to the city as apart of this application. t SIGNATURE: DATE 02 /� Property Own and/or Authorized Agent - f '3,7`c.1.:',.'"):" 3 � a NEW a ADDITION o ALTERATION a REPAIR a TENANT IMPROVEMENT BUILDING SHELL ONLY?. a YES a NO . BASIC PLAN? o YES a.NO ZONING DESIGNATION CHANGE OF USE? a YES a NO NEW ADDRESS REQUIRED? a YES o NO IIP/SEPA/SU? a YES a NO PLATTED LOT? a YES a NO DEMO PERMIT REQUIRED? a YES a NO Aaar+2 nf4 IAManrinnta\Permit Annlicatinn ` DEPARTII OF COMMUNITY DEVELOPMENT SERVICES ` 33325 8thAvenue South PO Box 9718 CITY OFAri Federal Way WA 98063-9718 Federal Way 253-835-2607;Fax 253-835-2609 www.cityoffederalway.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 TO APPLICANT: Utilities shall be disconnected and services performed,if applicable,prior to issuance of the demolition permit.All applicable items below are to be signed and dated by the respective agency representatives. 1.ASBESTOS ABATEMENT 6. ELECTRICITY (Copy of approval form and asbestos survey om Pu et Sound Clean Air (Electricity to be shut off a d meter removed) Agency provided) ,5��, ,4 77' I L , ,,vL S-e t47 / (Puget Sound Energy) (City of Federal Way Bui ding • ' i 2.GAS SUPPLY . FUEL STORAGE TANKS (Gas to be skit off,meter removed and final bill paid) ___ (Above or below grade fuel tanks, have been pumped or removed !VI A e E �S = Ik+iy I-I`I-0 / I, underf r rDepa ent permit prior any dismantle/excavation) (Puget Sound Energy) --TOO / ( uth Kingo„� Fire and Rescue' 3.SEPTIC SYSTEM 8.WATELli Public Source (Check applicable box) (Tank to be removed or tank to be drained and filled) deter removed and final utility bill paid o Meter to remain and be protected K , if to Tr .206-2y4..-1/i3� "5 a.� o6)J (txiurk zy%-r ( (iGng County Environmental Services) (Water Supplier) v��� up //f(14/61 4.SANITARY SEWER (Check applicable box) 9.WATER-Private Well(Check applicable box) o Sewer line capped at property line o Private well filled and capped o Existing sewer line to remain and be used by proposed new structure o Private well to be used for oOler purposes It)j A a.. 23 L1 f-ho-ue,) &/A Sewer District) tJ„-riu7.� QST (King County Environmental Services) 5. ARB; t(r�f/o� (Al Ouse • • ,•r e op diQff and final bill pal,) • 0 Disposal/ -•e •1 Way li'_••sa 11 Completed Construction Permit Application form . ®1 a 0 Provide the following fees: 1.Demolition Permit Fee 40'1ai ! c . ' I : ,I .tion Fee 5.50 3.WA Sta : :-1 , . •e 4.50 4. 1 Bond Deposit . 00.00 (Refundable upon Completed Final Inspection) $58I i I Bulletin#122—January 1,2008 Page 1 of 1 k:\llandouts\Demolition Permit Requirements DEPARTMENT OF COMMUNITY DEVELOPMENT SERVICES 33325 8th Avenue South CITY OF PO Box 9718 Federal Way Federal Way WA 98063-9718 253-835-2607;Fax 253-835-2609 www.ciWoffederalway.com DEMOLITION PERMIT CONTACT LIST This list of agencies may assist you in expediting the demolition permit process.Refer to the demolition permit requirements for signature blocks.All applicable signatures are required prior to permit approval. 1. Asbestos Removal: Puget Sound Clean Air Agency 110 Union Street,Suite 500 Seattle,WA 98101-2038 206-343-8800—OR—800-552-3565 www.pscleanair.org 2. Electricity: Puget Sound Energy Tacoma Public Utilities Attn:Construction Coordinator Customer Service 22828 681 Avenue South, Suite#102 —OR— 747 Market Street Kent,WA 98032 Tacoma,WA 98402 888-225-5773 253-383-9600 or 253-383-2471 3. Gas: Puget Sound Energy 805 156th Avenue NE Bellevue,WA 98004 888-225-5773 4. Telephone: Qwest Communications 801-962-2475(phone)/801-237-6491 (fax) 5. Water: Lakehaven Utility District Tacoma Public Utilities Technical Service Division Customer Service 31623 First Avenue South —OR— 747 Market Street Federal Way,WA 98003 Tacoma,WA 98402 253-941-2288 253-383-9600 or 253-383-2471 6. Garbage: Waste Management 655 Second NW Auburn,WA 98071 253-833-3333(residential)—OR—253-939-9792(commercial) 7. Sewer: Lakehaven Utility District Technical Services Division 31623 First Avenue South Federal Way,WA 98003 253-941-2288 8. Septic: King County Environmental Services 14350 SE Eastgate Way Bellevue,WA 98007 206-296-4932 9. Fire Department: South King Fire&Rescue 33325 8th Avenue South/PO Box 9718 Federal Way,WA 98063 253-946-7248 Bulletin#109—March 1,2007 Page 1 of 1 k:\Handouts\Demolition Permit Contact List v.JAN-20-2009 TUE 04: 14 P11 Ea"late Public Health C FAX NO. 1 2964919 P. 01 • • Community Environmental Health Services 14350 SE Eastgate Way Pllb11� Health La • Bellevue,WA 98007-6458 Seattle & King County 206-296-4932 Fax 206-296-4919 11Y Relay:711 www.kingcountygov/health FAx • • Confidential Health Information May Be Enclosed Health care information is personal and sensitive information related to a person's health care. It it being' faxed to you after appropriate authorization from the client or under circumstances that don't require client authorization. As the recipient, you are obligated to maintain it in a safe, secure and confidential manner_ Re-disclosure without additional client consent or as permitted •by law 'is prohibited. Unauthorized re-disclosure or failure to maintain confidentiality could subject you to penalties described in federal and state law. IF YOU RECEIVE THIS FAX IN ERROR, PLEASE CONTACT THE SENDER AND SHRED THIS FAX AND ALL ACCOMPANYING DOCUMENTS Date ./ -20-0 Pa•es 4go inCludin• this •a•e • • To e- L, ..a. From • Phone Phone Fax 23 a) — � r—�: 2. * �2 ' �, 5 . . 4L , 73 Fax 11 11 R ! RE: nc c. Email @kingcounty.gov K❑ URGENT! Please process the attached order r your information ' o Please sign the attached and returnr your request • ❑ Please respond to the attached Diver our phone conversation • •Message: ‘JAN-20-2009 TUE 04: 14 PM Ea1a t e Public Health C FAX NO. 12062964919 P. 02 • 13.04.050-13.04.060 • , ON-SITE SEWAGE 13.04.050 Connection to public sewer. A. The owner,or occupant of lands or premises located within the Urban Growth Area, as defined in the King County Comprehensive Plan, undertaking new residential or nonresidential construction, short subdivision or subdivision from which sewage will originate shall connect the construction to a public sewer if the sewer utility permits such connection. Within unincorporated King County such connection shall be in accordance with King County Code Section 13.24.136. Within incorporated cities such connection shall be in accordance with the polities of that city or the local sewer utility. The connection shall be made by connecting the building drain with an approved side sewer, and the side sewer to the public sewer. B. For existing development located within or outside the Urban Growth Area and which is within two hundred feet of a public sewer, where an on-site sewage system is operating, the owner shall abandon the on-site sewage system in accordance with WAC 246-272A-0300 and connect the sanitary drainage system to the public sewer when the sewering authority permits such connection and when: 1. Repair, modification or replacement of the on-site sewage system is necessary, or the existing on-site sewage system has failed and an on-site sewage system fully conforming to this title cannot be designed and installed;or 2. Additional construction which in any way affects the on-site sewage system is proposed. C. The distances set forth in subsection B. of this section shall be calculated along the shortest route ` in road rights-of-way and easements, consistent with the comprehensive planning and sewer extension practices of the sewer utility involved, from the existing sewer to the nearest point of the lands or premises to be served. D. Every plumbing fixture and every sanitary drainage system not connected to a public sewer, sor not required by law to be connected to a public sewer,shall be connected to an on-site sewage system, (R&R No. 08-03 §2,2008: R&R No, 99-01 §2(part), 3-19-99: R&R No. 3 Part 13§ 1, 12-19- 13.04.064 Abandonment. A. Persons permanently removing a septic tank, seepage pit, cesspool or other OSS wastewater tanks from service shall within thirty days: 1. Have the septage removed by an approved pumper;and 2_ Remove or destroy the lid; and 3. Fill the void with compacted soil or gravel; and 4. Report the abandonment to the health officer on a form obtained from the health officer and accompanied by the fee specified in the fee schedule. B. Contaminated. rock, sand and gravel material from repairs to failing OSS shall be properly disposed of by either burying at an appropriate location approved by the health officer or transported to an approved sanitary landfill. The process of disposal shall be supervised by a licensed master installer. (R&R No.08-03§3,2008: R&R No. 99-01 §2(part),3-19-99). 13,04.058 Introduction of non-sewage compounds and industrial wastewater prohibited, Persons shall not introduce into an OSS: A. Strong bases, strong acids or organic solvents for the purpose of system cleaning. B. Any sewage system additive not specifically approved by the Washington State Department of Health. C. Waste components atypical of residential sewage. D. Industrial wastewater_ E. Hazardous materials. (R&R No. 99-01 §2 (part), 3-19-99). 13.04.060 Failure prohibited. An owner may not allow an on-site sewage system or component or side sewer to remain in a condition of failure as defined in BOH chapter 13.08. The owner must cause the system, component or side sewer to be repaired or replaced, or the property served by the system to be connected to public sewer, as applicable, in accordance with the requirements of this title. (R&R No. 08-03§4,2008: R&R No.99-01 §2 (part), 3-19-99: R&R No. 3 Part 13§2, 12-19-86). (KCBOI-1 9-2008) 13-6 „ JAN-20-2009 TUE 04: 14 PM Ea ate Public Health C FAX NO, 42964919 P. 03 !rm1'J1'`1���5,�V1��dl�!I',14tii�' �Wp�w'�:�5 `d°�,t��!`T�d ��!FlUS ul�� j'+ a uun �,,b� ,i.::i1� 1��: '5��,!ryr�i,9F. �'jd.,f V,. 3�. ,.��, f 4� ,a•., h �J,.�''Sk �MG. Ih�'t2IftWir11' L;, c�iali'V�atv�;V{n n,ru.•�.�..,,yi„ .�u 'Y1rre7 "roFlu-` r�K;�)';7P4 11 J„JR�:1l,. i 11r,k�fi/�'1 IY ►P djJ I, i. UIP'il{It k i01 : 1' Irid�P� ji,11:1 pf . p I1 I 10 4I IIGP�G ,ii{ cl •P"q Grpe�' . 'F'.�r •,�'ti"�Ir,�1Y., J.SI:b ��,�. f ��1i7.! e���_�Y!�J,�I,R',.�. , l�Lf��'! .CV,i31 4itl,'�� if 411(y.,,l � 4p; 111 Vl M 411!i,. 1 �.�t;5��,'F;' V�Il i�i) +'� 1,i: .,..; Illi1 1L �1iL,�`�.� �ryr 11) t , aq)Z4'I (' ee,IPI,l 1� ,YV ihll a , ,i• o3 ,f 1„,240}f 1 �ig,i,q i �l•rq 0.4 1.,.4� t ri 1011,4 1L SVL In��qr,;• I I , ,R 141t r f 11 �irrI 1,f1 1 ,1,r, �lR Jr, �mC1-.11,, fi1 d� � , Gh1,1( 1 �1," i" 6'1'4' V n�� °I'''ill V y IAR4 ia.i S ,� a t1 V C `vll 01' i l' 8 911'1'; I 'P, iP F ;� 4 1 1,, tp 11L n4 F r ,�u d� �s ri-4 �1 i �� � V � ��i � ����'�. `I ���yy,,� � �.�'` S ��I'. '•�JII i�� V �'� 1F�'1 IW i"° �, Jif�j� rIJ�� :Ir• 9. i"�rr��,;�fJ��� i 1;;1i%:,9 {� '� - :q ,'L ',(•��I P� i ilf�' i �; ^11r���,'I%� •��'�4lbii �,;l 11R�,,IoII .,;13y�1I'� �41 1 1 ��,� �'�� i�. h e .11 i d wl'! II )'�,„, .: 1. ,,'i I1 '.. ��,,,, h l'} I ?. n l � r:�7 .41•� '�.e ,�, � ¢ 1u,�1'I�, P �,�;�,4;N d��!, ��r : �;�h�,���,�,�� �� ly � ^a'�lfh�a fit:i�v���°:; Instructions for completing form: This fore 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. _ Return Completed Form to the Following Address: Date Received: Eastgate Public Health Ce,nter 14350 SE Eastgate Way Bellevue,WA 98007 Phone(206)296-4932 General Information(Please print): -- Name of Owner/Occupant of Property: Address: — — Telephone: Date of Report:___/___/� • Wastewater Tank Data; Type of Sewage Tank:—Septic Tank Pump Tank Holding Tank ti Other: Number of Compartments Pumped: Number of Gallons Pumped: Checklist Item Yes No Not Applicable Comments Septage removed by an approved pumper?* Tank lid removed or destroyed? Tank void filled with compacted soil? *OSS Pumper Name:_ King County Certification Number: r • Reason for wastewater tank abandonment: • Property being served by public sewers Property being served by replacement tank Comments: Signature: Date:�/ / Report of Wastewater Tank Abandonment: Print Date 5/12/99 I'orms/sowpgo/foam,96 JAN-14-2009 13:29 From: • To33956820 P-2'2 JA�!l19i200� WEU '254 Fid FAX Pio. P. 002 DEPA27 JiBiifr of ComattFary Daver,OMMln tt Semen 33325 8''Avenue South CITY OF PO Box 9718 Fcdera1 Way WA 98463-9718 Federal Way 253.835-2607;FPX 2534354609 • DEMOLITION PERMIT REQUIREMENTS A demolition permit is required to remove any structure or structures on a subject properly.Check with the City's Planning Division to see if the proposal eziceeeds thresholds that tomer an environmiznIal review,An environmental review and submittal nem envit+oaimental checklist may be mquircd,which will mend the time period before a demolition permit can be issued. ❑Prior to anbmlttlaag a demolition permit,the following items(as applicable)must be signed by the respective agency(ace attached Demolition Permit Contact List). I v-tE To ertt1Gttrz- thibrias shall be d tmnneesed and amok= Tapp! e,prior to imams of the demolition penait.All applicable ito,ns below are to 6s ii and red, ,bl the=specula oBaeey represearartmr 1.ASBESTOS ABATEMENT 5.ELECfRICTlY (Copy of approval form and asbotos[survey from Puget Sand Clean ANto be shut r Agernt:y pnovIded) uA7/t I - 2 o-b Sou (Gty ort Federal Way&along Wilda!) 2.GAS SUPPLY 9.FUEL STORAGE TANKS (Gas to be shut off.meta-removed and finer to paid) (Above or below grade fuel tanks,have been pumped or removed • under Are Department permit prior to any disrnanfle/excavation) (Puget Sound mow) (Smith King e 3.SEF1IC SYSTEM S.WATER-Piddle Spa= (Check applicable Doi) (lank to be remained or bark tO be&elided and flied) p Meter to be removed and Mal Inlay bill paid Meter to rennin end be protected (0n9 Carty Emilmrmeuttal Services) (Mesta suppfir7) • :ewes OR sits*** 4.SANITARY SEWER (Check appiicabie box) 9.WATER-Peyote Well(Check applicable boxy • o sewer line tapper at property ire in PlMte well filed and capped o r3dsthp sower line to remain and be used t y proposed nen structure D Pllvare wen to used for oilier purposes IVO (Sewer Mince (Ono County Ernharrneial Services) 5.GARBAGE (All household;Jerboas did ort:and Taal bill paid) (RST DIs,� osal/Fede al Way Disposal) LI Completed Construction Permit Application form c o/ I D Provide tie following fetes: L.Demolition Permit Fee ADT,! ; • ' ' `: "- •oa Fee 590 3-WAS 4.50 4. I :orad Deposit 1 I 1 (i cfu dabte npat,Completed lima Inspection) 5581.4k Raclin 0122-January I,2008 Pa01 of i Ic%B* do etWorrtofition Pemit 12equaennte Approved Transaction 0 Page 1 of 1 pscteanaIr.org Puget Sound Clean Air Agency Single-Family Notification Case #: 200900151 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 $75.00 Credit Card Transaction # VRFF3B57EDD6 Transaction Date 01/22/09 Owner's Name St Lukes Church / Daniel R. Murray Phone (253) 941-3000 Site Address 31412 $th Ave So Site City Federal Way Zip 98023 Contact Person Terry Westercamp Phone (253) 941-3000 Mailing Address 515 So. 312 Federal Way,WA 98023 This project includes a demolition. Demolition Start Date 01/22/09 Completion Date 03/22/09 Demolition will be completed by a fire department This is an emergency project. The emergency reason: There was a sudden, unexpected event that resulted in a public health or safety hazard. I certify that: (1)This is a single-family residence project. The structure is used by one family who owns the property as their domicile. (2) The information I have provided is to the best of my knowledge accurate and complete. (3) I understand the fee for this Notification is nonrefundable. Create Another Notification View History Log Out If you have questions, contact us at asbestos@pscleanair.org or 206.689.4058. https://secure.pscleanair.org/Asbestos/Approved.aspx 1/22/2009 t Agency Case No. PUGET SOUND CLEAN AIRENCY Date Received , 110 Union Street, Suite 500 , Seattle.WA 98101-2038 y F www.pscleanair.org NOTICE OF INTENT Agency Use Only Clean Air Agency Agency Use Oniy A. Project Type: 1. ❑ Friable Asbestos Removal i,. ❑ Friable Asbestos Removal& Demolition 3. ❑ Demolition Only B. Property Owner: St Lukes Phone: 253-941-3000 Mailing Address: 515 S 312th Street City: Federal Way State WA Zip: 98003 C. Asbestos PLEASE PRINT CLEARLY,THIS WILL BE YOUR RETURN MAILING LABEL. Contractor: PARTNERS CONSTRUCTION, INC Owner/CEO: DANIEL R MURRAY Contractor Mailing Address: 1313 CENTRAL AVE SOUTH,SUITE A Phone:206-575-7429 Job No.: City: KENT State: WA Zip: 98032-7429 Fax:253-852-7936 7019 D. Site Address: 31412 4th Ave South City:Federal Way Zip: 98003 Site Manager: Terry Westerkamp Local Phone:253-941-3000 E. ® Asbestos Survey or No. of Date of Asbestos Was Friable Asbestos Identified? ❑Yes No ❑ Mat'l Presumed Structures:1 Survey:12-19-06 Was Nonfriable Asbestos Identified? ®Yes 0N AHERA BuildingAttach a copy of the survey unless friable asbestos Certification : is identified. Inspector: Orion Environmental Exp. Date: An A HERA Survey is required before all demolition projects F. Demolition Start No. of 1. ® Training Fire(List Fire Dept.)Fed.Way Information: Date:02-06-07 Structures:1 2. ❑ Ordered Demolition(attach copy of Order) Demolition Insert demolition contractor's mailing address on back. Will nonfriable asbestos be left in place during demo? ❑ Yes ® No Contractor: Sr Lakes If yes, list type and qty. C. Friable Asbestos Work Days: M T W Th F Sa Su Project Information: Start Date: Completion Date: Hours: Will all friable asbestos ❑ Yes Total Qty. to be Removed: Linear Ft. Square Ft. materials be removed? ❑ No ❑ Boiler\Fumace Insulation ❑Duct Insulation ❑Pipe Insulation 0 Fireproofing 0 Faints 0 Plaster 0 Texture Coatings 0 Cement Board 0 Cement Pipe 0 Friable Flooring 0 Friable Roofing Material ®Other VAT H. Asbestos/Demolition Project Categories: Notification Period Project Demolition 1. Single-Family Residence: Fee Surcharge A. ❑ Asbestos Removal Project Only A.Prior Notice A. $25 B. ❑ Demolition Project(with or without asbestos removal project) B. 10 Days* B. $50 *(Asbestos removal can begin upon notification;demolition must wait 10 days) :Vote: If the single family residence is owned by one family who has been or will be using the residence as their domicile, the above boxes 1A or 18 may be checked. A single family residence does not include rental property,multi family units, or any mixed-use buildi 2. ® All Other Demolitions (with no Asbestos removal or Nonfriable Asbestos 10 Days $50 only or less than 10LF and/or 48 SF friable Asbestos) Friable Asbestos Projects(other than Single Family Residence): Asbestos Demo 3. ❑ >_ 10 -259 linear feet or>_48 - 159 square feet of asbestos Prior Notice 10 Days $100 $50 4. ❑ 260 -999 linear feet or 160-4,999 square feet of asbestos 10 Days $200 $50 5. ❑ >1,000 and/or>5,000 square feet of asbestos 10 Days $600 $50 6. ❑ Emergency Asbestos Project or ❑ Emergency Demolition Project Prior Notice $50 Emergency Fee Sin e-Family Residences are exempt from emergency fee;however,property owners must provide a written emergency request) t I cerci that the information contained in this notification&supplemental data is,to the best of my knowledge,accurate&complete. Agency Use Only D v /i PARTNERS CONSTRUCTION,INC 01-23-07 _ 'gnature Representing Date Reviewed By ... • . • 0 . • -,/ -'7 RABANCO Cont.# = (./ WASTE SHIPMENT RECORD : ,7??, 1 Waste Generated Site Name and Address: Owner's Name: Owner's Phone No.: ‹.., 7, -.-e - '''.- --:f ,:•:> . :"--1 ,.,,--- / Z ,.....,,.... / ,/ 4:7> .--/) ;2;':,!•;"f;',.; 2,-OPeratorS Name and Address: — Operator's Phone No.: ," ,:: -3 'Waste Disposal Site-(WDSName,Aiddre /ssand Physicalte Location: WDS Phone No.: -- ,... „„ RABANCO REGIONAL LANDFILL - - - 500 Roosevelt Grade Rd. 1-800-927-5641 ..- Roosevelt,WA 99356 ---- : . - 4, Responsible Local.State or EPA Agency Name and Address: ' PSAPCA 110 Union Street . _ Seattle,WA 98101 ; - 5. Description of Waste Materials: 6. Containers 7, Total Quantity • . z No. Type m3 (yd3) . - -- ' ', 4:-.' ;‘......... , . Asbestos Containing Materials .-----; ,....„ 4,:,:'--,•-.. ' -:-,, ,--.'-- -::,..--/.1 / ;:,.-....-- 8. Special Handling Instructions and Additional Information: • DOUBLE BAGGED & LABELED ::-i9- OPERATORS CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified, packed, marked and labeled, and are in all respects in proper condition for transport by highway according to applicable international and government regulations. f'-':.:';''':":.- —•- • '-,-,-I- Printed/Typed-Name .. ,. - -- Signature u Month Day Year . ,. • „ - /;:' -) J ,. '-)-' ,/. i./ , ' ../ 10. Transporter 1 Acknowledgment of Receipt of Materials .' - ' " ..• Printed/Typed Name ., Signature Month Day. Year .• ;.t'7--',,,,'-' I.,.--` .-•• ----! .-.--' ,,,.,•-' ,. 4." / Z --.,_ ' - '• , -,. --1 I. Trsporer 2 Acknowledgment of Receipt of Materials ' Printed/Typed Name Signature ,. Month Day Year.. js i . . 1 Rabanco Transfer .:'-'' / ' I 1 ci ( I 2733 3rd Ave. S. Z.-- . Seattle, WA 206-646-2565 , r , °.-14 (..." . / I i . -- , 12. Discrepancy Indication Space ;,•-• ;-_,,, ,:, Waste Disposal RRLC ,-(_'•-•,-, ,...=,.,'J:Q 13. Authorized Waste Disposal Site Owner or Operator: Certification of receipt of asbestos materials covered by this manifest except as noted in item 12 Printed/Typed Name Signature Month Day Year WHITE: Return to Operator YELLOW: Waste Site PINK: Transporter WHITE: Operator TRUCTION INC 013 CENTRAL AVE SOUTH, SUITE A • PARTNERS CONS , KENT, WASHINGTON 98032-7409 LICENSE #PARTNCI065NU • ASBESTOS LICENSE#1172 (206)575-7429 FAX(253)852-7936 EMAIL: partnerscianawestnet ASBESTOS ABATEMENT • ASBESTOS MANAGEMENT • GENERAL CONTRACTOR 02-06-07 Community of Christ-St Luke's 515 South 312th Street Federal Way, WA 98003 Attn: Terry Westkamp To Whom It May Concern: Our Company has removed all Asbestos referred by Asbesto-Test, Inc. from the site at 31412 4th Ave South in Federal Way, WA. This has been done in accordance with all current Labor & Industry and PSCAA Regulations. Should you find any suspect material during the demolition phase of your project, please call us and we will come out ASAP to remove it. Call me with any questions you may have and thank you for allowing us to be of service to you. Donny R Murr-y, Manager • 0 • ORION Environmental Services An Environmental Compliance Consulting Firm Polarized Light Microscopy Test Report EPA Method 600/R-98/116 Client Community of Christ— St. Lukes Date December 19, 2006 515 S. 312th St. Page Page 1 of 2 Federal Way, WA 98003 Invoice 065482 Attn: Terry Wester; tamp - Date Received December 12,2006 Project Number N/A Project Name 31412 —4th Avenue South Federal Way, Washington Client Orion Sample Asbestos Other Number Number Stereo Scope Exam Treatment Percent Type Fibers 31412-Ola 61213-125a Gray w/Tan&Red Streak Ash ND - - 12"x 12"Vinyl Tile Homogeneous 31412-01b 61213-125b Red Vinyl Tile Ash 3 Chrysotile Cellulose Assoc.w/31412-Ola 31412-02 61213-126 Brown/Gold Vinyl - ND - Cellulose Sheeting w/Dark Gray Felt Backing Homogeneous 31412-03 61213-127 Brown&Tan Cobblestone - ND - Cellulose Pattern Self-Adhesive 9"x 9"Vinyl Tile Homogeneous 31412-04a 61213-128a Joint Compound - ND - Cellulose Assoc.w/31412-04b 31412-04b 61213-128b Wallboard - ND - Cellulose Homogeneous 31412-05a 61213-129a Joint Compound - ND - Cellulose Assoc.w/31412-05b 3 1412-05b 61213-129b Wallboard - ND - Cellulose Homogeneous 31412-06a 61213-130a Joint Compound - ND - Cellulose Assoc.w/31412-06b 31412-06b 61213-130b Wallboard - ND - Cellulose Homogeneous 34004 - 9th Avenue South • Suite 5 s Federal Way, Washington 98003-6740 s Tacoma(253)952-6717 s Seattle(253) 874-8118 • Facsimile(253)927-4714 • Email Info@OrionES.net WBE W2F9219763 • UR/ON Environmental Services An Environmental Compliance Consulting Firm • Polarized Light Microscopy Test Report EPA Method 600/R-98/116 Client Community of Christ— St. Lukes Date December 19, 2006 515 S. 312th St. Page Page 2 of 2 Federal Way, WA 98003 Invoice 065482 Attn: Terry Westercamp Date Received December 12, 2006 Project Number N/A Project Name 31412—4th Avenue South Federal Way, Washington Client Orion Sample Asbestos Other Number Number Stereo Scope Exam Treatment Percent Type Fibers 31412-07 61213-131 Ceiling Tile - ND - Cellulose Homogeneous 31412-08a 61213-132a Ceiling Tile - ND - Cellulose Homogeneous 31412-08b 61213-132b Tan Mastic Chloroform ND - Cellulose Assoc. w/31412-08a 31412-09 61213-133 Window Putty - ND - Cellulose Homogeneous 31412-10 61213-134 Black Exterior Slip Ash ND - Cellulose Sheeting Homogeneous 31412-11 61213-135 Black/Brown/Red 3-Tab Ash ND - Cellulose Roofing Homogeneous Dup:Laboratory QA/QC Duplicate;M;Mastic [(a), (b),(c),etc.]: Sample layers numbered from front to back. Comments: For layered samples,each component has been analyzed separately. ND means non-detect for asbestos fibers by EPA Method 600/R-98/l 16.Disclaimers: PLM has been known to miss asbestos in a small percentage of samples that contain asbestos. Thus negative PLM results cannot be guaranteed.Per EPA guidelines samples will be archived for 30 days then will be disposed of. This report may only be reproduced in full with written approval of ORION Environmental Services. s Analyzed By �/7 # Reviewed By Donna McNeal A len Clark Laboratory Director, CEO Laboratory Analyst Leading Environmental"Compliance Consulting Into the 21st Century 34004 - 9th Avenue South • Suite 5 o Federal Way, Washington 98003-6740 • Tacoma(253) 952-6717 • Seattle (253) 874-8118 • Facsimile (253) 927-4714 • Email lnfo@OrionES.net WBE W2F9219763 • • SOUTH KING FIRE& RESCUE INSPECTION MANUAL ADMINISTRATIVE POLICY SECTION N REVISED 7/07 Fire Prevention Division Guideline No. 6106 April 16, 1996 UNUSED RESIDENTIAL HEATING OIL STORAGE TANKS A. Scope and Purpose To establish requirements for the removal or abandonment of unused residential heating oil underground storage tanks (limited to R-3 Residential Occupancies) in South King Fire &Rescue (SKF&R) within the city limits of Federal Way and Des Moines. B. Code Authority International Fire Code section 104. C. Special Provisions Underground storage tanks of less than 1,100 U.S. gallon capacity, located on a R-3 Residential Occupancy property and used for the storage of home heating oil, that have not been used for a period of one year, shall either be removed and properly disposed of, or abandoned in place. 1. Permit Required An International Fire Code (IFC) Permit is required and shall be applied for by the person or company who will be conducting the removal or abandonment of the underground tank. The following information shall be submitted when applying for the IFC permit: a. A site plan drawing indicating the property lines and building locations in relation to the tank. Site plan need not be to scale. b. Tank capacity(in gallons). c. Type of fill material to be used, if tank is to be abandoned in place. The permit will be issued by SKF&R, located at 31617 1 Avenue S., Federal Way, WA 98003. The Fire Prevention Division may be reached at 253-946-7318 (inspection request line). If you call this number at least two business days before you are going to be removing/filling the tank(s),the paperwork can usually be completed on site. The cost of the permit is$50.00. NO WORK SHALL BE DONE PRIOR TO THE ISSUANCE OF A PERMIT, WITHOUT THE APPROVAL OF SOUTH KING FIRE &RESCUE,FIRE PREVENTION DIVISION. 2. General Safety Precautions a. Barricade off a minimum twenty(20') foot"safe zone"around the area of work. b. Maintain at least two 20-B:C rated fire extinguishers on site. c. Do not allow the release of any flammable or combustible liquids onto the ground or into a waterway. d. While the tank is being ventilated, flammable vapors flow into the surrounding atmosphere. Ignition sources shall be eliminated from the immediate vicinity. 3. Contamination of Soil and/or Groundwater If contamination of the soil or groundwater is detected during the removal or abandonment operation, contact the Washington State Department of Ecology at 425-649-7000. Remediation of the site, if required, will be under the direction of the Depaitment of Ecology. 23 0 . , . + SOUTH KING FIRE & RESCUE INSPECTION MANUAL ADMINISTRATIVE POLICY SECTION N REVISED 7/07 4. Conditions for Removal of Underground Tanks A site inspection by South King Fire &Rescue, Fire Prevention Division is required prior to removal of the tank from the ground. a. Liquid Removal: 1) Excavate down to the top of the tank. 2) Open all valves and allow product lines to drain back into the tank. Use particular care in emptying lines to avoid spilling product into the excavation. 3) All remaining contents of the tank shall be pumped out and properly disposed of. 4) The tank shall be triple rinsed. Documentation certifying the triple rinse of the tank shall be provided to the Fire Prevention Division either prior to, or at the time of site inspection. 5) Disconnect all product lines. Leave the vent line in place or provide a temporary vent if necessary. 6) Leave fill riser and drop tube in place and cap or plug all other tank openings. b. Vapor Removal: The tank must be rendered vapor free before removal. 1) Carbon dioxide shall be used to render the vapors inert. Use a carbon dioxide cylinder equipped with a pressure regulator. 2) Remove the fill riser and drop tube and plug opening. Remove a plug from the opposite end of the tank from the vent pipe. 3) Introduce carbon dioxide into the tank through this opening at a rate of 40 pounds per square inch(psi). The carbon dioxide hose should extend to the bottom of the storage tank. 4) Vapor concentrations shall be checked periodically with a combustible gas meter. Readings of 20% or less of LEL (lower explosive limit) must be obtained in the tank and the vent riser before the tank is considered to be gas free. 5) After the tank is gas free, distribute 1.5 pounds of dry ice per 100 gallons tank capacity throughout the length of the tank. c. Removal of Tank from Ground: 1) Plug and cap all openings. Use screwed(boiler)plugs to plug any corrosion leak holes. 2) Make sure that one plug in the tank has a one-half inch (1/2") size vent hole open to atmosphere to prevent pressure buildup. 3) Remove the tank from the site as promptly as possible after purging operations have been completed. 4) Exercise caution during the loading, securing on the truck and unloading at the disposal site. When transporting the tank, make sure the plug having the one-half (1/2") vent hole is positioned at the uppermost part of the tank. 5) If the tank must remain on site overnight, secure in place and barricade around tank. Vapor may be released from scale and sediment in the tank and vapor testing must be done to insure a gas free vessel. If testing indicates vapors are present,repeat vapor removal operations. 5. Conditions for Abandonment in Place A site inspection by the South King Fire&Rescue, Fire Prevention Division is required at the time of tank filling and sealing of openings. a. Open all valves and allow product lines to drain back into the tank. 24 • • SOUTH KING FIRE& RESCUE INSPECTION MANUAL ADMINISTRATIVE POLICY SECTION N REVISED 7/07 b. All remaining contents of the tank shall be pumped out and properly disposed of. c. The tank shall be triple rinsed. Documentation certifying the triple rinse of the tank shall be provided to the Fire Prevention Division either prior to, or at the time of site inspection. d. The tank shall be completely filled with cement-sand slurry or other filler material approved by the Fire Marshal. An acceptable cement-sand slurry mix consists of the following: 1) 1 yard sand 2) 1.5 sacks Portland type cement 3) 47 gallons water 4) 24 ounces air-entraining agent(Darex,Master Builders) 5) 18 ounces water wetting agent(WR Grace,Possith 300-N,Master Builders) e. All tank fill openings vent lines shall be sealed with a filler material and cut six (6") inches below grade if not covered by cement or asphalt. f. Sand or gravel shall not be used as a filler material G. Foam Filling of Tanks In lieu of filling with a cement-sand slurry mix, tanks may be filled with an approved foam agent. Fill the tank with foam until it comes out the tank vent-pipe opening. Type of foam used must be approved by the Fire Marshal. 25