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BLD2013-00239
BUILDING PERMIT APPLIC ON BLD13-00239 T 239 Review iew Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD13-00239 Received Date: 8/5/2013 SITE ADDRESS: MUNCIE AVE OWNER: HOOD CANAL SALMON ENHANCEMENT PHONE: 360-275-3575 PO BOX 2169 BELFAIR WA 98528-2169 QUI LCENE SUBDIVISION: Block: Lot: PARCEL NUMBER: 991201003 Section: 24 Township: 27 N Range: 02 W CONTRACTOR: PHONE: PHONE: REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOIA DEMO OF 5 RESIDENTIAL STRUCTURES TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP DEM MAIN: VALUATION ADD'L: HEAT TYPE: CODE EDITION: 2012 HEAT BASE: HEAT TYPE: OCCUPANCY: OCCUPANCY: UNHEATED: # OF STORIES: CONST TYPE: OTHER: SHORELINE: CONST TYPE: GARAGE: SETBACK: DECK: BANK HEIGHT: SEWAGE DISPOSAL: WATER SYSTEM: BEDROOMS: BATHROOMS: Exist: Exist: Prop: Prop: Total: Total: Routing Date: Type Amount Paid By: Date: Receipt: Approved/Date Permit $76.00 MEB 07/29/13 142315 APPROVED State Building Code $4.50 MEB 07/29/13 142315 APPROVED 1� Total: $80.50 JAI 2 1 2014 Jefferson County DCC \141rlemnrk1rlola\inrmc\G RI fl Ann DIA rn4 R/5/9M1 -6,(.D13' 3 /• �(� 1� ;`1y I �'SON �0 JEFFERSON COUNTY ' -r DEPARTMENT OF COMMUNITY DEVELOPMENT AUG 0 7 2013 621 Sheridan Street • Port Townsend • Washington 98368 360/379-4450 • 360/379-4451 Fax `� p �'��• 0 www.co.jefferson.wa.us/commdevelopment LL CCCCpCC��tt,,ii OW �L �INO - � iithdt111 bl1 Master Permit Application MLA: 'Project Description(ifn lude separate ss as necessary): 12/%f`/.4?,-, As/�j/'Gf/ ,s% _ Tax Parcel Number: 9/2f)/GIG?/y�//Z0/v/�-- Property Size: (acres/squarefeet) 'ZG/S/. 1�•�/��/so3 p Y /5,0e1 .-� Site Address and/or Directions to Property: 99/Zo/•�/ /4bes C . 3' 7 3Z1 3�0/ 33 // /s/o % i ( //cf -, /r s% s. Property Owner(s�of Record: 17, /- r lr%a / �ci/�/',i Ehkirn'e,- /- C'/,-;e iv/ Telephone: '5 ,0-Z 79 3 5 7 5- Fax: 340- 2-7S-00-2?".. email: ptr74/or, cr/n i,-C.eq`/,pa Mailing Address 2]m ,(/ ' (�LFir-D / / Cor �je(C/, moo,✓/ Applicant gent(if different from owner): G"-- //<<f' ,/4 ,9 4 Telephone: 3( -Z75-7384 Fax: 3Cv11' Z7 7 .-3/4'7 email: ,Ocrfcr�u dcox, Mailing Address: What kind of Permit?(Check each box that applies ❑Lot or Road Segregation , 'BV•Iding 0 Critical Areas Stewardship Plan ernolition Permit 0 Variance(Minor, Major or Reasonable Economic Use) ❑ ingle Family ❑Garage Attached/Detached 0 Conditional Use[C(a), C(d),or C]** ❑ Manufactured Home .0 Modular 0 Discretionary"D"or Unnamed Use Classification ❑ Commercial* 0 Special Use(Essential Public Facilities)** ❑ Change of Use 0 Boundary Line Adjustment ❑ Address 0 Road Approach ❑Short Plat** ❑ Home Business 0 Cottage Industry ❑ Binding Site Plan`* ❑ Propane ❑Long Plat** ❑Sign .. 0 Planned Rural Residential Development (PRRD)/Amendments** ❑Allowed"Yes"Use Consistency Analysis 0 Plat Vacation/Alteration' ❑ Stormwater Management 0 Shoreline Master Program Exemption/Permit Revisions** ❑ Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Substantial Development** ❑Temporary Use 0 Shoreline Management Variance ❑Wireless Telecommunication* 0 Comprehensive Plan/UDC/Land Use District Map Amendment ❑ Forest Practices Act/Release of Six-Year Moratorium 0 Jefferson County Shoreline Master Program Amendment *May require a Pre—Application Conference 0 Tree Vegetation Request **Requires a Pre-Application Conference Please identify any other local, state or federal permits required for this proposal, if known: •ESIGNATION OF AGENT I hereby designate -leT - 7 t, to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE 1 L.04 sir P Date:______ , ,, By signing this application form,the owner/agent attests that the information provided herein,and in any attachments, is true and correct to the best of his,her or its knowledge. Any material falsehood or any omission of a material fact made by the owner/agent with respect to this application packet may result in this permit being null and void. I further agree to save,indemnify and hold harmless Jefferson County against all liabilities,judgments,court costs,reasonable attorney's fees and expenses which may in any way accrue against Jefferson County as a result of or in consequence of the granting of this permit. I further agree to provide access and right of entry to Jefferson County and its employees,representatives or agents for the sole purpose of application review and any require later inspections. Staffs access anht of entry will be assumed unless the applicant informs the County in writing at the time of the application/at j�or s, v.• s pri•, ice. Signature: / / C .,, Date: The action or actions Applicant will undertake as a result of the issuance of this permit may negatively impact upon one or more threatened or endangered species and could lead to a potential"take"of an endangered species as those terms are defined in the federal law known as the "Endangered Species Act"or"ESA.'Jefferson County makes no assurances to the applicant that the actions that will be undertaken because this permit has been issued will not violate the ESA. Any individual,group • agency can file a lawsuit on behalf of an endangered species regarding your action(s)even if yo re in compliance with the Jeff= son County d- -lopment code.The Applicant acknowledges that he,she or it holds individual and non-transfer le s eri I nd coomplyin ith the ESA. The Applicant has read this disclai r�and igns and dates it below. Signature: - %% // /' _ _ Date: (/e--9- -- • • *.w spx cob JEFFERSON COUNTY Erg ' .� DEPARTMENT OF COMMUNITY DEVELOPMENT `4 621 Sheridan Street • Port Townsend • Washington 98368 • 360/379-4450 • 360/379-4451 Fax 1. 6,... www.co.jefferson.wa.us/commdevelopment �`�nI7:Np�' Master Permit Application MLA: f' 'Project Description (in lude separate sh is as eces ary): /- // AlJ ' / '7 r Zfe ' c / c, _1 • 0/ �_. /2,Q/x3/4— Tax Parcel Number: 2..e..," / qy,-,74f),/5r93 Property Size: /5-le S f= (acres/square feet) Site Address and/or Directions to Property: .9'9/.zo/"tv( 741. C •• 3za 32/ ? 33 /, /4 �/,- ,e.,, c.f � Property Owner(s{of Record: i t e / %-a i/ e• / i '' .ir -_ ^. - Telephone: 5 ,0--Z 75- 1, 7 5 Fax: 34./0- 275'- /elo email: ,. C ,. c,MC.ea;I Mailing Addres : 2i,p A/4:- ateici, t 4 ,A • Applican gen (+f different from owner):ri //L -; . .' v Telephone: 3 -Z15-7 3Fax: .?6,'19.?6,'19Z7 , - 7 -./i/e7 email:je.471r��Griot rC Got Li, e Mailing Address: What kind of Permit? (Check each box that applies 0 Lot or Road Segregation T(B ilding CI Critical Areas Stewardship Plan Dernolition Permit ❑Variance(Minor, Major or Reasonable Economic Use) ❑ Ingle Family 0 Garage Attached/Detached ❑ Conditional Use[C(a), C(d),or CI"` ❑ Manufactured Home .❑ Modular ❑ Discretionary"O"or Unnamed Use Classification O Commercial* 0 Special Use(Essential Public Facilities)" ❑ Change of Use 0 Boundary Line Adjustment ❑ Address ❑ Road Approach ❑ Short Plat"" ❑ Home Business ❑Cottage Industry 0 Binding Site Plan" 0 Propane ❑ Long Plat" • 0 Sign ❑ Planned Rural Residential Development(PRRD)/Amendments" ❑Allowed"Yes"Use Consistency Analysis ❑ Plat Vacation/Alteration" ❑ Stormwater Management ❑Shoreline Master Program Exemption/Permit Revisions** 0 Site Plan Approval Advance Determination(SPAAD)" ❑ Shoreline Management Substantial Development** ❑Temporary Use 0 Shoreline Management Variance 0 Wireless Telecommunication• ❑ Comprehensive Plan/UDC/Land Use District Map Amendment ❑ Forest Practices Act/Release of Six-Year Moratorium ❑Jefferson County Shoreline Master Program Amendment *May require a Pre—Application Conference ❑Tree Vegetation Request "Requires a Pre-Application Conference Please identify any other local, state or federal permits required for this proposal, if known: c---7--, e DESIGNATION OF AGENT I hereby designate / 4.7/7(" /� /if/rt /_ to act as my agent in matters relating to this/applicationicfor permit(s). OWNER SIGNATURE �" Date:-� _ c� By signing this application form,the owner/agent attests that the information provided herein,and in any attachments, is true and correct to the best of his,her or its knowledge. Any material falsehood or any omission of a material fact made by the owner/agent with respect to this application packet may result in this permit being null and void. I further agree to save,indemnify and hold harmless Jefferson County against all liabilities,judgments,court costs,reasonable attorney's fees and expenses`which may in any way accrue against Jefferson County as a result of or in consequence of the granting of this permit. I further agree to provide access and right of entry to Jefferson County and its employees,representatives or agents for the sole purpose of application review and any require.�later inspections. Staff's access and r ht of entry will be assumed unless the applicant informs the County in writing at the time of the application at/. or s -• s pp, ice. / Signature: ./•--'�/ a,i�. "q"//, Date: The action or actions Applicant will undertake as a result of the issuance of this permit may negatively impact upon one or more threatened or endangered species and could lead to a potential"take of an endangered species as those terms are defined in the federal law known as the "Endangered Species Act"or"ESA."Jefferson County makes no assurances to the applicant that the actions that will be undertaken because this permit has been issued will not violate the ESA. Any individual,group "r agency can file a lawsuit on behalf of an endangered species regarding your action(s)even if yo re in compliance ith the Jeff: son County d•Iopment code.The Applicant acknowledges that he,she or it holds individual and non-transfer e s i i � Z f win: , _c�ply�v ith the ESA. The Applicant has read this disclai r and igns and dates it below. Signature: / / �,/�/I Date: 7 e---5- _ Vr; (. 1239 • (...‹S--ON JEFFERSON COUNTYJl DEPARTMENT OF COMMUNITY DEVELOPMENT i? ''4 621 Sheridan Street • Port Townsend •Washington 98368 - 360/379-4450 " 360/379-4451 Fax ei. www.co.jefferson.wa.us/commdevelopment ,q`S4ING '' Master Permit Application MLA: Project Description (include separate sh=:ts as neces ary):ii • Tax Parcel Number: Oj 0e • -.. %70/503 Property Size: 750a Sf= (acres/square feet) Site Address and/or Directions to Property: ,/9/20./.72:9/ /-4/LSC� 32,9 3 2/ 3 3 4/o Aic�r. �'67E,, /c,/, /C/f O Property Owner(siof Record: /lived �%a / '✓G b/DY9 e%1hof Or e.>'rc /CVO E,,,,1 Telephone: alt 0-f 7S- ff.' 75- Fax: 3(r0-275 ss: - (ori` email: ,per (S a lo 'c ea`4� Mailing Addre _ 2/47 � �� S2 -0 ' rCQcJ- "/4 . � 9 Applican gen if different from owner): 4 //L ‘2. o ._,- 1y Telephone: 34%075 -t -73 604$ Fax: 3 ` t 77 -37,e7 email:,474 ea6iiarc e.,04A,e,. Mailing Address: What kind of Permit? (Check each box that applies 0 Lot or Road Segregation 1Bt'Iding 0 Critical Areas Stewardship Plan Demolition Permit 0 Variance(Minor, Major or Reasonable Economic Use) ❑ ingle Family 0 Garage Attached/Detached 0 Conditional Use[C(a), C(d),or Cj** ❑ Manufactured Home .0 PA •- q „ di DI •tionary"D"or Unnamed Use Classification ❑ Commercial* C E � V E r=ci:l Use(Essential Public Facilities)'" ❑ Change of Use •ary Line Adjustment ❑ Address 0 Rip. •ach ■ Plat** ❑ Home Business 0 Co lye, •ust ■ :. •i g Site Plan** ❑ Propane ` I 'i I JU L 2 9 2013 ■ l. "tat • 0 Sign I i 0 I ■ jbw,�u -a Rural Residential Development(PRRD)/Amendments** ❑Allowed"Yes"Use Consistency -i is r - at acation/Alteration** ❑ Stormwater Management JEFFERSON COUNTY 0 Shor=line Master Program Exemption/Permit Revisions** ❑ Site Plan Approval Advance Det,rminIttefi P."r +'+I ITY DEVELOP i .•. :line Management Substantial Development** ❑Temporary Use 0 Shoreline Management Variance ❑Wireless Telecommunication* 0 Comprehensive Plan/UDC/Land Use District Map Amendment ❑ Forest Practices Act/Release of Six-Year Moratorium 0 Jefferson County Shoreline Master Program Amendment *May require a Pre—Application Conference 0 Tree Vegetation Request **Requires a Pre-Application Conference Please identify any other local,state or federal permits required for this proposal, if known: DESIGNATION OF AGENT I hereby designate QCT " ,� to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE Date: 7/z9//✓ By signing this application form,the owner/agent attests that the information provided herein,and in any attachments, is true and correct to the best of his,her or its knowledge. Any material falsehood or any omission of a material fact made by the owner/agent with respect to this application packet may result in this permit being null and void. I further agree to save,indemnify and hold harmless Jefferson County against all liabilities,judgments,court costs,reasonable attorney's fees and expenses which may in any way accrue against Jefferson County as a result of or in consequence of the granting of this permit. I further agree to provide access and right of entry to Jefferson County and its employees,representatives or agents for the sole purpose of application review and any requi a later inspections. Staffs access and ht of entry will be assumed unless the applicant informs the County in writing at the time of the applica ion at orssyvapts pri �p�ice. - Signature: '�lif ,��% Date: The action or actions Applicant will undertake as a result of the issuance of this permit may negatively impact upon one or more threatened or endangered species and could lead to a potential"take"of an endangered species as those terms are defined in the federal law known as the "Endangered Species Act"or"ESA."Jefferson County makes no assurances to the applicant that the actions that will be undertaken because this permit has been issued will not violate the ESA. Any individual,group " agency can file a lawsuit on behalf of an endangered species regarding your action(s)even if yo re in compliance with the Jeff, son County d��opment code.The Applicant acknowledges that he,she or it holds individual and non-transfer e sppr ,�en/ nd complyin• ith the ESA. The Applicant has read this disclaai r and$$iiggnns and dates it below. Signature: �' '!i i %�`Zl / j'� Date: r/��/ • BUILDER STATEMENT The signer of this statement does hereby certify that they are the Owners of the parcel referenced herein,that they are not licensed contractors and that they will be assuming the responsibility of the General Contractor for the proposed project. Signature: Date: GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: ( ) ( ) MAILING ADDRESS: EMAIL: CONTRACTOR'S LICENSE WAINS NUMBER: NUMBER ARCHITECT/ENGINEER: PHONE ( ) Fm:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: O New U Wood Existing: C Sewer D Addition ❑ Steel Proposed: Bank 0 Community System ❑ Alteration/Remodel 0 Concrete Total: _ Height: 0 Individual System D Repair ❑ Masonry SEP Permit# D Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: ❑ Private well 0 Two Party Type of Heat: Proposed: ❑ Public Total: Name of System: If this is a Commercial Project you must answer the following: Number of Parking Spaces: Current: Proposed: Number of ADA Parking Spaces: Number of occupants(includes owners,tenants,employees,etc) Current Proposed - IBC Occupancy: IBC Type of construction: Will you have Food Service? Yes / No • If this is a Propane Tank andlor Appliance Installation permit,mark all items below that apply: 1 Underground Tank 1 Above ground Tank Size of Propane Tank: I Heat Stove 1 Cook Stove 1 Woodstove 1 Fireplace Insert 1 Hot Water Tank I Pellet Stove 1 Other Is this appliance being installed in a Manufactured/Mobile Home? Yes / No When applying for a permit to install a propane tank you must also submit a site plan showing all of the buildings,all property lines, tank location and size,distances from the propane tank to all property lines,buildings and septic system components, including the reserve area. Square Footage Current Proposed For Office Use Only Amount Revision Main Floor Heated EH Bid App Review: ¢, 7 2n°Floor Heated Consistency Review: y� Other Heated Base fee: Mezzanine Additional Section: �j Heated Basement Plan Check fee: ���jjj Unheated Basement State Surcharge fee: 1 ' 1`r,•, Other Unheated Pot Water Review fee: Garage/Carport SUBTOTAL Decks 911/Rd Approach fee: Other TOTAL: $ ,76 J V Receipt Number: l t•(2-3 (S Cash/Check Number: 'C- ESTIMATED COST(REQUIRED) Date: C°1/J2 f 3 .Fair market value of all labor and materials foundation to finish Initials: 41 o 8 1g co.) nocn>- IA n-o-In _ Inn C 00-101. Z{O� zp y-Ti Ar Pi y my F c; �m .A Dp03 mO rmf!I =A -0p y'4V�D Dz*. Ns _Iz a0D0d zz,m .m 1 22 KKS yn tummy_ ` r'm rr�-=L) a 0.,-,_x. �� mA r.026 pomp - L11n vp�m0 N�ny -1 ® zD „,-Mro0 CMZ; Z z� yymzocz m> > 2 n o0—c> zNND C O� nnpmZ v7,pmzc � D 1- 91 i3 I F . oDa?Z ommm mczi - ZEN m00 7,' A r Dpzo2 2~30 to r im r Z, mD m2 >9 C m?-.y,- zm<<pm S Z' LO p Dnn2 mn0< D T-'32 5. 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Belfair, WA 98528 Re: Asbestos Inspection Report Donald Newman Property—Jefferson County Parcel Number 991-201-003 Dear Mr. Harlow, On December 12, 2012 ADESA performed an Asbestos Building Inspection of the single wide manufactured home and garage located on the above referenced site. A "good faith inspection" of potential asbestos-containing materials (ACM) is required prior to any remodeling or demolition work in accordance with Department of Labor and Industries (L&I), and the Washington Industrial Safety and Health Act (WISHA), Chapter 296-62-07721, (2)(b)(ii) WAC Occupational Health Standards, Safety Standards for Carcinogens. Washington State standards require inspections to be conducted by an AHERA trained Asbestos Building Inspector (TSCA Title I1/40 CFR 763), and any associated analysis to be provided by an asbestos laboratory certified by the National Bureau of Standards. The property is improved with a single-wide, manufactured home and garage at 320 Muncie Avenue in Quilcene, Washington 98376 in Township 27N Range 2W, and Section 24 have the following characteristics: Year Built: 1981 Bedrooms/Bath rooms: 5/2 Construction Details: Wood-framed; metal roof; T-11 wood siding; drywall; carpet; linoleum and wood flooring; Addition,—10 ft. x 20 ft. includes bedroom and common room(western side of structure). Garage: 3-Bay, wood-framed; metal roof;wooden siding The services performed on the above mentioned property(Subject Property) during this asbestos inspection are detailed below. Scope of Services 1. An ADESA AHERA certified inspector performed an asbestos inspection of the structures at the above referenced location to identify potential Asbestos Containing Materials (ACM). 2. Sixteen (16) suspect materials were sampled and sent to an accredited laboratory for analysis. Triplicate samples were collected of ceiling tiles, wall skim coating and wall board throughout the addition; sample sets A9, All and Al2, respectively. 3. The sample descriptions,chain-of-custody,and laboratory results are attached to this report. PO Box 1009•Tenino,WA•98589 Phone:360-701-8797•Fax:360-2642028•Email:wrutherford i)adesa-wa.com g b i >o i mT n� ' MIA 11no y'�' 4z oo �sszi .-'_`= vg y'9zs MI�7. r~fzs AEF-- f Fn �g as zg .Y zzfv. y QT $8m' 4:1omm c ye 4 an > aL Ong �^ $ vpa CO�$ L xl� ODASE Cy2D A W f�y}6f 3 �og �� D I g L A = 6R.vg �i� a F i z 0 9 ce-zfm D WV o�e�a. F A m pp O. (}� O A OSz ZOm� �Nb01 'E e /' O O 4 D O _ Z z�L9 �NN401- I T J1Q < C OA O��O+NW O r— O Pn, 7) MC) 0 Is g Orn D M 73is e 11ri m r mlri r . C m —I OP I .. a ' ti }� P3 --1 rn ;111 z � n m3P43 O O rn PI i TM __I z 9999 sssss ..u� 16 p� 5555 = c hog! 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N L 4 ,- 1/ I i / � 1 d 1 .1, i = g .g -% 4 - - r Y 44.0A -- 'no"��ma_ s I raw — Iow ao a'o s ' ' • of t V e 1t121 wag*y Si�«- y 1 a iHO of O - G. 1,o o /� o o 1 .0 / \-- » 1 i P s N — E s o 2 a — s r• a o 'o aM a, 0 0 0 m v Flow v' Flow a &p� 0 0 'o N S1 1 raroc — - — — 0 ra*CI m — i s u o � tY dawa., ' 1. raw 1 �J.-1 A<11D R o '� • O o 1 vty 1 1 Alte / �} 1 i �.° l;� 1AF 1 I I ro Id' o ,ma lot o ow or 0 oo iya 0 a h, 0, 0 m�, m • Flow 1 1 _- _Flow a 0 "' P, y� C n Qa ~�0 0 0 W raw rc � >yWy p I. ^!� O Om'A.S n z 2ININ I. 19 114, 4. i he- 00111 Ab 414ets — 0,9 eer4ra , ",�oG s Historic Inventory Report Sel;€ 1EKJlIC PaCBFYAMx� Location Field Site No. QMR-4 DAHP No. Historic Name: Newman House 4 Common Name: Quilcene Marsh House 4 Property Address: No address Muncie Ave,Quilcene,WA 98376 Comments: ,nw �rn Tax No./Parcel No. 991201701 `✓ Plat/Block/Lot Block 18 Acreage<one Supplemental Map(s) Township/Range/EW Section 1/4 Sec 1/41/4 Sec County Quadrangle 727R02W 24 Jefferson QUILCENE Coordinate Reference Easting: 1059035 Northing: 914942 Projection: Washington State Plane South Datum: HARN(feet, Identification Survey Name: Quilcene Marsh South Restoration Project Date Recorded: 04/24/2013 Field Recorder: D.Nomen Owner's Name: Hood Canal Salmon Enhancement Group Owner Address: City: Belfair State: WA Zip: Classification:Building Resource Status: Comments: Survey/Inventory Within a District? No Contributing?No I C V E ri , National Register: +'I Local District: II 1 !1 I National Register District/Thematic Nomination Name: J U L 2 9 2013 I I Eligibility Status: Not Determined-SHPO JEFFERSON COUNTY I Determination Date: 1/1/0001 DEPT OF CMILINITY,r/E1_ nr'''''' J Determination Comments: Thursday,May 09,2013 Page 1 of 3 R'"t"' niK Historic Inventory Report ,aroc cOLOGY 3 e,c rResEfivAM7n Description Historic Use: Domestic-Single Family House Current Use: Vacant/Not in Use Plan: Irregular Stories: 1 Structural System: Braced Frame Changes to Plan: Slight Changes to Interior: Unknown Changes to Original Cladding: Intact Changes to Windows: Extensive Changes to Other: Other(specify): Style: Cladding: Roof Type: Roof Material: None Wood Vertical Pyramidal Wood -Shingle Foundation: Form/Type: Post&Pier Single Family Narrative Study Unit Other Architecture/Landscape Architecture Date of Construction: 1950 Built Date Builder: Engineer: Architect: Property appears to meet criteria for the National Register of Historic Places:No Property is located in a potential historic district(National and/or local):No Property potentially contributes to a historic district(National and/or local): No Statement of This house was probably built about 1950. It's unusual semi-pyramidal roof gives it a distinctive look,but Significance: otherwise it is quite a modest building. Aside From its poor condition,it lacks any distinguishing features that might warrant its listing in the National Register of Historic Places. Description of Although this residence is partially collapsed,it appears to be a wood framed structure with an irregular Physical plan and an unusual semi-pyramidal roof. The roof is covered with wood shingles and has short,open Appearance: eaves. A brick chimney emerges from near the roof peak. The foundation is mostly obscured, but appears to be post and pier. Exterior wall surfaces are clad with vertical board siding. It appears that all of the windows have been replaced with vinyl sash fixed and sliding units. The house was Hooded, probably during the 1993 flood which cut new river channels through the project APE. Flood sediments are piled against the outer walls to a depth of two to three feet. Occupants abandoned the house leaving the interior full of mud and debris coated furniture and personal belongings. Major Kamen,Dana,Ryan Ives,and Stephen Emerson 2013 Cultural Resources Investigations for the Quilcene Bibliographic Marsh South Restoration Project,Jefferson County,Washington- Short Report 1170. Archaeological and References: Historical Services,Eastern Washington University,Cheney. Thursday,May 09,2013 Page 2 of 3 DEPAR ‘ENT of ARCH4AEOLOGY LOGY Historic Inventory Report -i rc e.0 PRESEQVAI)ON Photos ` " �O is 1' '. <Y �, i.` � y i, :Aikli:�`` firl44- �' V a '' 2 'c } F ' jr{ iK" View to the north View to the northeast House, south elevation House,and west elevations 2013 2013 • b. 1 t IR ;.- View to the south Base of chimney in collapsed house 2013 Thursday,May 09,2013 Page 3 of 3 JAN/17/2014/FRI 04:43 PM ORCAA FAX No. 3604916308 P. 001/001 D otoncl�-Ed;1 Olympic Region Clean tlir Agency 11) JAN 2 1. o0 vs pi-4"N 2940 B Limited Lane NW � 2014 �,�/ c..a% Olympia,WA 98502 491-63080F.A.X. 08 Port Angeles office(360)417-146G L 1 m 9p4tatiN tr 4 ll t -, COf,'Iv1Uf;!TY DEVELOP(^ENT \!s, 0 RCAA Raymond Office(360)943-3137 'N.,...,4,,,or 07/ www.ORCi,A.org 7 , eras• • a ( 1 Owner occupied residential dwelling—Permit fee:$35.00--Prior Notice-Nonrefundable [ 1 Other Structures—Permit fee:$60.00—10 working day wait period-Nauref mdable • PROPERTYOWNER N le: Phone: 270 5 E C ....C#/ mail:,�81{h�I iw tet I. r, .L..a! FAX: Mobile: Mailing Address: City: / Stat Z so k Address: -de [ _ f 41A 1C Site Address: ggdlei ' fsty j • V"/t ( / 'yI / l ahex — Abaci fie Gv43 1 49 DEMOLITION CONTRACTOR[ ] Check if same as prop owner information oct#LJ41,if 1 t BusifN e: , Phone: ( ) Email ID/c/ AV'PQ M. FAX: ( ) Onsite Contact: `_rAyrk At"e Phone: . i .-4,i17 Mobile: ( ) FAX: ( ) Mailing Address:Q6 CC4CY City: Stale: I Zip: �`.5tv' 7 t S damsZr DEMOLITION INFORMATION ' #of Structures being demolished Start Date: Pb.. Completion Date- 1 Asbestos present Yes ____No Survey atter ed )Yes __No Has all i en ed cetoc been DEMOLITION PROJECT CATEGORY [Complete Demolition ]Training Fire—Fire Agency: [ ]Renovation,Alteration,Remodeling,Maintenance,of other Construction [ ] Emergency-Additional Fee of$50.00(must be accompanied by Government Ordered Dedaratian-Commercial only) !have read and will abide by the conditions set forth to this permit and any addendum thereto. Ido hereby certify that all ident7ftedasbestos has been removed and the information in this application and supplemental dam described herein is, to the best ofmy knowledge,accurate and complete. .6114fk. low Itt k -712,11 l3 Applicant Name Signature I Date 74T-�.�-.�a-. ~ Date A `P 'ti ' Payment Info. [)t Approved Asbestos Permit [ ] C z [ ] Disapproved Permit# _ASB00 AUG 0 heck: 7!T ILA( a Bemolition�3}Permit it 201 [ ] Credit Card Review date: 1 f3 � P1 Permit# DEM00 Receive datee , / 13 Reviewed by: P ,4,,,, j> AReiiel Use Oak Agetnyy Use Duly Agesc Use Ori t 08/11/11 • OVER . 3 31 ,?t4'oc'e Ave . or 4,a51Aa�N�tCto6N6 Historic Inve - 'sport O6-C FIESSivATION Location Field Site No. QMR-2 DAHP No. Historic Name: Newman House 2 Common Name: QLilcene March House 2 Property Address: 331 Muncie Ave,Quilcene,WA Comments: Tax No./Parcel No. 991201540 3d3 Plat/Block/Lot Acreage<one Supplemental Map(s) Township/Range/EW Section 1/4 Sec 1/4 1/4 Sec County Quadrangle T27R02W 24 Jefferson QUILCENE Coordinate Reference Easting: 1058279 Northing: 914872 Projection: Washington State Plane South Datum: HARN(feet! Identification Survey Name: Quilcene Marsh South Restoration Project Date Recorded: 04/24/2013 Field Recorder: Dana Komen Owner's Name: Hood Canal Salmon Enhancement Group Owner Address: City: Belfair State: WA Zip: 98376 Classification:Building Resource Status: Comments: Survey/Inventory Within a District? No Contributing?No National Register: E c E 0 v�7 Local District: IL National Register District/Thematic Nomination Name: Eligibility Status: NctDetermined-SHPO -1 JUL 2 9 2013 I� Determination Date: 1/1/0001 Determination Comments: JEFFERSON COUNTY DEPT.OF COMMUNITY DEVELOPMENT Thursday,May 09,2013 Page 1 of 3 446*AinmEti—i Historic Inventory Report t:H•EC1.CiGrs rOec nefeivA6oe Description Historic Use: Domestic -Single Family House Current Use: Vacant/Not in Use Plan: L-Shape Stories: 1 Structural System: Braced Frame Changes to Plan: Intact Changes to Interior: Unknown Changes to Original Cladding: Intact Changes to Windows: Intact Changes to Other: Other(specify): Style: Cladding: Roof Type: Roof Material: None Shingle Gable-Side Gable Asphalt/Composition - Concrete/Asbestos Shingle Foundation: Form/Type: Posi &Pier Single Family-Side Gable Narrative Study Unit Other Architecture/Landscape Architecture Date of Construction: 1950 Built Date Builder: Engineer: Architect: Property appears to meet criteria for the National Register of Historic Places:No Property is located in a potential historic district(National and/or local):No Property potentially contributes to a historic district(National and/ar local): No Statement of This residence,built in 1950,exhibits a muted ranch house appearance,due to its shallow-pitched roof, Significance: but the eaves are too short. It appears to have suffered some flood damage and is vacant. It!s a common example of modest domestic architecture. Neither the residence nor the associated garage exhibits a distinction necessary for listing in the National Register of Historic Places. Description of This wood frame,one-story residence plan consists of a side-gabled main section and a front gabled Physical extension to the north. It has a post and pier foundation. The side-gable profile has a salt box Appearance: appearance. The shallow-pitched roof is covered by composition shingles and has short,open eaves. A brick chimney emerges from the west end of the main roof crest. Exterior wall surfaces are clad with wood shingles,with vertical board in the gable faces. The front(south)entry contains a wood panel and glass door centrally located beneath a short,gabled canopy. The rear(north)entry contains a wood panel and glass door is situated to the right side of the front gable extension. The windows are a mix of fixed wood sash and sliding vinyl types. On the east elevation,much of the wood shingle has come away, revealing tar paper sheathing beneath. The house is associated with a wood frame,side-gable garage with vertical board siding and a shingle-covered roof. Major Komen,Dana,Ryan Ives,and Stephen Emerson 2013 Cultural Resources Investigations for the Quilcene Bibliographic March South Restoration Project,Jefferson County,Washington. Short Report 1170. Archaeological and References: Historical Services, Eastern Washington University. Thursday,May 09,2013 Page 2 of 3 ,..5.1w A44,4 RCH OLOGY& Historic Inventory Report . TORIC PRESERVATION Photos 'l' .,. •.3.7r! 'kms 4" '�.N \ •i .. ._ 1 .. ._ View to the northwest View to the north east House, north (front)and east elevations and garage remnant House,east and south elevations,garage remnant 2013 2013 t \r1l ,.. "Ne•. . . ' 1. --_. ' View to the northwest House,north(front)and east elevations 2013 Thursday,May 09,2013 Page 3 of 3 IL-3-2012 11:18A FROM:WITHERIDGE 3603850584 TO:1:4602750648 P.1/10 23 ritisfac.te . • NORTHWEST ASBESTOS CONSULTANTS Surveys, Inspection, Sampling AHERA Building Inspector / Mgmt. Planner EPA Certification WAMOA-0042 406 Reed St. Port Townsend,WA 98368 northwestasbestosconsultants@cablespeed.com 360-385-0584 Date; 7/3/12 +/ Ioocations, 331 Muncie Ave. pare ( • So` b L Quilcene,WA 98376 contact: Pacific Northwest Salmon Center Renee Rose-Scherdnik 600 NE Roessel Rd. P.O. Box 2169 Belfair,WA 98528 $ubiect: Demolition Inspector: Bob Witheridge AHERA - Building inspector / Management Planner WAMOA-0042-1021201102 Expires - 10/21/12 JUL-3-2012 11:188 FROM:WITHERIDGE 3603850584 TO:1360275064B P.2/10 Scope of work 1) Good faith inspection for asbestos containing building materials (ACBM). 2) Report to Renee Rose-Scherdnik with results from Northern Industrial Hygiene, Inc. Summary Report The inspection started with a visual survey looking for Asbestos Containing Building Material (ACBM). Sample results: 331 Muncie Ave. Sample #1: Window glaze. No asbestos detected. Sample #2: Roofing material. No asbestos detected. Sample #3: Living room ceiling tile. No asbestos detected. Sample #4: Front bedroom ceiling material. No asbestos detected. Sample #5: Living room top layer floor vinyl with mastic. Tan with green and brown pebble pattern. No asbestos detected. Sample #6: Living room, laundry and center storage room, bottom layer floor vinyl with mastic. Bright multi colors. No asbestos detected. Sample #7: Kitchen top layer floor vinyl with mastic. Tan No asbestos detected. Sample #8: Kitchen Second layer floor vinyl with mastic. White with blue. No asbestos detected. Sample #9: Kitchen third layer floor vinyl with mastic. Red No asbestos detected. Sample #10: Kitchen bottom layer floor vinyl with mastic. Gray No asbestos detected. Sample #11: Back entry floor vinyl with mastic. Gold and white. No asbestos detected. Sample #12: Bathroom bottom layer floor vinyl with mastic. Green No asbestos detected. Sample #13: Bathroom top layer floor vinyl with mastic. Tan and white. No asbestos detected. Sample #14: Laundry / storage room top layer floor vinyl with mastic. Brown No asbestos detected. JUL-3-2012 11:19A FROM:WITHERIDGE 3603850584 TO:13602750648 P.3/10 Sample #15: Storage room bottom layer floor vinyl with mastic. Tan, black and red. No asbestos detected. Sample #16: Center bedroom floor vinyl with mastic. Gray with pink and green. No asbestos detected. Sample #17: Hallway and south bedroom floor vinyl with mastic. Gray with blue and pink. No asbestos detected. Sample#18: Back side of house, roofing material. Black and gray. No asbestos detected. All asbestos containing building materials with a reading greater than 1% is considered a hazardous material if disturbed. If removed a certified abatement contractor must follow the rules of the EPA and governed by Olympic Region Clean Air Agency. During demolition it is possible that additional suspect asbestos containing building material {ACBM) may be found. Should such suspect material be discovered an AHERA certified inspector will have to sample and test the material to prove it is of non- asbestos. Northwest Asbestos Consultants is not responsible for identification of hidden materials that are not identifiable with reasonable diligence. Thank you, Bob Witheridge, E.F.M. JUL-3-2012 2012 11:195 FROM:IiiIITI-ERIDGE _ 3E0385058' T0:13602750648 P.4/10 C&er1 Semite Number: 331.1 Lab Sample Number:12. 0401.0027 Client Bampta Oucdp(lon: Window Giem Caere Sumps Location: 331 Muncie Sample ecumenic Mete&is dlatlnaulehoble but Inseparable Checked II Sample Not Analyzed n Blue and red pent on white compressed powdery material _ Albedo'Fibrous Components: Nan-Asbestos Recur Components Non-Parous Components: No Asbestos Detected 25% Paint 75% Filler and Binder Caont Sample Number: 331-2 Lab Sample Number: 1240401.002e Cant Sample Description: Roofing Materiel Client Semple Lac/Skint 331 Munde-Root Sample Comments: Checked II Sample Nat Analyzed [] Frown and ten pebbles on bleak tlbroua asphalt I)Asbestos Plbrous Components: Nan-Aabesloa Fibrous Components: Non-FIbmus Components: No Asbestos Detected 12% Fiberglass 59% Asphalt Filler and Binder 30% Aggregate Client Sample Number: 331-3 Lab Sample Number:12.00401.0029 Client Sample Description: Gelling lee Client Sample Location: 331 Muncie Living Room Sant*Comments: Materials dhi11nqusltSbIe but Inseparable Checked0Sample NotAnalyzed �"] White point and brown compressed Pbare Asbestos Fibrous Components: Non-Asbeeto*Fibrous Components: Non•Fltuous Component.: No Asbestos Detected 88% Cellulose 5% Paint 7% Filler and Stader (Sampts results continued on next page.) Sampled by: RobWlth.rldpe e12ei2012 ‘„;_j.,_-_-&...- e ,----- Recanted by: Jude Cummings 0129/2012 Rsvlewed by: Jude Cummings r1v2012 Jude Cummings,Laboratory Manger Page 0 JUL-3-2012 11:19R FROM:WITHERIDGE 3603850584 TO:13602750648 P.5/10 215 SW 153rd Street Burton,WA 98166 OFFICE:(206)988-1745 FAX:(206)988-1978 G7 O Z T H ER NI NVLAP Lab Code:200511-0'. INOYKNIAL.sinromNS. IMC. Bulk Asbestos Analysis Report • Northwest Asbestos Consultants NIH Balch Number: 12-00401 406 Reed Street Client Job Number: Port Townsend,WA 86368- Turn Around Time: 5 Day C Project Location: 321,331,330 Muncie Ave.,(Moine Samples Analyzed: 44 Client Sample Number: 331-4 Lab Sample Number: 12-00401.0030 Client Sample Description: Calling Material Client Sample Location: 331 Muncie Front Bedroom Sample Comments: Checked If Sample Not Analyzed n Layer 1 Blue paint on white lumpy material Asbestos Fibrous Components: Non-Asbestos Fibrous Components: Non-Fibrous Components: No Asbestos Detected 30% Fine Grains • 30% Paint 40% Filler and Binder Layer 2 Tan paper Asbestos Fibrous Components: Non-Asbestos Fibrous Components: Non-Fibrous Components: No Asbestos Detected 95% Cellulose 5% Filler and Binder Client Sample Number; 331-5 Lab Sample Number. 12-00401.0031 Client Sample Description: Floor Vinyl with Mastic Tan with Green and Brown Pebble Pattern Client Sample Location: 331 Muncie Living Room(top layer) Sample Comments: Checked if Sample Not Analyzed Li Layer 1 Tan vinyl with brown spots and black fibrous backing Asbestos Fibrous Components: Non-Asbestos Fibrous Components: Non-Fibrous Components: No Asbestos Detected 20% Cellulose 55% Asphalt Filler and Binder 25% Vinyl Filler and Binder Layer 2 Dark brown mastic Asbestos Fibrous Components: Non-Asbestos Fibrous Components; Non-Fibrous Components: No Asbestos Detected 5% Cellulose 95% Filler and Binder Client Sample Number: 331-6 Lab Sample Number: 12-00401.0032 Client Sample Description: Floor Vinyl win Mastic-Bright Multi-colors Client Sample Location: 931 Muncie Living room,Laundry and Storage Center(bottom layer) Sample Comments: Checked If Sample Not Analyzed fl (Sample results continued on next page.) Sampled by: Bob Witherldge 6/2812012 rL, e • Received by: Jude Cummings 6/29(2012 Reviewed by: Jude Cummings 7/2/2012 Jude Cummings,Laboratory Manager page 10 JUL-3-2012 11:20A FROM:WITHERIDGE 3603850584 TO:13602750648 P.6/10 -• 215 SW 153rd Street Burlen,WA 98166 OFFICE:(206)988-1746 FAX:(206)988-1978 ' O N NVLAP Lab Code:200511-0 miLimIroderseei. ING_ Bulk Asbestos Analysis Report Northwest Asbestos Consultants NIH Batch Number: 12-00401 406 Reed Street Client Job Number PortTownsend,WA 98368- Turn Around Time: 5 Cay C Project Location: 321,331,330 Muncie Ave.,Ouilccfne Samples Analyzed: 44 Layer 1 Bright colors vinyl with black fibrous backing Asbestos Fibrous Components: Non-Asbestos Fibrous Components: Non-Fibrous Components: No Asbestos Detected 15% Cellulose 50% Asphalt Filler and Binder 35% Vinyl Filler and Binder Layer 2 Dark brown mastic Asbestos Fibrous Components: Non-Asbestos Fibrous Components: Non-Fibrous Components: No Asbestos Detected 5% Cellulose 95% Filler and Binder • Client Sample Number: 331-7 Lab Sample Number.12-00401.0033 Client Sample Description: Floor Vinyl with Mastic-Tan Client Sample Location: 331 Muncie Kitchen(tap layer) Sample Comments: Checked It Sample Not Analyzed ri Layer 1 Tan vinyl Asbestos Fibrous Components: Non-Asbestos Fibrous Components: Non-Fibrous Components: No Asbestos Detected 30% Aggregate 70% Vinyl Filler and Binder Layer 2 Dark brown mastic Asbestos Fibrous Components: Non-Asbestos Fibrous Components: Non-Fibrous Components: No Asbestos Detected 5% Cellulose 95% Filler and Binder Client Sample Number: 3319 Lab Sample Number:12-00401.0034 Client Sample Description: Floor Vinyl with Mastic White with Blue Client Sample Location: 331 Muncie Kitchen(2nd layer) Sample Comments: Checked If Sample Not Analyzed [� Layer 1 Tan and black vinyl with black fibrous asphalt Asbestos Fibrous Components: Non-Asbestos Fibrous Components: Non-Fibrous Components: No Asbestos Detected 20% Cellulose 50% Asphalt Filler and Binder 30% Wood Layer 2 Tan mastic Asbestos Fibrous Components: Non-Asbestos Fibrous Components: Non-Fibrous Components: No Asbestos Detected 3% Cellulose 97% Filler and Binder (Sample results continued on next page.) Sempled by: Bob Witheridge 6/2812012 ,1. L Received by: Jude Cummings 6/29/2012 Reviewed by: Jude Cummings 7/2/2012 Jude Cummings,Laboratory Manager Page 11 JUL-3-2012 11:20A FROM:WITF-ERIDGE 3603850584 TO:13602750649 P.7/10 215 SW 153rd Street Burlen,WA 98186 OFFICE:(206)988-1746 FAX:(206)988-1978 I21 O R T H E R N NVLAP Lab Code:200511-0 INO%JSI IAL IIrarewM, I C. Bulk Asbestos Analysis Report Northwest Asbestos Consultants NIH Belch Number: 12-00401 406 Reed Street Client Job Number: Port Townsend,WA 98388- Turn Around Time: 6 Day C Project Location: 321,331,330 Muncie Ave.,Ouilcine Samples Analyzed: 44 Client Sample Number: 331.9 Lab Sample Number. 12-00401.0035 Client Sample Description: Floor vinyl with mastic-Red Client Sample Location: 331 Muncie Kitchen(2nd layer) Sample Comments: Materials distinguishable but Inseparable Checked If Sample Not Analyzed [] Red vinyl withblack fibrous backing and residue Asbestos Fibrous Components: Non-Asbestos Fibrous Components: Non-Fibrous Components: No Asbestos Detected 15% Cellulose 5% Filler and Binder 45% Asphalt Filler and Binder 35% Vinyl Filler and Binder Client Sample Number: 331-10 Lab Sample Number: 12-00401.0036 Client Sample Description: Floor vinyl with mastic-Gray Client Sample Location: 331 Muncie Kitchen(bottom layer) Sample Comments: Materiels distinguishable but Inseparable Checked if Sample Not Analyzed ;-] Tan and gray vinyl with black fibrous backing and tan residue Asbestos Fibrous Components: Non-Asbestos Fibrous Components: Non-Fibrous Components: No Asbestos Detected 15% Cellulose 5% Filler and Binder 40% Asphalt Filler and Binder 40% Vinyl Filler and Binder Client Sample Number: 331-11 Lab Sample Number. 12-00401.0037 Client Sample Description: Floor Vinyl with Mastic-Gold and White Client Sample Location: 931 Muncie Back Entry Sample Comments: Checked If Sample Nat Analyzed [] Layer 1 Gold,Yellow and white vinyl with black fibrous backing Asbestos Fibrous Components: Non-Asbestos Fibrous Components: Non-Fibrous Components: No Asbestos Detected 20% Cellulose 50% Asphalt Filler and Binder 30% Vinyl Filler and Binder Layer 2 Tan mastic Asbestos Fibrous Components: Non-Asbestos Fibrous Components: Non-Fibrous Components: No Asbestos Detected 5% Cellulose 95% Filler and Binder (Sample results continued on next page.) Sampled by: Bob Wi heridge 6/28/2012 ' i., C Received by: Jude Cummings 6129/2012 Reviewed by: Jude Cummings 7/2/2012 Jude Cummings,Laboratory Manager Page 12 JUL-3-2012 11 21R FROM:klITHERIDGE 3603850584 TO:13602750648 P.8/113 215 SW 153rd Street Burlen,WA 98168 OFFICE:(206)988-1746 FAX:(206)988-1978 O R T H E R N NVLAP Lob Code:200611-0 i AL 144/1:111.1MIA Bulk Asbestos Analysis Report Northwest Asbestos Consultants NIH Batch Number: 1240401 406 Reed Street Client Job Number: Port Townsend,WA 98388- Turn Around Time: 5 Day C Project Location; 321.331,330 Muncie Ave.,Ouilcine Samples Analyzed: 44 Client Sample Number: 331-12 Lab Sample Number: 12-00401.0038 Client Sample Description: Floor vinyl with mastic-Green Client Sample Location: 331 Muncie Bathroom(bottom layer) Sample Comments: Materiels distinguishable but Inseparable Checked If Sample Not Analyzed /-1 Green and gray vinyl with black fibrous backing and red residue Asbestos Fibrous Components: Non-Asbestos Fibrous Components: Non-Fibrous Components: No Asbestos Detected 20% Cellulose 10% Filler and Binder 50% Asphalt Filler and Binder 20% Vinyl Filler and Binder Client Sample Number: 331-13 Lab Sample Number: 12-00401.0039 Client Sample Description: Floor Vinyl with Mastic Tan end White Client Sample Location: 331 Muncie Bathroom(top layer) Sample Comments: Checked If Sample Not Analyzed ❑ Layer 1 Tan and white vinyl Asbestos Fibrous Components: Non-Asbestos Fibrous Components: Non-Fibrous Components: No Asbestos Detected 100% Vinyl Filler and Binder Layer 2 Clear sticky material Asbestos Fibrous Components: Non-Asbestos Fibrous Components: Non-Fibrous Components: No Asbestos Detected 100% Filler and Binder Client Sample Number: 331+14 Lab Sample Number.12.00401.0040 Client Sample Description: Floor Vinyl with Mastic•Brown Client Sample Location: 331 Muncie Laundry/Storage Room(top layer) Sample Comments: Materials distinguishable but Inseparable Checked If Sample Not Analyzed [ ] Black,white,gray and rad vinyl with black fibrous backing and red residue Asbestos Fibrous Components: Non-Asbestos Fibrous Components: Non-Fibrous Components: No Asbestos Detected 15% Cellulose 5% Filler and Binder 40% Asphalt Filler and Binder 40% Vinyl Filler and Binder Client Sample Number: 331-15 Lab Sample Number. 12-00401.0041 Client Sample Description: Floor Vinyl with Mastic-Tan Client Sample Location: 331 Muncie Storage Room(bottom layer) Sample Comments: Materials distinguishable but Inseparable Checked It Sample Not Analyzed El (Sample results continued on next page.) Sampled by: Bob Witherldge 6128/2012 k... C --^^-' --� Received by: Jude Cummings 6/29/2012 Reviewed by: Jude Cummings 7/2/2012 Jude Cummings,Laboratory Manager Page 13 JUL-3-2012 11:21A FROM:WITI-ERIDGE 3603850584 TO:13602750648 P.9/10 215 SW 153rd Street Burlen,WA 98166 OFFICE:(206)988-1746 FAX:(206)96B-1978 GO CP Z E NVLAP Lab Code:200511-0 4444444 NYQrarMt. 1NO. Bulk Asbestos Analysis Report Northwest Asbestos Consultants NIH Batch Number: 12-00401 408 Reed Street Client Job Number: Port Townsend,WA 98388- Tum Around Time: . 8 Osy C Project Location: 321,331,330 Muncie Ave.,Quilcine Samples Analyzed: 44 Red,green and gray vinyl with black fibrous backing and gray residue Asbestos Fibrous Components: Non-Asbestos Fibrous Components: Non-Fibrous Components: No Asbestos Detected 15% Cellulose 5% Filler and Binder 40% Asphalt Filler and Binder 40% Vinyl Filler and Binder Client Sample Number: 331-018 Lab Sample Number: 12-00401.0042 Client Sample Description: Floor Vinyl with Mantic-Gray Pink and Green Client Sample Location: 331 Muncie Center Bedroom Sample Comments: Materials distinguishable but Inseparable Checked II Sample Nal Analyzed U Gray,red and green vinyl with black fibrous asphalt and gray residue Asbestos Fibrous Components: Non-Asbestos Fibrous Components: Non-Fibrous Components: No Asbestos Detected 15% Cellulose 5% Filler and Binder 50% Asphalt Filler and Binder 30% Vinyl Filler and Binder Client Sample Number: 331-17 Lab Sample Number: 12430401.0043 Client Sample Description: Floor Vinyl with Mastic-Gray with Blue and Pink Client Sample Location: 331 Mande Hallway and South Bedroom Sample Comments: Materials distinguishable but Inseparable Checked If Sample Not Analyzed [ ,pink and white vin __.._... Gray, y yl with black fibrous backing and tan residue Asbestos Fibrous Components: Non-Asbestos Fibrous Components: Non-Fibrous Components: No Asbestos Detected 15% Cellulose 5% Filler and Binder 50% Asphalt Filler and Binder 30% Vinyl Filler and Binder Client Sample Number: 331-18 Lab Sample Number: 12-00401.0044 Client Sample Description: Roofing Material Black end Gray Client Sample Location: 331 Muncie Back Side of House Sample Comments: Checked II Sample Not Analyzed [ j White pebbles and black fibrous asphalt Asbestos Fibrous Components: Non-Asbestos Fibrous Components: Non-Fibrous Components: No Asbestos Detected 15% Cellulose 30% Aggregate 55% Asphalt Filler and Binder Sampled by: Bob WItheridge 6/28/2012 ,4. e Received by: Jude Cummings 6/2912012 Reviewed by: Jude Cummings 712/2012 Jude Cummings,Laboratory Manager Page 14 JUL-3-2012 11:228 FRU1:WITF-ERIDGE 3603850584 TO:13602T50618 P.10%10 ,,,,:,-,14::,j5.,-,.4.,..... , "iP •,.. w ¢p9 f ^, u, ° ,wq -�w,e rx R •'4 it spy,•;.?" w 't.;, �IC , r�i 1 . -. rics. * l' w%Q,1h - D� f1;\Jf Y'' rtiAJ`,s?j 0 N i p,..‘ft �9-111:.-6, ' !r( S .." ft .a I , ,✓ }, ;� ; ,,. • , .. Ild v` .r I I4 .1,i r 1' , r1 1 .4i I t_itell0 1 '. r 11r .1111 , r w, �� u JL. LI 4 11/�1 ,..._.~ I 1411 11`n_ .... __-I 1 s , � ,l a, 1111 1 � ,111'if,l d, A 1 �� f1'4b 11 1 1111 IU1 }. Ir 11 ,II4/11 I 1 )I 1 S •� ' VECICERICEMOMM 1�11.m.u. ��111i�,re., ,� I 1 f \n � , \ ' 1 4 o4 JP)'5 ,, ; ._0 • WASHINGTON o', i V' '7 ASSOCIATION of 6 M-r<+d► `l pori r . ,w MAINTENANCE and `, j. V 4 yrs a ,j 6 i ° ' - - OPERATIONS 3r '`', ly 3 �'� ADMINISTRATORS i` Yi - r THIS IS TO CERTIFY THAT Bob4• Witheridge x J ' 4 a Participated in the °4 ya y ..� . � r � n• r EPA AHERA d ' ; � 1..by o.4.1._,,.--,.,.-.42 {'..— • ✓.., mw INSPECTOR, . = .- MANAGEMENT PLANNER '' ' v� . ' , Refresher Course offered by the '`9«atv.)t ::‘f,/:‘'''i r, WASHINGTON ASSOCIATION of MAINTENANCE . �:. .i -- , and OPERATIONS ADMINISTRATORS 1 .:' - rte`''" '";2 {o'�, �'R J�, , The full day training program ::fir I�;.o:.: -`_ covered all topics specified in the - �'j� Model Accreditation Plan under .044.4. . 1 Section 206 of Title II of TSCA a ,C ' . I/ e. __,;:ti,',...),. ...t.,. ? The course was taken on October 21 , 2011 •; .ii 4)1 Ic.c»w in Silverdale, Washington. �, !s z` :_ r Certificate #1021201102 — Expiration October 21 , 2012 o Y •. 4>�`• :,..4.,,..- _ v ; ‘‘,....„. .- ...- 00,4_ .1 ii , Ct- Colin MacRae Course Administrator ir....1..4L: "� '•� !' 2714 228th St, SE, Bothell, WA 98021 ` vz } r ,`5•- (425) 485-698-0 < � $ yobs °:O:n.e:a oo.o:aC0.O:O:ao-, oAoe:a:o:n:oI.:ae'n:n:e;nW:O'D:O oo4ro* FM1 dQ� l On 6 Yi ' 1 '• '� 5.. 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Zr„ u est r !< - � h� �'•+err,„0 `- - J ax _ +s 33o Al u le, A Ue Historic Inventory Report Ar�M�tCADGT S ,16TOiC nemoVATK*4 Location Field Site No. QMR-3 DAHP No. Historic Name: Newman House 3 Common Name: Quilcene Marsh House 3 Property Address: 330 Muncie Ave,Quilcene, WA 98376 Comments: Tax No./Parcel No. el!tor 5-To Plat/Block/Lot Acreage Supplemental Map(s) Township/Range/EW Section 1/4 Sec 1/4 1/4 Sec County Quadrangle T27R02W 24 Jefferson QUILCENE Coordinate Reference Easting: 1058283 Northing: 914984 Projection: Washington State Plane South Datum: HARN(feet, Identification Survey Name: Quilcene Marsh South Restoration Project Date Recorded: 04/24/2013 Field Recorder: Dana,Komen Owner's Name: Hood Canal Salmon Recovery Group Owner Address: City: Belfair State: WA Zip: 98376 Classification:Building Resource Status: Comments: Survey/Inventory Within a District? No Contributing?No )) 1ECEOVIEB National Register: Local District: JUL 2 9 2013 National Register District/Thematic Nomination Name: Eligibility Status: Not Determined-SHPO JEFFERSON COUNTY Determination Date: 1/1/0001 FPI.OF COMMUNITY DEVELOPMENT' Determination Comments: Thursday,May 09.2013 Page 1 of 3 4 . "'`"`"� , °`rcxoc,s Historic Inventory Report Mir, "ctcey PZEMRVATION Description Historic Use: Domestic-Single Family House Current Use: Vacant/Not in Use Plan: L-Shape Stories: 1 Structural System: Graced Frame Changes to Plan: Intact Changes to Interior: Unknown Changes to Original Cladding: Intact Changes to Windows: Moderate Changes to Other: Other(specify): Style: Cladding: Roof Type: Roof Material: None Shingle Gable Side Gable Asphalt/Composition- Shingle Foundation: Form/Type: Post &Pier Single Family-Side Gable Narrative Study Unit Other Architecture/Landscape Architecture Date of Construction: 1950 Built Date Builder: Engineer: Architect: Property appears to meet criteria for the National Register of Historic Places:No Property is located in a potential historic district(National and/or local):No Property potentially contributes to a historic district(National and/or local): No Statement of This small house,built in 1940,has suffered from flood damage and is deteriorated,although mostly Significance: intact. It is currently vacant and in need of repair. It is a common example of modest domestic architecture neither the residence or associated collapsed garage possesses distinction sufficient for National Register of Historic Places eligibility. Description of This residence is a wood frame,one-story building with a semi-rectangular,L-shaped,plan,consisting of a Physical side-gabled main building with a gabled extension to the west. The front entry faces north and is under a Appearance: gabled canopy supported by two wood posts. It contains a wood panel and glass door. Composition shingles covers the roof and the moderately wide eaves are open,with exposed rafter ends and fascia boards. A brick chimney emerges from near the central crest. Exterior wall surfaces are clad with asbestos shingles,with wood corner boards. Most windows are multiple-pane wood sash units. Two small windows are casement types. An under-the-roof,gabled porch extends from the west elevation. A gabled garage is collapsed just to the west of the house. The walls have fallen away,leaving the roof structure,which is missing most of its shingles. Major Komen,Dana, Ryan Ives,and Stephen Emerson 2013 Cultural Resources investigations for the Qulcene Bibliographic Marsh South Restoration Project. Short Report 1170- Archaeological and Historical Services,Eastern References: Washington University,Cheney. Thursday,May 09,2013 Page 2 of 3 "'a:.... MfN!Of ,1101AECO.OGr 6 Historic Inventory Report NQTORIC PRESERVATION Photos '. - \ / r •A r L � ♦1 • - l ) • �. . iA 111141116, s. I View to the south View to the north House, north elevation South(front)elevation 2013 2013 ..' ' \-i .al ll �• T ` t f 111111H-.. View to the southwest House,east elevation 2013 Thursday,May 09,2013 Page 3 of 3 illiU L-3-2012 11:10R FROM:WITHERIDGE 3603850584 TO:13602750648 P.1/10 • 33o M14e NORTHWEST ASBESTOS CONSULTANTS Surveys, Inspection, Sampling AHERA Building Inspector / Mgmt. Planner EPA Certification WAMOA-0042 406 Reed St. Port Townsend,WA 98368 nor thwestasbestosconsultants@cablespeed.com 360-385-0584 DAMI 7/3/12 • 99/ • 2-01 - 510 •p • / Tob Locations: 330 Muncie Ave. Quilcene,WA 98376 Contact Pacific Northwest Salmon Center Renee Rose-Scherdnik 600 NE Roessel Rd. P.O. Box 2169 Belfair,WA 98528 Subject: Demolition Inspector: Bob Witheridge AHERA - Building inspector / Management Planner WAMOA-0042-1021201102 Expires - 10/21/12 JUL-3-2012 11: 118 FRc1:WITHERIDGE 3603850584 TO:13602750618 P.2'10 Scope of work 1) Good faith inspection for asbestos containing building materials (ACBM). 2) Report to Renee Rose-Scherdnik with results from Northern Industrial Hygiene, Inc. Summary Report The inspection started with a visual survey looking for Asbestos Containing Building Material (ACBM). Sample results: 330 Muncie Ave. Sample #1: Exterior siding material. 10% chrysotile asbestos. Approx. 24' x 30' x (9' and 12' Height). Sample #2: Kitchen and dining room top layer floor vinyl with mastic. Yellow 15%chrysotile asbestos. Approx. 240 sq. ft. Sample #3: Kitchen and dining room middle layer floor vinyl with mastic. Tan No asbestos detected. Sample #4: Kitchen and dining room bottom floor vinyl with mastic. Red No asbestos detected. Sample #5: Living room top layer floor vinyl with mastic. Off white pebble pattern with gold flecks, under carpet. 15% chrysotile asbestos. Approx. 180 sq. ft. Sample #6: Living room and hallway bottom layer floor vinyl with mastic. Tan marbled pattern with gold flecks. No asbestos detected. Sample #7: Kitchen wall material. No asbestos detected. Sample #8: Living room ceiling tile. No asbestos detected. Sample #9: Attic insulation. No asbestos detected. Sample #10: Bathroom 12" x 12" floor tile with mastic. Off white. No asbestos detected. Sample #11: Both bedrooms, top layer floor vinyl with mastic. Brown wood pattern. No asbestos detected. Sample #12: Both bedrooms, bottom layer floor vinyl with mastic. Gold No asbestos detected. Sample #13: Wall material, sheet rock mud and tape. No asbestos detected. JUL-3-2012 11:11R FROM:WITFERIDGE 3603850584 TO:13602750648 P.3/10 Sample #14: Window glazing on west side. No asbestos detected. Sample #15: Window glazing on north side. No asbestos detected. Sample #16: Roofing material. No asbestos detected. All asbestos containing building materials with a reading greater than. 1% is considered a hazardous material if disturbed.. If removed a certified abatement contractor must follow the rules of the EPA and governed by Olympic Region Clean Air Agency. During demolition it is possible that additional suspect asbestos containing building material (ACBM) may be found. Should such suspect material be discovered an AHERA certified inspector will have to sample and test the material to prove it is of non- asbestos. Northwest Asbestos Consultants is not responsible for identification of hidden materials that are not identifiable with reasonable diligence. After the facility is completely cleaned out a walk through and inspection is required by the original AHERA building inspector (NW Asbestos) after abatement, then a copy of the letter certifying that abatement has been completed needs to be received by the local permit center and Olympic Region Clean Air Agency. Thank you, get Bob Witheridge, E.F.M. JUL-3-2012 11:11A FROM:WITHERIDGE 3603850584 T0:13602750648 P.4'10 215 SW 153rd Street Burlen,WA 98166 OFFICE:(206)988-1746 FAX:(206)988-1978 ■ SAIL ■■vo■r<■s,r■■c- NVLAP Lab Code:200511-0 Bulk Asbestos Analysis Report Northwest Asbestos Consultants NIH Batch Number: 12-00401 406 Reed Street Client Job Number: Port Townsend,WA 80368- Turn Around Time: 5 Day C Protect Location: 321,331,330 Muncie Ave.,Qui/c/ne Samples Analyzed: 44 White and gold coating on medium brown compressed fibrous material Asbestos Fibrous Components: Non-Asbestos Fibrous Components: Non-Fibrous Components: No Asbestos Detected 85% Cellulose 5% Coating 10% Filler and Binder Cliem Sample Number; 330-1 Lab Sample Number: 1240401.0011 Client Sample Description: Siding Material Client Sample Location: 330 Muncie-Exterior Sample Comments: Materials distinguishable but inseparable Checked If Sample Not Analyzed [ ] Gray and white paint on gray fibrous hard material Asbestos Fibrous Components: Non-Asbestos Fibrous Components: Non-Fibrous Components: 104I4 Chrysotile Asbasios -. . 10% Paint 80% Filler and Binder Client Sample Number: 330-2 Lab Sample Number. 12-00401.0012 Client Sample Description: Floor Vinyl with Mestic-Yellow Client Sample Location: 330 Muncie•Kitchen&Dining Roo(Top Layer) Sample Comments: Materials distinguishable but Inseparable Checked If Sample Not Analyzed f Yellow vinyl with off-white fibrous backing and gold residue Asbestos Fibrous Components: Non-Asbestos Fibrous Components: Non-Fibrous Components: 15% Chrysolite Asbestos 40% Filler and Binder 45% Vinyl Filler and Binder Client Sample Number: 330-3 Lab Sample Number: 12-00401.0013 Client Sample Description: Floor Vinyl with Mastic-Tan Client Sample Location: 330 Muncie-Kitchen&Dining Room(middle Layer) Sample Comments: Materials distinguishable but inseparable Checked If Sample Not Analyzed [" Tan vinyl with black fibrous backing and dark brown residue Asbestos Fibrous Components: Non Asbeslos Fibrous Components: Non-Fibrous Components: No Asbestos Detectedo 15/o Cellulose 10% Filler and Binder 40% Asphalt Filler and Binder 35% Vinyl Filler and Binder (Sample results continued on next page.) Sampled by: Bob Witherldge 6/28/2012 Received by: Jude Cummings 6128/2012 Reviewed by: Jude Cummings 712/2012 Jude Cummings,Laboratory Manager Page 4 3-2012 11.: 12I1 FROM:klITt RIDGE 3E038525E14 TO:13602750E4B P.5'10 • • 215 SW 153rd Street Burien,WA 98166 OFFICE:(206)986-1746 FAX:(206)988.1978 H O Z T H E I N NVLAP Lab Code:200511-0 1 IAL MYOINN•.IMC. Bulk Asbestos Analysis Report Northwest Asbestos Consultants NIH Batch Number. 12-00401 406 Reed Street Client Job Number: Port'Townsend,WA 96368- Tum Around Time: 5 Day Project Location: 321,331,330 Muncie Ave.,Quiicine Samples Analyzed: 44 Client Sample Number: 3304 Lab Sample Number. 12.00401.0014 Client Sample Description: Red Floor Vinyl with Mastic Client Sample Location: 330 Muncie-Kitchen&Dining Room(bottom layer) Sample Comments: Materials distinguishable but Inseparable Checked If Sample Not Analyzed L7 Red vinyl and brown ue Asbestos Fibrous Components:lak fibrous -NoonAsbestos Fibrous Components: Non-Fibrous Components No Asbestos Detected 15% Cellulose 10% Filler and Binder 40% Asphalt Filler and Binder 35% Vinyl Filler and Binder Client Sample Number: 330-5 Lab Sample Number. 12-00401.0015 Cliieni Sample Description: Floor Vinyl with Mastic,Off-white Pebble Pattern with Gold Flecks Client Sample Location: 330 Muncie-Living Room(top layer) Sample Comments: Materials distinguishable but inseparable Checked If Sample Not Analyzed (i While pebble pattern vinyl with all-white fibrous backing and tan residue Asbestos Fibrous Components: Non-Asbestos Fibrous Components: Non-Fibrous Components: __156.chrysotile Asbestos. _ - 35% Filler and Binder 50% Vinyl Filler and Binder Client Sample Number: 330-6 Lab Sample Number: 1240401.0016 Client Sample Description: Floor Vinyl with Mastic,Tan Marble Pattern with Gold Flecks Client Sample Location: 330 Muncie-Living Room end Hallway(bottom layer) Sample Comments: Materials distinguishable but Inseparable Checked If Sample Not Analyzed r Oft-white,tan and gold marble look vinyl with black fibrous backing ens brown residue Asbestos Fibrous Components: Non-Asbestos Fibrous Components: Non-Fibrous Components: No Asbestos Detected 15% Cellulose 5% Filler and Binder 40% Asphalt Filler and Binder 40% Vinyl Filler and Binder Client Sample Number: 330-7 Lab Sample Number. 1240401.0017 Client Sample Description: Wall Materiel Client Sample Location: 330 Muncle-Xitchen Sample Comments: Checked If Sample Not Analyzed [i (Sample results continued on next page.) Sampled by: Bob Witherldge 6/2812012 e Received by: Jude Cummings 6/29/2012 Reviewed by: Jude Cummings 712)2012 Jude Cummings,LaboratoryManager Page 5 JUL-3-2012 11:12A FRt'1:WITl-ERIDGE 3603850584 TO:1360275O648 P.6/10 215 SW 153rd Street Sudan,WA 98168 [�] Z T E tZ N OFFICE:(206)986-1746 FAX:(206)988-1978 NVLAP Lab Code:200511.0 P PAL NVPlrPLNPI, MO. Bulk Asbestos Analysis Report Northwest Asbestos Consultants NIH Balch Number: 12-00401 406 Reed Street Client Job Number: Port Townsend,WA 98368- Turn Around Time: 5 Day C Project Location: 321,331,330 Muncie Ave.,Quilcine Samples Analyzed: 44 Layer 1 ON-white vinyl with black fibrous backing Asbestos Fibrous Components: Non-Asbestos Fibrous Components: Non-Fibrous Components: No Asbestos Detected 22% Cellulose 40% Asphalt Filler and Binder 38% Vinyl Filler and Binder Layer 2 Dark brown mastic Asbestos Fibrous Components: Non-Asbestos Fibrous Components: Non-Fibrous Components: No Asbestos Detected 5% Cellulose 95% Filler and Binder Layer 3 Tan paper and white compressed powder Asbestos Fibrous Components: Non-Asbestos Fibrous Components: Non-Fibrous Components: No Asbestos Detected 25% Cellulose - 75% Filler and Binder Client Sample Number: 330.8 Lab Sample Number: 12-00401.0016 Client Sample Description: Ceiling Tile Client Sample Location: 330 Muncie Living Room Sample Comments: Materials distinguishable but Inseparable Checked If Sample Not Analyzed ri White paint and medium brown compressed fibers Asbestos Fibrous Components: Non-Asbestos Fibrous Components: Non-Fibrous Components: No Asbestos Detected 85% Cellulose 5% Paint 10% Filler and Binder Client Sample Number: 330-9 Lab Sample Number: 12-00401.0019 Client Sample Description: Insulation Client Sample Location: 330 Muncie Attic Sample Comments: Checked If Sample Not Analyzed p7 Medium brown loosely compressed fibers Asbestos Fibrous Components: Non-Asbestos Fibrous Components; Non-Fibrous Components: No Asbestos Detected 100% Mineral Wool Client Sample Number: 330.10 Lab Sample Number: 12-00401.0020 Client Sample Description: OR-white 12"x12"Floor Tile with Mastic Client Sample Location: 330 Muncie Bathroom Sample Comments: Checked If Sample Not Analyzed [ (Sample results continued on next page.) Sampled by: Bob Witherldgo 6/26/2012 Received by: Jude Cummings 8129/2012 Reviewed by: Jude Cummings 712/2012 Jude Cummings,Laboratory Manager Page 6 JUL-3-2012 11:134 FROM:WITI-ERIDGE 3603850584 TO:1360275E648 P.7'10 215 SW 153rd Street Burlen,WA 98168 OFFICE:(206)988-1746 FAX:(206)908-1978 NVLAP Lab Code:200511-0 1NOUa1TNIAL MYOIWM•16 IMO. Bulk Asbestos Analysis Report Northwest Asbestos Consultants NIH Balch Number: 12-00401 406 Reed Street Client Job Number: Port Townsend,WA 98368- Turn Around Time: 6 Day C Project Location: 321,331,330 Muncie Ave.,Quilcine Samples Analyzed: 44 Layer 1 White vinyl Asbestos Fibrous Components: Non-Asbestos Fibrous Components: Non-Fibrous Components: No Asbestos Detected 30% Aggregate 7O% Vinyl Filler and Binder Layer 2 Yellow mastic Asbestos Fibrous Components: Non-Asbestos Fibrous Components: Non-Fibrous Components: No Asbestos Detected 3% Cellulose 97% Filler and Binder • Client Sample Number: 330-11 Lab Sample Number:12-00401.0021 Client Sample Description: Floor Vinyl with Mastic,Brown Wood Pattern Client Sample Location: 330 Muncie-Both Bedrooms(top layer) Sample Comments: Checked If Sample Not Analyzed ( I Layer 1 Yellow foam with clear sticky material Asbestos Fibrous Components: Non-Asbestos Fibrous Components: Non-Fibrous Components: No Asbestos Detected 3% Synthetic 5% Filler and Binder 92% Foam Layer 2 Brown wood grain pattern vinyl with black fibrous backing Asbestos Fibrous Components: Non-Asbestos Fibrous Components: Non-Fibrous Components: No Asbestos Detected 20% Cellulose 45% Asphalt Filler and Binder 35% Vinyl Filler and Binder Layer 3 Brown mastic Asbestos Fibrous Components: Non-Asbestos Fibrous Components: Non-Fibrous Components: No Asbestos Detected 5% Cellulose 95% Filler and Binder • Client Sample Number: 330-12 Lab Sample Number. 12-004014022 Client Sample Description: Flor Vinyl with Mastic-Gold Client Sample Location: 330 Muncie-Both Bedrooms(bottom layer) Sample Comments: Materials distinguishable but inseparable Checked If Sample Not Analyzed Brown and gold vinyl with black fibrous backing and residue Asbestos Fibrous Components: Non-Asbestos Fibrous Components: Non-Fibrous Components: No Asbestos Detected 25% Cellulose 5% Filler and Binder 50% Asphalt Filler and Binder 20% Vinyl Filler and Binder (Sample results continued on next page.) Sampled by: Bob Witherldge 6/28/2012 Received by: Jude Cummings 6/28/2012 Reviewed by: Jude CummIngs 7/2/2012 Jude Cummings,Laboratory Manager Page 7 JUL-3-2012 11:13R FRO11:NITHERIDGE 3603850584 TO:13602750E48 12.8/10 215 SW 153rd Street Sudan,WA 96166 O Z T 1'i E e N OFFICE:(206)988-1746 FAX:(206)988.1978 NVLAP Lab Code:200511-0 11•101.11111•11/111, NVOIRNt. INC. Bulk Asbestos Analysis Report Northwest Asbestos Consultants NIH Belch Number: 12.00401 406 Reed Street Client Job Number: Port Townsend,WA 08368- Turn Around Time: 5 Day C Project Location: 321,331,380 Muncie Ave.,Oullcine Samples Analyzed: 44 Client Sample Number: 330.13 Lab Sample Number: 12-00401.0023 Client Sample Description; Sheetrock,Mud and Tape Client Sample Location: 330 Muncie Wall Sample Comments: Checked If Sample Not Analyzed LI • Layer 1 White and blue paint with white compressed powdery material Asbestos Fibrous Components: Non-Asbestos Fibrous Components: Non-Fibrous Components: No Asbestos Detected 5% Mineral Fibers 30% Paint 65% Filler and Binder Layer 2 White paper ..._ y_._ Asbestos Fibrous Components: Non-Asbestos Fibrous Components: Non-Fibrous Components: No Asbestos Detected 88% Cellulose 12% Filler and Binder • • Layer 3 Tan paper and white compressed powder Asbestos Fibrous Components: Non-Asbestos Fibrous Components: Non-Fibrous Components: No Asbestos Detected 15% Cellulose 20% Perlite 65% Filler and Binder Client Sample Number: 330-14 Lab Sample Number. 12.00401.0024 Client Sample Description; Window Glazing Client Sample Location: 330 Muncie West Side Sample Comments: Materials distinguishable but inseparable Checked It Sample Not Analyzed [ j Brown and white paint on white compressed powdery material Asbestos Fibrous Components: Non-Asbestos Fibrous Components: Non-Fibrous Components: No Asbestos Detected 2% Wollastonite 30% Paint 68% Filler and Binder Client Sample Number: 330-15 Lab Sample Number: 12-00401.0025 Client Sample Description: Window Glazing Client Sample Location: 330 Muncie on North Side Sample Comments: Materials distinguishable but Inseparable Checked If Sample Not Analyzed [ Various colors of paint and white compressed powder Asbestos Fibrous Components: Non-Asbestos Fibrous Components: Non-Fibrous Components: No Asbestos Detected 25% Paint 75% Filler and Binder (Sample results continued en next page.) Sampled by: Bob Witherldge 6/2812012 ti- a� L� 6.•m--••^----Yo Received by: Jude Cummings 6/2912012 Reviewed by: Jude Cummings 7/2/2012 Jude Cummings,Laboratory Manager Page 8 JUL-3-2012 11:136 FROM:WITFERIDGE 3603850584 TO:13602750649 P.9/10 215 SW 153rd Street Burton,WA 98166 OFFICE:(206)668-1748 FAX:(205)9691978 NORTHERN NVLAP Lab Coda:200511-0 O A AVL AV• GNI&IMO. Bulk Asbestos Analysis Report Northwest Asbestos Consultants NIH Batch Number. 1090401 405 Reed 5traat Client Job Number Pon Townsend,WA 50365- Turn Around Time: 4 Day C Project Location: 921,331,330 Muncie Ave.,()WWII(' Samples Analyzed: 44 Cltanl Sample Number: 330.16 Lab Sample Number:12.00481,0026 Giem Sample Description: Rooting Malarial Chem Sample Location: 330 Muncic Rod Sample Comments: Checked ti Sample Not Analyzed F1 Layer 1 Brown and tan pebbles on bleak Introits asphalt Asbestos Fibrous Components: Non-Asbestos Fibrous Components: Non-Flbroua Components: No Asbestos Detected 15% Fiberglass 35% Aggregate 50% Asphalt Filler and Hinder JUL-3-2012 11:14A FROM:WITHERIDGE 3603850584 TO:17A0R750643 F.10/10 9 ✓. u ,.``—'-' ...«. r poglti•g` r'rax./t,�ry7, r . .. H s sIA 1[t .. w ,1'� 111 /. 02 >}1 IP '. I 0. 1, i - .Q f, -. hr n(f CY � t \r ^ 7N def tf� 0 �„�7�i°N e.F O P‘:;14,', � 3 ihr. r(1�;1 (l Z77 1 0 � {�, �,• , nlr9R Ili I/I I' I � I1111�It �1� I'e t 1�1111/;� �Mx t'le 1 :o,�Ir1o,//111 1 ��-. !,1 Ivo ��rl/, , 11 'i� � ''- _ o i 1 , ��•Y JJ •� T .. 1 [ t�3A1 111 I i.lY� II /1 T(�`' 40,10-i) �YYY�IIII O O �i O �O V` IUPC _. 6 +i O p. . •O O' .i{. :n 1 r A= oh at 1 _ � r�Q WASHINGTON P _ .. 4- l; - . ASSOCIATION of '`- ' Uoi> o I 9 �.I'. l( 1 i 4.41,, MAINTENANCE and �'' 4 a p. o . r"• 1. tk �• e iy OPERATIONS ' r �`, r , • __ =; :° ADMINISTRATORS {'C 0 ) !d° C` h :, THIS IS TO CERTIFY THAT " 4.7_ � �J°` U( ' 4. - a ' - z I _l 1• tom°: Bob Witheridge ,f , ,, - X50 : • Participated in the ,, '' `,. , z ,L, � EPA AHERA = � ' INSPECTOR, �? �u� ,. V' ` Y MANAGEMENT PLANNER , ;xI ` ! 'r j<:,)ate � : wi; - ..; `=-= �� Refresher Course offered bythe _- ;:,k -, +,� Vit ti� Vn e 1 ;�•x'. t> o WASHINGTON ASSOCIATION of MAINTENANCE '-- .... !`. • `-i =- and OPERATIONS ADMINISTRATORS — 4 Z) x, / of 0..t_ ;_ ,._ The full day training program ` I ;' '-- e ` covered all topics specified in the I> '''.:j-V2:- .t.--.--.. r Y -. _ o ; Model Accreditation Plan under /" !k*.: p„4c ►s f 'w e Section 206 of Title II of TSCA , As pC / .-",' ""'44.‘...r•1{ 'x a Ja r.. '�, '�'-O`4,s,b The course was taken on October 21 , 2011 g' )4,..F-).„....A: a in Silverdale, Washington. a ° Certificate #1021201102 — Expiration October 21 , 2012 p� 764°? .Sy):• .' I, i•y- R I .* ✓ I It, 1 1 - 10 t �r -0411G0119 i '° p•6w ; Cohn MacRae Course Administrator , ` •,it ,,, - 0 2714 228th St SE, Bothell, WA 98021 i� ' n$ I ; (425) 485-6980 _--- �' ,� a o ; , : - o:e:e.a'o:ao:o:o:o.%o:o:eao:o.o:o'arao.otd:a:o:?a vlolo:o:•;p;a;a:0.a:o:o eq A[¢o:oro.otC.4o.o-as o:o:eroto.e.o:u.o.oo.o:%o:o'epro:o;otae.o:owevxce;o o:ome:o:ao,o. wxtl ,:.: a2 ,(�Y4S^iMn w`3..:/ ,,I/4+1,i1i�°3:5'fi�•a,.t��I�II4IlOs 1,1 Lp Q1 ',��yP{�73'"]), �;Il,,lgA.-t,-SL:.4*,,II'//'III..t.;4rE -Its 1}41/I'Pp,.`I 4k—'4•L -kr ,1 il-W2 A• .. a':,:1�Ii iB{+�II r e.�M S4.1 °' '2 _ 040,0 +'011 ' 014 4"t10,1:414,10!A4,01110a! e1..'� l�), �y�l�pp l n ,7:`r.li "i.�� � 'T.df,':. F �� .��i`4''io x �'04* Al ..'e. etre{ ,�. i11 ,ge,.• P 17�� �IF� lid (, .� s 'mss,, d' sq a• ��' 1:� 4 � r S ' ��'V + �I M1 �{J ' M1 1 •45 . ivy �+� (" { �, �• P hl'rN-11v11PVay1t!. ,-l' ,Wc�y�'' 7 '!,*1 4; r;,:za,..`k V �;1.4 i°[51ix ,I`A?V ,2 z01 p ue ,R ''1l',/,) x - o- 3zi eve. Ave . get .atH.coi.Ocr s Historic Inventory _ •ort HISTORC MSEi vAnci Location Field Site No. QMR-1 DAHP No. Historic Name: Newman House 1 Common Name: Qcilcene Marsh House 1 Property Address: 321 Muncie Ave,Quilcene,WA 98376 Comments: I `C �� _ Tax No./Parcel No. 991201514 Plat/Block/Lot Acreage<one Supplemental Map(s) Township/Range/EW Section 1/4 Sec 1/4 1/4 Sec County Quadrangle T27R02W 24 Jefferson QUILCENE Coordinate Reference Easting: 1058230 Northing: 915006 Projection: Washington State Plane South Datum: HARN(feet) Identification Survey Name: Quilcene Marsh South Restoration Project Date Recorded: 04/24/2013 Field Recorder: D.Komen Owner's Name: Hcod Canal Salmon Enhancement Group Owner Address: City: Belfair State: WA Zip: Classification:Building Resource Status: Comments: Survey/Inventory Within a District? No Contributing?No National Register: 1E0E] Local District: National Register District/Thematic Nomination Name: 1u L 2 9 20 3 Eligibility Status: Not Determined-SHPO V Determination Date: 1/1/0001 JEFFERSON COUNTY Determination Comments: DEPT.OF COMMENT Thursday,May 09.2013 Page 1 of 3 o""6t °`s. Historic Inventory Report .46101..PiMekvAnGn Description Historic Use: Domestic-Single Family House Current Use: Vacant/Not in Use Plan: Irregular Stories: 1 Structural System: Braced Frame Changes to Plan: Unknown Changes to Interior: Unknown Changes to Original Cladding: Unknown Changes to Windows: Extensive Changes to Other: Other(specify): Style: Cladding: Roof Type: Roof Material: None Shingle Gable Asphalt/Composition - Shingle Foundation: Form/Type: Post&Pier Single family Narrative Study Unit Other Architecture/Landscape Architecture Date of Construction: 1940 Built Date Builder: Engineer: Architect: Property appears to meet criteria for the National Register of Historic Places:No Property is located in a potential historic district(National and/or local):No Property potentially contributes to a historic district(National and/or local): No Statement of This simple cottage was built in 1940. It appears to have suffered flood damage and is highly deteriorated Significance: and abandoned. Aside from its poor condition,it is a common example of modest domestic architecture and does not exhibit sufficient distinction to warrant National Register of Historic Places eligibility. The same is true for the associated shed. Description of This one-story wood frame residence consists of a central gabled section flanked on either side by shed Physical roof extensions. The front entry is situated on the south elevation beneath a gabled canopy. The Appearance: foundation is post and pier. The roof,clad with moss-covered composition shingles,has moderately wide, open eaves. An east elevation former picture window has been partially filled in and replaced with a smaller wood sash picture window. Other windows are wood sash casement units with multiple panes. Wood shingles and vertical board cover exterior walls. The latter is present on the north shed-roofed extension,which appears to be a partially open back porch. The house is in extremely deteriorated condition,with some windows breached. North of the house is a wood frame gabled shed nearly covered by a blackberry thicket. Many roof shingles are missing. Exterior wall surfaces are mostly clad with wood shingles. The southern portion of the building beneath the roof is open on the sides. Major Komen,Dana,Ryan Ives,and Stephen Emerson. 2013 Cultural Resources Investigations for the Quilcene Bibliographic Marsh South Restoration Project,Jefferson County,Washington. Short Report 1170. Archaeological and References: Historical Services, Eastern Washington University,Cheney. Thursday,May 09,2013 Page 2 of 3 4 AK.HA"`" °` Historic Inventory Report -fl5TQ C PRESERVATION Photos 4 old l }1� it s.. • .. 4.T'� I ._ . r . wn View to the west View to the northeast House,east elevation House,south and east elevations 2013 2013 r le. \ �i'' _ i /ice 4' iii j iiii VI • p View to the southwest House,east and north elevations 2013 Thursday,May 09,2013 Page 3 of 3 JAL-3-2012 11:03R FROM:WITHERIDGE 3603856584 TO:13602750648 P.2/9 32j /11emc/c 01)49 NORTHWEST ASBESTOS CONSULTANTS Surveys, Inspection, Sampling AHERA Building Inspector / Mgmt. Planner EPA Certification WAMOA-0042 406 Reed St. Port Townsend,WA 98368 northwestasbestosconsultants@cablespeed.com 360-385-0584 per: 7/3/12 ?arrAQ : `IRI 2( • SGZ 'fob Locations: 321 Muncie Ave. Qpilcene,WA 98376 Contact: Pacific Northwest Salmon Center Renee Rose-Scherdnik 600 NE Roessel Rd. P.O.Box 2169 Belfair,WA 98528 Subject: Demolition Jpspector: Bob Witheridge AHERA - Building inspector / Management Planner WAMOA-0042-1021201102 Expires - 10/21/12 JUL-3-2012 11:04A FR011:WITFERIDGE 3603850584 TO:13602750648 P.3'9 Scope of work 1) Good faith inspection for asbestos containing building materials (ACBM). 2) Report to Renee Rose-Scherdnik with results from Northern Industrial Hygiene, Inc. Summary Report The inspection started with a visual survey looking for Asbestos Containing Building Material (ACBM). Sample results: 7 M n ie AvQ- Sample #1: Roofing material. White No asbestos detected. Sample #2: Roofing material. Red No asbestos detected. Sample #3: Window glaze. No asbestos detected. Sample #4: Skirting material. 18% chrysotile asbestos. Perimeter approx. 30' x 30' x 2' Sample #5: Living room floor vinyl with mastic. Green pebble pattern. 15% chrysotile asbestos.Approx. 240 sq. ft. Sample #6: Living room floor vinyl with mastic. Green wood pattern. No asbestos detected. Sample #7: Living room floor vinyl with mastic. Wood pattern. No asbestos detected. Sample #8: Bedroom floor vinyl with mastic. Tan. stone pattern. 12% chrysotile asbestos. Approx. 96 sq. ft. Sample #9: Bathroom floor vinyl with mastic. Gold 12% chrysotile asbestos. Approx. 30 sq. ft. Sample #10: Ceiling tile. No asbestos detected. JUL-3-2012 11:04R FROM:14ITHERIDGE 3603850584 TO:13602750648 P.4/9 215 SW 153rd Street Burlen,WA 98166 OFFICE:(206)988-1746 FAX:(206)988.1976 lila O R T 11 E iZ N NVLAP Lab Code:200511.0, aikaws sweat.wvnra<Nat, ma. Bulk Asbestos Analysis Report Northwest Asbestos Consultants NIH Batch Number: 12-00401 408 Reed Street Client Job Number: Port Townsend,WA 08368- Turn Around Time: 6 Day C • Project Location: 321,331,330 Muncie Ave.,Qullclne Samples Analyzed: 44 Client Sample Number: 321-1 Lab Sample Number: 1240401.0001 Client Sample Description: Roofing Material-White Client Sample Location: 321 Muncie•Roof Sample Comments: Metarlaia distinguishable but Inseparable Checked If Sample Not Analyzed [" White costing on black fibrous asphalt Asbestos Fibrous Components: Non-Asbestos Fibrous Components: Non-Fibrous Components: No Asbestos Detected 15% Cellulose 10% Aggregate 20% Coating 55% Asphalt Filler and Binder Client Sample Number: 321.2 Lab Sample Number.12-00401.0002 Client Sample Description: Roofing Material•Red Client Sample Location: 321 Muncie•Roof Sample Comments: Checked If Sample Not Analyzed j.j Red and white pebbles and black fibrous asphalt Asbestos Fibrous Components: Non-Asbestos Fibrous Components: Non-fibrous Components: No Asbestos Detected 15% Cellulose 35% Aggregate 50% Asphalt Filler and Binder Client Sample Number: 321-3 Lab Sample Number: 1240401.0003 Client Sample Description: Window Glaze Client Sample Location: 321 Muncie•3 Sample Comments: Materials disUngulahable but Inseparable Checked II Sample Not Analyzed fl Red paint on gray and white compressed material Asbestos Fibrous Componenla: Non-Asbestos Fibrous Components: Non-Fibrous Components: No Asbestos Detected 1% Cellulose _ 30% Paint — _ 69% Filler and Binder Client Sample Number: 3214 T Lab Sample Number: 12-00401.0004 Client Sample Description: Skirting Material Client Sample Location: 321 Muncie Skirl Sample Comments: Materials distinguishable but Inseparable Checked If Sample Not Analyzed LI (Sample results continued on next page.) Sampled by: Bob Wltheridge 8128/2012 .k-.- e ,--- —y-. Received by: Jude Cummings 8/26/2012 Reviewed by: Jude Cummings 7/2/2012 Jude Cummings,Laboratory Manager Page 1 JUL-3-2012 11:04A FROM:WITHERIDGE 3603850584 TO:13602750648 P.5/9 215 SW 153rd Street Burlen,WA 98166 OFFICE:(206)968.1746 FAX:(206)988-1976 . NORTHERN NVLAP Lab Code:200511-0 ..L HWOIU 1 . IPSO. Bulk Asbestos Analysis Report Northwest Asbestos Consultants NIH Batch Number: 12-00401 406 Reed Street Client Job Number: Port Townsend,WA 98368- Turn Around Time: 5 Day C Project Location: 321,331,330 Muncie Ave.,Quilcine Samples Analyzed: 44 Oft-white paint end white fibrous material Asbestos Fibrous Components: Non-Asbestos Fibrous Components: Non-Fibrous Components: ' 18% ChrysotilbAsbestos 10% Paint 72% Filler and Binder Client Sample Number: 321-5 Lab Sample Number: 12-00401.0005 Client Sample Description: Floor Vinyl with Mastic•Green Pebble Pattern Client Sample Location: 321 Muncie-Living Room Semple Comments: Materials distinguishable but Inseparable Checked If Sample Not Analyzed Li Green peebie pattern vinyl with off-white fibrous backing end brown residue Asbestos Fibrous Components: Non-Asbestos Fibrous Components: Non-Fibrous Components: TS%_ONSOt(Ie 40% Filler and Binder 45% Vinyl Filler and Binder Client Sample Number: 321.6 Lab Sample Number: 12-00401.0008 Client Sample Description: Floor Vinyl with Mastic-Green Wood Pattern Client Sample Location: 321 Muncie-Living Room Sample Comments: Checked If Sample Not Analyzed.l Layer 1 Green wood grain pattern vinyl Asbestos Fibrous Components: Non-Asbestos Fibrous Components: Non-Fibrous Components: No Asbestos Detected 1% Cellulose 99% Vinyl Filler and Binder Layer 2 Clear sticky material with residue Asbestos Fibrous Components: Non-Asbestos Fibrous Components: Non-Fibrous Components: No Asbestos Detected 3% Cellulose 30% Miscellaneous Materials 5% Hair 62% Filler and Binder Client Sample Number: 921-7 Lab Sample Number: 12-00401.0007 Client Sample Description: Floor Vinyl with Mastic-Wood Pattern Client Sample Location: 321 Muncie-Living Room Sample Comments: Checked If Sample Not Analyzed Li (Sample results continued on next page.) Sampled by: Bob WRhsrldge 8!28/2012 ti -t, e Received by: Jude Cummings 6129/2012 Reviewed by: Jude Cummings 7/2/2012 Jude Cummings,Laboratory Manager Page 2 JUL-3-'2012 11:0511 FROM:WITHERIDGE 3603850584 TO:1360275 .48 P.6/9 215 SW 153rd Street Burten,WA 98166 • OFFICE:(206)966-1746 FAX:(206)988-1978 NORTHERN NYLAP Lab Code:200511-0 'AIL firmsNR,,NO- Bulk Asbestos Analysis Report Northwest Asbestos Consultants NIH Batch Number: 12-00401 408 Reed Street Client Job Number: Port Townsend,WA 88368- Turn Around Time: 5 Day C Project Location: 321,331,330 Muncie Ave.,QuiIcine Samples Analyzed: 44 Layer 1 Brown wood grain pattern vinyl Asbestos Fibrous Components: Non-Asbestos Fibrous Components: Non-Fibrous Components: No Asbestos Detected 100% Vinyl Filler and Binder Layer 2 Clear sticky material Asbestos Fibrous Components: Non-Asbestos Fibrous Components: Non-Fibrous Components: No Asbestos Detected 12% Miscellaneous Materials 88% Filler and Binder Layer 3 White compressed powder Asbestos Fibrous Components: Non-Asbestos Fibrous Components: Non-Fibrous Components: No Asbestos Detected 3% Cellulose 97%.Filler and Binder Client Sample Number: 321.8 Lab Sample Number. 12-00401.0008 Client Sample Description: Floor Vinyl with Mastic-Tan Stone Pattern Client Sample Location: 321 Muncie-Bedroom Sample Comments: Checked II Sample Not Analyzed [ j White stone pattern vinyl with off-white fibrous backing and brown residue Asbestos Fibrous Components: Non-Asbestos Fibrous Components: Non-Fibrous Components: 1254 QhrysotIle Asbestos 5% Cellulose 35% FIller and Binder 48% Vinyl Filler and Binder Client Sample Number: 321-9 Lab Sample Number:1240401.0009 Client Sample Description: Floor Vinyl with Mastic-Gold Client Sample Location: 321 Munde•Bathroom Sample Comments: Materials distinguishable but Inseparable Checked If Sample Not Analyzed C -I Gold end tan vinyl with off-white and blue fibrous backing Asbestos Fibrous Components: Non-Asbestos Fibrous Components: Non-Fibrous Components: 12%.Chrysgtlis Asbestos 40% Filler and Binder 48% Vinyl Filler and Binder Client Sample Number: 321-10 Lab Sample Number:12-00401.0010 Client Sample Description: Ceiling Tile Client Sample Location; 321 Mirada Semple Comments: Materials distinguishable but Inseparable Checked If Sample Not Analyzed [-( (Sample results continued on next page.) • Sampled by: Bob Witheridge 6128/2012 � y . e �- -----moo Received by: Judo Cummings 6(29/2012 Q' Reviewed by: Jude Cummings 7/2/2012 Jude Cummings,Laboratory Manager page 3 JUL-3-2012 11:05R FROM:WITHERIDGE 3603850584 TO:13602750648 P.7/S 215 SW 153rd Street Burlen,WA 98166 OFFICE:(206)988.1746 FAX:(206)988-1978 1�O Z T H E R N NVLAP Lab Code:200511-0 N IAl illrall114111, IMC. Bulk Asbestos Analysis Report Northwest Asbestos Consultants NIH Batch Number 12-00401 406 Reed Street Client Job Number: Port Townsend,WA 98368- Turn Around Time: 5 Day C Project Location: 321,331,330 Muncie Ave.,Ouiicine Samples Analyzed: 44 White end gold coating on medium brown compressed fibrous material Asbestos Fibrous Components: Non-Asbestos Fibrous Components: Non-Fibrous Components: No Asbestos Detected 65% Cellulose 5% Coating 10% Filler and Binder JUL-3-2012 11:05A FROM:WITHERIDGE 3603850584 TO:13602750648 P.8/9 All asbestos containing building materials with a reading greater than 1% is considered a hazardous material if disturbed. If removed a certified abatement contractor must follow the rules of the EPA and governed by Olympic Region Clean Air Agency. During demolition it is possible that additional suspect asbestos containing building material (ACBM) may be found. Should such suspect material be discovered an AHERA certified inspector will have to sample and test the material to prove it is of non- asbestos. Northwest Asbestos Consultants is not responsible for identification of hidden materials that are not identifiable with reasonable diligence. After the facility is completely cleaned out a walk through and inspection is required by the original AHERA building inspector (NW Asbestos) after abatement, then a copy of the letter certifying that abatement has been completed needs to be received by the local permit center and Olympic Region Clean Air Agency. Thank(hyou, BobP�10 Witheridge,oE. .M. JUL-3-2012 11:06R FROPI:WITHERIOGE 3603850584 TO:13602750648 P.9z9 n1 ,c: .. :;;.- J� ..."'751 ,---4&:!- --.---' +r' 79'-4f��y^'M• hy ., ill ./mss. f �9•�-�..�. �! �. �a 1F 1.[�q4 -TP'�" 11�'r • I� {�lY - t 1.i( Of ,qlY 1` ' 'A§'' l i '�5 ,I'r .J.IN+p 0�F a USN ,...,.2-501,41� fi � 4,,.:=11., �Il.1r* 1,I �'1i�4 t�o7s -_ iA�.rou• r3, ; .1. ..'14.297 +1 llolll li r '� J�-..y "4 "4 1{101 Ili Qv 1s 0.1/, „t .VI )I Moles/ 1 We ll 19.111 '' y F�Iq rl'`I,/1 hi ifr A.1J_� 1,1+00, { 4,41‘4 1 11 ""11 11 11 1 1, 11 . 1,1, 11,1 1,11 ,1 1,111"11 4t ti� ti �11N1 tF� �•*,�Ill�i� :� f •��i�glt/1 s%�f VoIs- c_�1 111�� .� Iµfi.d ��� ,,,,-Z�s)!1 ' oe•e:o0000olio: ao.11.11:0.11'11 0.4.4.0.0.00 a.o•o,0.0:060. .0.O.o.O.O:o.e.00.000.090:0:0:0.0'0:0.6ee e0.a11;a;e00.0.011.0'0.00.0.0.0.0,0.0 o;a eo00 • . k s `5 r60 WASHINGTON ;_,.: ASSOCIATION of , qr. .1 9 MAINTENANCE and - lit ' ., • •n OPERATIONS `.< i' ;`'. t ' ,A ..„. ADMINISTRATORS '. ,t 1- -, /• THIS IS TO CERTIFY THAT %; i.. • Bob Witheridge i. ,;.g( .;4 - - Participated in the , '.`�`.\. '' _ I - EPA AHERA � ' tet + , F0 �; ,; INSPECTOR, 9 04 ;t 4'( 1• �� MANAGEMENT PLANNER e rr + ,,, {` 3_�a'.-7.'-'-'::::11; ' Refresher Course offered by the 4': ' 11 11x. U .zss40 k 4*} WASHINGTON ASSOCIATION of MAINTENANCE ''1 i 3' t.. • Y• "psi` ' and OPERATIONS ADMINISTRATORS '!': ° �(ss1y 1] � - r(o ( i , .1 The full day training program .1_,,,,-.4.j. ', is` r •�= o ; covered all topics specified in the ; V. .:e> ; Model Accreditation Plan under ' •,... 44,==ae ; Section 206 of Title II of TSCA W az ter_. -`5 r= -�'.R The course was taken on October 21 , 2011 r • ' ` X175'; ?.;.;�o . /`.' a > ' ,t {< i ;o in Silverdale, Washington. :"y ; � � Certificate #1021201102 — Expiration October 21 , 2012 *. �d 4 ;. ‘‘ xiiii- If Rf / i s ' '} Colla MacRae Course Administrator ""� • ;t. 4 0 2714 228th St, SE, Bothell, WA 98021 _7:711)''' % �_ i�d (425) 485-6980 , i: im. j: ,� ° .,. i o:o.0:0:e:e:e:t.o1 a:o:o:o:o:uo:o:o:o.•o.o:o:aao:o:ao:•:o:o.. o:o]o:o:v.o:o;oo00:e:aao:¢oaBaa:o:o.e:0.0:0:0,o.o:a;o:o-oo:o:e:o.o:ol1111:o:o:o:ao:o:o:o:o:o:o:e:o:o.o:o:, °-"'T' >.�-�s-, .gyp 44,71V)�y" �;14'A'''s�;q/i,`I/i0,4W11 . 1� ,,, ,'1111ii01,1I1'��.]F�'�,.;':;V'+-41),("1 /"1.\i'1,7. .4.W1,I�IS'11'4�f� �ij1-'t:yyjg11x4-'':I 1'1j'11411♦1t1`711(pfi"?_•; ., i 1`i�1+�1�1'�1R49t71 any '111t1rI+.,.1, )yyq.y,r, 4(CT \ t,-,i7 IYrA,,Nlp{,.;iQ^�iY1�C +a „e7},'I�i/�0V1 'h1 �yliof 1 +.r1±1 uNe'�w'f111:f i1 ld1.l P N�Di'ii1. (1�d.�W, Il�i�l , 1d � 1r^�� r3�e+%n m N'.YKM1C+k pp 1'AY)NG''py i., f< ,�ltl 6 �,y�)n,Jk.0 l w .1 well, 16 :� s u " SYrS /yA�, G t II , i :. yyt��4 41k .k7@ e W) f�1 , "�'Jf I: �AQ��'�} it jq� �q LJ fl iyl'L I Y ;�� r lif is 4 j, rJ!'/�'•`�"jd44, ,1 fln j4i,' ,,,14 1i 4.. ,. 3r ',, , Y,,".1,+!y -•r4,'h$Y ✓yY. v `�!' x,14 . ' •!u_ y7� $ •.� 54' ,..�v,1r.rp �„ }t.+hv•W .,:kyi A.,)i . 1 C ADESA Phase I iromSe sm Jefferson County EnvTaxnParcelental it #991-201-003Assesent According to the Jefferson County Assessor's Office, the current owner of the Property is Donald E. Newman of Pomeroy, WA. Washington State and Jefferson County historical maps, photographs and public records indicate that the Town of Quilcene was platted for development in 1889, including Muncie Avenue (E/W) and vacated Dunning Avenue m (N/S), originally platted along the eastern side of the Property. This abutting portion of Dunning Avenue became a portion of the Subject Property in 1993. Jefferson County Assessor and Planning Department Records confirmed that the Site was vacant land prior to the current residential site development, completed 1981. The original septic permits for the Site were obtained from Jefferson County in 1977. ADESA found no evidence of any current or historical development on the Property prior to the 1980s. Additionally, ADESA's investigations conducted during this assessment did not reveal any past or present environmental issues associated with the Subject Property. The Property is not listed on any regulatory database researched for this report that would be suggestive of environmental degradation or potential environmental threats. During this investigation no nearby sites were discovered that are believed to pose an environmental threat to the Property. Conclusions ADESA has developed and performed this Phase I Environmental Site Assessment within the scope and limitations of ASTM Practice E 1527-05, and in conformance with the Federal MI Rules. Any exceptions to, or deletions from, this practice are described in this report. The Phase I Site Assessment of Jefferson County Tax Parcel #991-201-003 has revealed no evidence of Recognized Environmental Conditions (RECs). Recommendations No further investigation is recommended regarding the environmental integrity of the Subject Property. RECEOVIE0 JUL 29 2013 JEFFERSON COUNTY DEPT OF COMMUNITY DEVELOPMENT PO BOX 1009•Tentoo, WA•98589 Phone:360-701-8797•Fax 360-269-2028•emad wrulRerford(iilode �a cam ADESA Phase I Environmental Site Assessment rio _ Jefferson County Tax Parcel#991-201-003 EXECUTIVE SUMMARY This report represents the findings of ADESA's Phase I Environmental Site Assessment (ESA) performed on Jefferson County Tax Parcel #991201003 located at 320 Munck Avenue in Quilcene, Washington 98376 in Township 27N Range ase 2W,ase and Section ecESA i been prepared for the ct Property; Property; Site; D. Newman Property). Hood Canal Salmon Enhancement Group to satisfy the due diligence requirement necessary to qualify for the innocent purchaser defense to CERCLA environmental liability. The Subject Property is a rectangular, 0.52 -acre tax parcel situated at the northeast end of Muncie Avenue, and contains a vacant single-story, wood-framed, manufactured home, circa 1981. The residence is located on the western portion of the lot and appears to have been expanded to the west to include an additional living room and bd of ble Awaddi ionawelll improvements at the Site include a 960 square-foot, wooden 3-bay gdra9eP septic system and gravel driveway. The garage is located to the east of the residence in the center of the Site. The exterior of both structures are covered with wood siding and metal roofs; the north, east and south sides of the garage are improved with carports/covered areas with gravel surface material, which are currently used to store a truck, boat, camp trailer, and personal auto parts. One, 100-gallon, single wall steel aboveground storage tank (AST) was observed not in use beneath the covered area on the eastside of the garage. The northern portion of the Subject Property is overgrown with various noxious weeds and grasses, with tree cover increasing along the river. The southern portion has typical grasses and sparse vegetation and trees. °e , a` 4 ¢ Subject Property Looking North, Site Visit 12/12/2012 The Property is bound by the Big Quilcene River to the north and Muncie Avven and to thewesoThe uth. Dilapidated and unoccupied residences are located to the east, general topography of the Site is relatively flat (-16-feet above msl) with a gentle slope along the riparian area of Big Quilcene River embankment descending to the south-southeast. Surface water is managed along l Mncie v n the with shallow bioswales that flow toward ox Quilcene Bay, located app Y It PO BOX 1009•Tenina, WA•98589 Phone:360-701-8797•Fax:360-264-2028•email:nTnlherfardC2adesa-wu corn 3W #rmcic ,4 . PHASE I ENVIRONMENTAL SITE ASSESSMENT Conducted On: JEFFERSON COUNTY TAX PARCEL #991201003 QUILCENE, WASHINGTON 98376 4. r...-tea. fi December 18, 2012 Project No: 1212-04 Prepared for: HOOD CANAL SALMON ENHANCEMENT GROUP P.O. BOX 2169 600 NE ROESELL RD. BELFAIR, WA 98528 Phase I ESA Prepared By ADESA, LLC 4111 / P.O. Box 1009 Tenino, WA 98589 VI C o . c > R c! 15 i el V 0 N0. ca LL r—r1 N o o � 1 C `° d m (� , O m Z I o0 LL _J1 §- ... o ¢ E so Wu +0 isi ; y m 2 LI N aa O ) JH 0 N g .�a.. VL G Q a - en c rn 2y : d YN e yEci o Idyn J mE N < - o a < 0 m °o E t m m �, n ti Q N '' d $ 0 uiNar - ti A d 03 0 E .r 4 li > > IZ CZ d y g r� i), yq i 4 LL c.) Ci 0^1.... N �� _ o m V CD C u Q '0 coo ° a `o ° S'0 a. . IA E a. y N v a a E lc m m m a a. R ai 1• - i - I 'J G D J d 7 d 6. r ` {t a d w ... are ir I - ez 4 X O A et ao co 0:1 (-) C) = hi 0.tD �I !11� - LCr E �, I a I=W m C-1 - Ec y ...FL.� m C . z d z �fl a aa, l- 2M = yU _ ; ILI \` T.C i = m D E d YIE y .. d i42 CC "• y E �I E c c fl. u y O U z 0 o f a d 0 I N ce re U v s co v c O a 1 Ei 5 is) ( a H Q CI a !fi 0 t E —� [6 C O W weOa CU EIn it ° i x 15ZA5 - y G } ao? ° 0 ro hi ' / r•.13 1 .. ..i ,,., FAL,: a Fit ; lei. m re 4. ern E0, �. _ 1 C N M Y+ ' N w H N ` + IA mow 711. 0 v = c t O` m e Ie', , \ , L {6 Q p U a a Q y1 . • r a R 12 .0 tZ a. °' R CO !s g c at d CO a c c R _ ! a o Ire j " E r RI so G0 02 o � ep � E1111111111111111 F T E� a 'Q o 3 „gym aEc° O �' z V 5 3 �± z *It 1 iii c ri H ix i ? a _ 1 �..• m v E m v $ v NN• E I rE r C .0 Q N a g 3O • Cr V U Z c cV v a 7y V) z a I Analytical Services Report #: 1212114 Client: WILL RUTHERFORD Date of Receipt: 12/21/2012 POADBOX 1 LLC Report Date: 12/24/2012 TENINO WAA 98589 PO Date of Analysis: 12/24/2012 Project: NEWMAN PROPERTY, QUILCENE WA Project-ID: 12-12-04 Sample Material Detection Composition Client# Location Description ASBESTOS TYPES: Chrysotile,Crocidolite,Anthophyllite,Tremolite,Amosite,Actinolite The samples listed above were suspect of containing asbestos. A result of"Non Detect"means a thorough search using appropriate techniques was conducted and no type of asbestos was discovered. Samples submitted to this fadlity will be disposed of unless the cient r a period of no more than 3 years. The alccordance requests th EPA 600/M4-82-020e 00/M4 82-020eand EPAo600/R 3/116.1 Test ved oresults apply only to the samples submitted.It analysis performed is in not our be policy to distribute the customer's information without the writtenconsent customer. bseer. The the above reporteshall to t product reproduced except in full,without the written approval of the laboratory.This n report may not certification,approval or endorsement by NIST,National Voluntary Laboratory Accreditation Program or the Federal Government. Shawn Kearney Angela Kearney Laboratory Director/Analyst President ANALYTICAL SERVICES Report Number 2563 DIANE AVE, PALM BAY, FLORIDA 32909 1212114 Phone: (321)837-9837 Fax: (321)728-0728 Page 5 of 5 NVLAP CODE 200670-0 Analytical Client: WILL RUTHERFORD ADESA LLC Report #: 1212114 Date of Receipt: 12/21/2012 PO BOX 1009 Report Date: 12/24/2012 TENINO WA 98589 Date of Analysis: 12/24/2012 Project: NEWMAN PROPERTY, QUILCENE WA Project-ID: 12-12-04 Sample Material Client# Location Description Detection Al2-3 BENEATH SKIM COAT Composition Drywall,White, Non- None Detected Cellulose Fiber 10% homogeneous, Chalky- Fibrous, Non-Friable Non Fibrous Material 90% A13 EXTERIOR Paper, Black, Non- None Detected Cellulose Fiber 30% homogeneous, Fibrous- Resinous, Non-Friable Non-Fibrous Material 70% A14 Paper,Black, Non- None Detected homogeneous, Fibrous- Non-Fibrous Fiber 30% Resinous, Non-Friable Non-Fibrous Material 70°�° A15 RESIDENCE Paper,Black, Non- None Detected Cellulose Fiber 30% homogeneous, Fibrous- Resinous, Non-Friable Non-Fibrous Material 70% A16 GARAGE Paper,Black, Non- None Detected Cellulose Fiber 30% homogeneous, Fibrous- Resinous, Non-Friable Non-Fibrous Material 70% ANALY77CAL SERVICES 2563 DIANE AVE, PALM BAY, FLORIDA 32909 Report Number Page 4 of 5 Phone: (321)837-9837 Fax: (321)728-0728 1212114 NVLAP CODE 200670-0 AnalyticalServices Report #: 1212114 Client: WILL RUTHERFORDADDate of Receipt: 12/21/2012 PO SA BOXL1C1009 Report Date: 12/24/2012 TE NINO WA 98589 Date of Analysis: 12/24/2012 -Project: NEWMAN PROPERTY, QUILCENE WA Project-ID: 12-12-04 Sample Material Composition Location Description Detection Client# Cellulose Fiber 95% None Detected A9 3 THROUGHOUT HOUSE homogeneous,Ceiling Tile, Non-Fibrous, Friable Non-Fibrous Material 5% MO KITCHEN Drywall,White, Non- None Detected Cellulose Fiber 10% homogeneous, Chalky- Non-Fibrous Material 90% Fibrous, Non-Friable A11-1 WALL Skim Coat,White, Non- Chrysotile <1% Non-Fibrous Material 99% homogeneous, Chalky, Non- Friable A11-2 WALL Skim Coat,White, Non- Chrysotile <1% Non-Fibrous Material 99% homogeneous, Chalky, Non- Friable Skim Coat,White, Non- None Detected Cellulose Fiber 1% All-3 WALL Non-Fibrous Material 99% homogeneous, Chalky, Non Friable Al2-1 BENEATH SKIM COAT Drywall,homage eo s, Non- None Detected Cellulose Fiber 10% homogeneous, Chalky- Non-Fibrous Material 90% Fibrous, Non-Friable Al2-2 BENEATH SKIM COAT Drywall,homage eo s, Non- None Detected Cellulose Fiber 10% homogeneous, Chalky- Non-Fibrous Material 90% Fibrous, Non-Friable ANALYTICAL SERVICES Report Number 2563 DIANE AVE, PALM BAY, FLORIDA 32909 1212114 Phone: (321)837-9837 Fax: (321)728-0728 Page 3 of 5 NVLAP CODE 200670-0 AnalyticalServices Client: WILL RUTHERFORD ADESA LLC Report#: 1212114 PO BOX 1009 Date of Receipt: 12/21/2012 TENINO WA 98589 Report Date: 12/24/2012 Date of Analysis: 12/24/2012 Project: NEWMAN PROPERTY, QUILCENE WA Project-ID: 12-12-04 Sample Material Client# Location Description Detection A6 KITCHEN Composition Linoleum,Gray, Non- Chrysotile 10% homogeneous, Fibrous- Non-Fibrous Fiber 10% Rubbery, Non-Friable Non-Fibrous Material 80% Note: Paper Included/Not enough adhesive for Analysis A7 EXTRA BEDROOM LAYER 1 None Detected Non-Fibrous Material 100% 12x12 Floor Tile,White, Non- homogeneous, Fine Grained, Non-Friable LAYER 2 None Detected Adhesive,Clear, Non- Non-Fibrous Material 100% homogeneous, Resinous, Non- Friable A8 LAYER 1 None Detected Flooring,White/Tan Streaks, Non-Fibrous Material 100% Non-homogeneous, Rubbery, Non-Friable LAYER 2 None Detected Glue,Yellow, Non- Non-Fibrous Material 100% homogeneous, Resinous, Non- Friable A9-1 THROUGHOUT HOUSE Ceiling Tile,White, Non- None Detected homogeneous, Fibrous, Friable Cellulose Fiber 95% Non-Fibrous Material 5% A9-2 THROUGHOUT HOUSE Ceiling Tile,White, Non- None Detected homogeneous, Fibrous, Friable Cellulose Fiber 9 Non-Fibrous Material 5% ANALYTICAL SERVICES 2563 DIANE AVE, PALM BAY, FLORIDA 32909 ReoortNumber Page 2 of 5 Phone: (321)837-9837 Fax: (321)728-0728 1212114 NVLAP CODE 200670-0 Analytical Services Report #: 1212114 Client: WILL RUTHERFORD Date of Receipt: 12/21/2012 PAD ESA LLCCReport Date: 12/24/2012 TENINO WAA 98589 BOX 1009Date of Analysis: 12/24/2012 Project: NEWMAN PROPERTY, QUILCENE WA Project-ID: 12-12-04 Sample Material Detection Composition Client# Location Description 100%Al EXTERIOR LAYER 1 None Detected Fibrous Glass Insulation, Pink, Non- homogeneous, Fibrous, Non- Friable LAYER 2 None Detected Cellulose Fiber 80% Backing,Brown/Black, Non- Non-Fibrous Material 20% homogeneous, Fibrous, Non- Friable A2 LR WEST WALL LAYER 1 None Detected Non-Fibrous Material 100% Texture,White, Non- homogeneous, Chalky, Non- Friable None Detected Cellulose Fiber 10% LAYERR Drywall,White, Non- 2 Non-Fibrous Material 90% homogeneous, Chalky- Fibrous, Non-Friable LR SOUTH W&HALLWAY Drywall,omogsWous, Non- None Detected Cellulose Fiber 10% A3 homogeneous, Chalky- Non-Fibrous Material 90% Fibrous, Non-Friable None Detected Cellulose Fiber 10% A4 UTILITY ROOM DP/Wall,mage sous, Non- Non-Fibrous Material 90% homogeneous, Chalky- Fibrous, Non-Friable Cellulose Fiber 20% A5 SOUTHER HALF OF HOUSE Linoleum,Orange/homogeneous, Fibrous- Non- None Detected Non-Fibrous Material 80% Rubbery, Non-Friable Note: Paper Included/Not enough adhesive for Analysis ANALYTICAL SERVICES Report Number 2563 DIANE AVE, PALM BAY, FLORIDA 32909 1212114 Phone: (321)837-9837 Fax: (321)728-0728 Page 1 of 5 NVLAP CODE 200670-0 ADESA Environmental Investigations,LLC ADESA Project#1212-04 Donald Newman Property—Jefferson Co.Parcel#991-201-003 and analyzed prior to disturbance. Please call with questions or concerns regarding this asbestos inspection survey report. (360)701-8797. ADESA Environmen : Investigations /07William W. RutheAHERA AHERA Cert. Number: 138502 PO Box 1009•Tenino,WA•98589 Phone:360-701-8797•Fax:360-264-2028•Email:N-0' liherfordnn i sa-wa Sx.,. ADESA Environmental Investigations,LLC ADESA Project#1212-04 Donald Newman Property—Jefferson Co.Parcel#991-201-003 In adherence to 40 CFR 763.86,which governs asbestos sampling protocols,the laboratory was instructed to analyze all separable layers. The samples of potentialhA dispersing sM were alyzed z gatn Analytical Services with U.S. of Palm Bay, FL using polarized light microscopy (PLM) e EPA method 600/R-93-166 as specified in 40 CFR Chapter I (7-1-93 edition) Part 763, Subpart F, Appendix A, pages 499-504. Polarizing light microscopy quantifies asbestos concentrations at between 100% - 1% detection levels. See attached laboratory documents for further details of the anab is <Th� table below depicts the laboratory results of ACM containing samples and samples containing chrysotile. Sample Type of Material,Location and-Square Result Photograph Number Footage AS Gray Linoleum and paper backing,Kitchen,150 10%Chrysotile ` . } .41 Sample location at kitchen entrance,beneath wood(right)and close up of A6 llinoleum atop the bottom layer of linoleum beneath A6(left). A11_1 White trolled-on skim coat,Addition walls,400 <1%Chrysotile A11-2 White trolled-on skim coat,Addition walls,400 <1%Chrysotile Dyy*' A113 White Polled-on skim coat,Addition walls,400 Non-Asbestos Containing White wall skim coat,limited photographic coverage due to limited lighting. Sample A6, gray linoleum and paper backing, was collected from flooring located beneath the wood flooring within the kitchen and above an orange and brown layer of linoleum, shown in the photograph above. The laboratory results indicated the sample contains 10% chrysotile asbestos and must be treated as an ACM in accordance with all local, state and federal regulations for disposal and worker protection. No other ACM were discovered through laboratory analysis of the building materials sampled during this inspection. Samples All-1 and A11-2,white skim coat wall texture was collected from the addition walls, as well as Al1-3 from atop the drywall. The laboratory results indicated the presence of chrysotile at a level <1% asbestos. Therefore,per Federal regulations defining an ACM,the material is not required to be regulated as an ACM. However, Federal, State and Local rules and regulations may apply for worker protection and disposal. Additionally, the wood burning fireplace, brick-like fireproofing and associate chimney were not dismantled or sampled. ADESA understood these materials to be salvaged for reuse by the property owner or client prior to removal. If additional building materials are discovered during the demolition/remodeling process that could potentially contain asbestos,those materials should be sampled PO Box 1009•Tenino,WA•98589 Phone:360-701-8797•Fax:360-264-2028•Email:wrutherford 3desa-wa.coM Assessor Detail Building#1 Page 1 of 1 Aoe Jefferson County Weather Station a._ _.: ==alkkMaps � wocano Home County Info Departments xt Search Assessor Detail Building #1 Parcel Number: 991201003 Buildin• Number Year Built 1 Year Remodeled 1981 0 Buildin. Exterior Buildin. Area Buildin• Interior Building Type: MOBILE Building Style: DOUBLE MOBILE HOME 1st Floor Area: 0 Int. : Flls FORCED ): Foundation:POST&BLOCK/PIERS 2nd Floor Area: 0 Heat: AIR Exterior: SIDING/STUCCO (LAP) 3rdArea: 0 WOOD STOVE Roof Cover:COMPOSITON ft Area: 0 Floor Cover Ato (1): Attic Area: 0 Floor Cover(2): Total Area: 1728 Basement Area: 0 Buildin• Rooms Mobile Home Bedrooms: 0 Make: CORINTHIAN Full Baths: 0 Model: Type: Half Baths: 0 Area: 0 Length: 64 Exterior: Width: 28 Roof: Year Built:1981 Carport Square Footage: 0 Skirting: Area: 1728 1st Addition 2nd Addition Type: Area: 0 Year Built: 0 Area: 0 Exterior: Year Built: 0 Roof: Exterior: Roof: To view another buildin. associated with this .arcel. Select buildin• : 1 2 3 Jefferson County HOME I COUNTY INFO I DEPARTMENTS I SEARCH 000f Best viewed with Microsoft Internet Explorer 6.0 or later 0 Windows - Mac SSP - - 1O � http://www.co.jefferson.wa.us/assessors/parcel/assessordetail.asp?Parcel_NO=991201003 5/27/2013 Parcel Print Page 1 of 1 Parcel Number:991201003 06/24/2011 Owner Mailing Address: HOOD CANAL SALMON ENHANCEMENT PO BOX 2169 BELFAIR WA 985282169 Site Address: Section: 24 School District: Quilcene(48) Qtr Section: NE1/4 Fire Dist: Quilcene(2) Township: 27N Tax Status: Taxable Range: 2W Tax Code: 320 Planning area: Quilcene(10) Sub Division: QUILCENE Land Use Code: 1101 - MOBILE HOMES (owns mobile & land) Property Description: QUILCENE I BLK 10 LOTS 9 THRU 12 I I It No Photo Available http://www.co.jefferson.wa.us/assessors/Parcellparcelprint.asp?PARCEL N0=991201003... 5/27/2013 'Pr OCI Ot � , .4 --lc) O sz_c_a PI - `6,kiGio CLE,I:,:... Olympic Region Clean Air Agency („(' ` (^�7`^'K/) -., `t!R • 2940-B Limited Lane\\\' � T o�' �� 16.:4;• Olympia,WA 98502 i� �`, 360) 539 7610• F- .‘''-36(03)64°I;1--91.14-66631:18 (360' 491-6308 Demolition Permit /=1tj t Port Angeles office;360) 41?-1466 s. O RCA A Raymond Office (360) 942-213' `a www.ORCAA.org'4?Ut.::rFEras.vSCi.o?, [ ] Owner occupied residential dwelling—Permit fee: $35.00—Prior Notice- Nonrefundable [ ] Other Structures—Permit fee: $60.00— 10 working day wait period-Nonrefundable PROPERTY OWNER ,A) gee J gee Phone: aip):g S'is75 Email: Name: ( J Q /gO/'� PAIN `o ( ) /�OO��G(11 C! � � FAX: Mobile: ( ) Mailing Address: City: State: Zip: Site Address: City: State: Zip: DEMOLITION CONTRACTOR [ ]Check if same as property owner information i Business Name: Phone: ( ) Email: I FAX: ( Onsite Contact: Phone: ( Mobile: ( ) FAX: ( ) Mailing Address: City: State: Zip: DEMOLITION INFORMATION #of Structures being demolished: Start Date: Completion Date: Jr' ')//a Asbestos present Yes No Survey attached Yes No Has all identified asbestos been removed Yes _No DEMOLITION PROJECT CATEGORY [ I Complete Demolition [ ]Training Fire—Fire Agency: [ ] Renovation, Alteration,Remodeling,Maintenance,or other Construction [ ] Emergency—Additional Fee of$50.00(must be accompanied by Government Ordered Declaration-Commercial only) I have read and will abide by the conditions set forth in this permit and any addendum thereto. I do hereby certify that all identified asbestos has been removed and the information in this application and supplemental data described herein is, to the best ofmy knowledge, accurate and complete. Applicant Name Signature Date Date Application Received Payment Info. [ ] Approved Asbestos Permit t [ ] Cash [ ] Disapproved Permit# _ASB00 [ ] Check: # Demolition Permit [ ] Credit Card Review date: / / Permit# DEMOO Receive date:_/_-_ Reviewed by:Agrug Use Only Ageng'Use Only Agency Use Only Agent),Use Only 08/11/11 OVER • • DEMOLITION PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT #: BLD13-00239 Received Date 8/5/2013 SITE ADDRESS: MUNCIE AVE Issue Date 1/21/2014 APPLICANT: HOOD CANAL SALMON ENHANCEMENT PHONE: 360-275-3575 PO BOX 2169 BELFAIR WA 98528-2169 SUBDIVISION: QUILCENE Block: Lot: PARCEL NUMBER: 991201003 Section: 24 Township: 27N Range: 02W CONTRACTOR: OWNER, HOOD CANAL SALMON ENHANCEMENT PHONE: 360-275-3575 if different: PO BOX 2169 BELFAIR WA 98528-2169 PROJECT DESCRIPTION: DEMO OF 5 RESIDENTIAL STRUCTURES Directions To Site: THIS PERMIT IS VALID FOR ONE YEAR AND IS NOT RENEWABLE. THE FINAL INSPECTION MUST BE SCHEDULED AND PASSED WITHIN THAT YEAR. THE EXPIRATION DATE IS 1/21/2015. REQUIRED INSPECTION: FinalApproval: r1-.�oIi� )e'sr BUILDING INSPECTION HOT-LINE 379-4455. REQUESTS MUST BE RECEIVED BY 3 PM THE DAY BEFORE THE INSPECTION IS NEEDED. Office Hours 9:00 a.m. -4:30 p.m. Monday-Thursday SPECIAL CONDITIONS APPLY - SEE REVERSE HOT LINE AVAILABLE 24 HOURSA DAY • • SPECIAL CONDITIONS FOR CASE#BLD13-00239: 1.) Approval by the Health Department for this demolition permit is based on the owners signed acknowledgement that they will be decommissioning the existing septic system prior to final of this building permit. A record was located for the system on 991201003 under SEP77-00106. No records could be located for the other 4 systems and no evaluation has been completed. This approval for demolishing the residences does not ensure future building approval. Any future onsite sewage system shall meet code in effect at the time of application. 2.) Approval of this permit does not provide any assurance of future approvals for onsite sewage disposal on the property or use of any existing septic systems. Actions taken to date and proposed as part of this project may limit or prevent future development of an onsite sewage system. Future proposals must meet current code at the time of application. 3.) Wells shall be decommissioned in compliance with state code. An application for inspection of each of the decommissionings shall be made to Jefferson County Public Health a minimum of 3 working days prior to beginning the work. Decommissioning shall be completed by a licensed driller. 4.) All septic systems shall be abandoned/decommissioned by a Certified Jefferson County Installer. A$67 Technical Assistance fee is required for each of the 4 septic systems to be abandoned/decommissioned. A'Certificate of Tank Abandonment' shall be submitted for each septic system. Residences to be demolished that have a septic system to be decommissioned are on 991201003-Aon site plan, 991201514- 13 on site plan, 991201503 -Con site plan, 991201510- Don site plan, 991201701 or 702 - Eon site plan. Notice shall be given to JC Environmental Health two (2)working days prior to system/tank removal for inspection. If the septic tanks or other septic components such as PVC piping and drainfield materials are removed they shall be disposed of in an approved landfill. \\tidemark\data\forms\F_BLD_Permit_Propane.rpt 1/21/2014