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2009 June - Fire Training Exercises - Oakgreen Ave. Homes Demo Permits & Abestos Abatement Data
Fire Training Exercises Oakgreen Ave. Homes June 2009 Summary Documentation Owner: Tim Nolde GREENTWIG LLC City of Oak Park Heights Documentation: Demolition Permits & Asbestos Abatement Data Section r • Nolde Agreement with City of Bayport Fire Department to Burn Homes • Owner's Release to Burn Structure Form • Proof of Clear Title & Ownership - Count y Tax Statements AGREEMENT THIS AGREEMENT, entered into this day of fl4', ' oO by and between Tim Nolde, the CITY OF BAYPORT, a Municipal Corporation (the City), and the BAYPORT FIRE DEPARTMENT (the Fire Department). WHEREAS, Tim Nolde is the building owner of certain real property the Property legally described as , County of Washington, State of Minnesota; and, WHEREAS, there are /is Seven buildings(s) {the Building(s)} located on the Property; and WHEREAS, Tim Nolde desires to have the Building(s) destroyed; and WHEREAS, the Fire Department is willing to destroy the building(s) by fire if the Building(s) can be used for smoke drilling and other training exercises before and during their destruction by fire. NOW, THEREFORE, the parties hereto in consideration of the mutual covenants and considerations hereinafter set forth do agree as follows: 1. Entry onto the Property Authorized. Tim Nolde hereby expressly authorized the Fire Department and the City to enter onto the Property one or more times for the purpose or conducting smoke drilling and other training exercises (the Training Exercises and related activities in the Building(s) and on the Property.) The City and Fire Department shall enter the Property solely for the purpose of conducting training exercises and for related activities such as preliminary and follow -up inspections. 2. Waiver_�f ` res ass. Tim Nolde expressly waives any claim of trespass against the Fire Department or the City for entry onto the Property for the purposes of conducting training exercises and related activity on the Property. 3. waiver of Dama es. Tim Nolde expressly waives any claim against the Fire Department or the City for any damages to the Property or the Building(s) caused or allegedly caused by the Fire Department or the City in the course of performing the Training exercises and activities related thereto. 4. Liabili and Indemnification. The City and the Fire Department shall be solely liable for any injury to the Fire Department personnel or other persons caused by or as a direct result of the Training Exercises. The City and the Fire Department shall indemnify and save Tim Nolde harmless against any and all claims by or on behalf of any person or persons arising from the conduct of the Training Exercises. The City and the Fire Department shall not, however, be liable for any injuries caused by o r resultin g from Tim Nolde failure to clean up the Property debris of the Buildings) and remove the d s) within the time period allowed by g( Section 5 of this Agreement. 5. Clean Up. Tim solely Nolde shall be solel responsible for removing all debris from following completion of the Training Exercises, regardless of the the Property fo g P condition o f the Property and/or the Building(s) following completion of the � P �' Training exercises. The City shall notify Tim Nolde in writing when the � tY Training Exercises are completed leted and Tim Nolde shall have ten (10) days from � P the date of that notice to complete the removal of all debris and remnants of the so that the condition of the Property is in full compliance with the Building(s) requirements of the City of Oak Park Heights and any City of Oak Park Heights �' Demolition Permit Conditions. The City reserves the right to inspect the Property from time to time as necessary to insure Tim Nolde compliance with this obligation to clean up the Property. IN WITNESS WHEREOF, the parties hereto have executed this Agreement on the above date. Tim Nolde CITY OF BAYPORT By: Jonathan Nowaczek, Mayor BAYPORT FIRE DEPARTMENT By: Mike Bell, Fire Chief City of Oak Park Heights 14168 Oak Park Blvd. N 0 Box 2007 Oak Park Heights, MN 55082 Phone (651) 439-4439 * Fax (651) 439-0574 May 9th, 2009 Mayor John Nowaczek City of Bayport 294 N. 3r Street Bayport, MN 55003 RE: Bayport Fire Department Trctining Exercises Dear Mayor Nowaczek: have enclosed herewith a partially executed copy of the AGREEMENT between Developer Tim No Ide and the City of Bayport that contemplates the upcoming practice burn to occur in the City of Oak Park Heights. I believe this was to be delivered to your City offices. Please note that the City of Oak Park Heights does generally support the upcoming operation as it is part of a larger plan to redevelop a large parcel of land lying south of STH 36, near the Oak Park Heights City Hall and will offer a solid opportunity for training. To the best of my knowledge, it would appear that Mr. Nolde is working well with Captain Eisinger of the Bayport Fire Department to ensure that it is a well choreographed operation and that all hazardous materials are removed and all wells are capped prior to any 'burning' activities. As part of this process, Mr. No Ide will be required to secure a Demolition Permit from the City that will include several requirements that, among other items, he shall be responsible for the general activities of the site and all clean-up costs. Oak Park Heights will be requiring thc",. Mr. No Ide post a satisfactory Letter of Credit to secure any final site clearances and 51 an-up in the post-training phase of this project. Please , w if you have any questions. n Johnson / 0 Administrator Weekly Notes Mike Bell, Fire Chief BFD Al Eisinger. Captain -BFD M 21.03 PROOF OF CLEAR TITLE REMEMBER TO GAT PROOF OF CLEAR TITLE AND INSURANCE CANCELLATION DOCUMENTS FROM OWNER OR AGENT THIS MAY BE DOCUMENTATION FROM COUIN TY RECORDER OR TAX OFFICE Page -73- M 21 M2 OWNER'S RELEASE TO BURN STRUCTURE FORM Having agreed with the building official, Oak Park Heights MN City or County of Tim Nolde C oun t y: Washington Township: Fire Number: Nearest Cross Road.: Washington Oak Green Ave & 58th St. North is under condemnation or unfit for human habitation and is beyond rehabilitation. I further agree that the structure should be used by the fire service for training as they see fit. In order that demolition may be accomplished, I give my consent to the Bayport Fire Dept, to use or demolish the said structure b y burning or other means. (Owner / Agent) (DATED) (Owner / Agent)(DATED) (Witness) (DATED) tic.- 4 • ,3KMSm1 Page -72- , that a structure owned by owner /agent and located at: P i gton County 1 4949 62nd Street North PD Box 200 Stillwater, MN 55082 -0200 651 430 -6175 www.co.washingtommn.us Prop erty ID: R 05.029,20,14.0003 Taxpayer: 88894 GREEN TWIG LLC Po BOX 119 STILLWATER MN 55082 -0119 I I hi �IuitI�II1i� .iiiII i iiIIIiIrip��IIIiI �IiIi,I Desc: Sect -05 Twp -029 Range -020 PT N1/2- SE1 /4 -NE1 /4 COM AT SE COR SD N1/2 OF SD114 1/4 THEN N ALONG E LINE 560 FT TO PT BEG THIS DESC.THEN WLY AT R ANG TO LAST Property 5710 OAKGREEN AVE N Address: STILLWATER MN 55082 1. Use this amount on Form M1PR to see if you are eligible for a property tax refund. File by August 15. If this box is checked, you owe delinquent taxes and are not eligible. 2. Use this amounts on Form M 1 PR to see if you are eliible for a special refund. Your Property Tax and How It Is Reduced By The State 3. Your Property taxes before reduction by state -paid credits 4. Credits paid by the State of Minnesota to reduce your property tax: A. Homestead and Agricultural Market Value Credits B. Other Credits 5. Your property tax after reduction by state -paid credits Property Tax by Jurisdiction 6. County A. WASHINGTON COUNTY 1 B. COUNTY RRA 7. City or Town OAK PARK HEIGHTS 8. State General Tax 9. School District 0834 A. Voter Approval Levies B. Other Local Levies 10. Special Taxing Districts A. METRO DISTRICT B. OTHERS C D. 11. Non - school voter approved referenda levies 12. Total property tax before special assessments Special Assessments on Your Property 13. Special assessments Int: Principal: 3.00 CO ENVIRMNT 3.00 14. YOUR TOTAL PROPERTY TAX AND SPECIAL ASSESSMENTS FIRST HALF DUE SECOND HALF DUE PAYABLE 2009 2nd HALF PAYMENT STUB TO AVOID PENALTY PAY ON OR BEFORE: OCTOBER 15 (property ID: R 05.029.20.14.0003 Sill #: 60591 Taxpayer: 88894 GREEN TWIG LLC PO BOX 119 JTILLWATER MN 55082 -0119 Department of Property Records and Taxpayer Services Bill #: 60591 02 007 05029201400020 0000082200 2 Property Tax Statement for Taxes Payable in 2009 e.iz 7,: i�� �-f � r, •C' rY` "1:: � - � �f� efor future refere ; REFUNDS? Taxes Payable Year: Estimated Market Value: New Improvements/ Expired Exclusions: Taxable Market Value: Property Classification: x MAY 15 OCTOBER 15 MAKE CHECKS PAYABLE TO: Washington County P.O. Box 200 Stillwater MN 55082-0200 You may be eligible for one or even twc refunds to reduce your property tax. Read the back of this statement to find out how to apply. 2008 2009 187,900 186,400 187,900 RES HSTD 1,597.00 1,800.29 1,845.64 203.29 204.64 1,597.00 1,641.00 423.25 1,26 594.20 0.00 291.14 229.11 41,62 16.42 0.00 0.00 0.00 1,597.00 3.00 186,400 RES HSTD 1,641.00 428.38 1.22 634:-2.6. 0.00 280.10 243.44 41.07 16.53 0.00 0.00 0.00 1,641.00 1,600.00 1,644.00 822.00 822.00 Detach at perforation & mail this stub with your 2nd half payment in the enclosed green envelope RES HSTD SECOND HALF TAX AMT 822.00 ❑ CHECK ❑ CASH No Receipt sent. Your cancelled check is proof of payment. Do not send postdated checks. 3.00 \, Vas De artmnent of Pro ert p Property Records C ounty and Taxpayer Services 6. County i l . 8. 9. 14949 62nd Street North PO Box 200 Stillwater, MN 55082 -0200 (651) 430 -6175 www.comashington.mn.us r Property ID: R 05.029.20.11.0065 Taxpayer: 88894 Property Tax by Jurisdiction 10. Special Taxing Districts Bill #: 112721 Taxpayer: 88894 GREEN TWIG LLC °O BOX 119 yo MN 55082 -0119 Special Assessments on Your Property 13. Special assessments Int: Principal: 3.00 CO ENVIRMNT 3.00 - 13111#: 112721 GREEN TWIG LLC Po BOX 119 STILLWATER MN 55082 -0119 1ti 111 lilII111 1IiI11H11 1I11I1 Desc: OAKGREEN VILLAGE Lot -OOL OUTLOT SUBJ TO EASE Property 5800 OAKGREEN AVE N Address: STILLWATER MN 55082 1. Use this amount on Form M1PR to see if you are eligible for a property tax refund. File by August 15. If this box is checked, you owe delinquent taxes and are not eligible. 2. Use this amounts on Form MI PR to see if you are eligible fora special refund. Your Property Tax and How It Is Reduced By The State 3. Your Property taxes before reduction by state -paid credits 4. Credits paid by the State of Minnesota to reduce your property tax: A. Homestead and Agricultural Market Value Credits B. Other Credits • 5. Your property tax after reduction by state -paid credits A. WASHINGTON•COUNTY B. CQUNTY RRA City or Town OAK PARK HEIGHTS State General Tax School District 0834 A. Voter Approval Levies B. Other Local Levies A. METRO DISTRICT B. OTHERS C. D. 11, Non - school voter approved referenda levies 12. Total property tax before special assessments Property 1D: R 05.029.20.11.0065 14. YOUR TOTAL PROPERTY TAX AND SPECIAL ASSESSMENTS FIRST HALF DUE SECOND HALF DUE PAYABLE 2009 2nd HALF PAYMENT STUB TO AVOID PENALTY PAY ON OR BEFORE: OCTOBER 15 02 007 05029201100650 0000095800 Property Tax Statement for Taxes Payable in 2009 'au : fear f #u ' veference REFUNDS? axes = P ayable Year Estimated Market Value: New Improvements/ Expired Exclusions: Taxable Market Value: Property Classification: MAY 15 OCTOBER 15 MAKE CHECKS PAYABLE TO: Washington County P.O. Box 200 Stillwater MN 55082 -0200 You may be eligible for one or even two refunds to reduce your property tax. Read the back of this statement to find out how to apply. 0 0 8 2009 . 220,100 193,100 220,100 1 93,100 RES NON - HSTD RES NON - HSTD 0.00 2,109.00 0.00 2,109.00 1,913.00 570.13 509,47 1.69 1.45 799.91 747.91 0.00 0.00 354.86 300.52 304.29 285.29 56.02 48.74 22.10 19.62 0.00 0.00 0.00 0.00 0.00 0.00 2,109.00 1,913.00 2,112.00 0.00 1,913.00 0.00 3,00 3.00 Detach at perforation & mail this stub with your 2" half payment in the enclosed green envelope RES NON - HSTD SECOND HALF TAX AMT 958.00 ❑ CHECK ❑ CASH No Receipt sent. Your cancelled check is proof of payment. Do not send postdated checks. 1 1,916.00 958.00 958.00 ( \\7ashington Department of Property Records and Taxpayer Services 14949 62nd Street North PO Box 200 Stillwater, MN 55082 -0200 (651) 430 -6175 www.comashingtommn.us Property ID: R 05,029,20,11.0003 Taxpayer: 88894 Property 5754 OAKGREEN AVE N Address; STILLWATER MN 55082 Pro er Tax b Jurisdiction 6. County 7. 10. Special Taxing Districts Special Assessments on Your Property 13. Special assessments int: Principal: 3.00 CO ENVIRMNT 3.00 Bill #: 112719 Taxpayer: 88894 GREEN TWIG LLC PC BOX 119 ; 'T I LLWATE R MN 55082,-0119 BilI #: 112719 GREEN TWIG LLC Pa BOX 119 STILLWATER MN 55082 -0119 1il �l11l1l�ll111l, Il1r1l, lllh!< <Illl1•.11l1l11•11lll1lr1l�l11l Desc: OAKGREEN VILLAGE Lot -00J OUTLOT SUBS TO EASE 1. Use this amount on Form M1 PR to see if you are eligible for a property tax refund. File by August 15. If this box is checked, you owe delinquent taxes and are not eligible, 2. Use this amounts on Form M1PR to see if you are eligible for a special refund. Your Property Tax and How it Is Reduced By The State 3. Your Property taxes before reduction by state -paid credits 4. Credits paid by the State of Minnesota to reduce your property tax: A. Homestead and Agricultural Market Value Credits B. Other Credits 5. Your property tax after reduction by state -paid credits •A. WASHINGTON COUNTY B. COUNTY RRA City or Town OAK PARK HEIGHTS 8. State General Tax 9. School District 0834 A. Voter Approval Levies B. Other Local Levies A. METRO DISTRICT B. OTHERS C. D. 11. Non - school voter approved referenda levies 12. Total property tax before special assessments Property ID: R 03.029,20.'1 1.0053 14. YOUR TOTAL PROPERTY TAX AND SPECIAL ASSESSMENTS FIRST HALF DUE SECOND HALF DUE PAYABLE 2009 2nd HALF PAYMENT STUB TO AVOID PENALTY PAY ON OR BEFORE: OCTOBER 15 02 007 05029201100630 0000063600 8 Property Tax Statement for Taxes Payable in 2009 ve or f uture; referert REFUNDS? s:Na - le Ye Estimated Market Value: New Improvements/ Expired Exclusions: Taxable Market Value: Property Classification: MAY 15 OCTOBER 15 MAKE CHECKS PAYABLE TO: Washington County P.O. Box 200 Stillwater MN 55082 -0200 You may be eligible for one or even two refunds to reduce your property tax. Read the back of this statement to find out how to apply. 129,100 128,200 123,400 128,200 RES NON - HSTD RES NON - HSTD 0.00 1,183.00 0.00 1,183.00 320.22 .95 448.47 0.00 198.90 170.60 31.41 12.39 0.00 0.00 0.00 1,183.00 3.00 1,186.00 ❑ CHECK ❑ CASH 2009 . 0.00 1,209,00 0.00 1,269.00 337.20 .96 496.54 0.00 199,52 189.40 32.35 13.03 0.00 0.00 0.00 1269.00 3.00 1,272.00 636.00 636.00 No Receipt sent. Your cancelled check is proof of payment. Do not send postdated checks. Detach at perforation & mail this stub with your 2' half payment in the enclosed green envelope RES NON - HSTD SECOND HALF TAX AMT 636,60 1 0 W. gton Department of Property Records �4 �Coun and Taxpayer Services 14949 62nd Street North PO Box 200 Stillwater, MN 55082 -6260 (651) 430-6175 www.co.washington.mn.us Property ID: R 05,029.20,11.0028 Taxpayer: 88894 Desc: Sect -05 Twp -029 Range-020 PT NE114 -NE114 BEG AT A PT ON E LN OF SD NE1 /4 -NE114 357FT N OF THE SE CDR THEREOF THN W ON A LN PARLIW THE S LN DIST275FTTOA PT THN NON A Property 5830 OAKGREEN AVE N Address: STILLWATER MN 55082 1. Use this amount on Form M1 PR to see if you are eligible for a property tax refund. File by August 15. If this box is checked, you owe delinquent taxes and are not eligible. 2, Use this amounts on Form M 1 PR to see if you are eligible fora special refund. Your Property Tax and How It Is Reduced By The State 3. Your Property taxes before reduction by state -paid credits 4. Credits paid by the State of Minnesota to reduce your property tax: A. Homestead and Agricultural Market Value Credits B. Other Credits 5. Your property tax after reduction by state -paid credits Property Tax by Jurisdiction 6, County A: WASHINGTON COUNTY B. COUNTY RRA 7. City or Town OAK PARK HEIGHTS 8. State General Tax 9. School District 0834 10 Special Taxing Districts GREEN TWIG LLC PC BOX 119 STILLWATER MN 55082 -0119 A. Voter Approval Levies B. Other Local Levies A. METRO DISTRICT B. OTHERS C. D. 11. Non - school voter approved referenda levies 12. Total property tax before special assessments Special Assessments on Your Property • 13. Special assessments int: Principal: 3.00 CO ENVIRMNT 3.00 Property ID: R 05.029:20,11.9028 Bill #: 60597 Taxpayer: 88894 GREEN TWIG LLC 'DO BOX 119 oTILLWATER MN 55082 -0119 Bill #: 60597 PAYABLE 2009 2 ntl HALF PAYMENT STUB 02 00? 05029201100280 0000080300 8 ve for future : re .er'en ��i �. `:'•�f: i�iy =� [T Ta cF`i :�' ��r:F: "P.�.iwy,�: REFUNDS? axes property Tax Statement for Taxes Payable in 2009 14. YOUR TOTAL PROPERTY TAX AND SPECIAL ASSESSMENTS FIRST HALF DUE MAY 15 SECOND HALF DUE OCTOBER 15 p ay able You may be eligible for one or even two refunds to reduce your property tax. Read the back of this statement to find out how to apply. e;a Estimated Market Value: New Improvements/ Expired Exclusions: Taxable Market Value: Property Classification: • 2008 213,100 213,100 RES HSTD RELATIVE 0.00 2,043.61 180.61 2009 182,800 1 82,8 00 RES HSTD RELATIVE 0.00 1,810.88 207.88 1,863.00 1,603.00 497.46 1.47 695.68 0.00 333.09 267.37 48.71 19.22 0.00 0.00 0.00 1,863.00 3.00 418.80 1.19 614.86 0.00 274.34 237.62 40.06 16.13 0.00 0.00 0.00 1,603.00 3.00 1,866.00 1,606.00 803.00 803.00 Detach at perforation & mail this stub with your 2 half payment in the enclosed green envelope RES HSTD W RELATIVE TO AVOID PENALTY PAY ON OR BEFORE: OCTOBER 15 MAKE CHECKS PAYABLE TO: Washington County P.O. Box 200 Stillwater MN 55082 -0200 SECOND HALF TAX AMT 803.00 [❑ CHECK ❑ CASH No Receipt sent, Your cancelled check is proof of payment. Do not send postdated checks. 0 . gtan Department of Property Records y ou and Taxpayer Services 14949 62nd Street North PD Box 200 Stillwater, MN 55082 -0200 (651) 430 -6175 www.co.washington.mn.us Property ID: R 05.029.20.11.0026 Taxpayer: 88894 BiII #: 60595 GREEN TWIG LLC Po BOX 119 STILLWATER MN 55082 -0119 D esc : Sect -05 Twp -029 Range -020 PT NE 114 -NE114 BEG AT A PT ON E LN OF SD N E 114 -NE 114 DI ST 11 OFT OF SE COR THEREOF THN W ON A LINE PARLIW S LN THEREOF 150FT TO A PT THN N Property 5770 OAKGREEN AVE N Address: STILLWATER MN 55082 1. Use this amount on Form M1 PR to see if you are eligible fora property tax refund. File by August 15, If this box is checked, you owe delinquent taxes and are not eligible. 2. Use this amounts on Form M 1 PR to see if you are eligible fora special refund. Your Property Tax and How it Is Reduced By The State 3. Your Property taxes before reduction by state -paid credits 4. Credits paid by the State of Minnesota to reduce your property tax: A. Homestead and Agricultural Market Value Credits B. Other Credits 5. Your property tax after reduction by state -paid credits Property Tax by Jurisdiction 6. County ) 1. A. WASHINGTON COUNTY B. COUNTY RRA City or Town OAK PARK HEIGHTS 8. State General Tax 9. School District 0834 A. Voter Approval Levies B. Other Local Levies A. METRO DISTRICT B. OTHERS C. D. 11. Non- school voter approved referenda levies 12. Total property tax before special assessments 10 Special Taxing Districts Special Assessments on Your Property 13. Special assessments Int: Principal: 3.00 CO ENVIRMNT 3.00 14. YOUR TOTAL PROPERTY TAX AND SPECIAL ASSESSMENTS FIRST HALF DUE SECOND HALF DUE PAYABLE 2009 2"d HALF PAYMENT STUB TO AVOID PENALTY PAY ON OR BEFORE: OCTOBER 15 Property ID: R 05.029.20.11.0026 Bill #: 60595 Taxpayer: 88894 GREEN TWIG LLC - box 119 )FILLWATER MN 55082-0119 02 007 05029201100260 0000090600 eve. ` or uture refe rep REFUNDS? s `: f ?. a Estimated Market Value: New Improvements/ Expired Exclusions: Taxable Market Value: Property Classification: Property Tax Statement for Taxes Payable in 2009 MAY 15 OCTOBER 15 le MAKE CHECKS PAYABLE TO: Washington County P.O. Box 200 Stillwater MN 55082 -0200 You may be eligible for one or even two refunds to reduce your property tax. Read the back of this statement to find out how to apply. 203,400 201 ,800 1,500 203,400 RES HSTD 1,761.00 1,950.34 189.34 1,761.00 1,809.00 469.28 1.40 656.62 0.00 316.94 252.65 45.97 18.14 0.00 0.00 0.00 1,761.00 3.00 1,764.00 2009 . 201 ,800 RES HSTD 1,809.00 1,999.78 1 90.78 474.82 1.34 696.12 0.00 304.75 268.35 45.36 18.26 0.00 0.00 0.00 1,809.00 3.00 1,812.00 906.00 906.00 Detach at perforation & mail this stub with your 2d half payment in the enclosed green envelope RES HSTD t. SECOND HALF TAX AMT 906.00 ❑ CHECK ❑ CASH No Receipt sent. Your cancelled check is proof of payment. Do not send postdated checks. \ \ T as ton Department of Property Records -------------- Count and Taxpayer Services 14949 62nd Street North PO Box 200 Stillwater, MN 55082-0200 (651) 430 -6175 www.co.washington,mn.us r Property ID: R 05.029.20.11.0059 Taxpayer: 149793 Bi11 #: 112696 Desc: OAKGREEN VILLAGE Lot -00C OUTLOT SUBJ TO EASE Property 5762 OAKGREEN AVE N Add CeSS: STILLWATER MN 55082 OAKGREEN VILLA LLC PO BOX 2118 STILLWATER MN 55082 -3118 1�I lrilrI IIi. is irrl�li 1l���ill �ilU11 iii lllril�1��lil 1, Use this amount on Form M1 PR to see if you are eligible for a property tax refund. .:: File by August 15, If this box is checked, you owe delinquent taxes and are not eligible..:: 2. Use this amounts on Form M 1 PR to see if you are eligible fora special refund. =Your Property Tax and How It Is Reduced By The State 3. Your Property taxes before reduction by state -paid credits Credits paid by the State of Minnesota to reduce =your property tax: A. Homestead and Market Value Credits g Other r.. =K.M1 �..... 4ti =•. t.' S, y:.. r.:. . •.1.'.:..e._. R.'1...:..-, ........,r. N._..a.....�.,.j,v �'iAS�:4f :•:i: ti::'.i1'�.:c_ .. J... .r �.v.. �. ,. ..,_� .a -..-- a Credits x ��- �:�.:�:,:..:��.,�,_. ..��.�.� - ,;.�.:�.. -�,�. .. _ .__ .._. _. , 5. Your property tax after reduction by state -paid credits Property Tax by Jurisdiction. .,.. �6: County � A:��wASHINGTON�C4LJNTY B. COUNTY RRA '7. City or Town OAK PARK HEIGHTS 8. State General Tax 9, School District 0834 10. Special Taxing Districts D. 11. Non - school voter approved referenda levies 12. Total property tax before special assessments A. Voter Approval Levies B. Other Local Levies A. METRO DISTRICT B. OTHERS Special Assessments on Your Property 13. Special assessments lnt: Principal: 3.00 CO ENVIRMNT 3.00 14. YOUR TOTAL PROPERTY TAX AND SPECIAL ASSESSMENTS FIRST HALF DUE SECOND HALF DUE PAYABLE 2009 2 "d HALF PAYMENT STUB TO AVOID PENALTY PAY ON OR BEFORE: OCTOBER 15 c PropertylD: R 05.029.20.11.0059 Bill #: 112696 Taxpayer: 149793 OAKGREEN VILLA LLC ?O BOX 2118 JTILLWATER MN 55082 -3118 02 007 05029201100590 0000110700 . c. �. �. z- ss. s...,•_, ,.,- ....,:.cLi.i.4:..i= ,..•..�. �ri•a...'•.;_�.•.. ,.:�.:- �.In'su�_:�..w.a::.�.:..�.... _ Property Tax Statement for Taxes Payable in 2009 va or future re even REFUNDS? You may be eligible for one or even two refunds to reduce your property tax. Read the back of this statement to find out how to apply. Estimated Market Value: New Improvements/ Expired Exclusions: Taxable Market Value: Ptpp rty Classification:, ....., NON -HSTD . RES NON -HSTD _ X. MAY 15 OCTOBER 15 MAKE CHECKS PAYABLE TO: Washington County P.Q. Box 200 Stillwater MN 55082-0200 194,100 223,200 0.00 1,861.00 0.00 - 503.90 �.. 1.49 705.42 0.00 312.94 268.35 49.41 19.49 0.00 0.00 0.00 1,861.00 1,861.00 2,211.00 2,211.00 0.00 588.68 1.67 864.50 0.00 347.37 329.76 56.34 22.68 0.00 0.00 0.00 2,211.00 3.00 3.00 0.00 1,864.00 2,214.00 J 1,107.00 1,107.00 Detach at perforation & mail this stub with your 2' half payment in the enclosed green envelope RES NON - HSTD SECOND HALF TAX AMT 1,107.00 ❑ CHECK ❑ CASH No Receipt sent. Your cancelled check is proof of payment. Do not send postdated checks. Section II. Demolition Contractor's Application for Contractor's License - City of Oak Park Heights - Buelow Excavating • ]Buelow Excavating - Indemnification for City and Proof of Insurance Buelow's Notification to MPCA "Intent to Perform a demolition" Licensee CITY OF OAK PARK HEIGHTS ................ ....:...... ...... ........ .. 14168 Oak Park Boulevard No. • P.O. Box 2007 • Oak Park Heights,. MN 55082-2007 • Phone: 651/439 -4439 • Fax: 651/439-0574 License Expires : 12/31/2009 BUELOW EXCAVATING 13254 20TH ST STILLWATER, MN 55082- In accordance with provisions of the City of Oak Park Heights Ordinance(s), the above -named licensee is granted the following license(s): License Type : LOCAL CONTRACTOR LICENSE OPH LOCAL CONTRACTORS LICENSE Total Fee Paid This Certificate of License is hereby issued conditioned that said licensee shall comply with all the requirements set forth in the City Ordinances, pertinent Building Codes, and the laws of the State of Minnesota. A License issued under this Certificate may be suspended or revoked for violations thereof. Juli - NOT TRANSFERRABLE Hultman, Planning & Code Enforcement Tree City U.S.A. No.: 2009 -00072 Date: 06/12/2009 30.00 30.00 May 24 09 11:99a rim J. Business Narne: Address: Telephone: CONTILARTjaniji, C NSa APPLICN City of Oak Park Heights 14163 Oak Park Blvd. N. P.D. Box 2007 Oak Pam Heights, MN 55082 TELET'HO : DIRECT: (651) 351,16S GENERAL: (651) 43544 » FAX: (651) 439-0614 "" 4a 4P R Fax. f+( S LICENSE REOUREMENTS ▪ Fee baste an tra a State license Is requfred kw residential ger eral contracting, roofing. plornloing arxl fire protection. Mechanical Contractors (quire MN Si ta Suru y Bpi. ▪ Certikate or Insuranca, minimum coverage, $100,003 per pesor1 Public Liability; $250,000 per went. Body Injury; and $1130,C00 Property Daman. Cl`lY OF Q MUST NAMED AS AN, ..._ N ,INSURED on this. ▪ Agreement to hod CITY OF OAK PARK HEIGHTS Narmi s for A it crate of . t qability that may come against the licensepermk. horde'. • Pad of Cam- �`l'ICN Italgarif refit d, by law, to he camel, a Std and Federal Tax Identification numbers purl to MN STATE FrATuT1E 2 • The CON TRACTOR further agrees to adhere to all OSHA STANDARDS, UNIFORM TRAFFIC CODES and any CITY CODES /V O STANDARDS Mut may appy to this game, • License period: January 1 ID December 31 of each year. gEs00011 wit t r.rit' wxtrra. irrpno r (1\9 Commercial Gencrai Contractor m $SU RIacktopp)rg - $20 . Ming, Ventilation & A - $30 Building Moving -330 *Arch copy of MN Mechanical Bond Conte and Masonry - $30 . Outside Sewer & Mier - $10 . ExcavatingfGrading $30 _ ._ Sorg - $30 Pool Installation - $30 Sys & Bile : rds • $30 [relation System Installation • a Other: 530 Office Use Only: Liability Insurance . xpl tion: Worker's Comp. Instuarxe Expiration: .. Mechanical Surety Bond 10 : Mecharical Surety Bond Expiration: Date License Issud: COMPLETION OF THE HERS COMPENSATION INSURANCE ANDTAX LD. FORMS IS REQUIRED BEFORE A LICENSE CAN BE ISSUED. THESE FORMS ME ATTACHED AND MATE PART OF THIS APPUtATION. N o. Pj r • t ' ,e-JD May 24 09 11:OOa 1 I(1 1 .b..,./ C.. CO CJ a ° r.F LICENSE APPLICANT: Pursuant tQ Minnesota Statute 270a0 Tax Clearance: 1im r `or ses, the licensing auhgflt► is required to provide the Minnesota Cortvrtissioner of Rye your Mina business tar identification amber and the social security number of ezi 1 en a applicant. Under the Minnesota Government Data Prey Act and the Federal icy Act of 1974, we are required to advise you of the foaming ng 'regarding the use of tris Warm/Won: Tits infixmatitn may be used to @wife imr men) cr Disaster or your item In the evert you we the Mknesota Derma ti Revenue dquen't bus, penaltes or iiltafecSt 2. Upon reicelyirvg thls information, the I1t ng atihoray w l p it only to the Wrinesota Departmenr -of Revenues. However, wan' the Federal Exchange of Ir(imatIo the Depailmatt of Revenue may supply this ifonnad on to Ole internal Preemie &4ce. 3. Failure to suppty iris informatics jeoparaa er delay OE X of rat kensing fiance DT renewal application Please prrnrkde the following information and Tlaturn along with your application to the agent wing the lase. Do not ern to Oa Dwirtmant of Revenue. Lkken!tnEr Author License Period: Peer *cnI Information: (Corrylete orgy if appric tb ) Applicant's Nom; Applicant's Address: Social Security No.: Dus Inns Information: (Complete only if appkable) Busi S$ Nt 11 c: Business Address: cIty Minnesota Tax identification No.; ± - Y -1 ( Federal Tax Identification No , 1 9 werw r 11 a Minnesota Tax Identification number is no rewired, please ex plain: civ of Oak Park Heights Annual: awry 1 through December 31 1325420th sue: tip Co& p.4 May 24 09 11:01a 1 I 1 . .i:l'Ga s wr ` �.rti.os OR Printed Name of Signature PROOF OF WOMERS COMPENSATION INSURANCE OVERAGE Minnesota Statue„ Section 176182, requires every state and local licensing agency to withhold the issuance in( renewal of a license or permit to operate a business in Minnesota until the applkant presents acceptable evidence of compliance with the wor compensation insurance ccv'e 'age requirement of Chapter 176. The Information requited is: the name of the in5urance span, the policy number, and dates of coverage or the permit to self-insure, Tht tnf n an retai w ithin heir_l< es. Ths infonnation is required by law. Lenses and perm is to operate a business may not be issued or reed if it is not provided andlor is falser report" Furthermore, failure to provide or falsely reporting this information may resat In a $?.D nalty assesSul against the applicant by the Commissioner cif the Oeparment of Labor and indigary. Provide the information specifI awe, in the spaces provided, or certify tive precise reason you( bus'ness is excluded from compliance with the insurance coved requirement for wuers' compcnsatiitn. Insurance Company not the Insurance Agent): Poky Icy N u mb e r Data of Coverage: Co Title/Position or Person Signing ( ' A i have no employees covered bylaw; C ) i am seat- insured {inchuie pert* to selF instrre); or I am not required to have Workers' Compensation tnuurtinte became: (check 6 e), !have read and understand my rests and obligalfions w th regards to business !tenses, pemas and Workers' Compensation coverage and he eby =Iii by my signature below that to the best of my kr)ow ge, tfle inform tion provided is true and correct. Date: p r"I4f JzL May 28 09 1O:O7a To: City of Oak Park HeigttZ 14168 Oak Park Boulevard, N. P,O, Box Oak Park Heights, , MN MU The following must be sib by an Officer of the Corporation or by the Owner and • otarized. In consideration for the smiting of this License, the license se applicant egrets 10 hold the C harmless from all damages and Gis1ras of damage which may arm by reason of any negligence. on the part of the Contractor or the Contractor's agents or employees engaged In the perrormance of this ContractiPet, and will indemnify the City tor the amount or all Hens, tenses and claims for Dens of work, tool, machines, materials or insurance premier and rr the amp of all Inn by reason of the rain of the Contractor to My perform itS obIlaton under this Contract/Permit including but not limited to attorney fees and its incurred reatue to such claims and mss, Subscribed and sworn to before me . is • . day Q .� 2 - My commission err $; Mary Public. 3 g-e) Y t TERRA J. McALP NE NOTARY p„3UC - MINNESOTA My Comrni Expifes Jan. 31, 2012 S•;ShandffonTis & PutkatintCrirbletors Umnsii Aippl U$da tett 01•2 - INDEMVINAMMil EEMENT P.' TOTAL P May 24 09 11:OOa To :. City of Oak Partt. Helps 141$B Oak Farb Boulemi, N, P.O. BOX 2037 Oak PErk Mme, MN 55082 ELM T rnia b a� ` iotitikid. Date Su b soitett It ad Sin it before rr this day of My Conmilission expires; 5"� & P X01 lad by an Offices nMe Corxratian or by the Owner art in consideration for the Tatting of this racense. the kease appficant agrees to talc' the City Winless from all damages and clans of datnaga ‘vhith niay orisc by rson el any the part of the Contractor Or the Carinctoes wits or employees engaged in the pgitiormance of this ContracttPerrnit anti will Indemnify the City for the amt of all C1114115. Ora, expenses and claims thr limos or work. Ind, machinery, materials or insurance premiums and s the amount of ad loss by reison o( the Cot t Cortractrx to filly peril= its °No- : &`: this inchiting bid rte IWted ancaley fins and costs incurred a live to stidi liras and Notal caporate Ofkr or IroilAtuaf Propintonhip* Yni75 S��s ate- 67,4ff-ii U.v� �ffiP. :r7 1 AW-)317 //./ /G9, ///- Fi/6" TOTAL P.05 May 28 09 19.07a P. 1 B U E LOW EXCAVATING 13254 20TH STREET NORTH STILLWATER, MINNESOTA 55082 (651) 436 -5326 FAX (651) 436 -2244 DEMOLITION * STRUCTURES * HOUSE FIRES • CONCRETE &ASPHALT 6. DEB RI S EXCAVATING • BASEMENT EXCAVATION & BACKFILLING • UNDER HOUSES • PONDS • COMMERCIAL • INSIDE BUILDINGS • SWIMMING POOLS -- DIGGING AND FILLING • GIBING COMPACTION e ROADS, DRIVEWAYS, & PARKING LOTS UTILITIES • SEPTIC SYSTEMS MOUNDS, AT- GRADES, TRENCHES, FILTERS, • PERCOLATION TESTS, SOIL BORINGS • LIFT STATIONS — RAIN PS & ALARMS • BORING, TUNNELING • LOCATING PIPES & LINES • STORM & SANITARY SEWER • WATER LINES °' WELL, & CITY • REPAIRS WATER PROBLEMS • INSIDE & OUTSIDE OF BUILDINGS AND HOMES • DRAINAGE • _DRAIN TILE CLOG & GRUBBING MOWJNG • STUMPS • BRUSH • TREES WINTER WORK '` • SNOW PLOWING, SANDING, RAULEN1G • FROST RIPPING • .FROZEN LINES REPAIRED TRUCKING a SAND * GRAVEL • ROCK ® FILL SITE CXPLORA.TION • B °CGS ARCHEOLOGICAL ACORD CERTIFICATE OF LABLITY NSUR NCE THIS CERTIFICA E IS ISSUED AS A MATTER OF INFORMATION ONLY AND CO FEFtS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS ERTlFICATE DOES NOT AMEND, EXTEND OR ALTER THE CO RAGE AFFORDED BY THE POLICIES BELOW. INSURED COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE AMY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED- BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO AL- THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICY EFFECTIVE POLICY EXPIRATION POLICY NUMBER DA TE C/MD C1{'Y;< - PATE [MMtQD/VY1 INSR LTR A Maj 29 2009 11 :43 ADD'L INSR_p MCGARRY-KEARNEYAGENCY, INC 450 N MAIN ST STILLWATER, MN 55082 JOHN BUELOW 13250 20TH STREET N STILLWATER, MN 55082 GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY 1 CLAIMS MADE OCCUR IY1l9F INSURAJ WE AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS X SCHEDULED AUTOS X HIRED AUTOS NON -OWNED AUTOS GARAGE LIABILITY ANY. AUTO DEDUCTIBLE RETENTION 5 CERTIFICATE HOLDER ACORD 25 (2001/08) / GE 'L AGGREGATE LIMIT APPLIES PER: POLICY .1 LOC I.CCE$SNMBRELLA LIABILITY OCCUR [ CLAIMS MADE WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? if s, describe under S PROVISIONS below OWNER 1 McGarrj Hgenc j, 1 bn 1 — ff. - bJZU City of Oak Park Heights 14168 Oak Park Blvd PC Box2007 Oak Park Heights, MN 55082 8002466540 09101/08 052/01/09 BAP2215221 09/01/08 INSURERS -AFFOR INSURER A: STATE INSURER B: STATE INSURER C: INSURER D: INSURER E: AUTHORIZED REP 0 /01/09 DESCRIPTION OF OPERATIONS I LOCATIONS ? VEHICLES I EXCLUSIONS RUED BY ENDORSEMENT J SPECIAL PROVISIONS DATE THEREOF, THE I!SUING NOTICE TO THE CERTIill'C • E IMPOSE NO OEUCATI REPRESENTATIVE., ING COVERAGE UTO MILBANK INS CO UTO PROPERTY & CAS INS CO 25127 PRODUCTS - COMP /OP AGG COMBINED SINGLE LIMIT (Ea accident) BODILY INJURY (Par person) BODILY INJURY (Per accIde n#) PROPERTY DAMAGE (Per accident) AUTO ONLY - EA ACCIDENT OTHER THAN AUTO ONLY: EACH OCCURRENCE AGGREGATE WC STATU► E.L. EACH ACCIDENT E.L. DISEASE • EA EMPLOYEE $ E,L, DISEASE - POLICY LIMIT $ DATE (MM /DDIYYYY) 05/29/2009 NAIL # 41653 UMIT5 EACH OCCURRENCE S 1,000,000 PREMISES (Ea occurence) > 300, 000 MED EXP (Any on person) 15 5,000 PERSONAL& AOV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 EA ACC 5 x 1,000,000 $ AGO 5 OTH- 5 5 2 000,000 CANCELLATION SHOULD ANY OF THE A3OVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION RER WILL ENDEAVOR TO MAIL DAYS WRITTEN DER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL TY OF ANY KIND UPON THE INSURER, ITS AGENTS OR ACORD CORPORATION 1988 M, 29 2009 1 1 : 43 McGar~r - Kear9ne j A enc , 1 651-439 ACORD 25 (2001/08) If the certificate holder is an ADDITIONAL 1 NS URE D the po llcy(les) must be endorsed. A statement l~ t to the r rtificate holder in lieu of s�. ch endorsernent(s). .on this certificate does not confer rights s If SUBROGATION 18 WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the . certificate holder in lieu of such endorsements ). The Certificate of Insurance on the reverse side of this form does n t constitute a contract between the issuing insurer (s), authorized representative or producer, and th certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. IMPORTANT DISCLAIMER pd May 24 09 10:59a A � •...,ti0� ..f' r V 'Vi'W facsimile Fax: Re: Message: O Uingeitt 14 Review 0 Pima* Goiartittnit 0 Please Reply 0 Please Recycle Dacia nsmit From ,Fis jaive-7 paimesa - 5(goL ):: /WIZ- / W6 yr' 77-fiiv/55 P , r.Q.L.PuD City of Onic Park }hi� 14368 Oa Pan( Blvd. N, Box 2007 Oak Pik HeigJxt, MN 35 082 ]f (651) 4394439 File (651) 439 514 May 11 09 12:46p p,1 B ELM EXCAVATING 13254 2011 STREET NORTH STILLWATER, MINNESOTA 55082 (651)436-5326 FAX (651) 435-2244 May 11 09 12:48p icte-k; iftmesola Pollution Control Agency Notification of Intent to Perform a Demolition martrtesatz Pollution Type Of Nealization: I Ortztual I 1 iinr4ndell I Projet1 Cateenati:on Control Agency Demolition 0:in1ractor: ;7-1-Lunc ,&--9(-CV47/7P6" - Addrtss: / CY it) W )0? AV) e3 City, Stlite, Contact'ftrste: Bloat Nurnb(3): zi/ 3 6 45 Data 'Midi?, &malt or intentionitt b will &gin 157 & :End e _iz s tatc . v MA) max. „ten tiiHie pm (Tr rttebrea to (IB)WOREING dap Cortiartcrson: r / t Wale &inion bens. 4 See tizzu 6S Or calenencydeietolifions. 13th Beer:angst:tit Enaliftg tisittt abottki be tmervitil n writing Mono litimber(* ;t1t3 reEttet carrtrztiproitct If them i3 >2 linear feet or >160 square fra etRegaiztA• AzMfI (RAM) in Ole- btadivg hi be denioridzed, it tom b 21?-MiVeil by a. Etemegt abestea easti=tnrriforte deme5tion. The-State DIM ( the of Intent to Pertortre Etri Asbadas Myartanemit Proj Rt 1 Una Mary for the mbestes removal. place 2. Deseliptiou C, aR6-1-47- notariable AtJ4 prosept 11.40 etrammto b tiltamegmbLed ? Will riterfieble ACK be prEtoent te shaadvie tat Om tirdea dtraellirion, If WS to both questions above complgtz items 19. 1f1 to either tracstion complete ittros L RACI4 -grit] be tart '33 pfute for the mean fatilvM tft arnorgat eiCatogory Infer Csdegoty 11 non frfitble ACM ieft Caia g■ra1ifIc2fin eltit?lat Pitta11133 Dcmiiiiia fozn (WLAsz4.21.tioc) Lin= Eat SiFtwv.1 Cubk.E means asinaos-ccuat4. aciags, vskels, rtsilient floor covcring, zad asphalt roofing Fran= cosataining more ill= cat pertmat taestos., *Cattgory nenfiriarle ALM b rot nikFIVAd ru=ain pIt'ee for demolition if iris in poor Informaeon: ("Zi 2 c2 Ir ffildiagNain: Aatt2elsg.,benbica:_61a) (9 A1C Lr'irp, Zip" Camay: ilace„.11 )‹. iecrirP Presenti Prier Ust'AP;; PlammlIumbeals):. Ag, ofilitig. (pairs}:.....r2._ "Si= arElig. (/ 21): / $ Nmibe ofklatrs-Infilrg Baseivzat Lcvelfs): Location of .A.CM remshang in tante (imaullicag floor - 4 - arta room tf),: p2 : 1 I LIVES I I NO IYES UNO Lines.? Fed SquutTott cxi big F.eei. egtocrry Tuut-we Arm plcaus mxy matezizi, exclusla g fury nanfriable ACM, containing ware th ro. on patent AsbmstasLtwhzn•dxy cl.21010 caumbird pylveriz*. or ItetiCed 11) a powder hilm 71=am *tte441a tMfirtit42- ACM ntrt tamed to remain' 1ijiet dernolitio" ff it bet$ bleb probabny becortung mumbled, pathretizei, tir reduced to powder darin de/none:34,, Ts-at/1011, disrasztl, (ex Tricasite, emot, slate roothig) Fxvimci. OV06 May 11 09 12:46p Minnesota Pollution Control Agency Notification o Intent to Perform 21 Demolition AturdsevaPetatton lorigana 1.4tratmdtd [ I WOW 1.1npellatiou control Agency Type of Naiirmation: aformation: Demolition Contraztor: Na 150 610 er/C#IiefiLV-'6--- ior,q 57- io 41-1,0 AM) 6 eity. shim, ContaaPtastantik. Phonc-tiumbea(s):._ 661 4 3 6 9 2 . 6 N Ad plam Owner 1.? Coutatet p-emon: Phone Number(s): C1316 city, But, ACM preset:4in the sirmetnre to ha dezttakilied ? Will montriable ALCM be pit tia* stirmtare t dm iftle oregamettbraT VICES- to both questions above compete item i9 1€}O b cithzir vest:kat cow items'3-9, lear Fed Scprar Tog Cabic Ettq ble A1.6 ne pecans. gaskw, rtaitiga Boar Evueling, ad. asphnit ntoffngprodurts ixattuirtia' galore ihan cam peretat esbemn. *Cauey 1 rtairfriztac ACM Et not named' revvkirs in pta. for 4 =oaf= IX it is 'in war caralffion... Dlinualva ofintaft to Ptif=ln ts rkzr fa= (1-44R4214.) BizILTmg.Haultt_ ML ii J Ceg. P. Czq' 4) 41 • et 56 Alt-?46W Aelzo oltBid& Crush_ Siva ofliklg. iFzV Number pal= Indy-ding )3=fzi=.E.cstcl(s): Prize& U: • . • Dateg w demo or int/alit:lomat Been' s End Notiazattonimuld he prttlittritta or meaim ato woluam dAys Wort dzaintian hgn *Svc Et= 03 riaretici derseliti'ons. Wei ntin and Erettg thrtel should be metutzi in writing 6.1 "47 rarzt mwriEr1V1= r, ff There is ›260 'Mawr feet us. >160 stit flat or Reviewed AsEtestutp-Ccattnftriztallaterilat 0314011) n ei2 betildin to be deradintred, ft must be removed by a r=mjsea. anbestm- ca-rtasztur rfriurtu ttemolitim: iffts Slate of ti� uf Intent to Perform as Asbestez ...Mr.atementEgroject Elragt be valtd to notify for the nabesbas removal. I YES [ IXNO j Y E S f I NO 1. if ACM Nal bele" p?neer rer the donollaint 1,-Almto the alitiount el CaiApry I andlor Oftrtni fl &b1 ACM left 2. Description & Loal till In of ACM mnaittitlg in place (Inchtdiag Roar #. and rota31 AgrtrYil no5ifiinb_LA CM pawns any inataial, dizding Category I wafriable ACK, containing mem then one percent Asix:stozsttat wittm thy, cntinot.bt LLd u1ye4 Or ittISCed to. a pornicrby laxid pressu- *Ceegterirrf vth1ae ACM acren,a-tpremfun la *e or ftlalltiork Lflt lte4 hIgla prohnbitly of becolnin' g crumble-a, pzIverizeil, or retttleed to powder during demolition, transport, 1s (x ttnitnt, skit rootvg) R4)vistd 08/G6 May 11 09 12 :47p MInnescrta Pvllutitsrs GaotroE Agency Demolition Contractor: tr�r: N " ------7— alnw 4:50 6?-00 5iXcsi Address: 2 6 Z d7"y -. � it) s z p: Contact Perso z rime . 5 Owner: Van= Pf?b Addres Conte fin: i'hoae umb ): Catcg. 1 1,0 L City, Stat, 5 rat-WA--t-rk /- Lb6 t c� r � Miniiesota Pollution Control Ageney Notiflcafion of Intent to Perforrn a Demolition Type of Notification: c. }LJ 1 4 [ Orighial i tended L J Project Ca pllalon La ti Building 0 02. IC e kkc;t? ) .Ad aty. State. ZIP: Coux 'Size of Bldg. . it nnb r of Floors Including .. cl(s)' Presett i r A prior �- /Le Dates when deinolitivi Or intentimal bugtiog will Begin :E &End 7 Notification roust be pOstnitirked raxived ten 000) WORKING dap bed demolition bins. *See item #S far emergency demolitions. MTh Beginning and E.ndln.g dates Amnia to amended 1. writing is necattsary to reflect =rent project date If there is >260 linear fed or >160 square. feet or Regulated AsbestossColitaining Material (RA.c in the building to be demolished* it rust be remireed by a licensEd asbegtes contractur prior to demolition. The State of M l oli42 of intent to Perform an Asbestos Abatement:Project must be used to notify s Borkfriable ACM pent In the structure to be detotished ? Will nob a ACM be present i the mature at fie- time of dem�io ? if YES to both questions alxwe complete items :4. If NO to either mom complete Rama-9. : JIACM will be left In pines forth -deviation indkate the amount ofategory 1 andfor Category 11 nonfriable ACM Ieft in p ]nc int= ssbcstos-contninivs png► geskets, =Inca ter covering, and malt xooilng producis containiag molt than. a De pertat asbestos,. * dory X nonfriable ACM is tiot rowed to rem€" in iac for devzolitino int is r tutriliticks. 2 Description & Locatiox of ACK remaining In place marauding floor # And room #): [Notification of trittrtta Pot= a Emolition f (warPt4+ . ) LintarFeet So= Foet Coble Feet h &76'1FFYS Mme p.4 1 `6 ifoy 6f) i lYES [ INo { I YES I NO Liner Feet Sip am Feet Cubic Feet CrEtcgprill nonfritble 4kavl incans any nattrial bxct�g Cattgory Z nouftiabt ACK conbainim more than one percent tea . tb when dry, mot be munbled, ppivezized,. or xedoctd to a. powder-by hand yessitre. *Calvary 11 mariabte AC i not aimed to gin In place. for &Blandon lilt has a high p obniliky orberom .ang eruntbie .,, pulverized, ur reduced to a pawdcr duig demolition, transp-or`t, ors aL acct Trxitsite, ctinent, alarm roofing) Revisxd 48/06 May 11 09 12:47p C Demolition Contractor. N dOC;zoa)...__ P3 clei Or* 67- A) eilY. @liter zt= Phone s r 69 el 3 6 6 111 plate 2 D r p1ior ~ :x Minnso1 Minntsota PoIlution Control Agcy 1.4- No of Intent to Prfon a Derno 016-- U.- a 6 1 cik sue, z.t= 577 (fe)92 ' Phone Nwnberfs): Linezat Spam Fcct Oghie_ E 4 resilient rcoueir tad asphalt roofnz products cunialaing mem than Dne pelvealt *Ciategoly I rtnafriable ACM i5 bet rfilvatd to retsvfn b3 jpInce fur a emolx if it Ett poor coc a. I tented 1 Project Cancellation Imf#a��• Dadtagwerse: 5 1-- 02 at 20 / ' 066 3 frikr4 &VA. cam � �. f/Mil :S jL Couatr U te �. Aga ofB14 (YzErsX, - s ftr._lter Locotion of ACM reattairer h (induttlidg lloor roorni P. Nt ofFIngwa indudin B * Leve1s): present Prier • 4 Thatteg doh i. or intentional bugling — will Begin 44 ~ & End �..- I rstatratrkta t o (1.f) WORKING dhrys bet b y 7►. ee R -demolitions. EtcythBegitring twit Ertattg tam sboald he Jniertileti in Ong vs fi: = It there lig >260 Omer reetor >160 airfare. m (RACM) in the ceding to be demolishes it Eatrt leizaoved by zsrategtha csantrarrebr to del:n� The Sizte OWN- Ire btlient to Perform an ite t t Med b1t itaPy Air die zobtstem remote Will roariviblo A C M be in the dradvat st tintra o f ? I I I [) NO &YES to both questions alxwe complete iten3g I$ TINO to ca ape iz m 3.9. L RAM! will be left fn n fair&ztattm sarannt #' 0114Zgary 1 andfor CatvDry 1 mo fr b e ACM left #►. Linear Feet SquLtro Fee Cubic Feet C a r y I EG A M containaxg nu= tai one pment Ate$ 1114 Nut= thy,,, cab) Cuitabied,. pS?Iveezed, cr =ducal toe, pamicr by hand pressur ACM tis mat ailawalt to r x iu On ce far ►zi a1 i ' # ins Mgt protr2tbnXit c miming trumbltd or mitred In der dratig cr 11r m- rt dispmt (tx Ta slit, mut* ttEstt n g) ltcvssd (W06 May 11 09 12 :47p Conte AgencY Demolition. Contractor! Nomr4 4-7-0Le. 6 Addrete4 1'3 c O'7.11-- gr ift) 0±21 PA/ er0e Ciiy, State, Zip: Contactl TOY peza phone Numb,z(s): 661 bi 3 6 S .2 4 Coittporsion: Phone tittnabcr(s )+ Cam.. I Manesota Pollation Control Agency Notification of:Went to Perform .Danolition Type oiNaticrm: [) t?rttl ( 1 Amended ( Project: Cancellation Int * •''; Heinc,_26-222_ — Addx...._gee nom tk> er: city state. ziv sTraAti64---m'e XV) ,/c k5e ec) 1 IfThe,eis >260 li near feet or >10 square. fttet a Regulated (RACK) in thtt building to be deniolibhed, lama be removed el &eased arAtiza mr..trativir per a maim. The- Stag of MiNp Ian of Perm Ahatment Projtet mat be tinfotikY for the asbestos removal. 314333frialgC ACK pmt in the ntrurtaare to bet due ts? [ I1MS [ j N If YES to both cptestions above complete items 1 -9. LINE) t eithtriintoim couggetft Reins' 3-9. ' A C M w i l l ho bat im Plattt far tha ftnalithan i n t r n m & the * m t Categarj J air Catzgory 11 mailable ACM kft in Orme Cubic Feet texas zs Milt= c ove and asTaialt roofing prodtmts carktelaing mare thaa arm pn+t *Ceicgory I ACM rillarval to tnetzalr, rtbet 1b • deroolitietti if itisi per a= d OL [Nom a 'fit tom (v BmIdiag14 • AjF •' C7ty. Statc, Zfr i l Pilate Numbez(2): A g o a r B i l i ( y e e r s ) : . Si2D of Bldg, (s- f): N'uauber ln mss,:• Pmerit fp, will • ii7���llIFFF D — & End b "i be pdttstrulota tor rtecivotl ti CUD WOE dayii beiore dentniltfori Was. "'Sec- atm Mi mitafg duo liktth Ettemningswiltsuilng d mho cad be atmertiatd In linfatits s Cmg. 11 /cc b- 2. Description Loctirlam of ACM mall alning im pee 1tz for =t1 room fOr. x Feet Square Feet Cubic Fed P. mate:dul exclualg Catard•Xnotfilz± IzACK innx duan one percent M c when clzy =mat he clunblzd,,p9Iverized, or cCirtZ rtstariltb ACM Is trot rtUowta to rerrito in plaice dtaairaitti ifi he Prime or baccnnimg crtanbita, ar mamma to a Eiovitrter citning dean # on,, In nspor# disputiL (t Tr radf; cement altte rofng) • ttcdiva 08106 May 11 09 12:48p ...gat lkiEutio:t Control Agency Demolition. n Contrac#or: 0 67-660 5 I '3 2 for 57 A) 41- it 1 Nana Ad • 1 - � City, not; Zip: Contact Prison: TO Phfpne Ntrraba(s):_6_6:L_. Minnesota Pollution Control Agency Notification of Intent to Fedor:in a Demolition Type orN tfisn: 1 I Oriemt I 1 Antendd 13 Project Cancellation : BIATADttiMr44 2 3 2,6 • el',2g Adar.,A.c.±1. 6 eA B mune, R Y= S f 5 M A) PbOttO Ness)". fat pace, If ibere >260 linfser 1=10 or >4.61}Evinva feet of Regatitld Atilatecentri*g Mnittriell• (2112,C:611) in. tilt* brulding to be deniolinhod, it must hg =moved by a lIzer. Iggatradi3r F te demelitte The State OW- ( t to Perform min Anbestcra Alyzatemetat Project Wit be aztfl notirl for the asbestos remora]. 19 nOf#'rilablie ACM peat in the stractare Ete idwun th ? WM noariatbite Mb prEtSr9nt fitnictors tli*falm dza aftri ? If YES to both qnestio above comps items 1-9. IMO t& either question complete If ACM krit for gm detatattort inEctt t astmunt arlamiDgory 1 andh2r 6tegray Boachbra ACM left Foct Cubic Fat n r i b �1 �s gadzets, .ire ltnt Di= cu n 2, atd asptuait woring prudimta contairagmose than iYilD p=telat mss_ #Cabtgory X u o tri i$ rtat nowt& to- rerrmin i Nam for ofit is ©rcXd rt. • Nirtgitttion ezited be rAtttrvraVidta er• dt (1 WORKING asys belbre dlltioa3 tom. r cznotencydemaliattuis, dstmstotail 2antrultd in wriiiing r t ri ft Live ect tratts. 2. Deseriplioz 6RcLofotinn of ACM rung b plAce (inActINcag &ter and r m .1): yciancIttioTh (xi T ttl'erbria rrtfza fw-574. . 4 P.7 atyistartpt 1 `_� Ci i Arvti feu . Agc afB/4 &c �' (dint. (fir ► ( `-- cY p resta t vp PA= IfstAthiiy A-(6- D a l e s whes d 4 4 or inteata1 bupaing wilt If �.�_ & End Linz Feet Squeert Vett Cubk Fed t� YES Cl Ategury itniErrrnibiLAQimants my material, ai excludiug CategaxyI warfriale Aavi, =tail& gm= tiat onnpercent itslicsutilatovhfa dry, czanaz be or 4 rate.,; 11 AMA's not elowea to ran In plAce for dtmorrtl It biz F4 Vigb protrabffity incoanng crumble ter' mcitited tv a powder dig iledrboiltion trumport, 3 disposal. (ex Tr1 roofing) R tylscii. O� May 11 09 12 :48p 3 Cothp i)1y axed /or'iztdividual that conducted the building inspection and the procedure used to determine the presence or absence of ACM (includiug.analytic method): Prior to demolition all buildings inrst be inspected by U. S. Environmental Protection Agency ( EPA ) accredited inspector. ec,h t� vi tom 7AL .� 4. Description of panned demolition and the specific method (s) that will be used: 't AZL' / t - -M1,- ) 15 06 5 If the demolition was ordered by a government agency, please identify the agency and attach a copy of the order: Name: Date of Order (WD ): Date Ordered to Begin (MID/Y): * Notification for an emergency demolition must be submitted as early as possible before demolition begins, but not Later than the following working day. A demolition is considered an emergency ONLY when the facility has been deemed structurally unsound and in danger of irmninant collapse.. Ifthe structurally unsound building is known to contain nny regulated ACM or is suspected to contain any regulated .ACM, special procedures MAST be Col rowed. Tim are unaware Qf (he special ,procedures, thstructionsireguiations tau be obtained by contacting the MPCA at the address or phone number listed below. Descripl on of procedure to 'be followed in the event that unexpected BACM is found or Cat II non friable ACM becomes crumbled, pulverized or reduced to powder: Artf- VC( 7 ,. L f , 8. D emo1mo n Waste Disposal Information: Landfill Thlame: Owner/Operator: AddressfLacation: L ( fiP City, State, Zip : ii-Is-g---- .. - Phone Number: • 7 Demolition Waste Transporter(s) Information: Transporter Nara c: L , ` ' 1 Transporter Contact! - ' - Transporter Address: t � �� Vi ` City, State, Zip: _ PIA-4' :,'i MP 6 f Phone Numbr: $1 Zap, Refrigerant receiver name/ address /phone nurnber: of cation of Intent to Perform a D rrioii1ihn form ( sw4- 21.do0 Authority: 9, Y certify that the above information is correct and Z an3 a boxaaf de representative of the demolition contractor or building owner and have authority to enter into agreements for my employer. Signature of Contractor /Owner ........... .............. Send to: Minnesota Pollution Control •'!`eney Municipal Division 520 Lafayette Road Nooh St: Pnui, MN 55:155-4194 PCB Removal Information Polychlorinated bapheny1s (PCBs) must be r• ernoved from the building to deinalztion. EGEss may befo until in light ballasts, sxnudl cctpacite rsfound in old appliances, and transformer oils. For questions call the MPCA Hazardous 'Waste (MO business assistance unit of 1-800-657-3724. PCB remover name /address /phone number: PCB receiver name/address/phone number: For questions call: 651-296-6300 or 1-800-657 -3864 FAX: 651-215-1593 or 651 -- 297.2343 Mercury Removal Information A "erc containing material must be removed from the building prior to demolition lifercury containing materials may include fluorescent, metal halide, high pressure sodium, neon, mercury vapor lamps, mercury n-viiches, thermostat ,probes, manometers, and gages. For gnestions calf the MPCA 11W business assistance unit at 1-800-657-3724. Mercury remover nameladdresslphone number: Mercury receiver name/address/phone number: Refrigerants/CFCs/II Recovery Information A certified technician must recover r ef.' igera ?ts from refrigeration quipme and systems in the building prior to demo!ii arz For questions call the CFC program at 1-800-657-3864. Refrigerant recoverer narneladdresslphone number: 1 Date Revised 08106 e, pie WC) g' 2621 ( ir6- 2g 1 May 11 D9 12:48p • Lc( e•4 guaL r& evezrzt 0,4t( 1R Avvie P264org'ei5-- 1 > ( :‹eeil — YR 6)77-(7 Ry SY 3 /0 A-14 / 0 r/q A- 69t2 13254 20Th STREET NORTH STILLWATER, MINNESOTA 55032 (51) 436-5325 FAX (651) 436-2244 t t ic BU ELOW EXCAVATING ri i t( usitt5cr r Q/2 o2. ( 57 et F-nle ,4 OA- A6 4- 119 Section III. Demolition Permit Document - Additional Conditions Agreement Letter of Credit $2,5,000 City of Oak Park Heights — Addendum to Demolition Permit: Additional Conditions Agreement Property Owner Green Twig, LLC (the "Applicant) has petitioned the City of Oak Park Heights, (the "City), for a Demolition Permit to demolish the homes located at the following Oakgreen Ave. addresses: 5710, 5754, 5752, 5770, 5800, 5830 and are located west of Oakgreen Ave, south of the Xcel Energy Transmission Towers and north of 58th Street in the City of Oak Park Heights. The Applicant has also pursued the 'burning" these structures by the Bayport Fire Department as a "training exercise ". The Bayport Fire Department will be acting as a contractor for the Applicant. Buelow Excavating will be acting as a contractor for the Applicant that will be performing the final demolition and site restoration. The City does hereby permit the above actions pursuant to the following: Terms and Conditions of Demolition Permit: 1. Prior to the commencement of any training exercise(s), the Applicant shall provide documentation and certification to the City that all asbestos, lead or other hazardous materials have been removed from the properties and all wells have been appropriately capped. Training exercises may not commence on any home unless and until this documentation has been received by the City and found to be satisfactory. 2. Following the completion of the "training exercise" at each property, the Applicant shall within 10 calendar days fully demolish and remove all remaining structures and debris from the City and shall fully restore the property (or properties) to a clean, level condition ready for future construction. If construction does not commence by August 15th, 2009, the Applicant shall remove all in -place septic system infrastructure and shall place a final topsoil application to all areas and a grass cover shall be established and maintained. 3. Site restoration shall be on a site -by -site basis, the Applicant must restore each property not later than 10 calendar days following the commencement of demolition and/or training exercises. All sites shall be fully demolished and restored by July 15th, 2009. 4. Should no fire training exercises occur or should not all homes be included in such training exercises, the Applicant shall fully demolish and remove from the City all six homes including all basements, foundations and septic infrastructure and shall restore all such sites to a clean, level condition not later than July 15th, 2009. 5. The Applicant shall provide to the City of Oak Park Heights a Letter of Credit (LOC) in the amount of $25,000.000 securing the final demolition and site remediation of the six homes located along Oakgreen Ave., lying north of 58th Street and south of Xcel Energy Transmission Towers. The LOC shall be released by the City when all homes, foundations, septic systems are fully removed and when all properties have been returned to a clean, level condition. 6. The Applicant does hereby grant the City the unilateral right to complete any demolition and debris removal should the Applicant fail to complete any required restoration actions in a timely manner. The Applicant shall be responsible to the reimburse the City for all costs associated with such actions required on the part of the City ensure the sites are clean, safe and presentable to the general public; including waiving all rights objecting to special assessments to recover any costs by the City. Should the City be required to take remediation actions, the Applicant shall also forfeit the $25,000 Le -r of Credit to the City as penalty. Page 1 of 2 7. The Applicant shall reimburse the City for costs associated with water -use for training exercises and shalt follow standard City water consumption / rates tables. The City will not charge the Applicant for costs associated with additional staff time required by the Public Works Department. 8. The City provides no warranty or guaranty that these properties are in a condition suitable for fire training exercise. The Applicant agrees to indemnify and hold harmless the City, its agents, officers, and employees from any and all claims, causes of action, liabilities, losses, damages, costs, expenses including reasonable attorneys fees, suits, demands and judgments of any nature, because - of bodily injury to, or death of, any person or persons and/or because of damages to property of the Applicant or others, including loss of use from any cause whatsoever, which may be asserted against the City on account of any act or omission, including negligence, of the Applicant, or the Applicant's employees or agents in connection with the performance of the work contemplated in the Permit. The Applicant agrees to defend any action brought against the City on any such matters, and to pay and satisfy any judgment entered thereof together with all costs and expenses incurred in connection therewith. The City shall in no way be liable for any claims or charges incurred by the Contractor in the performance of this Contract, 9. The City is not responsible for any site security, site protection or other measures to prevent injury, damages, property theft of loss, etc. of the Applicant or his contractors or agents. 10. The City may revoke any authorities conveyed to the Applicant in this document at anytime and for any reason. Such revocation shall be in writing by the City Administrator and/or Building Official and shall be immediate. 11. Following demolition of the buildings, erosion and silt control measures shall be coordinated on the site as directed by the City Engineer. Appropriate control measures as required by the City Engineer shall be installed prior to development and as may be necessary to control erosion and shall at a minimum follow "best management practices". The Applicant does agree to all terms and conditions listed above and are in addition to all federal, state and focal rules, ordinances, laws and requirements of record. Ti Nolde, Presid Green Tw <y . Page 2 of 2 ry (Affix notary stamp —>) Date 6 I DI 0 a l nson, City Administrator Pe y' it . ' - ly signed by City Administrator: JEN NOTAR NIFER M. PINSKI Y PUBIC - MINNESOTA My Commission Expires Jan. 31, 2012 JENNIFER M. PINSKI NOTARY PUBLIC - MINNESOTA My Commission Expires Jan. 31, 2012 l `# of Oak Park Heights 14168 Oak Park Blvd. N • Box 2007 • Oak Park Heights, MN 55082 • Phone (651) 439 -4439 • Fax (651) 439 -0574 Ci July 17, 2009 Mr. Tim Nolde GREEN TWIG LLC PO Box 119 Stillwater, MN 55082 RE: LOC # 124492502 (original enclosed) - $25,000.00 Dear Mr. Nolde: With this letter, the City is releasing in full the above letter of credit from Lake Area Bank, effective 7- 17-09. As we discussed, there are a few small clean -up items to be addressed at the site and an outstanding water bill for the fire training services. Please have Buelow Excavating complete the final pick -up of the debris and we will roll and water charges and removal of the septic systems in to the upcoming Development Agreement. Notwithstanding this release, the City does still consider the terms and conditions of the Demolition Permit to remain in force. We would anticipate these issues being address with your upcoming project. Should this not occur, we will require that all stated conditions be ompleted by September 15th, 2009. It •s 1' cf essful project and we do appreciate the opportunity. c . nson dministrator Judy Hoist Mark Vieriing City of Oak Park Heights 14168 oak Park Blvd. N Box 2007 • Oak Park Heights, MN 55082 • Phone (651) 439 -4439 • Fax (651) 439-0574 July 17, 2009 Mr. Tim Nolde GREEN TWIG LLC PO Box 119 Stillwater, MN 55082 RE: LOC # 124492502 (original enclosed) - $25,000.00 Dear Mr. Nolde: With this letter, the city is releasing in full the above letter of credit from Lake Area Bank, effective 7- 17 -09. As we discussed, there are a few small clean -up items to be addressed at the site and an outstanding water bill for the fire training services. Please have Buelow Excavating complete the final pick -up of the debris and we will roll and water charges and removal of the septic systems in to the upcoming Development Agreement. Notwithstanding this release, the city does still consider the terms and conditions of the Demolition Permit to remain in force. We would anticipate these issues being address with your upcoming project. Should this not.occur, we will require that all stated conditions be completed by September 15th, 2009. It was a successful project an we do appreciate the opportunity. Thank Yo Eric Johns City Administrator Cc: Judy Hoist Mark Vierl i ng June 12, 2009 To: To Whom It May Concern: We hereb y establish in favor of the City of Oak Park Heights this Irrevocable Letter of Credit No. 124492502 for the account of Green Twig, LLC, for the homes located at 5710 Oakgreen Avenue, 5754 Oakgreen Avenue, 5752 Oakgreen Avenue, 5770 Oakgreen Avenue, 5800 Oakgreen Avenue, and 5830 Oakgreen Avenue, located west of Oakgreen Avenue, south of the Xcel Energy Transmission Towers and north of 58 Street in the City of Oak Park Heights, in an aggregate amount of $25,000.00. This LETTER OF CREDIT shall be deemed automatically renewed without modification for one 1 from June 12, 2010, or any extended expiration date unless sixty (60) days or more p rior to such date we shall notify you by registered or certified mail that we elect not to extend the LETTER OF CREDIT for any such additional period. Partial drawings permitted. LAKE AREA BANK Friends Serving Neighbors Since 1915 Irrevocable Letter of Credit No 124492502 City of Oak Park Heights City Administrator 14169 Oak Park Blvd. Oak Park Heights, MN 55082 Each draft under this Letter of Credit must: 1. Be signed on behalf of the City; 2. Bear on its face the clause "drawn under Lake Area Bank Letter of Credit No. 124492502 dated June 12, 2009; and Be accomplished by a certification signed on behalf of the City 3. p y of Oak Park (1) Heights that either Hei g Green Twig, LLC has failed to comply with the terms of the demolition p ermit, or (11) Green Twig, LLC has failed to comply with the demolition p ermit, or (iii) this Letter of Credit will expire within sixty (60) days and this Letter of Credit has not been renewed or replaces as required. Visit Us Online At: www.lakeareabank.com Phone Banking 24 hours a day, 7 days a week Metro (651) 257 -1115 Toll Free (888) 257 -1115 Member FDIC Alznelund 4. Forest Lake • Harris • Hugo • Lindstrom ® Maplewood • Stillwater • White Bear Lake Q. The original Letter of Credit is NOT required to be presented to draw upon this Letter of Credit. We hereby engage with drawers and/or bona fide holders that drafts drawn and negotiated in conformity with the terms of the credit wilt be duly honored upon presentation. Except as otherwise state herein, this Letter of Credit shall be governed by the most recent version of the Uniform Customs and Practice for Documentary Credits (2007 Revision), International Chamber of Commerce Publication No. 600. Lake Area Bank By: R. S ott Johnson.: ' . Metro Market President Section IV. Per address Information: Issued City Demo Permit & Additional.Conditions Application fro Demolition Permit Well Closure Documentation Asbestos Abatement Removal Certification 5710 Oakgreen Issued City Demo Permit & Additional Conditions Application fro Demolition Permit Well Closure Documentation Asbestos Abatement Removal Certification 1 1 1 1 b RESS 5710 OAKGREEN AVE N PIN 05- 029 -20 -14 -0003 LEGAL DESC N/A LOT 0 BLOCK. 0 PERMIT TYPE OTHER PROPERTY TYPE RESIDENTIAL - OTHER THAN NEW CONSTRUCTION TYPE DEMOLITIONS NOTE: SFD- WORK SHALL BE PERFORMED IN COMPLIANCE WITH APPLICABLE REQUIREMENTS OF LOCAL, COUNTY, STATE JURISDICTIONS AND THEIR AGENCIES AS THEY PERTAIN TO THE PROJECT,INCLUDING CITY OF OAK PARK HEIGHTS ADDENDUM TO DEMOLITON PERMIT DATED 06 -10 -09 AND ATTACHED TO PERMIT. NOTE: (1) 24 HOURS NOTICE REQUIRED PRIOR TO UTILITY WORK (2) WATER SHALL BE SHUT OFF AT VALVE BOX AND COPPER CUT OFF NEAR VALVE & CRIMPED CLOSED (3) TREE REMOVALS TO BE APPROVED BY CITY ARBORIST PRIOR TO THEIR REMOVAL (4) WELLS & SEPTICS SHALL BE CLOSED OR ABANDONED PER ESTABLISHED CRITERIA. GREEN TWIG LLC P.O. BOX 19 STILLWATER, MN 55082- APPLICANT GREEN TWIG LLC P.O. BOX 119 STILLWATER, MN 55082- OWNER AGREEMENT AND SWORN STATEMENT The work for which this permit is issued shall be performed according to: (1) the conditions of this permit; (2) the approval plans and specifications; (3) the applicable city approvals, Ordinances, and Codes; and, (4) the State Building Code. This permit is for only the work described, and does not grant permission for additional or related work which requires separate permits. This permit will expire and become null and void if work is not started within 1 80 days, or if work is suspended or abandoned for a period of 180 days any time r work has commenced. The applicant is responsible for assuring all required inspections are requested in conformance with the Minnesota State Building Code. CITY OF OAK PARK HEIGHTS 14168 OAK PARK BLVD. N. #2007 OAK PARK HEIGHTS, MN 55082 -2007 (651) 351 -1661 FAX: (651) 439 -0574 PERMIT NO.: 2009 -00082 OTHER PERMIT FEE 25.00 OTHER PERMIT SURCHARGE, FLAT 0.50 TOTAL 25.50 PAID WITH CHECK # 5040 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBE] ABOVE. DATE ISSUED: 06/25/2009 F; '7 I D oJ L\f city of Oak Park Heights -- Addendum to Demolition Permit: Additional Conditions Agreement Property Owner Green Twig, LLC (the "Applicant') has petitioned the City of Oak Park Heights, (the "City "), for a Demolition Permit to demolish the homes located at the following Oakgreen Ave. addresses: 5710, 5754, 5752, 5770, 5800, 5830 and are located west of Oakgreen Ave, south of the Xcel Energy Transmission Towers and north of 58th Street in the City of Oak Park Heights. The Applicant has also pursued the "burning" these structures by the Bayport Fire Department as a "training exercise ". The Bayport Fire Department will be acting as a contractor for the Applicant. Buelow Excavating will be acting as a contractor for the Applicant that will be performing the final demolition and site restoration. The City does hereby permit the above actions pursuant to the following: Terms and Conditions of Demolition Permit: 1. Prior to the commencement of any training exercise(s), the Applicant shall provide documentation and certification to the City that all asbestos, lead or other hazardous materials have been removed from the properties and all wells have been appropriately capped. Training exercises may not commence on any home unless and until this documentation has been received by the City and found to be satisfactory. 2. Following the completion of the "training exercise" at each property, the Applicant shall within 10 calendar days fully demolish and remove all remaining structures and debris from the City and shall fully restore the property (or properties) to a clean, level condition ready for future construction. If construction does not commence by August 15th, 2009, the Applicant shall remove all in -place septic system infrastructure and shall place a final topsoil application to all areas and a grass cover shall be established and maintained. 3. Site restoration shall be on a site -by -site basis, the Applicant must restore each property not later than 10 calendar days following the commencement of demolition and/or training exercises. All sites shall be fully demolished and restored by July 15th, 2009. 4. Should no fire training exercises occur or should not all homes be included in such training exercises, the Applicant shall fully demolish and remove from the City all six homes including all basements, foundations and septic infrastructure and shall restore all such sites to a clean, level condition not later than July 1 5th, 2009. 5. The Applicant shall provide to the City of Oak Park Heights a Letter of Credit (LOC) in the amount of $25,000.000 securing the final demolition and site remediation of the six homes located along Oakgreen Ave., lying north of 58th Street and south of Xcel Energy Transmission Towers, The LOC shall be released by the City when all homes, foundations, septic systems are fully removed and when all properties have been returned to a clean, level condition. 6. The Applicant does hereby grant the City the unilateral right to complete any demolition and debris removal should the Applicant fail to complete any required restoration actions in a timely manner. The Applicant shall be responsible to the reimburse the City for all costs associated with such actions required on the part of the City ensure the sites are clean, safe and presentable to the general public; including waiving all rights objecting to special assessments to recover any costs by the City. Should the City be required to take remediation actions, the Applicant shalt also forfeit the $25,000 Le -r of Credit to the City as penalty. Page 1 of 2 7. The Applicant shall reimburse the City for costs associated with water -use for training exercises and shall follow standard City water consumption / rates tables. The City will not charge the Applicant for costs associated with additional staff time required by the Public Works Department. 8, The City provides no warranty or guaranty that these properties are in a condition suitable for fire training exercise. The Applicant agrees to indemnify and hold harmless the City, its agents, officers, and employees from any and all claims, causes of action, liabilities, losses, damages, costs, expenses including reasonable attorneys fees, suits, demands and judgments of any nature, because of bodily injury to, or death of, any person or persons and/or because of damages to property of the Applicant or others, including loss of use from any cause whatsoever, which may be asserted against the City on account of any act or omission, including negligence, of the Applicant, or the Applicant's employees or agents in connection with the performance of the work contemplated in the Permit. The Applicant agrees to defend any action brought against the City on any such matters, and to pay and satisfy any judgment entered thereof together with all costs and expenses incurred in connection therewith. The Cit y shalt in no way be liable for any claims or charges incurred by the Contractor in the performance of this Contract. 9. The City is not responsible for any site security, site protection or other measures to prevent injury, damages, property theft of loss, etc. of the Applicant or his contractors or agents. 10. The City may revoke any authorities conveyed to the Applicant in this document at anytime and for any reason. Such revocation shall be in writing by the City Administrator and/or Building Official and shall be immediate. 11. Following demolition of the buildings, erosion and silt control measures shall be coordinated on the site as directed by the City Engineer. Appropriate control measures as required by the City Engineer shall be installed prior to development and as may be necessary to control erosion and shalt at a minimum follow "best management practices ". The Applicant does agree to all terms and conditions listed above and are in addition to all federal, state and local rules, ordinances, laws and requirements of record. Ti Nolde, Presid Green Tw' Paige 2 of 2 Date ' 1 nson, City Administrator Pe ' • signed by City Administrator: t Vi - .Date: • i 2 - r (Affix notary stamp 3) Date: l b' JENNIFER M. PINSKI NOTARY PUBLIC - MINNESOTA My Commission Expires Jan. 31, 2012 • o Filr 51110 OLL'r iswo--0 (0I 0 7 JENNIFER M. PINSKI NOTARY PUBLIC - MINNESOTA My Commission Expires Jan. 31, 2012 JOB ADDRESS CLASS OF WORK Number Street S 10 A.K6i2 6 F Al ,4 e New Add Sign . Alter Repair Move Demolish _ Front or Width in Feet Side or Length in Feet Height in Feet No of Stories .. Area of Lot Occupied Type of Construction Occupancy Project goo Valuation Owner:CtflW-406 CLC. Address: 5t t\ Phone: (al) q3�qi R7 Applicant's Signature For Office Use only: Total: Oak Park Heights Application for Permit Legal Description (if no address assigned: 4 Description of Work Being Done: OEfbLt�HU* °" C Q� ?QkC#T10E Bt)(P'J IA) A* LE A .UP rsrogrffil IAA City Building: City Plumbing: City Mechanical: Plan Review: State Surcharge: Signage: City Utility Meter: Utility Connection: Utility Inspection: Metro S.A.C.: Investigation Fee: Other: contractnr5 u Elp1t) EM'A1Th1 C � , (, (J oHNBvEW�J) Address: 132.5&J. 2.0 „T� • Slit,LtdArgQ. Phone: (I�) X36 - 53 L(1, F‘t4Pit. TEAR hours i ed upon the Inspection Record Card. OWN By signature below, the applicant hereby agrees to work in accordance with the Ordinances of the Local Municipality, State Building Code, and the requirements enforced by the City of Oak Park Heights Building Department. The applicant further agrees to notify the Building Official of each the required inspections 24 Dated: 'Jk BaYpon.T DET C,b,bJr: Al 4.E 2q� N. Lt Sr. M�port, 550D.3 Jim Butler, Building Official City of Oak Park Heights 5/zila 14168 Oak Park Blvd. N. P.O. Box 2007 Oak Park Heights, MN 66082 Phone: (661) 439 -4439 FAX: (661 439-0574 Dte101-1$ RsiTtAguvl WELL OR BORING LOCATION County Name WASHINGTON Township Name Township No. BAY'TOWN Amerock N s 1 Mile 29 Latitude_____ degrees._ minutes seconds 1 .i ION: Longitude degrees seconds Numerical Street Address or Fire Number and City of Well or Boring Location 5710 Oakgreen Ave N. , Oak Park Heig Show exact location of well or boring in section grid with "X." LOGICAL MATERIAL and/ Gravel � 0ee P f E COMPANY NAME Property owner's retailing address if different than well location address indicated above 773 . Green Twig Way Stillwater, MN 55082 WELL OWNER'S NAME /COMPANY NAME SCREEN /OPEN HOLE Well owner's mailing address if different than property owner's address indicated above Screen from to ft. Open Hole from to _ It. L Range No. Section No. Fraction (sm. Ig,) Date Sealed 20 5 N 6/9/2009 'h Mile COLOR If not known, indicate estimated formation log from nearby well or boring. MINiN. DEPT OF HE.ALT':-•1 COPY Varied Yellow WELL AND BORING SEALING G RE O D Sketch map of well or boring location, showing property lines, roads, and buildings. Hard HARDNESS OR FORMATION Varied REMARKS, SOURCE OF DATA, DIFFICULTIES IN SEALING 27651 MINNESOTA DEPARTMENT OF HEALTH Minnesota Statutes, Chapter 1031 Steel ❑Plastic ❑Tile ❑Other c'. FROM 0 121 160 1 Depth Before Sealing 1 60 AQUIFER(S) Single Aquifer T 1 Multiaquifer WELL/BORING j Water - Supply Well ❑ Monit. Well ❑ Env. Bore Hole ❑ Other CASING TYPE(S) WELLHEAD COMPLETION Outside: ❑ Well House K At Grade ❑ Pitless Adapter /Unit El Buried Li Well Pit ❑ Other Type of Obstructions (Describe) PUMP T ype Submersible Removed [] Not Present OTHER WELLS AND BORINGS Ma-n._t Licensee Business Name ft. Name of Person Sealing Well or Boring Minnesota Well and Boring Sealing No. Minnesota Unique Well No. or W- series No. (Leave b!e k il not known) Date Well or Boring Constructed Original Depth _fl. STATIC WATER LEVEL M Measured ❑ Estimated Date Measured 6/9/2009 2009 128 ft. j below [] above land surface ❑ Other Inside: ❑ Basement Offset ❑ Well Pit Buried ❑ Other TO Obstructions removed? ❑ Yes ❑ No Describe H 276'514 CASING(S) Diameter Depth Set in oversize hole? Annular space initially grouted? 5 in. from 1_ 1_ to ft. [1 Yes ] No [ 1 Yes ❑ No ❑ Unknown in. from to ft. ❑ Yes ❑ No ❑ Yes ❑ No [] Unknown in. from to ft. ❑ Yes ❑ No 0 Yes ❑ No Unknown OBSTRUCTIONS ❑ Rods /Drop Pipe [l1 Check Valve(s) U Debris ❑ Fill TO No Obstruction METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS, OR CASING AND BORE HOLE: No Annular Space Exists ❑ Annular Space Grouted with Trernie Pipe ❑ Casing Perforation /Removal in. from to ft. ❑ Perforated ❑ Removed in. from to ft. ❑ Perforated [l Removed Type of Perforator ❑ Other GROUTING MUTATERIAL(S) (One bag of cement = 94 lbs., one bag of bentonite = 50 lbs.) Grouting Material_______ eat_Cernea . t _ from_a ___ to leQ_ ft. yards_ 23 bags from to • ft. • yards bags from to ft. ._ yards bags Other unsealed and unused well or boring on property? ❑ Yes J No How many? LICENSED OR REGISTERED CONTRACTOR CERTIFICATION This well or boring was sealed in accordance with Minnesota Rules, Chapter 4725. The information contained in this report is true to the best of my knowledge. Certi - epre _ - • •nature .. Certified Rep. No. Date e r 4 Rieha . - - ; a r ren .. Rob Lyon License or Registration No. 583 6/9/2009 HE- 01434 -11 105 140 -0423 2108R City of Oak Park Heights 14168 Oak Park Blvd. North Oak Park Heights, MN 55082-2007 June 26, 2009 RE: Asbestos Removal Fire Training Exercise Dear sir: Sincerely, 76 S1 Croix Trail N Lakeland, MN 55043 651. 36.8559 (n651.436.2021 4 14,4 , 4 Dennis Schumann Vice President, VUI Environmental Ikic. 651 436 8559 •.. r If you have any questions please feel free to contact me. Val Environmental Inc. has successfully co �i pier 1 the removal of asbestos containing materials identified in Envir : # e ..1.' roperty Audit's asbestos survey reports for the houses located at 5830 an 5710 l a.k Green Ave. in Oak Park Heights, MN1 1.0 INTRODUCTION Enviro locate materia s purpose of the survey was to identify, sample and assess suspect building materials that may contain asbestos. The inspection was requested in order to facilitate an upcoming demolition of the structure, and to provide an inventory of asbestos containing materials (ACM) as found in or on the residence. This survey included an inspection of all suspected asbestos containing building materials and collection of bulk samples. EMSL Analytical, Inc., Minneapolis, MN, analyzed the samples utilizing Polarized Light Microscopy (PLM) - Method EPA 600/R-93/116. The primary materials, which were sampled, included: sheetrock /joint compound, floor tile, panel adhesive, ceiling texture, siding, and roofing materials. 2.0 SCOPE OF WORK A Minnesota licensed asbestos inspector from EPA, Inc. conducted a building survey for the identification and assessment of accessible suspect ACM at the residence located at 5710 Oakgreen Avenue, Stillwater. The following activities have been completed by EPA, Inc.: • A walk- through of the buildings interior spaces, with observations of accessible suspect ACM. • Random sample collection from suspect ACM building materials with consideration to homogeneous areas and material types. • Mapping and logging bulk samples for future reference. • Estimated quantity of material types identified as asbestos containing (greater than 1%). • Analysis of bulk samples by polarized light microscopy, utilizing EMSL Analytical, Inc. of Minneapolis. The laboratory analysis confirmed materials that are asbestos containing and the summary includes the following information: 3M Building Description, 4M Suspect Building Materials, 5.0 Asbestos Containing Building Materials List (including estimated quantities), 6.0 Non - asbestos Containing Materials List, 7.0 Non - suspect Materials, and 8.0 Inspector Accreditation. 2.1 LIMITATIONS ASBESTOS MATERIAL SURVEY 5710 OAKGREEN AVENUE NORTH OAK PARK HEIGHTS, MINNESOTA - operty Audits, Inc. (EPA, Inc.) conducted a visual survey at the residence akgreen Avenue, Oak Park Heights, MN. The survey for asbestos - containing CM) was completed on May 29, 2009, for Mr. Dennis Schumann, VCI. The EPA Inc. made reasonable attempts to access all areas of the residence as presented within the scope of this work. The following areas and/or materials were not able to be accessed due to safety concerns or other limitations. • No excavations were made to identify foundation conditions below grade (i.e. exterior damp- proofing). • A limited number of roof samples were collected from the residence. Based on the similar appearance, it is assumed that the findings were consistent with the remainder of the roof area. 5710 Oakgreen Ave N 02009 EPA, Inc 3.0 BUILDING DESCRIPTION 4.0 SUSPECT BUILDING MATERIALS ASBESTOS MATERIAL SURVEY 5710 OAKGREEN AVENUE NORTH OAK PARK HEIGHTS, MINNESOTA The project consisted of a split level two -story residence. • The exterior walls of the building are constructed of wood framing with fiberglass insulation. • The main floor areas were a mix of hardwood flooring, carpet and linoleum. • The interior walls are primarily wood framing with a sheetrock application. • The basement foundation was concrete block with a concrete slab floor. • The roof had 3-tab asphalt shingles over a tarpaper .underlayment system. • The exterior walls are vinyl siding. • The heating was provided by a forced air furnace system. Representative bulk samples of suspect ACM building materials were collected from the building. The identified materials that were considered suspect and subsequently sampled include: • Floor tile • Ceiling tile • Sheetrock.lj o int compound • Panel adhesive • Siding • Roofing Materials Of the materials sampled, the following were found to be asbestos containing: • Ceiling texture • Paneling adhesive Due to the plans for the burning of the residence, removal of all identified asbestos containing materials is mandatory. The removal of the identified materials must be completed prior to the start of the demolition. A licensed abatement contractor using appropriate removal methods and engineering controls would be required to perform the removal of the asbestos containing materials. Please refer to the following section for the analytical laboratory results, including material locations, and quantities. 5710 oakgreen Ave N 2 02009 EPA, Inc Functional Space Material Identification Foundation Concrete Supports /Framing Wood 5.0 ASBESTOS CONTAINING MATERIAL INVENTORY The following materials were found to have an asbestos content of greater than 1% by weight. Sample # 09 -04107 B -01 09-04107 B -04 Functional -��� p a c e Living Room Kitchen /Living Room Material Identification Ceiling texture Paneling adhesive Asbestos Content 3% Chrysotile 5% Chrysotile Material Amount** 1200 sq. ft. 200 sq. ft. **Estimate of visible material amounts. Require abatement contractors to verify material amount for bidding purposes. NOTE: Samples #B -02 and B -03 were not analyzed due to similar material on B -01 was positive 6.0 NON - ASBESTOS CONTAINING MATERIAL INVENTORY The following materials had laboratory results of "None Detected" (ND) for asbestos content. No special regulations pertain to these building materials. Sample # 09 -04107 13-05 09 -04107 B -06 09 -04107 13-07 09 -04107 13-08 ASBESTOS MATERIAL SURVEY 5710 OAKGREEN AVENUE NORTH OAK PARK HEIGHTS, MINNESOTA Functional Space Material Identification Hallway Sheetrockljoint compound Basement Bathroom 1.2x 12Floor tile (yellow )/mastic Roof Garage Siding 7.0 NON-SUSPECT ASBESTOS MATERIALS The following materials are present in this building but are not considered as suspect asbestos building materials. 8.0 ASBESTOS BUILDING INSPECTOR ACCREDITATION Inspector Jim Lindahl Exp. Date 11/25/09 Minnesota Certification Number — #Al2333 Felt underlayment Felt paper underlayment Asbestos Content ND ND ND ND Please see the following pages for Minnesota Department of Health certification information. 5710 Oakgreen Ave N 3 ©2009 EPA, Inc EMSL Analytical, Inc. 14375 23rd Avenue North, Minneapolis, Mn 55447 Phone: (763) 449 -4922 Fax: (763) 449 -4924 Email: minneapolislab@emsl.com emsl.com Attn: Jim Li nd a h l Environmental Property Audits Inc 2701 4th Avenue North Anoka, MN 55303 Fax: (763) 323 -6677 Phone: (763) 323 -6700 Project: 5710 Oak Green Ave Asbestos Analysis of Bulk Materials via EPA 600/R-93/116 Method using Polarized Light Microscopy Non- Asbestos Sample 09 -04107 B -01 350902600 -0001 09 -04107 B -02 350902600 -0002 Description Ceiling Texture L. White Non - Fibrous Homogeneous Rm Ceiling Texture SW Bed Rm. Appearance % Fibrous Customer ID: ENVP52 Customer PO: Received: 06/01/09 1:30 PM EMSL Order: 350902600 EMSL Proj: Analysis Date: 6/2/2009 % Non - Fibrous Asbestos % Type 3% Chrysotile Stop Positive (Not Analyzed) Stop Positive (Not Analyzed) 97% Non - fibrous (other) '- 04107 B -03 j02600-0003 Ceiling Texture SE Bed Rm 09 -04107 B -04 350902600 -0004 09 -04107 B -06- Bsmt Bath Rm Brown/Yellow Floor Tile Floor Tile 12x12 Non - Fibrous 350902600 -0006 Yellow Homogeneous Paneling Adhesive Brown Non - Fibrous Homogeneous 09-041076-05 SheetrocklJT TanANhite 350902600 -0005 Compound Non - Fibrous Heterogeneous Analyst(s) Heidi Johnson (8) Test Report PLM - 7.12.0 Printed: 612/2009 9:26:34 AM Adhesive Only Tested 10% Cellulose SheetrocklJoint Compound 95% Non - fibrous (other) 90% Non - fibrous (other) 100% Non - fibrous (other) Rachel Travis, Laboratory Manager or other approved signatory Due to magnification limitations inherent in PLM, asbestos fibers in dimensions below the resolution capability of PLM may not be detected. The limit of detection as stated in the `hod is 1 %. The above test report relates only to the items tested and may not be reproduced in any form without the express written approval of EMSL Analytical, Inc. EMSL's )ty is limited to the cost of analysis. EMSL bears no responsibility for sam collection activities or analytical method limitations. Interpretation and use of test results are the ,onsibility of the client.. Samples received in good condition unless otherwise noted. This report must not be used to claim product endorsement by NVLAP or any agency of the U.S. Government. NVLAP Lab Code 200019 -0 5% Chrysotile None Detected None Detected 1 Attn: Sample 09 -04107 8 -06 -Tan Mastic 350902600 -0006A 09 -04107 B -06- Black Mastic 350902600 -00068 -04107 B -07 350902600 -0007 09 -04107 8 -08 350902600 -0008 Analyst(s) Heidi Johnson (8) Test Report PLM - 7.12.0 Printed: 6/2/2009 9:26:35 AM EMSL Analytical, Inc. 14375 23rd Avenue North, Minneapolis, Mn 55447 Phone: (763) 449 -4922 Fax: (763) 449 -4924 Email: minneapolislab@emsl.com Jim Lindahl Environmental Property Audits Inc 2701 4th Avenue North Anoka, MN 55303 Fax: (763) 323 -6677 Project: 5710 Oak Green Ave Asbestos Analysis of Bulk Materials via EPA 600/R- 93/116 Method using Polarized Light Microscopy Non - Asbestos Description Bsmt Bath Rm Floor Tile 12x12 Yellow Bsmt Bath Rm Floor Tile 12x12 Yellow Felt underlayment Roof Felt paper underlayment garage siding Phone: (763) 323 -6700 Appearance Tan Non - Fibrous Homogeneous Black Non - Fibrous Homogeneous Black Fibrous Heterogeneous Black Fibrous Heterogeneous % Fibrous 65% Cellulose 80% Cellulose EMSL Proj: Analysis Date: Customer ID: ENVP52 Customer PO: Received: EMSL Order: 06101/09 1:30 PM 350902600 6/2/2009 % Non- Fibrous 100% Non - fibrous (other) 100% Non - fibrous (other) 35% Non - fibrous (other) 20% Non - fibrous (other) 1 t1 Rachel Travis, Laboratory Manager or other approved signatory Asbestos % Type None Detected None Detected None Detected None Detected I Due to magnification limitations inherent in PLM, asbestos fibers in dimensions below the resolution capability of PLM may not be detected. The limit of detection as stated in the 'hod is 1 %. The above test report relates only to the items tested and may not be reproduced in any form without the express written approval of EMSL Analytical, Inc. EMSL's ty is limited to the cost of analysis. EMSL bears no responsibility for sample collection activities or analytical method limitations. Interpretation and use of test results are the nsibility of the client. Samples received in good condition unless otherwise noted. This report must not be used to claim product endorsement by NVLAP or any agency of the U.S. Government. • • . . NVLAP Lab Code 200019-0 THIS IS THE LAST PAGE OF THE REPORT. 2 , •;4 thfrct.pil • 8$1. OittA'',W0001: 0044 0°0: 63_ • • (O25% sen5t1jlty • ;' - nOtie„: _Pi. tidtt 4n. fOr $01 Ah $ t a I dti 7400 ttinvOlgid - - Vilit201 NOB (<1%) Pori Cor 0 1.00:(..o10,4,) Poriit0006tWelOirrit)trft 0400 (425q 0 two (01%) 4y$ 96.1 (ri4b16.in WY) i rnpIer Nah lieT. impIers gnturo l $011100 p e�rIptIor i, 711 an ot Custody r • • '48 ties praffifm a; fir Hr ram • Accordenge with Emsus refirns and AtiEkA 40 CFR, Part n3 -NiOSH 1402 0 EPA Levet 0.1s014,312 00 tic.e 0 NYC NOB 198,4 (tur -f0able-NY) Cialflofif SOP 600 sec, 2. 1062 Fib:eS*1t110 0 Waste 0 - Qr1010nO ElWatte -Elbiltiklii0 IT 1,4-( tec Datil: ate: Page 1 pages . .^*•••••••••....k, � n$ kaat.' • a Et0S1- Mit4 • 755 t4(rttutoki Time; TLCAL NC -4924 Ott Wirt fo ;Pfte 11%, miox'rnxio Istr Additidnal Pag0s,of tho Chain of Cu=stody are only necessofy if nOodad for additional saMple'Inforrntion . .............. Cotrao OA% .-V141.f.;•.0.9 pescrjojo 6 01 Page • • • • • • • •,•• • • • • • • .• • --^••• of pages PHO • . • • '• • • •• '• - • • • • • • EMSL ANALYTICAt , 1 14373 23 AVENUE ••••- • • - • • L. • • • • • . • • - ••;• ommets fSpeIaI 1rrntructJons : F E E rvj CL CID an = = 5 — C) co E 8 ce, E 5754 Oakgreen Issued City Demo Permit & Additional Conditions Application fro Demolition Permit Well Closure Documentation Asbestos Abatement Removal Certification ADDRESS 5754 OAKGREEN AVE N PIN 05- 029 -20 -11 -0063 LEGAL DESC OAKGREEN VILLAGE LOT 0 BLOCK 0 PERMIT TYPE OTHER PROPERTY TYPE RESIDENTIAL -- OTHER THAN NEW CONSTRUCTION TYPE DEMOLITIONS NOTE: SFD- WORK SHALL BE PERFORMED IN COMPLIANCE WITH APPLICABLE REQUIREMENTS OF LOCAL, COUNTY, STATE JURISDICTIONS AND THEIR AGENCIES AS THEY PERTAIN TO THE PROJECT,INCLUDING CITY OF OAK PARK HEIGHTS ADDENDUM TO DEMOLITON PERMIT DATED 06 -10 -09 AND ATTACHED TO PERMIT. NOTE: (1) 24 HOURS NOTICE REQUIRED PRIOR TO UTILITY WORK (2) WATER SHALL BE SHUT OFF AT VALVE BOX AND COPPER CUT OFF NEAR VALVE & CRIMPED CLOSED (3) TREE REMOVALS TO BE APPROVED BY CITY ARBORIST PRIOR TO THEIR REMOVAL (4) WELLS & SEPTICS SHALL BE CLOSET) OR ABANDONED PER ESTABLISHED CRITERIA. GREEN TWIG LLC P.O. BOX 119 STILLWATER, MN 55082- GREEN TWIG LLC P.O. BOX 119 STILLWATER, MN 55082- APPLICANT OWNER AGREEMENT AND SWORN STATEMENT The work for which this permit is issued shall be performed according to: (1) the conditions of this permit; (2) the approval plans and specifications; (3) the applicable city approvals, Ordinances, and Codes; and, (4) the State Building Code. This permit is for only the work described, and does not grant permission for additional or related work which requires separate permits. This permit will expire and become null and void if work is not started within 180 days, or if work is suspended or abandoned for a period of 180 days any time r work has commenced. The applicant is responsible for assur all required inspections are requested in conformance q p q with the Minnesota State Building Code. CITY OF OAK PARK HEIGHTS 14168 OAK PARK BLVD. N. #2007 OAK PARK HEIGHTS, MN 55082 -2007 651 351 -1661 FAX: 651 439-0574 OTHER PERMIT FEE OTHER PERMIT SURCHARGE, FLAT TOTAL PAID WITH CHECK # 5040 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. PERMIT NO.: 2009 DATE ISSUED: 06/18/2009 25.00 0.50 25.50 City of Oak Park Heights — Addendum to Demolition Permit: Additional Conditions Agreement Property Owner Green Twig, LLC (the "Applicant") has petitioned the City of Oak Park Heights, (the "City"), for a Demolition Permit to demolish the homes located at the following Oakgreen Ave. addresses: 5710, 5754, 5752, 5770, 5800, 5830 and are located west of Oakgreen Ave, south of the Xcel Energy Transmission Towers and north of 58th Street in the City of Oak Park Heights. The Applicant has also pursued the "burning" these structures by the Bayport Fire Department as a "training exercise ". The Bayport Fire Department will be acting as a contractor for the Applicant. Buelow Excavating will be acting as a contractor for the Applicant that will be performing the final demolition and site restoration. The City does hereby permit the above actions pursuant to the following: Terms and Conditions of Demolition Permit: 1. Prior to the commencement • of any training exercise(s), the Applicant shall provide documentation and certification to the City that all asbestos, lead or other hazardous materials have been removed from the properties and all wells have been appropriately capped. Training exercises may not commence on any home unless and until this documentation has been received by the City and found to be satisfactory. 2. Following the completion of the "training exercise" at each property, the Applicant shall within 10 calendar days fully demolish and remove all remaining structures and debris from the City and shall fully restore the property (or properties) to a clean, level condition ready for future construction. If construction does not commence by August 15th, 2009, the Applicant shall remove all in -place septic system infrastructure and shall place a final topsoil application to all areas and a grass cover shall- be established and maintained. 3. Site restoration shall be on a site -by -site basis, the Applicant must restore each property not later than 10 calendar days following the commencement of demolition and/or training exercises. All sites shall be fully demolished and restored by July 16th, 2009. 4. Should no fire training exercises occur or should not all homes be included in such training exercises, the Applicant shall fully demolish and remove from the City all six homes including ail basements, foundations and septic infrastructure and shall restore all such sites to a clean, level condition not later than July 15th, 2009. 5. The Applicant shall provide to the City of Oak Park Heights a Letter of Credit (LOC) in the amount of $25,000.000 securing the final demolition and site remediation of the six homes located along Oakgreen Ave,, lying north of 58th Street and south of Xcel Energy Transmission Towers. The LOC shall be released by the City when all homes, foundations, septic systems are fully removed and when all properties have been returned to a clean, level condition. 6. The Applicant does hereby grant the City the unilateral right to complete any demolition and debris removal should the Applicant fail to complete any required restoration actions in a timely manner. The Applicant shall be responsible to the reimburse the City for all costs associated with such actions required on the part of the City ensure the sites are clean, safe and presentable to the general public; including waiving all rights objecting to special assessments to recover any costs by the City. Should the City be required to take remediatin actions, the Applicant shall also forfeit the $25,000 Le -r of Credit to the City as penalty. Page 1 of 2 ��. 5 7 5'-/ 0 ONE y 7. The Applicant shall reimburse the City for costs associated with water-use for training exercises and shall follow standard City water consumption 1 rates tables. The City will not charge the Applicant for costs associated with additional staff time required by the Public Works Department. 8. The City provides no warranty or guaranty that these properties are in a condition suitable for fire training exercise. The Applicant agrees to indemnify and hold harmless the City, its agents, officers, and employees from any and all claims, causes of action, liabilities, tosses, damages, costs, expenses including reasonable attorneys fees, suits, demands and judgments of any nature, because of bodily injury to, or death of, any person or persons and/or because of damages to property of the Applicant or others, including loss of use from any cause whatsoever, which may be asserted against pp � i including Applicant, or the the City on account of any act or omission, including negligence, of the Applica , a Applicant's employees or agents in connection with the performance of the work contemplated in the Permit. The Applicant agrees to defend any action brought against the City on any such matters, and to pay and satisfy any judment entered thereoftogetherwth all costs and expenses incurred in connection Y g therewith, The City shall in no way be liable for any claims or charges incurred by the Contractor in the performance of this Contract. 9. The City is not responsible for any site security, site protection or other measures to prevent injury, damages, property theft of loss, etc. of the Applicant or his contractors or agents. 10. The City may revoke any authorities conveyed to the Applicant in this document at anytime and for any reason. Such revocation shall be in writing by the City Administrator and/or Building Official and shall be immediate. 11. Following demolition of the buildings, erosion and silt control measures shall be coordinated on the site as directed by the City Engineer. Appropriate control measures as required by the City Engineer shall be installed prior to development and as may be necessary to central erosion and shall at a minimum follow "best management practices ". The Applicant does agree to all terms and conditions listed above and are in addition to all federal, state and local rules, ordinances, laws and requirements of record, Ti Nolde, Presid Green Tw ��, r Aft" o f ( x • cry tamp 4) Page 2 of 2 !6 10/0 it Date I d ir nson, City Administrator Pe ' It i is • " ly ~ signed by City Administrator: A la A . . A l ate: 1 0°1 t.ry 1b7 (Afflx notary stamp -3) I JENNIFER M. PINSKI NOTARY PUBLIC - MINNESOTA My Commission Expires Jan. 31, 2012 ENNIFER M. PINSKI OTARY PUBLIC - MINNESOTA My Commission Expires Jan. 31, 2012 JOB ADDRESS GLASS OF WORKS Number Street . S 51 04 v New . Add Sign • Alter Repair Move Demolish Front or Width in Feet Side or Length in Feet Height in Feet No of Stories Area of Lot 1 Occupied Type of Construction Occupancy Project soolo Valuation . . $ 2- 5 - - - owner:C301'4W \6 (LC. Address: Tu.1IATff& Phone: l^ ((�) q3q The applic ho Applicant's For Office Use Only: City Building: City Plumbing: City Mechanical: Plan Review: State Surcharge: Total: a oted upon the Inspection Record Card. Oak Park Heights Application for Permit Phone:( BAy pool Fi VieE: C.bp4)Thr: Al 1 � 2q�1 N. 3RD sr. gA.Yi Port rAk 55003 uEtptJ E VA'TN (.» (:rD1N E L BvOiJ) Contractor$ Address: 13264 2,04$1 5 /v Legal Description (if no address assigned: ____4444 Description of Work Being Done: tE(bLt�H SON r' � � QE ?QMC�T1 CE 131.,) P ) 1.4.01#0ED 3 sire. CLE " P 07%.1. Dated: By signature below, the applicant hereby agrees to work in accordance with the Ordinances of the Local Municipality, State Building Code, and the requirements enforced by the City of Oak Park Heights Building Department. er agrees to notify the Building Official of each the required inspections 24 5 ?O Jim Butler, Building official City of Oak Park Heights Signage: 14168 Oak Park Blvd. N. City Utility Meter: P.O.. Box 2007 Utility Connection: Oak Park Heights, - MN 55082 Utility Inspection: Metro'S.A.C.: Phone: (651) 439 -4439 Investigation Fee: FAX: (651) 439 -0574 Other: De rita-1!) 6 MANTYLA WELL DRILLING INC. THIS FAX CONSISTS OF 6 PAGES INCLUDING THIS COVER SHEETS. Date: May 12, 2009 To: Eric Johnson Company: City of yak Park Height FAX Number: 651 - 439 -4439 From: Susan Phone: 651 -436 -7600 • Fax: 651 - 436 -5106 1392 St. Croix Trail N. • P.O. Box 797 Lakeland, Minnesota 55043 -0797 FAX SHEET Comments: Oakgreen abandonments for house #'S 5710,5762,5770,5800,5830, We could not locate the well for house # 5754. This address may have shared a well with the house #5710. *IF TRANSACTION IS INCOMPLETE OR ILLEGIBLE, PLEASE CALL SENDER. 1 COREL WPWINI FAXFORA9 City of Oak Park Heights 14168 Oak Park Blvd. North Oak Park Heights, MN 55082 -2007 ATTN: Eric A. Johnson June 17, 2009 76 St. Croix Trail N Lakeland, MN 55043 651.436.3559 (F)651.436,2021 RE: Asbestos Removal Fire Training Exercise Dear Sir: VcI Environmental Inc. has successfully completed removal of asbestos containing ta�ning materials identified in Environmental Property Audit's asbestos survey reports y p for houses located at 5800, 5770, 5762 and 5755 Oak Green Ave. in Oak Park Heights, .� g s, MN. VcI is scheduled to be complete asbestos removal of the houses located at 5830 and 5710 Oak Green Ave. by Jun. 23, 2009. If you have any questions please feel free to contract me at the number listed below. Sincerely, ennls Schum Vice President 651 436 -8559 651 436-2021 fax Atif De cyf,„ { ..r Palo 1 . LO INTRODUCTION Enviro a �Pr party Audits, Inc. (EPA, Inc.) conducted a visual survey at the residence located . t 5754 / akgreen Avenue, Oak Park Heights, MN. The survey for asbestos - containing materials = ' ) was completed on May 29, 2009, for Mr. Dennis Schumann, VCI. The purpose of the survey was to identify, sample and assess suspect building materials that may contain asbestos. The inspection was requested in order to facilitate an upcoming demolition of the structure, and to provide an inventory of asbestos containing materials (ACM) as found in or on the residence. This survey included an inspection of all suspected asbestos containing buildin g materials and collection of bulk samples. EMSL Analytical, Inc., Minneapolis, MN, analyzed the samples utilizing Polarized Light Microscopy (PLM) - Method EPA 600 /R- 93/116. The primary materials, which were sampled, included: Wall sheetrock/j oint compound, floor tile, panel adhesive, ceiling texture, and roofing materials. 2.0 SCOPE OF WORK ASBESTOS MATERIAL SURVEY 5754 OAKGREEN AVENUE NORTH . OAK PARK HEIGHTS, MINNESOTA A Minnesota licensed asbestos inspector from EPA, Inc. conducted a building survey for the identification and assessment of accessible suspect ACM at the residence located at 5754 Oakgreen Avenue, Stillwater. The following activities have been completed by EPA, Inc.: • A walk - through of the buildings interior spaces, with observations of accessible suspect ACM. • Random sample collection from suspect ACM building materials with consideration to homogeneous areas and material types. • Mapping and logging bulk samples for future reference. • Estimated quantity of material types identified as asbestos containing (greater than 1%). • Analysis of bulk samples by polarized light microscopy, utilizing EMSL Analytical, Inc. of Minneapolis. The laboratory analysis confirmed materials that are asbestos containing and the summary includes the following information: 3.0 Building Description, 4.0 Suspect Building Materials, 5.0 Asbestos Containing Building Materials List (including estimated quantities), 6.0 Non - asbestos Containing Materials List, 7.0 Non - suspect Materials, and 8.0 Inspector Accreditation. .1 LIMITATIONS EPA Inc. made reasonable attempts to access all areas of the residence as presented within the scope of this work. The following areas and/or materials were not able to be accessed due to safety concerns or other limitations. • No excavations were made to identify foundation conditions below grade (i.e. exterior damp - proofing). • A limited number of roof samples were collected from the residence. Based on the similar appearance, it is assumed that the findings were consistent with the remainder of the roof area. 5754 Oakgreen Ave N 02009 EPA, Inc 3.0 BUILDING DESCRIPTION The proj ect consisted of a one story residence with an unfinished basement. • The exterior walls of the building are constructed of wood framing with fiberglass insulation. • The main floor areas were a mix of hardwood flooring, carpet and ceramic tile. • The interior walls are primarily wood framing with a sheetrock application. • This house has a partial basement foundation with concrete block and concrete slab floor. • The main roof had 3-tab asphalt shingles over a tarpaper underlayment system. • The exterior walls had a steel siding over the original wall shingles. • The heating was provided by a forced air furnace system. 4.0 SUSPECT BUILDING MATERIALS ASBESTOS MATERIAL SURVEY 5754 OAKGREEN AVENUE NORTH OAK PARK HEIGHTS, MINNESOTA Representative bulk samples of suspect ACM building materials were collected from the building. The identified materials that were considered suspect and subsequently sampled include: • Floor tile • Ceiling tile • Wall Sheetrocklj oint compound • Panel adhesive • Roofing Materials Of the materials sampled, the following were found to be asbestos containing: • Original floor tile (kitchen) • Plastic cement patch (chimney) Due to the plans for burning of the residence, removal of all identified asbestos containing materials is mandatory. The removal of the identified materials must be completed prior to the start of the demolition. A licensed abatement contractor using appropriate removal methods and engineering controls would be required to perform the removal of the asbestos containing materials. Please refer to the following section for the analytical laboratory results, including material locations, and quantities. 5.0 ASBESTOS CONTAINING MATERIAL INVENTORY The following materials were found to have an asbestos content of greater than 1% by weight. Sample # 09 -04109 B -03 09-04109 B-10 Functional Space Kitchen Roof (chimney) Material Identification Original floor tile Plastic cement patch Asbestos Content 5% Chrysotile 12% Chrysotile Material Amount** 90 sq. ft. 10 sq. ft. **Estimate of visible material amounts. Require abatement contractors to verify material amount for bidding purposes. 5754 Oakgreen Ave N 2 ©2009 EPA Inc 6.0 NON -ASBESTOS CONTAINING MATERIAL INVENTORY The following materials had laboratory results of "None Detected" (ND) for asbestos content. No special regulations pertain to these building materials. Sample # 0904109 B -01 09 -04109 B-02 09-04109 B-03 09-04109 B -04 09-04109 B-05 09-04109 B-06 09 -04109 B -07 09-04109 B -08 09-04109 B -09 09 -04109 B -11 Functional Space Kitchen SW Bedroom Living Room NW Exterior Wall NW Exterior Wall Roof Roof Garage Material Identification Sheetrock/j oint compound Glue on wall panels Wall Bathroom Original 9x9 floor tile mastic Ceiling texture Ceiling texture Shingles /siding Paper underlayment Original roofing under metal Asbestos Content ND ND ND ND ND ND ND Top shingle (grey) Original shingle (grey) ND ND ND 7.0 NON-SUSPECT ASBESTOS MATERIALS The following materials are present in this building but are not considered as suspect asbestos building materials. Tunctidnal Space Foundation Supports /Framing Material Identification Concrete Wood 8.0 ASBESTOS BUILDING INSPECTOR ACCREDITATION ASBESTOS MATERIAL SURVEY 5754 OAKGREEN AVENUE NORTH OAK PARK HEIGHTS, MINNESOTA Please see the following pages for Minnesota Department of Health certification information. Inspector Jim Lindahl Exp. Date 11/25/09 Minnesota Certification Number — #AI2333 5754 Oakgreen Ave N 3 ©2009 EPA, Inc Attn: Jim Lindahl Environmental Property Audits Inc 2701 4th Avenue North Anoka, MN 55303 Fax: (763) 323-6677 Project: 5754 Oak Green Ave Sample 09 -04109 B -01 350902599-0001 09 -04109 B -02 350902599 -0002 )4109 B -03- ,00r Tile 350902599 -0003 09- 04109 B -03- Mastic 350902599 -0003A 09 -04109 B -04 350902599 -0004 09 -04109 B -05 350902599 -0005 09 -04109 B -06 350902599 -0006 Analyst(s) Heidi Johnson (1 2) EMSL Analytical, Inc. 14375 23rd Avenue North, Minneapolis, Mn 55447 Phone: (763) 449 -4922 Fax: (763) 449 -4924 Email: minneapolislab @emsl.com .- ate• ax>1 ..G��:crt 2�2M+'<`.?:f?wrl' . :'sM�Sft.•.w c4'�...�.n:;� ..rMS; �#:Cc4 ^L s,... -3% kC..- _ .�. .._:��iYr,S -a'.w �S�Sir• �"..fF,c,�r. r. TS'.'. r'� `:�M1�:�:Y -..y� �= ��n�7 ,^rra�:::, "'SAti,..`�. .i.�- .;.:��. :•i�C• Description Bathrm Glue on Wall Panels Ceiling Texture SW Bedrm Ceiling Texture L. Rm NWExtWall Shingle /Siding Phone: (763) 323 -6700 Asbestos Analysis of Bulk Materials via EPA 600/R- 93/116 Method using Polarized Light Microscopy Non - Asbestos Asbestos % Fibrous % Non - Fibrous % Type None Detected Appearance Wall Sheetrock/Jt TanNVhite Compound Non- Fibrous Heterogeneous Brown/Tan Non - Fibrous Homogeneous Kitchen Original Gray 9x9 Grey Floor Tile Non - Fibrous Homogeneous Kitchen Original Black 9x9 Grey Floor Tile Non - Fibrous Homogeneous White Non - Fibrous Homogeneous White Non - Fibrous Homogeneous 10% Cellulose Sheetrock /Joint Compound 5% Cellulose Customer ID: ENVP52 Customer PO: Received: EMSL Order: EMSL Proj: Analysis Date: 06/01/09 1:30 PM 350902599 612/2009 90% Non - fibrous (other) 95% Non - fibrous (other) 95% Non - fibrous (other) 100% Non - fibrous (other) 90% Non - fibrous (other) 10% Perlite 90% Non - fibrous (other) 10% Perlite 45% Non - fibrous (other) None Detected 5% Chrysotile None Detected None Detected None Detected None Detected White /Black Fibrous Heterogeneous 55% Cellulose Test Report PLM - 7.12.0 Printed: 6/2/2009 12:02:13 PM Rachel Travis, Laboratory Manager or other approved signatory 1 Due to magnification limitations inherent in PLM, asbestos fibers in dimensions below the resolution capability of PLM may not be detected. The limit of detection as stated in the `god is 1 %. The above test report relates only to the items tested and may not be reproduced in any form without the express written approval of EMSL Analytical, Inc. EMSL's ty is limited to the cost of analysis. EMSL bears no responsibility for sample collection activities or analytical method limitations. Interpretation and use of test results are the ionsibility of the client. Samples received in good condition unless otherwise noted, This report must not be used to claim product endorsement by NVLAP or any agency of the U.S- Government. NVLAP Lab Code 200019-0 1 Sample 09 -04109 B -07 350902599 -0007 09 -04109 B -08 350902599 -0008 04109 B -09 d02599-0009 09-04109 B -10 350902599-0010 09 -04109 B -11 350902599-0011 Analyst(s) Heidi Johnson (12) NVLAP Lab Code 200019 -0 EMSL Analytical, Inc. 14375 23rd Avenue North, Minneapolis, Mn 55447 Phone: (763) 449 -4922 Fax: (763) 449 -4924 Email: minneapolislab@emsl.com • =u- .6'� rr:.v .W.v^ "/.•:....' OF."_ A;: E: z: ri^.: isY ..._..- .Nlii'.K.%iY�z'1':v'�' I53A0'7 V�Y:�J.Y`S]�.C - °J.ii� a�9'. - �'S: a ' - 'a n � i : =.�;SSF:��iis7fi7.= m .':�Fi e.�n�'�% �'SiaXa�:�7'.�ttx:- azir..�.= .a�:�:T �vr. ,3!3;��:�';�:o:Gf'v�.- `• -;�iX: :�i'r;':1:;:1�4iz.,�'�.x..�: ^�a;gus:. - .;. -.. = .R.�3m GF�.�.,.- ..ti,.- r-� Ci "":.ri'':. .-� Attn: Jim Lindahl Environmental Property Audits Inc 2701 4th Avenue North Anoka, MN 55303 Fax: (763) 323 -6677 Phone: (763) 323 -6700 Project: 5754 Dak Green Ave Customer ID: ENVP52 Customer PO: Received: 06/01/09 1:30 PM EMSL Order: 350902599 EMSL Proj: Analysis Date: 6/2/2009 Asbestos Analysis of Bulk Materials via EPA 600 /R- 93/116 Method using Polarized Light Microscopy Non - Asbestos Description NWExtWall Paper Underlayment Roof Top Shingle Gray /Black Fibrous Heterogeneous Grey Roof Original Shingle Grey Roof Plastic Cement Patch Chimney Original Garage Roofing Under Metal Appearance Black Fibrous Heterogeneous Gray /Black Fibrous Heterogeneous Black Non - Fibrous Heterogeneous Brown /Black Fibrous Heterogeneous Test Report PLM - 7.12.0 Printed: 6/2/2009 12:02:14 PM % Fibrous 75% Cellulose 25% Glass 40% Cellulose % Non - Fibrous 25% Non - fibrous (other) 75% Non - fibrous (other) 60% Non - fibrous (other) 40% Cellulose 88% Non- fibrous (other) 60% Non - fibrous (other) Rachel Travis, Laboratory Manager or other approved signatory Due to magnification limitations inherent in PLM, asbestos fibers in dimensions below the resolution capability of PLM may not be detected. The limit of detection as stated in the `god is 1 %. The above test report relates only to the items tested and may not be reproduced in any form without the express written approval of EMSL Analytical, Inc. EMSL's ty is limited to the cost of analysis. EMSL bears no responsibility for sample collection activities or analytical method limitations. Interpretation and use of test results are the lonsibility of the client. Samples received in good condition unless otherwise noted. This report must not be used to claim product endorsement by NVLAP or any agency of the U.S. Government. Asbestos % Type None Detected None Detected None Detected 12% Chrysotile None Detected THIS IS THE LAST PAGE OF THE REPORT. 2 .7= !MOIL '- '4;r:Ort:f 4 . 44 0 1 1 rn!N uThber n.Pa# QLjj 0 6 1 Citipnt Samp)e s Relinquished (Client): to a CO310:00 • D-t4 — -04 b.r1 I Coe _ 3) lt,2009 140 Point Count Ej 404) (<o425%) 0 1000 . (,4o,.1%) Paint-QourihryiGrbvec 4 ( 0 low (-‹0.1%) NYs, lachi -(triOt.e in NY) ,•„_ • ST.■• - ,•-•,•■• • roAfoLii Page 1 of _Fx #: 3A22,6_612_ Email Adtpss: iinda,h3,1 Pages prentim flovartionoe $vitit • La Ott r pk, 0 PPR, Prt763 NICSH 7402 LJ EPA Level 11 139 1P312 Li TEM EPA i 0 NYS' NOB 198.,4 (non-friable-NY) laehatfield SOP P11*§IEPA 60 itLERA'1002 rs 1Oiirn EJ Wa$1,0 D iber lOs 0 Waste Onk1ni Qato Date: Lv D a 5_ dy tqr 75VitAiErVI orEP4 14.0,g0i ti T4? You* ', 01;1:600Pf) kwarati Ana 5iP004btft • Lg .42. MOVitaC ASTM 0 575$ 0 WiPe. G arpet Sor ( Des-cri Ow) vid (111 1 Q, K vY) ckNorml PHoNE: 1FAx (7 PLM cARt3 '436 A (025%,SehOtiiii PIM CARS 435 E3 (01% sehtiliiiiity) 0 TEM Cffli3 435 - B (0,1%senainvity) TEm CARB C (0.01 EPA Protocol (Semi-Quantitatlito PA Protocol (Quairititsti1/13)_ Mori' Vo1UflIA HA it .10 "Fatal # of Samples: EMSI.. Al\LA INC. i4375 2r MINN OLP, ' Time Time: • 350902599 Emak, .1,0404, €4044 Addition41 Peos cf the Chain of Custody are on)y necessary if ne-ecled for acfclitioPol sample informatl'on pir44 a ,1 41 bits! Di 'MO R —'VAMP Asbestos Chain of Custody EMSL Order Number (49,b use onw: ,geserl tELDri Pag _ pages Volume/Area lAir) DaterTime HA 13uIk Simi ad EMS1, ANALYTICAL 14375 23R AVENUE MINNWOLISi 001 55447 PHONE; (763) 449-4922 FAX: (763)4494924 CP CP Cc gz- ,=) CP E co Lfl CP (T3 cj S762 Oakgreen Issued City Demo Permit & Additional Conditions Application fro Demolition Permit Well Closure Documentation Asbestos Abatement Removal Certification CITY OF O PARK HEIGHTS 14168 OAK PARK BLVD. N. #2007 OAK PARK HEIGHTS, MN 55082 -2007 (r 651 351 -1661 FAX: 651 439 -0574 FA,biiitEss 5762 OAKGREEN AVE N PIN 05- 029 -20 -11 -0024 LEGAL DESC N/A LOT 0 BLOCK 0 PERMIT TYPE OTHER PROPERTY TYPE RESIDENTIAL - OTHER THAN NEW CONSTRUCTION TYPE DEMOLITIONS NOTE: SFD- WORK SHALL BE PERFORMED IN COMPLIANCE WITH APPLICABLE REQUIREMENTS OF LOCAL, COUNTY, STATE TURISDICTIONS AND THEIR AGENCIES AS THEY PERTAIN TO THE PROJECT,INCLUDING CITY OF OAK PARK HEIGHTS 'ADDENDUM TO DEMOLITON PERMIT DATED 06 -10 -09 AND ATTACHED TO PERMIT. NOTE: (1) 24 HOURS NOTICE REQUIRED PRIOR TO UTILITY WORK (2) WATER SHALL BE SHUT OFF AT VALVE BOX AND COPPER CUT OFF NEAR VALVE & CRIMPED CLOSED (3) TREE REMOVALS TO BE APPROVED BY CITY ARBORIST PRIOR TO THEIR REMOVAL (4) WELLS & SEPTICS SHALL BE 2,LOSED OR ABANDONED PER ESTABLISHED CRITERIA. OAKGREEN VILLA LLC P.O. BOX 2118 3TILLWATER, MN 55082µ APPLICANT JAKGREEN VILLA LLC ?.O. BOX 2118 STILLWATER, MN 55082- OWNER AGREEMENT AND SWORN STATEMENT The work for which this permit is issued shall be performed according to: (1) the conditions of this permit; (2) the approval plans and specifications; (3) the applicable city approvals, Ordinances, and Codes; and, (4) the State Building Code. This permit is for only the work described, and does not grant permission for additional or related work which requires separate permits. This permit will expire and become null and void if work is not started within 180 days, or if work is suspended or abandoned for a period of 180 days any time work has commenced. The applicant is responsible for asp .zing all required inspections are requested in conformance with the Minnesota State Building Code. OTHER PERMIT FEE OTHER PERMIT SURCHARGE, FLAT TOTAL PAID WITH CHECK # 5040 SEPARATE PERMITS REQUIRED FOR WORK, OTHER THAN DESCRIBED ABOVE. PERMIT NO.: 2009-00084 DATE ISSUED: 06/18/2009 25.00 0.50 25.50 City of Oak _Park Heights Addendum to Demolition Permit: Additional Conditions Agreement Property Owner Green Twig, LLC (the "Applicant ") has petitioned the. City of Oak Park Heights, (the "City' }, . for a Demolition Permit to demolish the homes located at the following Oakgreen Ave. addresses: 5710, 5754, 5752, 5770, 5800, 5830 and are located west of Oakgreen Ave, south of the Xcel Energy Transmission Towers and north of 58th Street in the City of Oak Park Heights. The Applicant has also pursued the "burning" •these strictures by the Bayport Fire Department as a 'training exercise ". The Bayport Pire Department will be acting as a contractor for the Applicant. Buelow Excavating will be acting as a contractor for the Applicant that will be performing.the final demolition and site restoration. The City does hereby permit the above actions pursuant to the following: Terms and Conditions of Demolition Permit: Prior to the commencement of any training exercise(s), the Applicant shall provide documentation and certification to the City that all asbestos, lead or other hazardous materials have been removed from the properties and all wells have been appropriately capped. Training exercises may not commence on any home unless and until this documentation has been received by the City and found to be satisfactory. 2. Following the completion of the "training exercise" at each property, the Applicant shall within 10 calendar days fully demolish and remove all remaining structures and debris from the City and shall fully restore the property (or properties) to a clean, level condition ready for future construction. If construction does not commence by August 15th, 2009, the Applicant shall remove all in -place septic system infrastructure and shall place a final topsoil application to all areas and a grass cover shall be established and maintained. 1. 8. Site restoration shalt be on a site -by -site basis, the Aplicantirmst restore each property not later than 10 calendar days following the commencement of demolition and/or training exercises. All sites shalt be fully demolished and restored by July 15th, 2009. 4. Should no fire training exercises occur or should not all homes be included in such training exercises, the Applicant shall fully demolish and remove from the City all six homes including all basements, foundations and septic infrastructure and shall restore all such sites to a clean, level condition not later than July 15th, 2009. 5. The Applicant shall provide to the City of Oak Park Heights a Letter of Credit (LOC) in the amount of $25,000.000 securing the final demolition and site remediation of the six homes located along Oakgreen Ave., lying north of 58th Street and south of Xcel Energy Transmission Towers. The LOC shalt be released by the City when all homes, foundations, septic systems are fully removed and when all properties have been returned to a clean, level condition. 6. The Applicant does hereby grant the City the unilateral right to complete any demolition and debris removal should the Applicant fail to complete any required restoration actions in a timely manner. The Applicant shall be responsible to the reimburse the City for all costs associated with such actions required on the part of the City ensure the sites are clean, safe and presentable to the general public; including waiving all rights objecting to special assessments to recover any costs by the City. Should the City be required to take remediation actions, the Applicant shall also forfeit the $25,000 Let r of Credit to the City as penalty. Page 1 of 2 X02 572.. o,;!ir6/2t dtuL-' 7. pp The Applicant shall reimburse the City for costs associated with water -use for training exercises and shall follow standard'City water consumption / rates 'tables. The City will not charge the Applicant for costs associated with additional staff time required by the Public Works Department. 8. The City p rovides no warranty or guarantf that these properties are in a condition suitable for fire training exercise. The Applicant agrees to indemnify and hold harmless the City, its agents, officers, and employees from any and all claims, causes of action, liabilif ids, fosses, damages, costs, expenses including reasonable attorneys fees, suits, demands and judgments of any nature, because of bodily injury to, or death of,.any person or persons and/or because of damages to property of the Applicant or others, including loss of use from any cause whatsoever, which may be asserted against pp � negligence, the Applicant, or the City on account of any act or omission, including negligee , of pp Applicant's y em p to ees or agents in connection with the performance of the work contemplated in the Permit. The ., Applicant agrees to defend any action brought against the City on any such matters, and to pay and satisfy any judgment entered thereof together with all costs and expenses incurred in connection therewith. The City way in no be liable for any claims or charges incurred by the Contractor in y the performance of this Contract. 9. The City is not responsible for any site security, site protection or other measures to prevent injury, damages, property theft of loss, etc. of the Applicant or his contractors or agents. 10. The City may revoke any authorities conveyed to the Applicant in this document at anytime and for any reason. Such revocation shall • be In writing by the City Administrator and/or Building Official and shall be immediate. 11. Following demolition of the buildings, erosion and silt control measures shall be coordinated on the site as directed by the City Engineer. Appropriate control measures as required the City Engineer shall be installed prior to development and as may be necessary to control erosion and shall at a minimum follow "best management The Applicant does agree to all terms and conditions listed above and are in addition to all federal, state and local rules, ordinances, laws and requirements of record. Ti Nolde, Presid Green Tw' , VA � of Page2of2 tamp -->j ry (Affix notary stamp —>) Date:_. (6 u110/69 Date F 1 nson, City Administrator ly signed by City Administrator: 'Date: {- `G( JENNIFER M. PINSKI NOTARY PUBLIC .MINNESOTA My Commission Expires Jan. 31, 2012 oAJL-r 4.A7/9; ti JENNIFER M. PINSKI NOTARY PUBLIC . MINNESOTA My Commission Expires Jan. 31, 2012 1 ,7 Own er:aReeraW% Address: T IttIMf? M I� Phone: ((2S1) 430'°q Applic. •t's Signature For Office Use Only: City Building: City Plumbing: City Mechanical: Plan Review: State Surcharge: Total: Legal Description (if no address assigned: Description of Work Being Done: Oak Park Heights Application for Permit ?Ay pocr te DE tor e WwfitCr Al St cr It. 241 N. Lb sr. &pr,rA) 5oD 3 Contractors ELDk1) EM%11P1 (, (Tv NN Bv E1.o1J 13154 ' 2.o 41 Address: � 5*. StirL1MIJ , Phone: ('I) yb - 53 Ll0 JOB ADDRESS Number 576 Front or Width in Feet Street 4K 6E,V Ave New Add Sign Alter Repair Move Demolish Side or Length Height in No of Area of Type of in Feet Feet Stories Lot Construction Occupied GLASS OF WORK Occupancy Project Valuation 2— 5 U..o taJ:X /hi s ire CLE AN P ��� F1 N1k4 TE. oN R fr1b 1.� By signature below, the applicant hereby agrees to work in accordance with the Ordinances of the Local Municipality, State Building Code, and the requirements enforced by the City of Oak Park Heights Building Department. T. - . , .lica ., . ., ,. er agrees to notify the Building Official of each the required inspections 24 ha'''...w ► de ..> noted upon the Inspection Record Card. f Dated: Jim Butler, Building Official City of Oak Park Heights Signage: 14168 Oak Park Blvd. N. City Utility Meter: P.O -. Box 2007 Utility Connection: Oak Park Heights, MN 55082 Utility Inspection: Metro S.A.C.: Phone: (661) 439 -4439 Investigation Fee: FAX: (651.) 439-0574 Other: Devilim 5) 6 Rstivapicos4 WELL OR BORING LOCATION County Name Washington Township Name Township No. Range No :gay t awn 29 20 Latitude_______ degrees minutes seconds ION: Longitude_ degrees minutes seconds Numerical Street Address or Fire Number and City of Well or Boring Location 5762 Oakgreen Ave N, OaPark Hgts Show exact location of well or boring in section grid with "X." N 1 Mile .PERTY OWNERS NA I�IC NIPANY NAME r e en 11''S�r�:.. JJ�� 773 Green Twig Way Stillwater, MN 55082 VVELL OWNER'S NAME /COMPANY NAME Section No. Fraction (sm. --e lg.) SE' NE' N' Sketch map of well or boring location, showing properly lines, roads, and buildings. Property owner's [nailing address if different than well location address indicated above Well owner's Irlailing address if different than property owner's address indicated above ORMATI LOGICAL MATERIAL COLOR H F OR OOMATION If not known, indicate estimated formation log from nearby well or boring. Sand /Gravel Varied Varied Lime Rock Yellow -lard REMARKS, SOURCE OF DATA, DIFFICULTIES IN SEALING MINN. DEPT OF HEALTH COPY HE- 01434 -11 IC# 140-0423 iViiNNESOTA DEPARTMENT OF HEALTH WELL AND BORING SEALING RECORD Minnesota Statutes, Chapter 1031 FROM 0 r 12 2 TO 122 131 Date Sealed 6/12/2009 Depth Before Sealing 131 AQUIFER(S) IK] Single Aquifer [] Multiaquifer WELLIBORING Water - Supply Well 0 Monit. Well ❑ Env. Bore Hole ❑ Other CASING TYPE(S) Steel ❑ Plastic ❑ Tile . ❑ Other WELLHEAD COMPLETION Outside: ❑ Well House ❑ Pitless Adapter /Unit ❑ Well Pit ❑ Other CASING(S) Diameter (� in. from in, from in. from 0 Minnesota Well and Boring Sealing No. Minnesota Unique Well No. or W- series No. (Leave blank it nol known) [� At Grade ❑ Buried Date Well or Boring Constructed Original Depth ft. STATIC WATER LEVEL M Measured ❑ Estimated Date Measured 6/12/2009 125 ft. H 27 below ❑ above land surface Inside: Basement Offset ❑ Well Pit ❑ Buried ❑ Other Depth Set in oversize hole? Annular space initially grouted? to 122 ft . [] Yes [No ❑ Yes ❑ No ❑ Unknown to fit. 0 Yes ❑ No ❑ Yes ❑ No ❑ Unknown to ft. ❑ Yes L No ❑ Yes [] No ❑ Unknown SCREEN /OPEN HOLE Screen from to ft. Open Hole from 122 w 1 3 1 tt. OBSTRUCTIONS ❑ Rods /Drop Pipe ❑ Check Valve(s) ❑ Debris ❑ Fill 41 No Obstruction Type of Obstructions (Describe) Obstructions removed? ❑ Yes 0 No Describe PUMP Type.-- _..S.Ubm " si - C Removed ❑ Not Present METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS, OR CASING AND RODE HOLE: LI No Annular Space Exists in. from to ft. ❑ Perforated [ 1 Removed in. from Type of Perforator_,_ - -. U Other_ r�_ Name of Person Sealing Weil or Boring 0 Annular Space Grouted with Tremie Pipe ❑ Casing Perforation /Removal to ❑ Other OTHER WELLS AND BORINGS Other unsealed and unused well or boring on properly? ❑ Yes Ki No How many? Marityla Well Drilling, Inc Licensee Business Name ft. ❑ Perforated ❑ Removed GROUTING MATERIAL(S) (One bag of cement = 94 Ibs., one bag of bentonite = 50 lbs.) Grouting Material Neat. Cer en t from 0 to 131 ft. yards I* .. -__ bags from to ft. _ yards bags from to ft. yarns �.__ - -- bags LICENSED OR REGISTERED CONTRACTOR CERTIFICATION This well or boring was sealed in accordance with Minnesota Rules, Chapter 4725. The information contained in this report is true to the best of my knowledge. 1394 License or Registration No. 583 6/12/2009 Certi a Representativy ttrre Certified Rep. No. Date 2 /08R City of Oak Park Heights 14168 Oak Park Blvd. North Oak Park Heights, MN 55082 -2007 ATTN: Eric A. Johnson June 17, 2009 RE: Asbestos Removal Fire Training Exercise Dear Sir: vcI Environmental Inc. has successfully completed removal of asbestos containing materials identified in Environmental Property Audit's asbestos surve y reports for houses P located at 5800, 5770 g 5762 and 575 Oak Green Ave. in Oak Park Heights, MN. vcI is scheduled to be complete asbestos removal of the houses located at 5830 and 5710 Oak Green Ave. by Jun, 23, 2009. If you have any questions please feel free to contract me at the number listed below. Sincerely, ennis S chum Vice President 651 436 -8559 651 436 -2021 fax 76 St. Croix Trail .N Lakeland, MN 55043 651.435.8559 (F)651.436. 2021 iff17.36 Ok a (.1 6j/do 1.0 INTRODUCTION Enviro • roperty Audits, Inc. (EPA, Inc.) conducted a visual survey at the residence located . t 5762 e akgreen Avenue, Oak Park Heights, MN. The survey for asbestos - containing materials ) was completed on May 29, 2009, for Mr. Dennis Schumann, VCI. The p purpose of the survey was to identify, sample and assess .suspect building materials that may contain asbestos. The inspection was requested in order to facilitate an upcoming demolition of the structure, and to provide an inventory of asbestos containing materials (ACM) as found in or on the residence. This survey included an inspection of all suspected asbestos containing building materials and collection of bulk samples. EMSL Analytical, Inc., Minneapolis, MN, analyzed the samples utilizing Polarized Light Microscopy (PLM) - Method EPA 600 /R- 93/116. The primary materials, which were sampled, included: linoleum, sheetrock /joint compound, panel adhesive, and roofing materials. 2.0 SCOPE OF WORK A Minnesota licensed asbestos inspector from EPA, Inc. conducted a building survey for the identification and assessment of accessible suspect ACM at the residence located at 5762 Oakgreen Avenue, Stillwater. The following activities have been completed by EPA, Inc.: • A walk- through of the buildings interior spaces, with observations of accessible suspect ACM. • Random sample collection from suspect ACM building materials with consideration to homogeneous areas and material types. ® Mapping and logging bulk samples for future reference. • Estimated quantity of material types identified as asbestos containing (greater than 1%). • Analysis of bulk samples by polarized light microscopy, utilizing EMSL Analytical, Inc. of Minneapolis. The laboratory analysis confirmed materials that are asbestos containing and the summary includes the following information: 3.0 Building Description, 4.0 Suspect Building Materials, 5.0 Asbestos Containing Building Materials List (including estimated quantities), 6.0 Non - asbestos Containing Materials List, 7.0 Non- suspect Materials, and 8.0 Inspector Accreditation. 2.1 LIMITATIONS ASBESTOS MATERIAL SURVEY 5762 OAKGREEN AVENUE NORTH OAK PARK HEIGHTS, .MINNESOTA EPA Inc. made reasonable attempts to access all areas of the residence as presented within the scope of this work. The following areas and/or materials were not able to be accessed due to safety concerns or other limitations. e No excavations were made to identify foundation conditions below grade (i.e. exterior damp - proofing). • A limited number of roof samples were collected from the residence. Based on the similar appearance, it is assumed that the findings were consistent with the remainder of the roof area. 5762 OA:green Ave N 1 ©2009 EPA_ Inc .3.4 BUILDING DESCRIPTION The project consisted of a single -story residence with an unfinished basement. • The exterior walls of the residence are constructed of wood framing with fiberglass insulation. • The main floor areas were a mix of carpet and linoleum. • The interior ceiling was primarily painted sheetrock. • The interior walls are wood framing with sheetrock application. • The basement foundation was concrete block with a concrete slab floor. • The roof had 3 -tab asphalt shingles over a tarpaper underlayment system. The house had two layers of shingles. • The heating was provided by a forced air furnace system. 4.0 SUSPECT BUILDING MATERIALS Representative bulk samples of suspect ACM building materials were collected from the building. The identified materials that were considered suspect and subsequently sampled include: • Linoleum • Sheetrocklj oint compound • Panel adhesive • Roofing Materials • Original kitchen (gold) linoleum backing • Paneling adhesive (kitchen) • Plastic cement patch ASBESTOS MATERIAL SURVEY 5762 OAKGREEN AVENUE NORTH OAK PARK HEIGHTS, MINNESOTA Of the materials sampled, the following were found to be asbestos containing: Due to the plans for burning the residence, removal of all identified asbestos containing materials is mandatory. The removal of the identified materials must be completed prior to the start of the demolition. A licensed abatement contractor using appropriate removal methods and engineering controls would be required to perform the removal of the asbestos containing materials. Please refer to the following section for the analytical laboratory results, including material locations, and quantities. 5762 Oa1:green Ave N 2 ©2009 EPA, Inc 5.0 ASBESTOS CONTAINING MATERIAL INVENTORY The followin g materials were found to have an asbestos content of greater than 1% by weight. Sample # 09 -04112 B -02 09 -04112 B -05 09 -04112 B -09 unc ionai Kitchen Kitchen Roof ace Material Identification Original linoleum (gold) backing Paneling adhesive Plastic cement patch Asbestos Conten 65% Chrysotile 3% Chrysotile 5% Chrysotile Material Amount 120 sq. ft. 200 sq. ft. 6 sq. ft. **Estimate of visible material amounts. Require abatement contractors to verify material amount for bidding purposes. 6.0 NON -ASBESTOS CONTAINING MATERIAL INVENTORY The following materials had laboratory results of "None Detected" (ND) for asbestos content. No special regulations pertain to these building materials. 09 -04112 B -01 09 -04112 B -03 09 -041 12 B -04 09 -04112 13-06 09 -04112 B -07 09 -04112 B-08 Bathroom Kitchen Kitchen Roof Roof Linoleum (white whines) Linoleum (cream w /black pattern) /mastic Sheetrockljoint compound Felt paper underlayrent New shingle (dark w /white) ND ND ND ND ND ND Sample # Functional Space ASBESTOS MATERIAL SURVEY 5762 OAKGREEN AVENUE NORTH OAK PARK HEIGHTS, MINNESOTA Roof 8.0 ASBESTOS BUILDING INSPECTOR ACCREDITATION Inspector Jim Lindahl Exp. Date 11/25/09 Minnesota Certification Number — #Al2333 Material Identification Original shingle (green /white) 7M NON- SUSPECT ASBESTOS MATERIALS The followin g materials are present in this residence but are not considered as suspect asbestos building materials. Functional Space Foundation Supports/Framing Material Identification Concrete Wood Asbestos Content Please see the following pages for Minnesota Department of Health certification information. 5762 Oakg een Ave N 3 ©2009 EPA, Inc Attn: Sample Jim Lindahl Environmental Property Audits Inc 2701 4th Avenue North Anoka, MN 55303 Fax: (763) 323 -6677 Phone: (763) 323 -6700 Project: 5762 Oak Green Ave Asbestos Analysis of Bulk Materials via EPA 600/R-93/116 Method using Polarized Light Microscopy Non- Asbestos % Fibrous 25% Cellulose 20% Cellulose 09 -04112 B -01 350902602 -0001 09 -04112 B -02- Kitchen Orig. Backing Linoleum Gold 350902602 -0002 . -04112 B -02- Kitchen Orig. Mastic Linoleum Gold 350902602 -00024 09- 04112 B -02 -Vinyl Kitchen Orig. 350902602 -00028 Linoleum Gold 09 -04112 B -03- Linoleum 350902602 -0003 09 -04112 B -03- Mastic 350902602 -0003A Analyst(s) Kristen Lindfors (10) Description EMSL Analytical, Inc. 14375 23rd Avenue North, Minneapolis, Mn 55447 Phone: (763) 449 -4922 Fax: (763) 449 -4924 Email: minneapolislab @emsl.com i�ziS.. �,:, �1,. �r'. H"<- v...... t:{' �"' il�f .�:'STr�a�;StL:"�::`r'P..��. 'S��S'>%Sis5 �'r %�`�'°... �.s'r: =,t. *�`:ai.:4� .. '�= t``...x'Y "'± "'•7.5a °w .. 3t::t'!::::.m��P ' •�":•;3L.: __ ,r_y _. .. ^w-,.. _ .. ,c �a- , rY�f'Yl��, ✓'. "�' af.'. Th -` ^': ?�...i rn �;��°r• �3�'� .t. ..� �-= c,£.. �. av r .•b �ct•5.... -s#:' €?s= %:r::. Bath Rm Linoleum Gray/White White w /Lines Fibrous Heterogeneous Kitchen Linoleum Cream w /Black pattern Kitchen Linoleum Cream w /Black pattern Appearance Gray Fibrous Due to magnification limitations inherent in PLM, asbestos fibers in dimensions below the resolution capability of PLM may not be detected. The limit of detection as stated in the method is 1 %. The above test report relates only to the items tested and may not be reproduced in any form without the express written approval of EMSL Analytical, Inc. EMSL's ity is limited to the cost of analysis. EMSL bears no responsibility for sample collection activities or analytical method limitations. Interpretation and use of test results are the onsibility of the client. Samples received in good condition unless otherwise noted. This report must not be used to claim product endorsement by NVLAP or any agency of the ~u �. Government. NVLAP Lab Code 200019 -0 Heterogeneous Test Report PLM - 7.12.0 Printed: 6/212009 11:22:22 AM Gray /Black/Cream 25% Cellulose Fibrous 5% Glass Heterogeneous Tan Non - Fibrous Homogeneous Customer ID: ENVP52 Customer PO: Received: 06/01/09 1:30 PM EMSL Order: 350902602 EMSL Proj: Analysis Date: 6/2/2009 % Non - Fibrous 75% Non - fibrous (other) 15% Non - fibrous (other) Analyzed back pad first per client instructions- Stop Positive. 70% Non - fibrous (other) 100% Non - fibrous (other) ,r. f Rachel Travis, Laboratory Manager or other approved signatory Asbestos % Type None Detected 65% Chrysotile Stop Positive (Not Analyzed) Stop Positive (Not Analyzed) None Detected None Detected 1 Attn: Jim Lindahl Environmental Property Audits Inc 2701 4th Avenue North Anoka, MN 55303 Fax: (763) 323 -6677 Phone: (763) 323 -6700 Project: 5762 Oak Green Ave Sample Asbestos Analysis of Bulk Materials via EPA 600/R- 93/116 Method using Polarized Light Microscopy Non - Asbestos Fibrous % Non - Fibrous 09 -04112 B -04 350902602 -0004 09 -04112 B -05 350902602 -0005 ,d -04112 B -06 350902602 -0006 09 -04112 B -07 350902602 -0007 09 -04112 B -08 350902602 -0008 09 -04112 B -09 350902602 -0009 Analysts) Kristen Lindfors (10) EMSL Analytical, Inc-. 14375 23rd Avenue North, Minneapolis, Mn 55447 Phone: (763.) 449 -4922 Fax: (763) 449 -4924 Email: minneapolislab@emsl.com .,s : ... n; '._.:i�f..�xc......::kii`.'rF'S �rY. %:�:{• "<:.s .y;, _... • . !'r.? r::-3:c k-:b ?S '.x,w.�<L�a ..� •'' r, �c: �. t. �J. .^'.ca'S'�^s?si. ?- 1,5<Sw$:iin "Y...Li;.: S'�s��� � :sti e ms' %1'wC:.x: �Iei.-. �.: ZE' i .�.;:... <....iC�':�>cu"..'.: �i �`F "" Description Appearance Kitchen Sheetrock/Jt Compound Kitchen Paneling Gray Adhesive Roof Felt paper underlayment Tan/White Fibrous Heterogeneous Non - Fibrous Homogeneous Roof Plastic Black Cement Patching Non - Fibrous (Chimney) Heterogeneous Roof New Shingle White /Black Dark with White Fibrous Heterogeneous Roof Original White /Black Shingle green /white Fibrous Heterogeneous Brown /Black Fibrous Homogeneous Test Report PLM-7.12.0 Printed: 6/2/2009 11:22:24 AM °In 10% Cellulose SR!JC Composite Customer ID: ENVP52 Customer PO: Received: 06101/09 1:30 PM EMSL Order: 350902602 EMSL Proj: Analysis Date: 6/2/2009 Only tested adhesive per client instructions. 90% Non - fibrous (other) 97% Non - fibrous (other) 70% Non-fibrous (other) Asbestos % Type None Detected 3% Chrysotile None Detected 30% Cellulose 45% Cellulose 35% Cellulose 55% Non - fibrous (other) 65% Non - fibrous (other) 95% Non - fibrous (other) - f- J Rachel Travis, Laboratory Manager or other approved signatory Due to magnification limitations inherent in PLM, asbestos fibers in dimensions below the resolution capability of PLM may not be detected. The limit of detection as stated in the -, thod is 1%. The above test report relates only to the items tested and may not be reproduced in any form without the express written approval of EMSL Analytical, Inc- EMSL's 'ty is limited to the cost of analysis- EMSL bears no responsibility for sample collection activities or analytical method limitations. interpretation and use of test results are the 3nsibility of the client. Samples received in good condition unless otherwise noted. This report must not be used to claim product endorsement by NVLAP or any agency of the u.S. Government. NVLAP Lab Code 200019 -0 None Detected None Detected 5% Chrysotile THIS IS THE LAST PAGE OF THE REPORT. 2 350902602 100 17 r 74 FJA 8r. IV th • 7:7 RT Sampte rlQIa CQC R VilOga •4 pint Colint ) 1000 (<0 1% 40 (ka25% Paint Couht w/Gravimetrfc 400 (<0,25%) .0 1000 (<111%) Li NYS 198,1 (fdabe ln NY) NYS 19;8 NOB (non-fliable.NY) M*9002 •c71% tient Sam le Relinquished (Clint) • Reolver$ (Lab): Comments/Spfic Ihstructions: '1 4Ni c `40,trogige.*There apr trOehld ptict«rdairco MEW% 40 CFR PM NIOSH 740.2 0 EPA Levei II 1$0 19112 TM EPA NO3 • 17.1 Non 198,4 (nori-fr1dble44Y) Ch440.1d• SOP TEM Mass. 600 Set, tE.Waj2PA 160.2 Fibers 1Oin D Wo,a0 D.P r iOdh g All Fiber SizeS V a OerJ.tIon 1 Dat 1111 rf Page 1 of pagers NAL YTJ (V our EMSL'.1 Tei - erit i t , , ornolle is s? 435 - senftiv • f a ' B ( • 1 3 435 - c (cii EPA Protocol (SfirrIl-Quari EPA Ptotacof (c104Ilitat4VP). .-• - pthet: td itA k r,i1t) a it • ; • VOttviik •••• ••••• •-•• L , TIMP: Time: • u ;f1 °No? P emilciiflf o • Total # of Samples: •, Ad ItITI 50902602 amiK..1.,1"41.11V40. c, - Corn nuints/Special Instivc ns: tied t1fflW — 44,4,4* COC- 1 Asbestos Chain of Custody MS.L Oider Nurnber inb Usi Otity) Page Addition/ Pages of the Chain of Custody are only necessaly if flooded for additioaal semple infarrnatio Page EMS). ANALyricAL, JNC. 14375 23 FID AVENUE MINNEAPOLIS, MN 55447 PHoNe: (764)4494922 FAx: (163) 449-4924 c J E W co CCI E { E CID [ CvD {�1 Cal T_ E. r C'- CC. O) co on ori Cu w 5770 Oakgreen Issued City Demo Permit & Additional Conditions Application fro Demolition Permit Well Closure Documentation Asbestos Abatement Removal Certification A RESS PIN LEGAL DESC PERMIT TYPE PROPERTY TYPE CONSTRUCTION TYPE CITY OF OAK PARK HEIGHTS 14168 OAK PARK BLVD. N. #2007 OAK PARK HEIGHTS, MN 55082 -2007 651 351 4661 FAX: 651 439 -0574 5770 OAKGREEN AVE N 05- 029 -20 -11 -0026 N/A LOT 0 BLOCK 0 PARCEL 0 OTHER RESIDENTIAL - OTHER THAN NEW DEMOLITIONS NOTE: SFD- WORK SHALL BE PERFORMED IN COMPLIANCE WITH APPLICABLE REQUIREMENTS OF LOCAL, COUNTY, STATE JURISDICTIONS AND THEIR AGENCIES AS THEY PERTAIN TO THE PROJECT,INCLUDING CITY OF OAK PARK HEIGHTS ADDENDUM TO.DEMOLITON PERMIT DATED 06 -1 0-09 AND ATTACHED TO PERMIT. NOTE: (1) 24 HOURS NOTICE REQUIRED PRIOR. TO UTILITY WORK (2) WATER SHALL BE SHUT OFF AT VALVE BOX AND COPPER CUT OFF NEAR VALVE & CRIMPED CLOSED (3) TREE REMOVALS TO BE APPROVED BY CITY ARBORIST PRIOR TO THEIR REMOVAL (4) WELLS & SEPTICS SHALL BE CLOSED OR ABANDONED PER ESTABLISHED CRITERIA. APPLICANT G BEN TWIG LLC P.O. BOX 119 STILLWATER, MN 55082- GREEN TWIG LLC P.U. BOX 119 STILLWATER, MN 55082- OWNER AGREEMENT AND SWORN STATEMENT The work for which this permit is issued shall be performed according to: (1) the conditions of this permit; (2) the approval plans and specifications; (3) the applicable city approvals, Ordinances, and Codes; and, (4) the State Building Code. This permit is for only the work described, and does not grant permission for additional or related work which requires separate permits. This permit will expire and become null and void if work is not started within 180 days, or if work is suspended or abandoned for a period of 180 days any time • work has commenced. The applicant is responsible for _L•ing all required inspections are requested in conformance with the Minnesota State Building Code. OTHER PERMIT FEE OTHER PERMIT SURCHARGE, FLAT TOTAL PAID WITH CHECK # 5 040 PERMIT NO.: 2009 -00085 DATE ISSUED: 06/12/2009 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. 25.00 0.50 25.50 (( City of Oak Park Heights — Addendum•to Demolition Permit; Additional Conditions Agreement Property Owner Green Twig, LLC (the "Applicant ") has petitioned the City of Oak Park Heights, (the "City), for a Dem . � ' [ e l ern it to demolish the homes located at the following Oakgreen Ave. addresses: 5710, • line 5754, 575 5770 ' 800, 5830 and are located west of Oakgreen Ave, -south of the Xce Energy Transmission . wers and north of 58th Street in the City of Oak Park Heights, The Applicant has also • pursued the 'burning' these strictures-by the Bayport Fire Department as.a "training exercise ". The Bayport Fire Department wilt be acting as a contractor for the Applicant. euelow Excavating wilt be acting as a contractor for the Applicant that will be performing the final demolition and site restoration. Page 1 of 2 The City does hereby perm ermit the above actions pursuant to the following: Terms and Conditions of Demolition Permit: 5 T1 o O t\J 1. Prior to the commencement of any training exercise(s), the Applicant shall provide documentation and certification to the City that all asbestos, lead or other hazardous materials have been removed from the properties and all wells have been appropriately capped. Training exercises may not commence on any home unless and until this documentation has been received by the City and found to be satisfactory. 2. Following the completion of the "training exercise" at each property, the Applicant shall within 10 calendar days fully demolish and remove all remaining structures and debris from the City and shall fully restore the property (or properties) to a clean, level condition ready for-future construction. If construction does not commence by August 15t; 2009, the Applicant shall remove all in -place septic system infrastructure and shall place a final topsoil application to all areas and a grass cover shalt be established and maintained. 3. Site restoration shall be on a site-by-site basis, the Applicant must restore each property not later than 10 calendar days following the commencement of demolition and/or training exercises. All sites shall be fully demolished and restored by July 15th, 2009. 4. Should no fire training exercises occur or should not ail homes be included in such training exercises, the Applicant shall fully demolish and remove from the City ail six homes including all basements, foundations and septic infrastructure and shall restore all such sites, to a clean, level condition not later than July 15 2009. t:' 5. The Applicant shall provide to the City of Oak Park Heights a Letter of Credit (LOC) in the amount of $25,000.000 securing the final demolition and site remediation of the six homes - located along Oakgreen Ave., lying north of 58th Street and south of Xcel Energy Transmission Towers. The LOC shall be released by the City when all homes, foundations, septic systems are fully removed and when all properties have been returned to a clean, level condition. 6. The Applicant does hereby grant the City the unilateral right to complete any demolition and debris removal should the Applicant fail to complete any required restoration actions in a timely manner. The Applicant shall be responsible to the reimburse the City for all costs associated with such actions required on the part of the City ensure the sites are clean, safe and presentable to the general public; including waiving all rights objecting to special assessments to recover any costs by the City. Should the City be required to take remediation actions, the Applicant shall also forfeit the $25,000 Le -r of Credit to the City as penalty. 7. The Applicant shall reimburse the City for costs associated with water-use for training exercises and shall follow standard City water consumption 1 rates tables. The City will not charge the .Applicant for costs associated with additional staff time required by the* Public Works Department. 8, The City provides nb warranty or guaranty that these properties are in a condition, suitable for fire trainin g exercise. The Applicant agrees to indemnify and hold harmless the City, its agents, officers, and employees from any and all claims, causes of action, liabilities, losses, damages, costs, expenses including reasonable attorneys fees, suits, demands and judgments of any nature, because of bodily injury to, or death any person or persons and/or because of damages to property of the Applicant or others, including loss of use from any cause whatsoever, which may be asserted against the City on account of any act or omission, including negligence, of the Applicant, or the Applicant's employees or agents in connection with the .performance of the work contemplated in the Permit. The Applicant agrees to defend any action brought against the City on any such matters, and to pay and satisfy any judgment entered thereof together with all costs and expenses incurred in connection therewith. The City 'shall In no way b liable for any claims or charges incurred by the Contractor in the performance of this Contract. 9. The City is not responsible for any site security, site protection or other measures to prevent injury, damages, property theft of loss, etc. of the Applicant or his contractors or agents. 10. The City may revoke any authorities conveyed to the Applicant in this document at anytime and for any reason. Such revocation shall be in writing by the City Administrator and/or Building Official and shall be immediate. 11. Following demolition of the buildings, erosion and silt control measures shall be coordinated on the site as directed by the City Engineer. Appropriate control measures as required by the City Engineer shall be installed prior to development and as may be necessary to control erosion and shall at a minimum follow best management i The Applicant does agree to all terms and conditions listed above and are in addition to all federal, state and local rules, ordinance, laws and requirements of record. Ti Nolde, Presid Green T of Page 2 of 2 Atk' x Pr Aid) 414y 1117 /LISP L . (Afflx notary stamp -) • Date :. l A: rrhplofl Date rie c nson, City Administrator signed by City Administrator: ate: :' I ` - 0 ° / F o r JENNIFER M. PINSKI NOTARY PUBLIC - MINNESOTA My Commission Expires Jan, 31, 2012 flo OJL'( JENNIFER M. PINSKI NOTARY PUBLIC - MINNESOTA My Commission Expires Jan. 31, 2012 JOB ADDRESS CLASS OF WORK Number Street ..577 0 5'77Q 4K,6eMA v Front or Width in Feet New Add .. Sign Alter Repair Move Demolish Side or Length in Feet Height in Feet No of Stories .. Area of Lot , Occupied Type of Construction occupancy Project e Valuation . . $ . C----- Oak Park _Heights Application for Permit Owner:(QtltrA IW \6 (11Lc:. Contractor,5 U eux,) Exo (ruN b17 el.pt.)) Address: . f � W - y ; Address: 132.54 VA Th ho Applic _ is Signature For Office Use only: TLu.tIATa& M Phone: () q30-i � Legal Description (if no address assigned: 4 City Building: City Plumbing: City Mechanical: Plan Review: State Surcharge: Signage: City Utility Meter: Utility Connection: Utility Inspection: Metro S.A.C.: Investigation Fee: Other: Total: 13A\(pofL:r Fv l)EpT Co,1,mr: Al 41: 24 N. 3 "-n sr. M.porhf,rA 5-5 Phone:() 4,36,'S3 �O Description of Work Being Done: DEMOLISH ION w ri Peotem ce 13i J fi• Lt. o wEip 3 5 I M CLE AN-UP oK1 By signature below, the applicant hereby agrees to work in accordance with the Ordinances of the Local Municipality, State Building Cade, and the requirements enforced by the City of Oak Park Heights Building Department. r agrees to notify the Building Official of each the required inspections 24 as , ed upon the Inspection Record Card. Dated: Jim Butler, Building official City of Oak Park Heights 14168 Oak Park Blvd. N. P.O. Box 2007 Oak Park Heights, MN 55082 Phone: (65'1) 439 -4439 FAX: (65'I) 439 -0574 flevv4otIs 6 R stvizAc cvt WELL OR BORING LOCA TION County Name Washington 3ownship Name Township No. Range No. Baytown 29 20 Latitude . Longitude Section No. 5 Fraction (sm. --+ lg.) SE'° NE'' NE degrees_____..._ minutes seconds degrees minutes Numerical Street Address or Fire Number and City of Well or Boring Location 5770 Oakgreen Ave N, Oak Park Hgts Show exact location of well or boring in section grid with "X." N s 1 Mile P E >r1 MPANY NAME Property owner's mailing address if different than well location address indicated above 773 Green Twig Way Stillwater, MN 55082 WELL OWNER'S NAME /COMPANY NAME Well owner's mailing address if different than property owner's address indicated above LOGICAL MATERIAL Lirnerock C HE- 01434 -11 ICJt 140 -0423 DEPT OF HEALTH COPY COLOR Sanci /Gravel. varied Yellow MINNESOTA DEPARTMENT OF HEALTH WELL AND BORING SEALING RECORD Minnesota Statutes, Chapter 1031 Sketch map of well or boring location, showing property lines, roads, and buildings. HARDNESS OR FORMATION REMARKS, SOURCE OF DATA, DIFFICULTIES IN SEALING FROM 3 not known, indicate estimated formation log from nearby wet or boring. Varied 0 Hard. 123 H 276516 TO 123 151 Date Sealed 6/12/2009 Depth Before Sealin ft. AQUIFER(S) Single Aquifer U Multiaquifer WELL/BORING f Water - Supply Well ❑ Monit. Well ❑ Env. Bore Hole ❑ Other CASING TYPE(S) Steel ❑ Plastic [] Tile ❑ Other WELLHEAD COMPLETION Outside: ❑ Well House Pitless Adapter /Unit ❑ Well Pit [] Other CASING(S) Diameter 5 in. from 0 in. from to in. from to SCREEN /OPEN HOLE Screen from to Depth to 123 Type of Obstructions (Describe)_.._ Obstructions removed? ❑ Yes [] No Describe PUMP Type Submersible KI Removed ❑ Not Present in. from Type of Perforator ❑ Other GROUTING IJiATERIAL(S) OTHER WELLS AND BORINGS Licensee Business Name ob Lyon Name of Person Sealing Well or Boring Minnesota Welk and Boring Sealing No. Minnesota Unique Weil No. or W- series No. (Leave b!anr; e not known) ❑ At Grade ❑ Buried Date Well or Boring Constructed Original Depth Mantyla Well Drilling, Inc H 2 ft. STATIC WATER LEVEL Measured ❑ Estimated Date Measured 6/12/09 121 ft. below ❑ above land surface c Inside: Basement Offset ❑ Well Pit ❑ Buried ❑ Other Set in oversize hole? Annular space initially grouted? ft. ❑ Yes [ No ❑ Yes ❑ No ❑ Unknown ft, ❑ Yes ❑ No ❑ Yes ❑ No ❑ Unknown ft. ❑ Yes ❑ No ❑ Yes L] No U Unknown Open Hole from 123 to 151. ft. OBSTRUCTIONS Rods /Drop Pipe ❑ Check Valve(s) ❑ Debris ❑ Fill No Obstruction to Other, (One bag of cement = 94 lbs., one bag of bentonite = 50 lbs.) Other unsealed and unused well or boring on property? ❑ Yes No Idow many? Certified Rep. 1■0. 1 394 Date METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS, OR CASING AND BORE HOLE: No Annular Space Exists ❑ Annular Space Grouted with Tremie Pipe ❑ Casing Perforation/Removal in. from to ft. ❑ Perforated [ Removed 11. n Perforated [ Removed Grouting Material Neat Cement from 0 10 151 ft. T yards 22 bags from to ft. yards .______ bags from to ft. yards bags LICENSED OR REGISTERED CONTRACTOR CERTIFICATION This well or boring was sealed in accordance with Minnesota Rules, Chapter 4725. The information contained in this report is true to the best of my knowledge. License or Registration No. 583 6/12/2009 2108R City of Oak Park Heights 14168 Oak Park Blvd. North Oak Park Heights, MN 55082 -2007 ATTN: Eric A. Johnson June 17, 2009 RE: Asbestos Removal Fire Training Exercise Dear Sir: 76 St. Croix Trail N Lakeland, MN 55043 651.43 6.8559 (F)651. 43 6.2021 VcI Environmental Inc. has successfully completed removal of asbestos containing materials identified in Environmental Property Audit's asbestos surve y reports for houses .� located at 5800, 5770 5762 and 575,4 Oak Green Ave. in Oak Park Heights, MN. VcI is scheduled to be complete asbestos removal of the houses located at 5830 and 5 710 Oak Green Ave. by Jun; 23, 2009. If you have any questions please feel free to contract me at the number listed below. Sincerely, ennis Schum Vice President 651 436 -8559 651 436-2021 fax /14 ok-e2 F 'arc 4a D c. s p Dt� a 4gree Uri Zg. ood to 11/25/09 '� d :a sus t as:be`stos - u �esldence ��ut� are �o�� �ori:sdere • s p , . ete ION est ...:...... -cation nfor nati o P��ase, s,e� the fol�ov��ng p.a� for sota I7epartmen ...,- '02009 EPA, Inc Attn : Fax: ample Project: 5770 Oak Green Ave )9 -0411 B -01 -Skim )oat 150902601 -0001 19 -0411 B -01- reen Layer 50902601 -0001A 9 -041 J1-Tan ayer 50902601 -0001B 9-0411 B -02 -Skim oat 50902601 -0002 9 -0411 B -02- urple Layer 10902601 -0002A Jim Lindahl Environmental Property Audits Inc 2701 4th Avenue North Anoka, MN 55303 (763) 323 -6677 Description Wall Plaster Living White Rm Wall Plaster Living Rm Wall Plaster Living Rm Wall Plaster SE Bed Rm Wall Plaster SE Bed Rm -0411 B -02 -Tan Wall Plaster SE Byer Bed Rm 0902601 -0002B IL A Aar Johnson (17) Report PLM - 7.12.0 Printed: 6/2/2009 1 0:28:52 AM EMSL Analytical, Inc. 14375 23rd Avenue North, Minneapolis, IVin 55447 Phone: (763) 449 -4922 Fax: (763) 449 -4924 Email: minneapolislabt emsl,com Phone: (763) 323 -6700 Asbestos Analysis of Bulk Materials via EPA 600 /R- 931116 Method using Polarized ed Light Microscopy Non - Asbestos % Fibrous Appearance Non - Fibrous Heterogeneous Green Non - Fibrous Heterogeneous Tan Non - Fibrous Heterogeneous White/Blue Non - Fibrous Heterogeneous Purple Non - Fibrous Heterogeneous Tan Non - Fibrous Heterogeneous <1% Hair <1% Hair Customer ID: ENVP52 Customer PO: Received: EMSL Order: EMSL Proj: Analysis Date: 6/2/2009 06/01/09 1:30 PM 350902601 % Non - Fibrous 100% Non - fibrous (other) 100% Non - fibrous (other) 100% Non - fibrous (other) 100% Non - fibrous (other) 100% Non - fibrous (other) 100% Non - fibrous (other) ..r/ '11). Rachel Travis, Laboratory Manager or other approved signatory to mad on limitations inherent in PLM, asbestos fibers in dimensions below the resolution capability of PLM may not be detected. The limit of detection as stated in the :hod is .. .1e above test report relates only to the items tested and may not be reproduced in any form without the express written approval of EMSL Analytical, Inc. EMSL's Oily is limited to the cost of analysis. EMSL bears no responsibility for sample collection activities or analytical method limitations. Interpretation and use of test results are the Donsibility of the client. Samples received in good condition unless otherwise noted. This report must not be used to claim product endorsement by NVLAP or any agency of the . Government. .AP Lab Code 200019 -0 Asbestos % Type None Detected None Detected None Detected None Detected None Detected None Detected 1 --n: Jim Lindahl Environmental Property Audits Inc 2701 4th Avenue North Anoka, MN 55303 'Fax: (763) 323 -6677 :l ,jest: 5770 Oak Green Ave pampie c 0411 B -03 -Skim =( it 350902601 -0003 Asbestos Analysis of Bulk Materials via EPA 600/R-93/116 Method using Polarized Light Microscopy Non - Asbestos c )411 B -03- Plaster 350902601 -0003A O1 -04 , , -04 350902601 -0004 09 -0411 B -05- T tore a 02601 -0005 D °- -0411 B -05 -Gray Basmt Wall :r Texture mist 3: 02601 -0005A ) 1411 B -06- ure 350902601 -0006 3alyst(s) Johnson (17) EMSL Analytical, Inc. 14375 23rd Avenue North, Minneapolis, Mn 55447 Phone: (763) 449 -4922 • Fax: (763) 449 -4924 Einaii: minneapolislabt3emsl.com • max; • = "csPi`its^ESY£ _L »v"�sx?n 3z�s~..' 7zxx #:: r' �iey "3s3c`33"�a�a:T.3ti- ;�:T +33t�Si 4 f? -0nssC` Description Wall Plaster Hallway Wall Plaster Hallway Sheetrock!Jt Compound SW Bdrm Basmt Wall Texture mist Garage Ceiling Texture Phone: (763) 323 -6700 Appearance White Non - Fibrous Heterogeneous White Non - Fibrous Heterogeneous Tan/White Non - Fibrous Heterogeneous White Non - Fibrous Heterogeneous Gray Non - Fibrous Heterogeneous White Non - Fibrous Heterogeneous eport PLM - 7.12.0 Printed: 6/2/2009 10:28:54 AM % Fibrous <1% Cellulose 10% Cellulose Sheetrock /Joint Compound Customer ID: ENVP52 Customer PO: Received: EMSL Order: EMSL Pro]: Analysis Date: 6/2/2009 06/01/09 1:30 PM 350902601 % Non- Fibrous 100% Non - fibrous (other) 100% Non - fibrous (other) 90% Non - fibrous (other) 100% Non - fibrous (other) 100% Non - fibrous (other) 100% Non - fibrous (other) 1 Asbestos % Type None Detected None Detected None Detected None Detected None Detected None Detected Rachel Travis, Laboratory Manager or other approved signatory ue to r( ation limitations inherent in PLM, asbestos fibers in dimensions below the resolution capability of PLM may not be detected. The limit of detection as stated in the The above test report relates only to the items tested and may not be reproduced in any form without the express written approval of EMSL Analytical, Inc. EMSL's i1 y is limited to the cost of analysis. EMSL bears no responsibility for sample collection activities or analytical method limitations. Interpretation and use of test results are the isibility of the client, Samples received in good condition unless otherwise noted. This report must not be used to claim product endorsement by NVLAP or any agency of the S. Government. /LAP Lab Code 200019-0 2 Attn: Fax: :Sample 09 -0411 3-06 - Sheetrock 35090260 1 -0006A 09 -0411 B -07- Texture 350902601-0007 09 -04 11 B -07- Sheetrock 350902601 -0007A EMSL Analytical, Inc. 14375 23rd Avenue North, Minneapolis, Mn 55447 Phone: (763) 449 -4922 Fax: (763) 449 -4924 Email: minnea • olislab Jim Lindahl Environmental Property Audits Inc 2701 4th Avenue North Anoka, MN 55303 (763) 323 -6677 Phone: (763) 323 -6700 Project: 5770 Oak Green Ave Asbestos Analysis of Bulk Materials via EPA 600/R- 93/116 Method using Polarized Light Microscopy Non - Asbestos Description Appearance Garage Ceiling Texture \nalyst(s) leidi Johnson (17) Garage Ceiling Texture Garage Ceiling Texture 09 -0411 B -08- Garage Ceiling Texture Texture 350902601 -0008 09 -0411 B -08- Garage Ceiling Sheetrock Texture 350902601 -0008A TanAN kite Non - Fibrous Heterogeneous White Non- Fibrous Heterogeneous Tan/White Non - Fibrous Heterogeneous White Non - Fibrous Heterogeneous TanIW hite Non - Fibrous Heterogeneous 1st Report PLM - 7.12.0 Printed: 6/2/2009 10:28:55 AM 10% Cellulose 10% Cellulose 10% Cellulose emsl.com Customer ID: ENVP52 Customer PO: Received: EMSL Order: EMSL Proj: Analysis Date: 6/2/2009 06/01/09 1:30 PM 350902601 % Fibrous % Non- Fibrous 90% Non - fibrous (other) 100% Non - fibrous (other) 90% Non - fibrous (other) 100% Non - fibrous (other) 90% Non- fibrous (other) Rachel Travis, Laboratory Manager or other approved signatory Due reification limitations inherent in PLM, asbestos fibers in dimensions below the resolution capability of PLM may not be detected. The limit of detection as stated in the ;metho .. 1%. The above test report relates only to the items tested and may not be reproduced in any form without the express written approval of EMSL Analytical, Inc. EMSL's inability is limited to the cost of analysis. EMSL bears no responsibility for sample collection activities or analytical method limitations. Interpretation and use of test results are the responsibility of the client. Samples received in good condition unless otherwise noted. This report must not be used to claim product endorsement by NVLAP or any agency of the tJ.S. Government. LVLAP Lab Code 200019 -0 Asbestos % Type None Detected None Detected None Detected None Detected None Detected THIS IS THE LAST PAGE OF THE REPORT. 3 •EMSL ANALYTICAL, INC. Lae UfATonY. psODUCTS .rRAJNING Company : EPA, Inc Street: City: Anoka Report To (Nam6): Jim Lindahl Telephone #: 763.323.6700 Project Name /Number: 5 0 o Pr Please Provide Results: ❑ Fax ❑ Email Turnaround Time (TAT) Options* --- Please Check C] 6 Hours j 24 Hrs 1 ❑ 48 Hrs I ❑ 3 Days 1 ❑ 4 Days 1 ❑ 5 Days 1 ❑ 10 Days *For TEM Air 3 hours/6 hours, please call ahead to schedule. *There is a premium charge for 3 Hour TEM AHERA or EPA Level 11 TAT. You will be asked to sign an authorization form for this service. Analysis completed in accordance with EMSL's Terms and Conditions located in the Analytical Price Guide. ❑ 3 Hours PCM - Air ❑ NIOSH 7400 ❑ wl OSHA 8hr. TWA LM - Bulk re • ortin • limit :►1 PLM EPA 600 /R- 931116 (<1%) ❑ PLM EPA NOB (<1%). Point Count ❑ 400 (<0.25%) ❑ 1000 <0.1 %) Point Count w /Gravimetric LI 400 ( <0.25 %) ❑ 1 000 (<O.1%) [] NYS 198.1 (friable in NY) ❑ NYS 198.6 NOB (non- friable -NY} ❑ NIOSH 9002 (<1 %) Samplers Name: 0.5 Client Sample # (s): Q0f -- LI Relinquished (Client): 1/ Received (Lab): Comments /Special Instructions: Controlled Document — Asbestos COC — R't — 3/i 8/2009 SsO (9(00( Asbestos Chain of Custody EMSL Order Number (Lab Use Only): State /Province: j Purchase Order: TEM - Air ❑ AHERA 40 CFR, Part 763 ❑ NIOSH 7402 ❑ EPA Level II ❑ ISO 10312 TEM --w Water: EPA 100.2 5T7o CE '\ 1) a-0- Gb- P I� Date: Date: Page 1 of pages EMSL -Bill to: lid Same ❑ Different If Bill to is Different note instructions in Comments ** Third Part Billin • re. uires written authorization from third party • Zip /Postal Code: Fax #: 763.323.6677 Email Address: lin TEM - Bulk ❑ TEM EPA NOB ❑ NYS NOB 198.4 (non- friable -NY) C] Chatfield SOP C] TEM Mass Analysis -EPA 6.00 sec. 2.5 Fibers >10pm ❑ Waste ❑ Drinking Other: All Fiber Sizes C] Waste C] Drinking [] Check For Positive Stop — Clearly Identify Homogenous Group Samplers Signature: Volume /Area (Air) Sample Description HA # (Bulk) 0Asik P t ¶L 2w (AJ n 11 PL_r? \ ,.. ‘-6-7 l l - • i vo 0--I\ f A(L �. c„-- 1 Count U.S. State Samples Taken: TEM- Dust ❑ Microvac -- ASTM D 5755 ❑ Wipe - ASTM D6480 ID Carpet Sonication (EPA 600 /J- 93/167) Soil /RockNerm icul ite ❑ PLM CARB 435 - A (0.25% sensitivity) ❑ PLM CARB 435 -. B (0.1% sensitivity) ❑ TEM CARB 435 - B (0.1 % sensitivity) ❑ TEM CARB 435 - C (0.01% sensitivity) ❑ EPA Protocol (Semi- Quantitative) ❑ EPA Protocol (Quantitative) 1 —6 P b o 1 - ro Taal # of Samples: EMSL ANALYTICAL, INC. 14375 23 AVENUE MINNEAPOLIS, MN 55447 PHONE: (763)449 --4922 FAx: (763)449 -4924 Tine: Date/Time Sampled Time: jr • i EMS. ANALYTICAL, INC. LABORATORY. PRODUC78.TRAINING Additional Pages of the Chain of Custody are only necessary if needed for additional sample information *Comments /Special Instructions: Controlled Document - Asbestos COC - R1 - 3/18/2009 Asbestos Chain of Custody EMSL Order Number (Lab use only: ago 1 Page 2 of pages EMSL ANALYTICAL, INC. 14375 23 AVENUE MINNEAPOLIS, MN 55447 PHONE: (763) 4494922 . FAx: (763) 449 -4924 DatelTime Sampled BD5 was taken in the basement at this location Living Room 1305 O2* SE Bedroom EMI* Garage 503* *B06 517* Bath Kitchen *BOB Family Room Foyer 5770 OAKOREEN ::EuIEUUE OAK PARK HEIGHTS, MN Master Bedroom TO4 TV ROOM Not to scale 1 :1 • \ Certified by: State of Minnesota Department of Health Expires: 11/25/2009 James R Lindahl 2701 4th Ave N Anoka, MN 55303 • . Director, Env. Health Div. No, Al2333 issued: 12/09/2008 0 - r i - ) (I\ !;,,• 580o Oakgreen Issued City Demo Permit & Additional Conditions Application fro Demolition Permit Well Closure Documentation Asbestos Abatement Removal Certification A� ZESS PIN LEGAL DESC PERMIT TYPE PROPERTY TYPE CONSTRUCTION TYPE NOTE: SFD- WORK SHALL BE PERFORMED IN COMPLIANCE WITH APPLICABLE REQUIREMENTS OF LOCAL, COUNTY, STATE JURISDICTIONS AND THEIR AGENCIES AS THEY PERTAIN TO THE PROJECT,INCLUDING CITY OF OAK PARK HEIGHTS ADDENDUM TO DEMOLITON PERMIT DATED 0640-09 0 -09 AND ATTACHED TO PERMIT. NOTE: (1) 24 HOURS NOTICE REQUIRED PRIOR TO UTILITY WORK (2) WATER SHALL BE SHUT OFF AT VALVE BOX AND COPPER CUT OFF NEAR VALVE & CRIMPED CLOSED (3) TREE REMOVALS TO BE APPROVED BY CITY ARBORIST PRIOR TO THEIR REMOVAL (4) WELLS & SEPTICS SHALL BE CLOSED OR ABANDONED PER ESTABLISHED CRITERIA. GREEN TWIG LLC P.O. BOX 119 STILLWATER, MN 55082- GREEN TWIG LLC P.O. BOX 119 STILLWATER, MN 55082- APPLICANT OWNER 5800 OAKGREEN AVE N 05- 02920 -11 -0065 OAKGREEN VILLAGE LOT 0 BLOCK 0 OTHER RESIDENTIAL - OTHER THAN NEW DEMOLITIONS AGREEMENT AND SWORN STATEMENT The work for which this permit is issued shall be performed according to: (1) the conditions of this permit; (2) the approval plans and specifications; (3) the applicable city approvals, Ordinances, and Codes; and, (4) the State Building Code. This permit is for only the work described, and does not grant permission for additional or related work which requires separate permits. This permit will expire and become null and void if work is not started within 1 80 days, or if work is suspended or abandoned for a period of 180 days any time work has commenced. The applicant is responsible for a5,aring all required inspections are requested in conformance with the Minnesota State Building Code. CITY OF OAK PARK HEIGHTS 14168 OAK PARK BLVD. N. #2007 OAK PARK HEIGHTS, MN 55082 -2007 (651) 351 -1661 FAX: (651) 439 -0574 OTHER PERMIT FEE OTHER PERMIT SURCHARGE, FLAT TOTAL PAID WITH CHECK # 5040 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. PERMIT NO.: 2009 -00086 DATE ISSUED: 06/12/2009 25.00 0.50 25.50 Cif of Oak Park Heights — Addendum to Demolition Permit; Additional Conditions greement Property Owner Green Twig, LLC (the "Applicant ") has petitioned the City Oak Park Heights, (the "City"), for a Demolition P = to demolish the homes located at the following Oakgreen Ave., addresses. 5710, 5754, 5752, 577 t' 5800 5830 and are located west of Oakgreen Ave, south of the Xcel Energy Transmission To - nd north of 58th Street in the City of Oak Park Heights. The Applicant has also pursued the "burning" these.structuresby the Bayport Fire Department as a "training exercise ". The Bayport Eire Department will be acting as a contractor for the Applicant. Buelow Excavating will be acting as a contractor for the Applicant that will be performing the final demolition and site restoration. The City does hereby permit the above actions pursuant to the following: Page 1 of 2 Far 5800 bu,y Terms and Conditions of Demolition Permit: 1. Prior to the commencement of any training exercise(s), the Applicant shall provide documentation and certification to the City that all asbestos, lead or other hazardous materials have been removed from the properties and all wells have been appropriately capped. Training exercises may not commence on any home unless and until this documentation has been received by the City and found to be satisfactory. 2. Following the completion of the "training exercise" at each property, the Applicant shall within 10 calendar days fully demolish and remove all remaining structures and debris from the City and shall fully restore the property (or properties) to a clean, level condition ready for future construction, If construction does not commence by August 15th, 2009, the Applicant shall remove all in -place septic system infrastructure and shall place a final topsoil application to all areas and a grass cover shalt be established and maintained. 3. Site restoration shall be on a site -by -site basis, the Applicant must restore each property not tater than 10 calendar days following the commencement of demolition and/or training exercises. All sites shall be fully demolished and restored by July 15th, 2009. 4. Should no fire training exercises occur or should not all homes be included in such training exercises, the Applicant shall fully demolish and remove from the City all six homes including all basements, foundations and septic infrastructure and shall restore all such sites to a clean, level condition not later than July 15th, 2009. 5. The Applicant shall provide to the City of Oak Park Heights a Letter of Credit (LOC) in the amount of $25,000.000 securing the final demolition and site remediation of the six homes located along Oakgreen Ave., lying north of 58th Street and south of Xcel Energy Transmission Towers. The LOC shall be released by the City when all homes, foundations, septic systems are fully removed and when all properties have been returned to a clean, level condition. 0. The Applicant does hereby grant the City the unilateral right to complete any demolition and debris removal should the Applicant fail to complete any required restoration actions in a timely manner. The Applicant shall be responsible to the reimburse the City for all costs associated with such actions required on the part of the City ensure the sites are clean, safe and presentable to the general public; including waiving all rights objecting to special assessments to recover any costs by the City. Should the City be required to take remediation actions, the Applicant shall also forfeit the $25,000 Le * r of Credit to the City as penalty. 7.. The Applicant shall reimburse the City for costs associated with water-use for training exercises and shall follow standard City water consumption 1 rates tables. The City will not charge the Applicant for costs associated with additional staff time required by the Public Works Department. 8.. The City provides no warranty or guaranty that these properties are in a condition suitable for fire training exercise. The Applicant agrees to indemnify and hold harmless the City, its agents, officers, and employees from any and all claims, causes of action, liabilities, losses, damages, costs, expenses including reasonable attorneys fees, suits, demands and judgments of any nature, because of bodily injury to, or death of, any person or persons and/or because of damages to property of the Applicant or others, including loss of use from any cause whatsoever, which may be asserted against the City on account of any act or omission, including negligence, of the Applicant, or the Applicant's employees or agents in connection with the performance of the work contemplated in the Permit. The Applicant agrees to defend any action brought against the. City on any such matters, and to pay and satisfy any judgment entered thereof together with all costs and expenses incurred in connection therewith. The City shall in no way be liable for any claims or charges incurred by the Contractor in the performance of this Contract. 9. The City is not responsible for any site security, site protection or other measures to prevent injury, damages, property theft of loss, etc. of the Applicant or his contractors or agents. 10. The City may revoke any authorities conveyed to the Applicant in this document at anytime and for any reason. Such revocation shall be In writing by the City Administrator and/or Building Official and shall be immediate. 11, Following demolition of the buildings, erosion and silt control measures shall be coordinated on the site as directed by the City Engineer. Appropriate control measures as required by the City Engineer shall be installed prior to development and as may be necessary to control erosion and shall at a minimum follow 'best management practices". The Applicant does agree to all terms and conditions listed above and are in addition to all federal, state and focal rules, ordinances, laws and requirements of record. Ti Nolde, Presid Green Till , f Page 2of2 of ( �x tamp 4) (Affix notary stamp -->) Date;_ (4' tp opc1 Aft. Date 1 ric i r nson, City Administrator Pe t it . - signed by City Administrator: fa, r . 1 ...Date. to / i .2 16 ° 1 AA JENNIFER M. P1NSK1 ti NOTARY PUBLIC - MINNESOTA • . ' My Commission Expires Jan. 31, 2012 5$00 OL'( Or JENNIFER M, PINSKI N NOTARY PUBLIC - MINNESOTA § • My Commission Expires Jan. 31, 2012 JOB ADDRESS CLASS OF WORK Number Street se or) 4,K6/266A/hve New 1 Add - ' Sign : . Alter Repair Move Demolish Front or Width in Feet Side or Length in Feet Height in Feet No of Stories Area of Lot Occupied Type of Construction Occupancy Project wog Valuation . . 5. $ 2--S Owner:CtlEeh1 I.06 (LC,. Address: TLL1tIATa& 1 Phone: (4) q3Qq Legal Description (if no address assigned: The hour Applic. •t's Signature For Office Use. Only: City Building: City Plumbing: City Mechanical: Plan Review: State Surcharge: Signage: City Utility Meter: Utility Connection: Utility Inspection: Metro S.A.C.: Investigation Fee: Other: Total: Oak Park Heights Application for Permit Contractor Address: 13154 2,0 Sttu.wttC'g� r�N Phone: ((�) q3 b 1 ftA uelp0 EXtAVM1iJG (:JoN v E 1.atJ) Description of Work Being Done: OEf\bL%�HU*I "" � 1 ex ?P2)'I'C.T1 Cc BU1) wr..3) 3 ire. CLE AWL* o By signature below, the applicant hereby agrees to work in accordance with the Ordinances of the Local Municipality, State Building Code, and the requirements enforced by the City of Oak Park Heights Building Department. cant f r agrees to notify the Building Official of each the required inspections 24 s ► ted upo e Inspection Record Card. Dated: BAypoer Fi D E o T C. b1I1: a� Et610 r 291t N. 3 Sr, BPrport Mk.) 65 Jim Butler, Building Official City of Oak Park Heights 14168 Oak Park Blvd. N. P.O Box 2007 Oak Park Heights, MN 55082 Phone: (651) 439 -4439 FAX: (651 439 -0574 Dity40-15) R stIviaActdvi WELL OR BORING LOCATION County Name WASHINGTON Township Name Township No. BAY OWN 29. Show exact locat i o g in section grid with X. )LOGICAL MATERIAL SAND?GRAVEL L .MI�ROCK N S 1 Mile HE-01434-11 l C fl 1 Range No. 20 WELL OWNER'S NAME/COMP NAME COLOR MINN. DEPT OF HEALTH COPY Numerical Street Address or Fire Number and City .. of well or borin re-en— e N P OPERTY Ei N 'S 1 OMPANY NAME reeri O 1W3 �L 773 Green Twig Way Stillwater, MN 55082 VARIED YELLOW Section No. Latitude____ degrees minutes seconds .,f ION: Longitude degrees minutes seconds of Well or Boring Location Property owner's mailing address 0 different than well location address indicated above Well owner's mailing address 0 different than property owner's address indicated above HARDNESS OR FORMATION If not known, indicate estimated formation log from nearby well or boring. VARIED HARD REMARKS, SOURCE OF DATA, DIFFICULTIES IN SEALING H 2 76 51 7 MINNESOTA DEPARTMENT OF HEALTH WELL AND BORING SEALING RECORD Oak Park He-i. Sketch map of well or b location, showing property lines, roads, and buildings. Minnesota Statutes, Chapter 1031 Fraction (em. .4 lg.) NE' SE' NE FROM ng TO 0 121 121148 Date Sealed 6/9/2009 Depth Before Sealing__.._ 148 AQUIFER(S) Nj Single Aquifer D Multiaquifer WELIJBORING H Water- Suppl Well ❑ Monit. Well ❑ Env. Bore Hole ❑ Other, CASING TYPE(S) 14 Steel ❑ Plastic ❑ Tile ❑ Other WELLHEAD COMPLETION Outside: ❑ Web House ❑ Pitless Adapter /Unit [] Well Pit ❑ Other CASING(S) Diameter 5 in. from in. from in. from SCREEN /OPEN HOLE Screen from to OBSTRUCTIONS [] Rods /Drop Pipe Type of Obstructions (Describe) OTHER WELLS AND BORINGS Depth to 121 ft. to to [� Check Valve(s) xi No Annular Space Exists in. from to in. from to Minnesota Well and Boring Sealing No. Minnesota Unique Well No. or W- series No. (Leave blank if not ivtown) ft. ❑ At Grade n Buried STATIC WATER LEVEL x1 Measured C❑ Estimated Certified Repres r a L ure Richard A- Thron Rob Lyon Name of Person Sealing Well or Boring Date Well or Boring Constructed H 2765` Original Depth ft. Date Measured_6 9 126 ft. )L] below ❑ above land surface Inside: Basement Offset ❑ Well Pit L Buried [1❑ Other Set in oversize hole? Annular space initially grouted? ❑ Yes o No ❑ Yes ❑ No ❑ Unknown ft. ❑ Yes U No ❑ Yes U No 0 Unknown ❑ Yes ❑ No ❑ Yes [] No 0 Unknown ft. Open Hole from, 121_. to 14a . ft. ❑ Debris 1] Fill Xi No Obstruction Obstructions removed? [_1 Yes ❑ No Describe PUMP SUBI ERS IBLE Type Removed [0 Not Present ❑ Other METI USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS, OR CASING AND BORE HOLE: Annular Space Grouted with Tremie Pipe 0 Casing Perforation /Removal ft. [__1 Perforated [-__] Removed ft. [_1 Perforated [.] Removed Type of Perforator - [1 Other GROUTING MATERIAL(S) (One bag of cement = 94 lbs., one bag of bentonite w 50 lbs.) Grouting Material NEAT CEMENT from 0 to 148 R. yards_ 21___ bags from _ to ft. yards_ ...._ bags from to ft. _ yar ds_-.___._ bags Other unsealed and unused well or boring on property? n Yes Xj No How many? LICENSED OR REGISTERED CONTRACTOR CERTIFICATION This well or boring was sealed in accordance with Minnesota Rules, Chapter 4725. The information contained in this report is true to the best of my knowledge. M >.NTYLA WELL _ DRIL_ LING ____:ANC - - -- -1394 Licensee Business Name License or Registration No. 583 Certified Rep. No. 619L2009 Date 2/08R City of Oak Park Heights 14168 Oak Park Blvd. North Oak Park Heights, MN 55082 -2007 ATTN: Eric A. Johnson June 17, 2009 RE: Asbestos Removal Fire Training Exercise Dear Sir: VCI Environmental Inc. has successfully completed removal of asbestos containing materials identified in Environmental Property Audit's asbestos survey reports for houses located at 5800, 5770 5762 and 5755 Oak Green Ave. in Oak Park Heights, MN. VCI is scheduled to be complete asbestos removal of the houses located at 5 830 and 5 710 Oak Green Ave. by Jun. 23, 2009. If you have any questions please feel free to contract me at the number listed below. Sincerely, ennis S chum Vice President 651 436 -8559 651 436-2021 fax frt. 'f frjertiosm Ore 1.—/ int — • 76 St. Croix Trail N Lakeland, MN 55043 6514 43 6.8559 (F)651. 43 6.2021 6 ri/t)0 1.0 INTRODUCTION- ental Property Audits, Inc. (EPA, Inc.) conducted a visual survey at the residence Env�ronm p y located at 5800 Oakgreen Avenue, Oak Park Heights, MN. The survey for asbestos - containing materials (ACM ) was completed on May 29, 2009, for Mr. Dennis Schumann, VCI. The p purpose of the was to identify, sample and assess suspect building materials that may p ose survey contain asbestos concerns. The inspection was requested in order to facilitate an upcoming demolition provide of the structure, and to rovide an inventory of asbestos containing materials (ACM) as found in or on the residence. This survey included an inspection of all suspected asbestos containin g building buildin materials and collection of bulk samples. EMSL Analytical, Inc., Minneapolis, MN , analyzed the - samples utilizing Polarized Light Microscopy (PLM) - Method EPA 600 /R- 93/116. The p rimary materials, which were sampled, included: ceiling tile, linoleum, wall plaster, and glazing materials. 2.0 SCOPE OF WORK r A Minnesota licensed asbestos inspector from EPA, Inc. conducted a building survey for the identification and assessment of accessible suspect ACM at the residence located at 5 800 Oakgreen Avenue, Stillwater. The following activities have been completed by EPA, Inc.: • A walk-through of the buildings interior spaces, with observations of accessible suspect ACM. O Random sample collection from suspect ACM building materials with consideration to homogeneous areas and material types. • Mapping and logging bulk samples for future reference. • Estimated uantit of material types identified as asbestos containing (greater than 1%). q y • Analysis samples a1 sis of bulk by polarized light microscopy, utilizing EMSL Analytical, Inc. of p es y p Minneapolis. The laborator y analysis sis confirmed materials that are asbestos containing and the summary includes the following inforrzlation: 3.0 Building Description, 4.0 Suspect Building Materials, 5.0 .0 Asbestos Containing Materials List, 6.0 Non- asbestos Containing Materials List, 7.0 Non - suspect Materials, and 8.0 Inspector Accreditation. 5800 Oalcgreen Ave N ASBESTOS MATERIAL SURVEY 5800 OAKGREEN AVENUE NORTH OAK PARK HEIGHTS, MINNESOTA 1 ©2009 EPA, Inc • 2.1 LIMITATIONS ASBESTOS MATERIAL SURVEY 5800 OAKGREEN AVENUE NORTH OAK PARK HEIGHTS, MINNESOTA EPA Inc. made reasonable attempts to . access all areas of the residence as presented within the scope of this work. The following areas and/or materials were not able to be accessed due to safety concerns or other limitations. . • No excavations were made to identify foundation conditions below grade (i.e. exterior damp - proofing). • No roof samples were collected from the residence. This residence had newer fiberglass shingles on the roof. Based on the similar appearance, it is assumed that the findings were consistent with the remainder of the roof area. 3M BUILDING DESCRIPTION The project consisted of a two -story cape cod style residence with an unfinished basement. ® The exterior walls of the building are constructed of wood framing with fiberglass insulation. • The main floor areas were a mix of hardwood flooring, carpet and linoleum. • The interior ceiling was primarily a plaster ceiling system. O The interior walls are primarily wood framing with either sheetrock or a plaster application. • The basement foundation was concrete block with a concrete slab floor. • The roof had 3-tab asphalt shingles over a tarpaper underlayment system. • The heating was provided by a forced air furnace system. 4.D SUSPECT BUILDING MATERIALS Representative bulk samples of suspect ACM building materials were collected from the building. The identified materials that were considered suspect and subsequently sampled include: • Ceiling tile • Linoleum ® Wall plaster • Glazing Of the materials sampled, none of the materials were found to be asbestos containing: Please refer to the following section for the analytical laboratory results, including material locations, and quantities. 5800 C akgreen Ave N 2 ©2009 EPA, Inc 5.0 ASBESTOS CONTAINING MATERIAL INVENTORY . 'n building materials identified inlon this residence. There were no asbestos-containing g g 6.0 NON ASBESTOS CONTAINING MATERIAL INVENTORY The following materials had laborato r y results of "None Detected" for asbestos content. No special g pertain re ulations ertain to these building materials. Sample ::# 09 -04108 B-01 09 -04108 B -02 09 -04108 B -03 09 -04108 13-04 09 -04108 13-05 09-04108 13-06 09-04108 B-07 09 -04108 B -08 09 -04108 13-09 Functional Space Exterior walls Foundation slab /walls Supports /Framing 5800 oakgreen Ave N ASBESTOS MATERIAL SURVEY 5800 OAKGREEN AVENUE NORTH OAK PARK HEIGHTS, MINNESOTA Functional Space. Upstairs Room Upstairs Room Upstairs Room Kitchen Living Room Hallway SW Bedroom East Entry Main Window 7.0 NON- SUSPECT ASBESTOS MATERIALS present following materials are suspect asbestos building resent in this residence but are not considered as susp materials. ate ial Identification Wood Concrete /block Wood $.0 ASBESTOS BUILDING INSPECTOR ACCREDITATION to Department of :Health certification information. Please see the following pages for M�ruleso p r p eetor JTin Lindahl Exp. Date 11125/09 innesota Certification Number -- #Al2333 Material Identification Ceiling tile Ceiling tile Ceiling tile Original linoleum, mastic, felt Wall Plaster (white & grey layer) Wall Plaster (grey & green layer) Wall Plaster (grey & green layer) Linoleum (brick pattern) Glazing 3 Asbestos Content ND ND ND ND ND ND ND ND ND ©2009 EPA, Inc Attn: Jim Lindahl Environmental Property Audits Inc 2701 4th Avenue North Anoka, MN 55303 Fax: (763) 323 -6677 Project: 5800 Oak Green Ave Sample Asbestos Analysis of Bulk Materials via EPA 600 /R- 93/110 Method using Polarized Light Microscopy Non - Asbestos 09 -04108 8-01 350902604 -0001 EMSL Analytical, inc. 14375 23rd Avenue North, Minneapolis, Mn 55447 Phone: (763) 449 -4922 Fax: (763) 449 -4924 Email: minneapolislab @emsl.cnm Description Upstairs Rm Ceiling Tile 09 -04108 B -02 350902604 -0002 09 -0 , B -03 35090 ,,4 -0003 1 Kristen Lindfors (14) Upstairs Rm Ceiling Tile Upstairs Rm Ceiling Tile 09 -04108 8 -04- Original Layer Linoleum Kitchen Linoleum 350902604 -0004 09 -04108 B -04- Original Layer Mastic Kitchen Linoleum 350902604 -0004A 09 -04108 B -04 -Tar Original Layer Felt Kitchen Linoleum 350902604 -0004B Phone: (763) 323 -6700 Appearance White Non - Fibrous Heterogeneous White Non - Fibrous Heterogeneous White Non - Fibrous Heterogeneous White /Beige Non- Fibrous Heterogeneous Tan Non - Fibrous Homogeneous Brown /Black Fibrous Homogeneous Test Report PLM - 7.12.0 Printed: 6/2/2009 11:21:38 AM 2% Cellulose 55% Cellulose % Fibrous Customer ID: ENVP52 Customer PO: Received: EMSL Order: EMSL Pro]: Analysis Date: 6/2/2009 06101/09 1:30 PM 350902604 % Non - Fibrous •3 85% Non - fibrous (other) 15% Mica 85% Non - fibrous (other) 15% Mica 85% Non - fibrous (other) 15% Mica. 100% Non - fibrous (other) 98% Non - fibrous (other) 45% Non - fibrous (other) Rachel Travis, Laboratory Manager or other approved signatory Due iification limitations inherent in PLM, asbestos fibers in dimensions below the resolution capability of PLM may not be detected. The limit of detection as stated in the methoa""",s 1 %. The above test report relates only to the items tested and may not be reproduced in any form without the express written approval of EMSL Analytical, Inc. EMSL's liability is limited to the cost of analysis. EMSL bears no responsibility for sample collection activities or analytical method limitations. Interpretation and use of test results are the responsibility of the client. Samples received in good condition unless otherwise noted. This report must not be used to claim product endorsement by NVLAP or any agency of the U.S. Government. NVLAP Lab Code 200019-0 Asbestos % Type None Detected None Detected None Detected None Detected None Detected None Detected 1 Attn: Sample Jim Lindahl Environmental Property Audits Inc 2701 4th Avenue North Anoka, MN 55303 LFax: (763) 323 -6677 y . Project: 5800 Oak Green Ave 09-04108 B -05- Gray Layer :. 350902604 -0005 09 -04108 B -05- White Layer 350902604 -0005A 08 B -06- Gray Layer 350902604 -0006 09 -04108 B -06- Green Layer 350902604 -0006A 09 -04108 B -07- G ray Layer 350902604 -0007 09-04108 B -07- Green Layer 350902604 -0007A Asbestos Analysis of Bulk Materials via EPA 60O /R- 93/116 Method using Polarized Light Microscopy Non - Asbestos Kristen Lindors (14) �L Anaytia, Inca 14375 23rd Avenue North, 11.4inneapolis, Mn 55447 phone: (763) 449 -4922 . Fax: (763) 449 -4924 Email: minneapolislab @emsl.com Description Wall Plaster Living Gray Rm Non - Fibrous Homogeneous Wall Plaster Living White Rm Wall Plaster Hallway Wall Plaster Hallway Wall Plaster SW Gray Bed Rm Non - Fibrous Homogeneous Wall Piaster SW Pink/Green Bed Rm Phone: (763) 323 -6700 Appearance Non - Fibrous Heterogeneous Gray Non- Fibrous Heterogeneous Pink/Green Non - Fibrous Heterogeneous Non - Fibrous Heterogeneous est Report PLM - 7.12.0 Printed: 6/2/2009 11:21:39 AM % Fibrous <1% Hair <1% Cellulose <1% Hair <1% Hair Customer ID: ENVP52 Customer PO: Received: EMSL Order: EMSL Proj: Analysis Date: 6/2/2009 06/01/09 1 :30 PM 350902604 % Non- Fibrous 100% Non - fibrous (other) 100% Non - fibrous (other) 100% Non- fibrous (other) 100% Non - fibrous (other) 100% Non- fibrous (other) 100% Non - fibrous (other) Rachel Travis, Laboratory Manager or other approved signatory t �gnification limitations inherent in PLM, asbestos fibers in dimensions below the resolution capability of PLM may not be detected. The limit of detection as stated in the meth— :s 1%. The above test report relates only to the items tested and may not be reproduced in any form without the express written approval of EMSL Analytical, Inc_ EMSL's liability is limited to the cost of analysis, EMS(.. bears no responsibility for sample collection activities or analytical method limitations. Interpretation and use of test results are the responsibility of the client. Samples received in good condition unless otherwise noted. This report must not be used to claim product endorsement by NVLAP or any agency of the U.S. Government. NVLAP Lab Code 200019 -0 Asbestos % Type None Detected None Detected None Detected None Detected None Detected None Detected 2 1 kiln: 09 -04108 B-08 350902604 -0008 09 -04108 B -09 350902604 -0009 Anal Kristen Lindfors (14) EMSL Analytical, Inca 1 4375 23rd Avenue North, Kilinneapolis, Nin 55447 Phone: (763) 449 -4922 Fax: (763) 449 -4924 Email: t inneapolislab(emSI.com Jim Lindahl Environmental Property Audits Inc 2701 4th Avenue North Anoka, MN 55303 =ax: (763) 323 -6677 3roject: 5800 Oak Green Ave ;ample Description Appearance E. Entry Linoleum Brown/Tan/Green Brick Pattern Fibrous Heterogeneous Main Window Glazing Phone: (763) 323 -6700 Brown /Beige Non - Fibrous Heterogeneous I 30% Cellulose 10% Synthetic 5% W ollastonite Customer ID: ENVP52 Customer PG: Received: 06/01/09 1:30 PM EMSL Order: 350902604 EMSL Proj: Analysis Date: 6/212009 60% Non - fibrous (other) 95% Non - fibrous (other) • Asbestos Analysis of Bulk Materials via EPA 6OO /R- 93/116 Method using Polarized Light Microscopy Non - Asbestos % Fibrous % Non- Fibrous Rachel Travis, Laboratory Manager or other approved signatory Asbestos % Type None Detected None Detected Du e to ( :;ation limitations inherent in PLM, asbestos fibers in dimensions below the resolution capability of PLM may not be detected. The limit of detection as stated in the method ... .. The above test report relates only to the items tested and may not be reproduced in any form without the express written approval of EMSL Analytical, inc. EMSL's liability is limited to the cost of analysis. EMSL bears no responsibility for sample collection activities or analytical method limitations. Interpretation and use of test results are the responsibility of the client. Samples received in good condition unless otherwise noted. This report must not be used to claim product endorsement by NVLAP or any agency of the U.S. Government. ,..NVLAP Lab Code 200019-0 hest Report PLM - 7.12.0 Printed: 612/2009 11:21:40 AM THIS IS THE LAST PAGE OF THE 'REPORT. 3 treet: Report To E14. IALYTICAL, INC. LASU ,Y•PRODUCTS• FLAINING Company : EPA, Inc . Anoka Name PLM EPA 600 /R- 93/116 (<1%) ll PLM EPA NOB (<1%) Point Count 400 ( <0.25 %) ❑ woo ( <0.1 %) Point Count w /Gravimetric ❑ 400 (<O.25 %) ❑ 1 000 (<0.1%) S 198.1 (friable in NY) 1 ❑ NYS 198.6 NOB (non- friable -NY) ❑ NIOSH 9002 <1% Samplers Name: : Jim Lindahl Controlled Document — Asbestos CDC — R1 — 3118/2009 State /Province: 4 Asbestos Chain of Custody EMSL Order Number (Lab Use only): Client Sam le # s): �-i• ed Client L� P �nqu�sh (Client): e kCGeived Lab) Comments/Special Instructions: "'S."' 1. EMSL -Bill to: I Same Q Different if Bill to is Different note instructions in Comments ** Third Party Billing requires written authorization from third party Count Zip /Postal Coder Fax #: EMSL ANALYTICAL, INC. 14375 23 AVENUE MINNEAPOLIS, MN 55447 PHONE: (763)449 -4922 FAX: (763)449 -4924 u!k .. Date: Date: Page 1 of pages Email Address: find Samplers Signature: "elephone #: 763.323.6700 Project Name/Number: - .5 - 15 1 . 90 Please Provide Results: Fax d Email Purchase Order: Turnaround Time (TAT) Options* -- Please Check , Days 3 Days Days 1 ❑ 5 Days � ❑ 4 Hrs ❑ 48 Hrs 1 � ❑ 4 Da y f T. You will �e asked to sign 3 Hours ❑ 6 Hours � 1 � e. for 3 Hour TE�11.ANERA or EPA t 11 TA D o schedule. There is a premium charge. *For TEM Air 3 hours/6 hours, please call ahead t in accordance with EN1SL's Terms and Conditions located in the Anal ical Pace Guide, an aulh�rizafian form for this service. Anal sis corn feted �n TEM Dust PClyl -Air TEM - Air - 40 CFR Part 763 C] Micravac - ASTM D 5755 SH 7400 ❑ AHERA El SH 7402 D Wipe -ASTM D648o NIO wl O SHA 8hr. TWA ❑ NlO ❑ 0 Carpet Sanicatian (EPA 600/J-93/167) • E PA Level 11 PLM - Bulk re•ortin• limi Q ❑ ISO 10312 SoillRock TEM -Bulk ❑ PLM CARB 435 - A (0.25% sensitivity) 0 TEM EPA NOB (0.1% PLM CARB 435 - B �0.� sensitivity) E] NYS NCB 198.4 (non-friable-NY) El TEM CARB 435 - B (0.1 %. sensitivity) ❑ Chatfield SOP ID TEM CARB 435 - C 0.01% sensitivity) ❑ TEM Mass Analy sis -EPA 6.00 sec. 2.5 ❑ EPA Protocol (Semi- Quantitative) TEM — Water: EPA 100.2 ❑ EPA Protocol (Quantitative) Fibers >10pm El Waste ❑ Drinking Other All Fiber Sizes ❑ Waste ❑ Drinking ❑ Check For Positive ositive Sto — Clearly Identify Homogenous Group U.S. State Samples Taken: Sample Description Total # of Samples: Time: Time: 1 Date/Time Sampled 61) EMSL ANALYTICAL,.INC. LA BORATOR, PROOUCTS.TRAINING Asbestos Chain of Custody EMSL Order Number (Lab use Only): oc-') Additional Pages of the Chain of Custody are only necessary if needed for additional sample information EMSL ANALYTICAL, !NC. 14375 23 AVENUE MINNEAPOLIS, MN 55447 PHONE: (763) 449-4922 FAX: (763) 449 -4924 Sample # oi.,o9\09 g7 fO C . E.N.)11 A e C 6P) WtOODki *Com ments /Special Instructions: Controlled Document — Asbestos COC — RI -- 3/18/2009 Sample Description L.--).--10\_(-; cn Page 7of ? ages Date /Time Sampled Bdroom 1305 Bedroo M Bedroort: 1AAIN LEVEL 5800 OAKOREEN AVENUE OAK PARK HEIGHTS, MN 3 Season Porch Family Room 1E2 To1 *903 UPSTAIRS 5800 OAKOREEN AVENUE OAK PARK HEIOHTS, iN Director, Env. Health Div. No. Al2333 issued: 12/09/2008 - I )4 - - Certified by: State of Minnesota Department of Health Expires: 11/25/2009 . James R Lindahl 2701 4th Ave N Anoka, MN 55303 • • Iowa 4:1 • Cr* Lllj - , (i"...'‘> • • ._. 11 1 1 i ' l , ... - •,,,---_ .... ' ,..,),.2.:/.7,,--",: ' l r 7 1 1 : :: ' ,.. . , - .. , , 1 - -.": 1 :: -.. : : : ; 17,:, 1 i ii ',...,•,„.., • ',....,,,,•:,,--•' -- •-• l',/.- • . _,.., v , Q, „ •• : ,- 5 Oakgreen Issued City Demo Permit & Additional Conditions Application fro Demolition Permit Well Closure Documentation Asbestos Abatement Removal Certification x,JRESS : 5830 OAKGREEN AVE N PIN : 05-029-20-11-0028 LEGAL DESC : N/A LOT 0 BLOCK 0 PERMIT 'TYPE : OTHER PROPERTY TYPE : RESIDENTIAL - OTHER THAN NEW CONSTRUCTION TYPE : DEMOLITIONS NOTE: SFD- WORK SHALL BE PERFORMED IN COMPLIANCE WITH APPLICABLE REQUIREMENTS OF LOCAL, COUNTY, STATE JURISDICTIONS AND THEIR AGENCIES AS THEY PERTAIN TO THE PROJECT,INCLUDING CITY OF OAK PARK HEIGHTS ADDENDUM TO DEMOLITON PERMIT DATED 06 -10 -09 AND ATTACHED TO PERMIT. NOTE: (1) 24 HOURS NOTICE REQUIRED PRIOR TO UTILITY WORK (2) WATER SHALL BE SHUT OFF AT VALVE BOX AND COPPER CUT OFF NEAR VALVE & CRIMPED CLOSED (3) TREE REMOVALS TO BE APPROVED BY CITY ARBORIST PRIOR TO THEIR REMOVAL (4) WELLS & SEPTICS SHALL BE CLOSED OR ABANDONED PER ESTABLISHED CRITERIA. GREEN TWIG LLC P.O. BOX 119 STILLWATER, MN 55082- GREEN TWIG LLC P.O. BOX 119 STILLWATER, MN 55082- APPLICANT OWNER AGREEMENT AND SWORN STATEMENT The work for which this permit is issued shall be performed according to: (1) the conditions of this permit; (2) the approval plans and specifications; (3) the applicable city approvals, Ordinances, and Codes; and, (4) the State Building Code. This permit is for only the work described, and does not grant permission for additional or related work which requires separate permits. This permit will expire and become null and void if work is not started within 180 days, or if work is suspended or abandoned for a period of 180 days any time 3r work has commenced. The applicant is responsible for assuring all required inspections are requested in conformance with the Minnesota State Building Code. CITY OF OAK PARK HEIGHTS 14168 OAK PARK BLVD. N. #2007 OAK PARK HEIGHTS, MN 55082 -2007 (651)351-1661 FAX: (651) 439 -0574 OTHER PERMIT FEE OTHER PERMIT SURCHARGE, FLAT TOTAL PAID WITH CHECK # 5040 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. PERMIT NO.: 2009 -00087 DATE ISSUED: 06/25/2009 25.00 0.50 25.50 Fa. 5'3:o oiLr City of Oak Park Heights — Addendum to Demolition Permit: Additional Conditions Agreement Property Owner Green Twig, LLC (the "Applicant ") has petitioned the City of Oak Park Heights, (the "City "), for a Demolition Permit to demolish the homes located at the following Oakgreen Ave. addresses: 5710, 5754, 5752, 5770, 5800, 5830 and are located west of Oakgreen Ave, south of the Xcel Energy Transmission Towers and north of 58th Street in the City of Oak Park Heights, The Applicant has also pursued the "burning" these structures by the Bayport Fire Department as a "training exercise ". The Bayport Fire Department will be acting as a contractor for the Applicant. Buelow Excavating will be acting as a contractor for the Applicant that will be performing the final demolition and site restoration. The City does hereby permit the above actions pursuant to the following: Terms and Conditions of Demolition Permit: 1. Prior to the commencement of any training exercise(s), the Applicant shall provide documentation and certification to the City that all asbestos, lead or other hazardous materials have been removed from the properties and all wells have been appropriately capped. Training exercises may not commence on any home unless and until this documentation has been received by the City and found to be satisfactory. 2. Following the completion of the `training exercise" at each property, the Applicant shall within 10 calendar days fully demolish and remove all remaining structures and debris from the City and shall fully restore the property (or properties) to a clean, level condition ready for future construction, If construction does not commence by August 15th, 2009, the Applicant shall remove all in -place septic system infrastructure and shall place a final topsoil application to all areas and a grass cover shall be established and maintained. 3. Site restoration shall be on a site -by -site basis, the Applicant must restore each property not later than 10 calendar days following the commencement of demolition and/or training exercises. All sites shall be fully demolished and restored by July 15th, 2009. 4. Should no fire training exercises occur or should not all homes be included in such training exercises, the Applicant shall fully demolish and remove from the City all six homes including all basements, foundations and septic infrastructure and shall restore all such sites to a clean, level condition not later than July 1 5th, 2009. 5. The Applicant shall provide to the City of Oak Park Heights a Letter of Credit (LOC) in the amount of $25,000.000 securing the final demolition and site remediation of the six homes located along Oakgreen Ave., lying north of 58th Street and south of Xcel Energy Transmission Towers. The LOC shall be released by the City when all homes, foundations, septic systems are fully removed and when all properties have been returned to a clean, level condition. 6. The Applicant does hereby grant the City the unilateral right to complete any demolition and debris removal should the Applicant fail to complete any required restoration actions in a timely manner. The Applicant shall be responsible to the reimburse the City for all costs associated with such actions required on the part of the City ensure the sites are clean, safe and presentable to the general public; including waiving all rights objecting to special assessments to recover any costs by the City. Should the City be required to take remediation actions, the Applicant shall also forfeit the $25,000 Le r of Credit to the City as penalty. Page 1 of 2 7. The Applicant shall reimburse the City for costs associated with water-use for training exercises and shall follow standard City water consumption / rates tables. The City will not charge the Applicant for costs associated with additional staff time required by the Public Works Department. 8. The City provides no warranty or guaranty that these properties are in a condition suitable for fire training exercise. The Applicant agrees to indemnify and hold harmless the City, its agents, officers, and employees from any and ail claims, causes of action, liabilities, losses, damages, costs, expenses including reasonable attorneys fees, suits, demands and judgments of any nature, because of bodily injury to, or death of, any person or persons and/or because of damages to property of the Applicant or others, including loss of use from any cause whatsoever, which may be asserted against the City on account of any act or omission, including negligence, of the Applicant, or the Applicant's employees or agents in connection with the performance of the work contemplated in the Permit. The Applicant agrees to defend any action brought against the City on any such matters, and to pay and satisfy any judgment entered thereof together with all costs and expenses incurred in connection therewith. The City shall in no way be liable for any claims or charges incurred by the Contractor in the performance of this Contract. a The City is not responsible for any site security, site protection or other measures to prevent injury, damages, property theft of loss, etc. of the Applicant or his contractors or agents. 10. The City may revoke any authorities conveyed to the Applicant in this document at anytime and for any reason. Such revocation shall be in writing by the City Administrator and/or Building Official and shall be immediate. 11. Following demolition of the buildings, erosion and silt control measures shall be coordinated on the site as directed by the City Engineer. Appropriate control measures as required by the City Engineer shall be installed prior to development and as may be necessary to control erosion and shall at a minimum follow "best management practices". The Applicant does agree to all terms and conditions listed above and are in addition to all federal, state and local rules, ordinances, laws and requirements of record. Ti Nolde, Presid Green Ta Date: of ( tamp 4) Page2of2 E lb OPI Date ric / nson, City Administrator P ' It . ii ` ly . - signed by City Administrator: E' � ' .'. T ate: AI - ry (Affix notary stamp - ) '-r.. JENNIFER M. PINSKI � • _:171 NOTARY PuBUC - MINNESOTA My Commission Expires Jan. 31, 2012 0 JENNIFER M. PINSKI NOTARY PUBLIC - MINNESOTA My Commission Expires Jan. 31, 2012 ll tl .r��rrr�.�. err ..r.� :�. JOB ADDRESS CLASS OF WORK Number Street 5830 Ax 1 2 F 4 i' e New Add Sign Alter Repair Move Demolish r. Front or Width in Feet Side or Length in Feet Height in Feet No of Stories .. Area of Lot Occupied Type of Construction Occupancy Project votto VAluation 27- Owner:Citl.EeN1 lWIb LLC. Address: sriu�2, Phone: (6S1) Legal Description (if no address assigned: Description of Work Being Done: OEMbLI�H IoN � � �E Pap ce Bu ap By signature below, the applicant hereby agrees to work in accordance with the Ordinances of the Local Municipality, State Building Code, and the requirements enforced by the City of Oak Park Heights Building Department. The - ant f :: r agrees to notify the Building Official of each the required inspections 24 hour • e as - * ted po the Inspection Record Card. Applicant's Signature For Office Use only: City Building: City Plumbing: City Mechanical: Plan Review: State Surcharge: Signage: 14168 Oak Park Blvd. N. City Utility Meter: P.O. Box 2007 Utility Connection: Oak Park Heights,. MN 55082 - Utility Inspection: Metro S.A.C.: Phone: (651) 439 -4439 Investigation Fee: FAX: (651) 439 -0574 Other: Total: Oak Park Heights Application for Permit ContractorS ElptJ EM%'flP1 C» (Tow BvE1.,otJ� Address: 13264 24 5+- St)rYL MN Phase: (K1 ) 436 s'5 Dated: 13Ay pear Fi tte Dr CourwcT: Al EtsiN 3LD sr. &prporf, 5'5o&3. Jim Butler, Building Official City of Oak Park Heights �E Ik ° U P ohs , Dtploo5/ R straustitm WELL OR BORING LOCATION County Name WASHINGTON Township Name Township No. BAY] OWN 2 9 Latitude_ minutes_ L� Ar ION: Longitude degrees_ minutes Numerical Street Address or Fire Nuinber and City of Well or Boring Location 5830 Oakgreen Ave N ti , Oak Park I-igts Show exact location of well or boring in section grid with X vY LI E OCI s 1 Mile LOGICAL MATERIAL MINN. DEPT OF 1 COPY 773 Green Twig Way Stillwater, MN 55082 WELL OWNER'S NAME /COMPANY NAME HE- 01434 -11 Icfi 140 -0423 Range No. 20 Y iMe l COLOR Section No. 5 . MfNNESOTA DEPARTMENT OF HEALTH ; u; WELL AND BO lI � 0 SEALING � , E C0 G lines, roads, and buildings. CASING TYPE(S) HARDNESS OR FORMATION V AR IEU7ARIED YELLOW HARD REMARKS, SOURCE OF DATA, DIFFICULTIES IN SEALING Minnesota Statutes, Chapter 1031 Fraction (sin. lg.) Date Sealed SE/ti NEA NE Well owner's mailing address if different than property owner's address indicated above FROM If not known, indicate estimated formation log from nearby well or boring. seconds seconds - ---- -- 121 276511 TO Depth Before Sealing 131 ft. PF=RTY OV 1Ef4'5 NA f - fMPANY NAME CASING(S) reen " i a LLU Diameter Property owner's mailing address if different than well location address indicated above 6/9/2009 AQUIFER(S) Single Aquifer ❑ Multiaquifer WELL/BORING Water - Supply Well ❑ Monit. Well Sketch map of well or boring ❑ Env. Bore Hole ❑ Other location, showing property Xi Steel ❑ Plastic ❑ Tile [} Other WELLHEAD COMPLETION Outside: ❑ Well House Pitiess Adapter /Unit Li well Pit ❑ Other 5 in. from in. from to in. from SCREEN /OPEN HOLE - Screen from to Type of Obstructions (Describe) PUMP Type 191 A Removed WSJ JBMER S T HT , No Annular Space Exists ❑ Not Present OTHER WELLS AND BORINGS Minnesota Well and Boring Sealing No. Minnesota Unique Well No or W- series No. {Leave blank if not known) At Grad: Li Buried Depth �. to 121 ft. to ft. Obstructions removed? ❑ Yes ❑ No Describe Original Depth 0 Other from to Mantyla Well Drilling, Inc Licensee business Name Certified Repre __ -��=- ignature Ric. and A . Thron Rob Lyon Name of Person Sealing Well or Boring Date Well or Boring Constructed STATIC WATER LEVEL L 6/ /_2009 �� Measured Estimated Date Measur�ti7d _.� _125_ ft. Xj below [❑ above land surface Inside: ❑ Basement Offset Ei Well Pit ri Buried L) Other Set in oversize hole? 2 TE5IE ft. ❑ Yes ] No ❑ Yes L.) No LI Unknown 1..1 Yes ❑ No ❑ Yes [_]Yes 0 N ❑Yes ft. Open Hole from 121 to 131 ft. OBSTRUCTIONS ❑ Rods /Drop Pipe ❑ Check Valve(s) [1 Debris ❑ Fill V No Obstruction 131 METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS, OR CASING AND BORE HOLE: ❑ Annular Space Grouted with Tremie Pipe ❑ Casing Perforation /Removal in. from ft. Li Perforated ❑ Removed in. from to ft. ❑ Perforated ❑ Removed Type of Perforator f_J Other GROUTING MATERIAL(S) (One bag of cement = 94 Ibs., one bag of bentonite e 50 lbs.) Grouting Material CEMENT from 0 t131 ft. from to Other unsealed and unused well or boring on property? ❑ Yes kl No How many? 5-8 Certified Rep_ No. Annular space initially grouted? Li No L Unknown Li No 111 Unknown yards 16 bags ft. yards bags ft. yards bags LICENSED OR REGISTERED CONTRACTOR CERTIFICATION This well or boring was sealed in accordance with Minnesota Rules, Chapter 4725. The information contained in this report is true to the best of my knowledge. 1394 License or Registration No. 6 A-1-200-9- Date 2/08R " City of Oak Park Heights 14168 Oak Park Blvd. North Oak Park Heights, MN 55082-2007 Dennis Schumann Vice President, VCI Environmental Inc 6514368559 76 St,. Croix Trail N Lakeland, MN 55043 651.436.8559 (F)651.436.2021 June 26, 2009 RE: Asbestos Removal Fire Training Exercise Dear Sir: VCI Environmental Inc. has successfu ly completed the removal of asbestos containing materials identified . .1 tenmental Property Audit's asbestos survey reports for the houses located .1 5 3Oaiid 5710 Oak Green Ave. in Oak Park Heights, MN. If you have any questions please feel free to contact me. Sincerely, 1.0 INTRODUCTION 2.0 SCOPE OF WORK ASBESTOS MATERIAL SURVEY 5830 OAKGREEN AVENUE NORTH OAK PARK HEIGHTS, MINNESOTA Environnr •a ' - operty Audits, Inc. (EPA, Inc.) conducted a visual survey at the residence located c 5830 S akgreen Avenue, Oak Park Heights, MN. The survey for asbestos - containing materials M) was completed on May 29, 2009, for Mr. Dennis Schumann, VCI. The purpose of the survey was to identify, sample and assess suspect building materials that may contain asbestos. The inspection was requested in order to facilitate an upcoming demolition of the structure, and to provide an inventory of asbestos containing materials (ACM) as found in or on the residence. This survey included an inspection of all suspected asbestos containing building materials and collection of bulk samples. EMSL Analytical, Inc., Minneapolis, MN, analyzed the samples utilizing Polarized Light Microscopy (PLM) - Method EPA 600 /R- 93/116. The primary materials, which were sampled, included: ceiling texture, linoleum, wall plaster, floor tile, vermiculite, window glazing, and roofing materials. A Minnesota licensed asbestos inspector from EPA, Inc. conducted a building survey for the identification and assessment of accessible suspect ACM at the residence located at 5830 Oakgreen Avenue, Stillwater. The following activities have been completed by EPA, Inc.: 6 A walk - through of the buildings interior spaces, with observations of accessible suspect ACM. • Random sample collection from suspect ACM building materials with consideration to homogeneous areas and material types. • Mapping and logging bulk samples for future reference. ® Estimated quantity of material types identified as asbestos containing (greater than 1 %). • Analysis of bulk samples by polarized light microscopy, utilizing EMSL Analytical, Inc. of Minneapolis. The laboratory analysis confirmed materials that are asbestos containing and the summary includes the following information: 3M Building Description, 4.0 Suspect Building Materials, 5.0 Asbestos Containing Building Materials List (including estimated quantities), 6.0 Non - asbestos Containing Materials List, 7.0 Non - suspect Materials, and 8.0 Inspector Accreditation. 2.1 LIMITATIONS EPA Inc. made reasonable attempts to access all areas of the residence as presented within the scope of this work. The following areas and/or materials were not able to be accessed due to safety concerns or other limitations. e No excavations were made to identify foundation conditions below grade (i.e. exterior damp - proofing). • A limited number of roof samples were collected from the residence. Based on the similar appearance, it is assumed that the findings were consistent with the remainder of the roof area. 5830 Oakgreen Ave N 1 ©2009 EPA Inc 3.0 BUILDING DESCRIPTION 4.0 SUSPECT BUILDING MATERIALS ASBESTOS MATERIAL SURVEY 5830 OAKGREEN AVENUE NORTH OAK PARK HEIGHTS, MINNESOTA The proj ect consisted of a two -story cape cod style residence with an unfinished basement. • The exterior walls of the building are constructed of wood framing with fiberglass insulation. • The main floor areas were a mix of hardwood flooring, carpet and linoleum. • The interior walls and ceilings were primarily a plaster application. • The basement foundation was concrete block with a concrete slab floor. • The main roof had 3 -tab asphalt shingles over a tarpaper underlayment system. • The exterior walls were aluminum over the original wood. • The heating was provided by a forced air furnace system. Representative bulk samples of suspect ACM building materials were collected from the building. The identified materials that were considered suspect and subsequently sampled include: • Linoleum /sheet flooring • Floor tile • Ceiling texture • Window glazing • Roofing Materials of the materials sampled, the following were found to be asbestos containing: • Original linoleum (kitchen) • Vermiculite • Plastic cement patch (chimney) Due to the plans for burning of the residence, removal of all identified asbestos containing materials is mandatory. The removal of the identified materials must be completed prior to the start of the demolition. A licensed abatement contractor using appropriate removal methods and engineering controls would be required to perform the removal of the asbestos containing materials. Please refer to the following section for the analytical laboratory results, including material locations, and quantities. 5830 Oakgreen Ave N 2 ©2009 EPA, Inc Sample # F Functional Space M Material Identification C Asbestos 09 -04110 B -01 S SW Bedroom C Ceiling texture N ND 09 -04110 B -02 H Hallway C Ceiling texture N ND 09 -04110 B -03 S SE Bedroom C Ceiling texture N ND 09- 04110 B -05 L Living Room W Wall plaster (both layers) N ND 09 -04110 B -06 S SW Bedroom W Wall plaster (both layers) N ND 09 -04110 B -07 K Kitchen W Wall plaster (both layers) N ND 09 -04110 B -08 U Upstairs E Attic Room S Sheet flooring (yellow /brown) N ND 09 -04110 B -09 B Bathroom Upstairs 1 12 x 12 Floor tile (it green w /spots) /adhesive N ND 09 -04110 B -10 S SW Attic area S Sheet flooring (brown) N ND 09-04110 B -14 W Window G Glazing N ND 09 -04110 B -15 R Roof S Shingle N ND 09 -04110 B -16 R Roof U Underlayment tar paper N ND 09 -04110 B-18 E Exterior Wall T Tar paper N ND Material Sam p p Amount** 09 -04110 B -04 Kitchen Original linoleum (green) 35% Chrysotile 120 sq. ft. 09 -04110 B-11 Attic Vermiculite <1% Actinolite 800 sq. ft. 09 -04110 B -17 Chimney Plastic cement patch 7% Chrysotile 6 sq. ft. Functional Space Material Identification Foundation Concrete Supports /Framing Wood ASBESTOS MATERIAL SURVEY. 5830 OAKGREEN AVENUE NORTH OAK PARK HEIGHTS, MINNESOTA 5.0 ASBESTOS CONTAINING MATERIAL INVENTORY The following materials were found to have an asbestos content of greater than 1% by weight. **Estimate of visible material amounts. Require abatement contractors to verify material amount for bidding purposes. NOTE: Samples B -12 & B -13 are similar material to B -11. Vermiculite is assumed to be asbestos - containing. 6.0 NON ASBESTOS CONTAINING MATERIAL INVENTORY The following materials had laboratory results of "None Detected" (ND) for asbestos content. No special regulations pertain to these building materials. 7.0 NON - SUSPECT ASBESTOS MATERIALS The following materials are present in this residence but are not considered as suspect asbestos building materials. 5830 Oakgreen Ave N 3 ©2009 EPA, Inc Functional Space Material Identification Foundation Concrete Supports /Framing Wood ASBESTOS MATERIAL SURVEY. 5830 OAKGREEN AVENUE NORTH OAK PARK HEIGHTS, MINNESOTA 5.0 ASBESTOS CONTAINING MATERIAL INVENTORY The following materials were found to have an asbestos content of greater than 1% by weight. **Estimate of visible material amounts. Require abatement contractors to verify material amount for bidding purposes. NOTE: Samples B -12 & B -13 are similar material to B -11. Vermiculite is assumed to be asbestos - containing. 6.0 NON ASBESTOS CONTAINING MATERIAL INVENTORY The following materials had laboratory results of "None Detected" (ND) for asbestos content. No special regulations pertain to these building materials. 7.0 NON - SUSPECT ASBESTOS MATERIALS The following materials are present in this residence but are not considered as suspect asbestos building materials. 5830 Oakgreen Ave N 3 ©2009 EPA, Inc ASBESTOS MATERIAL SURVEY. 5830 OAKGREEN AVENUE NORTH OAK PARK HEIGHTS, MINNESOTA 5.0 ASBESTOS CONTAINING MATERIAL INVENTORY The following materials were found to have an asbestos content of greater than 1% by weight. **Estimate of visible material amounts. Require abatement contractors to verify material amount for bidding purposes. NOTE: Samples B -12 & B -13 are similar material to B -11. Vermiculite is assumed to be asbestos - containing. 6.0 NON ASBESTOS CONTAINING MATERIAL INVENTORY The following materials had laboratory results of "None Detected" (ND) for asbestos content. No special regulations pertain to these building materials. 7.0 NON - SUSPECT ASBESTOS MATERIALS The following materials are present in this residence but are not considered as suspect asbestos building materials. 5830 Oakgreen Ave N 3 ©2009 EPA, Inc ASBESTOS MATERIAL SURVEY 5830 OAKGREEN AVENUE NORTH OAK PARK HEIGHTS, MINNESOTA 8.0 ASBESTOS BUILDING INSPECTOR ACCREDITATION Please see the following pages for Minnesota Department of H ealth certification information. Inspector Jim Lindahl Exp. Date 11/25/09 Minnesota Certification Number — #Al2333 5830 OA - green Ave N 4 ©2009 EPA, Inc Attn: Sample Jim Lindahl Environmental Property Audits Inc 2701 4th Avenue North Anoka, MN 55303 Fax: (763) 323 -6677 Project: 5830 Oak Green Ave Asbestos Analysis of Bulk Materials via EPA 600/R- 93/116 Method using Polarized Light Microscopy Non - Asbestos % Fibrous % Non - Fibrous 09-04110 B -01 350902603 -0001 09 -04110 B -02 350902603 -0002 p4110 B -03 _,.902603 -0003 09 -04110 B -04 350902603 -0004 09 -04110 B -05- Skim Coat 350902603 -0005 09 -04110 B -05- Plaster 350902603 -0005A Analysts) Heidi Johnson (23) EMSL Analytical, Inc. 14375 23rd Avenue North, Minneapolis, Mn 55447 Phone: (763) 449 -4922 Fax: (763) 449 -4924 Email: minnea ■olislab hi Phone: (763) 323 -6700 Description Appearance Ceiling Texture White SW Bd Rm Non - Fibrous Homogeneous Ceiling Texture White Hallway Non- Fibrous Homogeneous Ceiling Texture SE White Bd Rm Non - Fibrous Homogeneous Kitchen Original Linoleum (green) Gray Fibrous Heterogeneous Wall Plaster Living White Rm Non - Fibrous Wall Plaster Living Rm Homogeneous Gray Non - Fibrous Heterogeneous Test Report PLM- 7.12.0 Printed: 6/2/2009 9:05:05 AM 10% Cellulose <1% Glass emst.com Customer ID: ENVP52 Customer PO: Received: EMSL Order: EMSL Prof: Analysis Date: 6/2/2009 Back Pad tested first, adhesive not tested per stop positive. 06/01/09 1:30 PM 350902603 100% Non - fibrous (other) 100% Non - fibrous (other) 100% Non - fibrous (other) 55% Non - fibrous (other) 100% Non- fibrous (other) 100% Non - fibrous (other) t Rachel Travis, Laboratory Manager or other approved signatory Asbestos % Type None Detected None Detected None Detected 35% Chrysotile None Detected None Detected Due to magnification limitations inherent in PLM, asbestos fibers in dimensions below the resolution capability of PLM may not be detected, The limit of detection as stated in the - thod is 1 %. The above test report relates only to the items tested and may not be reproduced in any form without the express written approval of EMSL Analytical, Inc. PMSL's yty is limited to the cost of analysis. EMSL bears no responsibility for sample collection activities or analytical method limitations. Interpretation and use of test results are the . nsibility of the client. Samples received in good condition unless otherwise noted. This report must not be used to claim product endorsement by NVLAP or any agency of the u. S. Government, NVLAP Lab Code 200019 -0 1 Attn: Sample Jim Lindahl Environmental Property Audits Inc 2701 4th Avenue North Anoka, MN 55303 Fax: (763) 323 -6677 Phone: (763) 323 -6700 Project: 5830 Oak Green Ave Asbestos Analysis of Bulk Materials via EPA 600/R- 931116 Method using Polarized Light Microscopy Non - Asbestos % Non - Fibrous 100% Non - fibrous (other) 09 -04110 B -06- Skim Coat 350902603 -0006 Bd Rm Bd Rm EMSL Analytical, Inc. 14375 23rd Avenue North, Minneapolis, Mn 55447 Phone: (763) 449 -4922 Fax: (763) 449 -4924 Email: minneapolislab @emsl.com Description Wall Plaster Kitchen Wall Plaster Kitchen Appearance Wall Plaster SW White Non - Fibrous Homogeneous 09 -04110 B -06- Wall Plaster SW Gray Plaster 350902603 -0006A .;x'04110 6-07 - Skim Coat 350902603 -0007 09-04110 B -07- Piaster 350902603 -0007A 09 -04110 B -08 350902603 -0008 09 -04110 B -09- Floor Tile 350902603 -0009 Non - Fibrous Heterogeneous White Non - Fibrous Homogeneous Gray Non - Fibrous Heterogeneous Analyst(s) Heidi Johnson (23) Upstairs E. Attic Brown /Yellow Rm Sheet Flooring Fibrous Yellow /brown Heterogeneous Bathroom Upstairs White /Green 12x12 F.T. (Lt. Green w /spots) Non - Fibrous Homogeneous Test Report PLM - 7,12.0 Printed: 6/2/2009 9:05:07 AM % Fibrous <1% Glass 45% Cellulose Customer ID: ENVP52 Customer PO: Received: 06/01/09 1:30 PM EMSL Order: 350902603 EMSL Proj: Analysis Date: 6/2/2009 100% Non - fibrous (other) 100% Non - fibrous (other) <1% Glass 100% Non - fibrous (other) 55% Non - fibrous (other) 100% Non - fibrous (other) Rachel Travis, Laboratory Manager or other approved signatory Due to magnification limitations inherent in PLM, asbestos fibers In dimensions below the resolution capability of PLM may not be detected. The limit detection as stated in the - -thod is 1 %. The above test report relates only to the items tested and may not be reproduced in any form without the express written approval of EMSL Analytical, Inc. EMSL's ;'ty is limited to the•cost of analysis. EMSL bears no responsibility for sample collection activities or analytical method limitations. Interpretation and use of test results are the iionsibility of the client. Samples received in good condition unless otherwise noted. This report must not be used to claim product endorsement by NVLAP or any agency of the u. s. Government. NVLAP Lab Code 200019 -0 Asbestos % Type None Detected None Detected None Detected None Detected None Detected None Detected 2 Attn: Jim Lindahl Environmental Property Audits Inc 2701 4th Avenue North Anoka, MN 55303 Fax: (763) 323 -6677 Project: 5830 Oak Green Ave Sample Asbestos Analysis of Bulk Materials via EPA 6O0 /R- 93/116 Method using Polarized Light Microscopy Non - Asbestos 09 -04110 8-09 - Adhesive 350902603 -0009A 09 -04110 B -10 350902603 -0010 b4110 8 -11 350902603 -0011 09 -04110 B -12 350902603 -0012 09 -04110 B -13 350902603 -0013 09 -04110 B -14 350902603 -0014 09 -04110 B -15- Shingle 350902603 -0015 Description Bathroom Upstairs Tan 12x12 F.T. (Lt. Non - Fibrous Green w /spots) Brown Sheet Flooirng SW Attic Area Attic Vermiculite Attic Vermiculite Attic Vermiculite Window Glazing Roof Shingle White /Black Fibrous Analyst(s) Heidi Johnson (23) EMSL Analytical, Inc. 14375 23rd Avenue North, Minneapolis, Mn 55447 Phone: (763) 449 -4922 Fax: (763) 449 -4924 Email: minneapolisiab@emsi.com Phone: (763) 323 -6700 Appearance Homogeneous Brown /Black Fibrous Heterogeneous Gold Non- Fibrous Heterogeneous Gold Non- Fibrous Heterogeneous Gold Non - Fibrous Heterogeneous White Nori- Fibrous Homogeneous Heterogeneous Test Report PLM - 7.12.0 Printed: 6/2/2009 9:05:11 AM % Fibrous Customer ID: ENVP52 Customer PO: Received: EMSL Order: EMSL Proj: Analysis Date: 6/2/2009 06/01/09 1:30 PM 350902603 % Non - Fibrous 100% Non - fibrous (other) 45% Cellulose 55% Non - fibrous (other) 100% Non - fibrous (other) 100% Non - fibrous (other) 100% Non - fibrous (other) Asbestos % Type None Detected None Detected <1% Actinolite <1% Actinolite <1% Actinolite None Detected None Detected 25% Glass 100% Non - fibrous (other) 75% Non - fibrous (other) 7 is , r :i fr _ Rachel Travis, Laboratory Manager or other approved signatory Due to magnification limitations inherent in PLM, asbestos fibers in dimensions below the resolution capability of PLM may not be detected. The limit of detection as stated in the _- thod is 1 %. The above test report relates only to the items tested and may not be reproduced in any form without the express written approval of EMSL Analytical, Inc. EMSL's ity is limited to the cost of analysis. EMSL bears no responsibility for sample collection activities or analytical method limitations. Interpretation and use of test results are the bnsibility of the client. Samples received in good condition unless otherwise noted. This report must not be used to claim product endorsement by NVLAP or any agency of the u.S. Government. NVLAP Lab Code 200019 -0 3 EMSL Analytical, Inc. 14375 23rd Avenue North, Minneapolis, Mn 55447 Phone: (763) 449 -4922 Fax: (763) 449 -4924 Email: minneapolislab msl.com • Attn: Jim Lindahl Environmental Property Audits Inc 2701 4th Avenue North Anoka, MN 55303 Fax: (763) 323 -6677 Phone: (763) 323 -6700 Project: 5830 Oak Green Ave Sample Asbestos Analysis of Bulk Materials via EPA 600 /R- 9311'16 Method using Polarized Light Microscopy Non - Asbestos 350902603 -0015A 09 -04110 B -16 350902603 -0016 p411013-17 ,,902603 -0017 09 -04110 B-18 350902603 -0018 Analyst(s) Heidi Johnson (23) Description 09 -04110 B -15 -Tar Roof Shingle Appearance Black Non - Fibrous Homogeneous Roof Black Underlayment Tar Fibrous Paper Heterogeneous Plastic Cement White /Black Patch on Chimney Non - Fibrous Heterogeneous Exterior Wall Tar Paper Black Fibrous Heterogeneous Test Report PLM - 7.12.0 Printed: 6/2/2009 9:05:13 AM Fibrous 65% Cellulose Customer ID: ENVP52 Customer PO: Received: 06/01/09 1:30 PM EMSL Order: 350902603 EMSL Proj: Analysis Date: 6/2/2009 % Non - Fibrous 100% Non - fibrous (other) 35% Non - fibrous (other) 93% Non - fibrous (other) 25% Non - fibrous (other) 75% Cellulose Bag not labeled, sample matches description on C.O.0 Rachel Travis, Laboratory Manager or other approved signatory Due to magnification limitations inherent in PLM, asbestos fibers in dimensions below the resolution capability of PLM may not be detected. The limit of detection as stated in the - - lthod is 1 % The above test report relates only to the items tested and may not be reproduced in any form without the express written approval of EMSL Analytical, Inc. EMSL's \ity is limited to the cost of analysis. EMSL bears no responsibility for sample collection activities or analytical method limitations. Interpretation and use of test results are the )onsibility of the client. Samples received in good condition unless otherwise noted. This report must not be used to claim product endorsement by NVLAP or any agency of the 0.5. Government. NVLAP Lab Code 200019 -0 Asbestos % Type None Detected None Detected 7% Chrysotile None Detected THIS IS THE LAST PAGE OF THE REPORT. 4 35 902603 'a240.o T R ..-. rt To Oyme): ` to how' 763: 3 a umber: 400 hi'. 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T Via. 0 6 /J9 ) 350902603 WANAtVTCAL, INC, giowpfooriOtP01-0 Asbestos Chain of Custody EMSL Order Number (Lab Use 0 *I . 1=WiM.K P1,1 - e pageG Additional Pages of the Chain of Qustody are only neces-sary if needed for additional sample information EMSL Ali,1ALYT1CAL, iNC 14375 23D AVENUE MINNEAPOLIS, MN 55447 PHONE: (763) 449-4922 FAX: (763) 4494924 W NI,90 (A) till:- I 0 5‘ clocuLligi 5&J tvprq... MTL PL SflL CL VolumelArea (Air) HA# Bulk CO CP E co E r._ CO LIJ Ls) Lt CAP E w C.) L.L.1 CP c ca } - C ry 3 CO 01 -- I 1 ILLJ LI . 1 7 j1 b. W LIJ wigt C:3 CI- on Lroi