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HomeMy WebLinkAboutNolde House Demolition Oakgreen Ave - Summer 2009 i Fire Training Exercises Oakgreen Ave. Homes June zoog Summary Documentation Owner: Tim Nolde - GREENTWIG LLC City of Oak Park Heights Documentation: Demolition Permits & Asbestos Abatement Data Section I • 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 8 day of Mir, ,2 00 ( 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 of Tresnass. 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 Damages. 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. Liabilitv 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 r . i i injuries caused by or resulting from Tim Nolde failure to clean up the Property and remove the debris of the Building(s) within the time period allowed by Section 5 of this Agreement. 5. Clean Uv. Tim Nolde shall be solely responsible for removing all debris from the Property following completion of the Training Exercises, regardless of the condition of the Property and/or the Building(s) following completion of the Training exercises. The City shall notify Tim Nolde in writing when the Training Exercises are completed and Tim Nolde shall have ten (10) days from the date of that notice to complete the removal of all debris and remnants of the Building(s) so that the condition of the Property is in full compliance with the 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. BUI G By: Tim Nolde CITY OF BAYPORT By4- xx- �a-4n y6Q04-J • Jonathan Nowaczek, Mayor BAYPORT FIRE DEPARTMENT B Mike Bell, Fire Chief I I 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 May 9m, 2009 Mayor John Nowaczek City of Bayport 294 N. 3rd Street Bayport, MN 55003 RE: Bayport Fire Department - Training Exercises Dear Mayor Nowaczek: I have enclosed herewith a partially executed copy of the AGREEMENT between Developer Tim Nolde 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. Nolde 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 that Mr. Nolde post a satisfactory Letter of Credit to secure any final site clearances and an -up in the post - training phase of this project. Please I m k w if you have any questions. Eri Johnson /CI Administrator Cc; Weekly Notes Mike Bell, Fire Chief - BFD Al Eisinger, Captain -BFD t I M 21.03 PROOF OF CLEAR TITLE • i REMEMBER TO GET PROOF OF CLEAR TITLE AND INSURANCE CANCELLATION DOCUMENTS FROM OWNER OR AGENT THIS MAY BE DOCUMENTATION FROM COUNTY RECORDER OR TAX OFFICE Page -73- • M 21.02 OWNER'S RELEASE TO BURN STRUCTURE FORM Having agreed with the building official Oak Park Heights MN City or County of Washington , that a structure owned by Tim Nolde owner /agent and located at: County: Washington Township: Fire Number: Nearest Cross Road.: 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 • jBayport Fire Dept. + to use or demolish the said structure by burning or other means. V - / I C 940 (Z-'S/5 /rf (Owner/ Agent) (DATED) (Owner / Agent)(DATED) (Witness) (DATED) for- A •�KNS�1 Page -72- as Wng tOn Department of Property Records Property Tax Statement C OUn�y and Taxpayer Services for Taxes Payable in 2009 i 14949 62M Street North PO Box 200 Stillwater, MN 55082 -0200 . (651) 430-6 Save fo www.co.washingt shington.mn.us (Property ID: R 05.029.20.14.0003 , $$$ You may be eligible for one or even two Taxpayer: 88894 Bill #: 60591 refunds to reduce your property tax. REFUNDS? Read the back of this statement to find out how to apply. GREEN TWIG LLC PO BOX 119 Taxes Payable Year: 2008 2009 STILLWATER MN 55082 -0119 I r l r l rrl �l rl l rrr l rrlr �� lr' � Irrrrrrllrrrl „ rlrrrrr'llrlrrlrlrrl Estimated Market Value: 187,900 186,400 New Improvements/ DeSc: Sect-05 Twp -029 Range -020 PT N1/2- SE1 /4 -NE1 /4 COM AT SE COR SD N1 /2 OF Expired Exclusions: SD1 /4 1/4 THEN N ALONG E LINE 560 FT TO PT BEG THIS DESC.THEN WLY AT R ANG Taxable Market Value: 187,900 186,400 TO LAST Property Classification: RES HSTD RES HSTD Property 5710 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, 1,641.00 File by August 15. If this box is checked, you owe delinquent taxes and are not eligible. x 2. Use this amounts on Form M1PR to see if you are eligible fora special refund. 1,597.00 Your Property Tax and How It Is Reduced By The State 3. Your Property taxes before reduction by state -paid credits 1,800.29 1,845.64 4. Credits paid by the State of Minnesota to reduce your property tax: A. Homestead and Agricultural Market Value Credits 203.29 204.64 B. Other Credits 5. Your property tax after reduction by state -paid credits 1,597.00 1,641.00 ProDerty Tax by Jurisdiction 6. County A. WASHINGTON COUNTY 423.25 428.38 10 1 B. COUNTY RRA 1.26 1.22 7. City or Town OAK PARK HEIGHTS 594.20 630-26. 8. State General Tax 0.00 0.00 9. School District 0834 A. Voter Approval Levies 291.14 280.10 B. Other Local Levies 229.11 243.44 10. Special Taxing Districts A. METRO DISTRICT 41.62 41.07 B. OTHERS 16.42 16.53 C. 0.00 0.00 D. 0.00 0.00 11. Non - school voter approved referenda levies 0.00 0.00 12. Total property tax before special assessments 1,597.00 1,641.00 Soecial Assessments on Your Pro_oerty 13. Special assessments Int: Principal: 3.00 3.00 3.00 CO ENVIRMNT 3.00 14. YOUR TOTAL PROPERTY TAX AND SPECIAL ASSESSMENTS 1,600.00 1,644.00 FIRST HALF DUE MAY 15 822.00 ' SECOND HALF DUE OCTOBER 15 822 00 PAYABLE 2009 2 "d HALF PAYMENT STUB Detach at perforation &mail this stub with your 2 ^a half payment in the enclosed green envelope RES HSTD TO AVOID PENALTY PAY ON OR BEFORE: OCTOBER 15 1 Property ID: R 05.029.20.14.0003 SECOND HALF TAX AMT J - -- - - - - - . 822.00 Bill #: 60591 Taxpayer: 88894 MAKE CHECKS PAYABLE TO: ❑ CHECK Washington County P.O. Box 200 ❑ CASH GREEN TWIG LLC Stillwater MN 55082 -0200 ( O BOX 119 T I LLWATER MN 55082 -0119 No Receipt sent. Your cancelled check is proof of payment. Do not send postdated checks. 02 007 05029201400030 0000082200 2 Wastjn' ton Department of Property Records Property Tax Statement %: COUrity and Taxpayer Services for Taxes Payable in 2009 14949 62MStreet North PO Box 200 Stillwater, MN 55082 -0200 (651) • www.co.washingt shington. n.mn.us (Property ID: R 05.029.20.11.0065 , $ $$ You may be eligible for one or even two Taxpayer: 88894 Bill #: 112721 refunds to reduce your property tax. REFUNDS? Read the back of this statement to find out how to apply. GREEN TWIG LLC PO BOX 119 Taxes Payable Year: 2008 2009 STILLWATER MN 55082 -0119 I� I �I�� I � Irll � r � lr � l �� rlrlll ���� rrll ��� lll � l ����� lllrl �� l � l � rl Estimated Market Value: 220,100 193,100 New Improvements/ Desc: OAKGREEN VILLAGE Lot -OOL OUTLOT SUBJ TO EASE Expired Exclusions: Taxable Market Value: 220,100 193,100 Property Classification: RES NON -HSTD RES NON -HSTD 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. 0.00 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. 0.00 Your Proaerty Tax and How It Is Reduced By The State - 3. Your Property taxes before reduction by state -paid credits 2,109.00 1,913.00 4. Credits paid by the State of Minnesota to reduce your property tax: A. Homestead and Agricultural Market Value Credits 0.00 0.00 B. Other Credits 5. Your property tax after reduction by state -paid credits 2,109.00 1,913.00 Property Tax by Jurisdiction 6. County A. WASHINGTON COUNTY 570.13 509.47 i 00i. B. COUNTY RRA 1.69 1.45 City or Town OAK PARK HEIGHTS 799.91 747.91 8. State General Tax 0.00 0.00 9. School District 0834 A. Voter Approval Levies 354.86 300.52 B. Other Local Levies 304.29 285.29 10. Special Taxing Districts A. METRO DISTRICT 56.02 48.74 B. OTHERS 22.10 19.62 C. 0.00 0.00 D. 0.00 0.00 11. Non - school voter approved referenda levies 0.00 0.00 12. Total property tax before special assessments 2,109.00 1,913.00 Special Assessments on Your Prooertv - - 13. Special assessments Int: Principal: 3.00 3.00 3.00 CO ENVIRMNT 3.00 14. YOUR TOTAL PROPERTY TAX AND SPECIAL ASSESSMENTS 2,112.00 1,916.00 FIRST HALF DUE MAY 15 958.00 SECOND HALF DUE OCTOBER 15 958.00 PAYABLE 2009 2 "d HALF PAYMENT STUB Detach at perforation & mail this stub with your 2n half payment in the enclosed green envelope RES NON -HSTD TO AVOID PENALTY PAY ON OR BEFORE: OCTOBER 15 Property ID: R05.029.20.11.0065 1 SECOND HALF TAX AMT 958.00 Bill #:112721 Taxpayer: 88894 MAKE CHECKS PAYABLE TO: ❑ CHECK Washington County GREEN TWIG LLC P.O. Box 200 ❑ CASH Stillwater MN 55082 - 0200 S O BOX 119 TI LLWATER M N 55082 -0119 No Receipt sent. Your cancelled check is proof of payment. Do not send postdated checks. 02 007 05029201100650 0000095800 3 W as hing ton Department of Property Records Property Tax Statement =� COUY1Cy and Taxpayer Services for Taxes Payable in 2009 14949 621dStreet North PO Box 200 Stillwater, MN 55082 -0200 (651) 430 -6175 Save fo www.co.washington.mn.us ( Property ID: R 05.029.20.11.0063 4 You may be eligible for one or even two Taxpayer: 88894 Bill #: 112719 refunds to reduce your property tax. REFUNDS? Read the back of this statement to find out how to apply. GREEN TWIG LLC PO BOX 119 Taxes Payable Year:' 200$ 2009 STILLWATER MN 55082 -0119 lilrliililrllr�rlrrlr�rlrlllriirrrllrrrlllilrrrrrlllilrrlrlrrl Estimated Market Value: 129,100 128,200 New Improvements/ DeSc: OAKGREEN VILLAGE Lot -OOJ OUTLOT SUBJ TO EASE Expired Exclusions: Taxable Market Value: 123,400 128,200 Property 5754 0AKGREEN AVE N Property Classification: RES NON -HSTD RES NON -HSTD Address: STILLWATER MN 55082 1. Use this amount on Form M1PR to see if you are eligible for a property tax refund. 0.00 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. 0.00 Your Property Tax and How It Is Reduced By The State 3. Your Property taxes before reduction by state -paid credits 1,183.00 1,269.00 4. Credits paid by the State of Minnesota to reduce your property tax: A. Homestead and Agricultural Market Value Credits 0.00 0.00 B. Other Credits 5. Your property tax after reduction by state -paid credits 1,183.00 1,269.00 Property Tax by Jurisdiction 6. County A. WASHINGTON COUNTY 320.22 337.20 B. COUNTY RRA .95 .96 7. City or Town OAK PARK HEIGHTS 448.47 496.54 f 8. State General Tax 0.00 0.00 9. School District 0834 A. Voter Approval Levies 198.96 199.52 B. Other Local Levies 170.60 189.40 10. Special Taxing Districts A. METRO DISTRICT 31.41 32.35 B. OTHERS 12.39 13.03 C. 0.00 0.00 D. 0.00 0.00 11. Non- school voter approved referenda levies 0.00 0.00 12. Total property tax before special assessments 1,183.00 1,269.00 Special Assessments on Your Propertv 13. Special assessments Int: Principal: 3.00 3.00 3.00 CO ENVIRMNT 3.00 14. YOUR TOTAL PROPERTY TAX AND SPECIAL ASSESSMENTS 1,186.00 1,272.00 FIRST HALF DUE MAY 15 636.00 SECOND HALF DUE OCTOBER 15 636.00 PAYABLE 2009 2 n d HALF PAYMENT STUB Detach at perforation & mail this stub with your 2n payment in the enclosed green envelope RES NON -HSTD TO AVOID PENALTY PAY ON OR BEFORE: OCTOBER 15 1 Property ID: R 05.029.20.11.0063 J SECOND HALF TAX AMT 636.00 Bill #:112719 Taxpayer: 88894 MAKE CHECKS PAYABLE TO: ❑ CHECK Washington County P.O. Box 200 ❑ CASH GREEN TWIG LLC Stillwater MN 55082 -0200 C O BOX 119 TI LLWATER MN 55082 -0119 No Receipt sent. Your cancelled check is proof of payment. Do not send postdated checks. 02 007 050292011100630 0000063600 8 %�h �%ton Department of Property Records Property Tax Statement ty and Taxpayer Services for Taxes Payable in 2009 14949 62nd Street North PO Box 200 Stillwater, MN 55082 -0200 (651) - for future reference www.co.washingt shington. n.mn.us (Property ID: R 05.029.20.11.0028 $ $$ You may be eligible for one or even two Taxpayer: 88894 Bill #: 60597 refunds to reduce your property tax. REFUNDS? Read the back of this statement to find out how to apply. GREEN TWIG LLC PO BOX 119 Taxes Payable Year: 2008 2009 STILLWATER MN 55082 -0119 I r l r � rr l r l r �� r � r l rr � rrr � r � I l rrr � rrllrrrlllrlrrrrrlllrlrrlr � r � ' Estimated Market Value: 213,100 182,800 New Improvements/ DeSc: Sect -05 Twp -029 Range -020 PT NE1 /4 -NE1 /4 BEG AT A PT ON E LN OF SO Expired Exclusions: NE1 /4 -NE1 /4 357FT N OF THE SE COR THEREOF THN W ON A LN PARUW THE S LN Taxable Market Value: 213,100 182,800 DIST 275FT TO A PT THN N ON A Property Classification: RES HSTD RES HSTD Prop 5830 OAKGREEN AVE N RELATIVE - RELATIVE Address: STILLWATER MN 55082 1. Use this amount on Form M1PR to see if you are eligible for a property tax refund. 0.00 File by August 15. If this box is checked, you owe delinquent taxes and are not eligible. 2. Use this amounts on Form M1 PR to see if You are elioible fore special refund. 0.00 Your Property Tax and How it Is Reduced By The State 3. Your Property taxes before reduction by state -paid credits 2,043.61 1,810.88 4. Credits paid by the State of Minnesota to reduce your property tax: A. Homestead and Agricultural Market Value Credits 180.61 207.88 B. Other Credits 5. Your property tax after reduction by state -paid credits 1,863.00 1,603.00 Prooertv Tax by Jurisdiction 6. County A. WASHINGTON COUNTY 497.46 418.80 B. COUNTY RRA 1.47 1.19 9 7 City or Town OAK PARK HEIGHTS 695.68 614.86 8. State General Tax 0.00 0.00 9. School District 0834 A. Voter Approval Levies 333.09 274.34 B. Other Local Levies 267.37 237.62 10. Special Taxing Districts A. METRO DISTRICT 48.71 40.06 B. OTHERS 19.22 16.13 C 0.00 0.00 D. 0.00 0.00 11. Non - school voter approved referenda levies 0.00 0.00 12. Total property tax before special assessments 1,863.00 1,603.00 Sr>ecial Assessments on Your ProDertv - 13. Special assessments Int: Principal: 3.00 3.00 3.00 CO ENVIRMNT 3.00 14, YOUR TOTAL PROPERTY TAX AND SPECIAL ASSESSMENTS 1,866.00 1,606.00 FIRST HALF DUE MAY 15 803.00 SECOND HALF DUE OCTOBER 15 803.00 PAYABLE 2009 2 nd HALF PAYMENT STUB Detach at perforation & mail this stub with your 2n payment in the enclosed green envelope TO AVOID PENALTY PAY ON OR BEFORE: OCTOBER 15 RES HSTD - RELATIVE Property ID: R 05.029.20.11.0028 1 SECOND HALF TAX AMT 803.00 Bill #: 60597 Taxpayer: 88894 MAKE CHECKS PAYABLE TO: ❑ CHECK Washington County P.O. Box 200 ❑ CASH GREEN TWIG LLC Stillwater MN 55082 -0200 O O BOX 119 TI LLWATER M N 55082 -0119 No Receipt sent. Your cancelled check is proof of payment. Do not send postdated checks. 02 007 05029201100280 0000080300 8 W as hington Department of Property Records Property Tax Statement =:z::�COUrity and Taxpayer Services for Taxes Payable in 2009 14949 62MStreet North PO Box 200 Stillwater, MN 55082 -0200 (651) - fo www.co.washingt shington. n.mn.us (Property ID: R 05.029.20.11.0026 ) $ $$ You may be eligible for one or even two Taxpayer: 88894 Bill #: 60595 refunds to reduce your property tax. REFUNDS? Read the back of this statement to find out how to apply. GREEN TWIG LLC _ PO BOX 119 Taxes Payable Year: 2008 2009 STILLWATER MN 55082 -0119 Irlilirlrli�lrrrlr��rrr�rll��rrrrrlli�rl��r�irrrr���r�rr�ilirl Estimated Market Value: 203,400 201,800 New Improvements/ Desc: Sect -05 Twp -029 Range -020 PT NE1 /4 -NE1 /4 BEG AT APT ONE LN OF SD Expired Exclusions: 1,500 NE1 /4 -NE1 /4 DIST 11 OFT OF SE COR THEREOF THN W ON ALINE PARLNV S LN Taxable Market Value: 203,400 201,800 THEREOF 15OFT TO A PT THN N Property Classification: RES HSTD RES HSTD Property 5770 CAKGREEN AVE N Ad dress: STILLWATER MN 55082 1. Use this amount on Form M1 PR to see if you are eligible for a property tax refund. 1,809.00 File by August 15. If this box is checked, you owe delinquent taxes and are not eligible. X 2. Use this amounts on Form M1 PR to see if you are eligible for a special refund. 1,761.00 Your Property Tax and How It Is Reduced By The State 3. Your Property taxes before reduction by state -paid credits 1,950.34 1,999.78 4. Credits paid by the State of Minnesota to reduce your property tax: A. Homestead and Agricultural Market Value Credits 189.34 190.78 B. Other Credits 5. Your property tax after reduction by state -paid credits 1,761.00 1,809.00 Property Tax by Jurisdiction 6. County A. WASHINGTON COUNTY 469.28 474.82 B. COUNTY RRA 1.40 1.34 10 17. City or Town OAK PARK HEIGHTS 656.62 696.12 8. State General Tax 0.00 0.00 9. School District 0834 A. Voter Approval Levies 316.94 304.75 B. Other Local Levies 252.65 268.35 10, Special Taxing Districts A. METRO DISTRICT 45.97 45.36 B. OTHERS 18.14 18.26 C. 0.00 0.00 D. 0.00 0.00 11. Non - school voter approved referenda levies 0.00 0.00 12. Total property tax before special assessments 1,761.00 1,809.00 Special Assessments on Your Propertv 13. Special assessments Int: Principal: 3.00 3.00 3.00 CO ENVIRMNT 3.00 14. YOUR TOTAL PROPERTY TAX AND SPECIAL ASSESSMENTS 1,764.00 1,812.00 FIRST HALF DUE MAY 15 906.00 SECOND HALF DUE OCTOBER 15 906.00 PAYABLE 2009 2nd HALF PAYMENT STUB Detach at perforation & mail this stub with your 2^ enclosed green envelope "half payment in the enclo RES HSTD TO AVOID PENALTY PAY ON OR BEFORE: OCTOBER 15 1 Property ID: R 05.029.20.11.0026 SECOND HALF TAX AMT J 906.00 Bill #: 60595 Taxpayer: 88894 MAKE CHECKS PAYABLE TO: ❑ CHECK Washington County P.O. Box 200 CASH ❑ GREEN TWIG LLC Stillwater MN 55082 -0200 W BOX 119 I LLWATER MN 55082 -0119 No Receipt sent. Your cancelled check is proof of payment. Do not send postdated checks. 02 007 05029201100260 0000090600 8 1 �VaSLlmgt n Department of Property Records Property Tax Statement COUrity and Taxpayer Services for Taxes Payable in 2009 14949 62N Street North PO Box 200 Stillwater, MN 55082 -0200 (651) 430 -6175 Save fo www.co.washington.mn.us (Property ID: R05.029.20.11.0059 $ $$ You may be eligible for one or even two Taxpayer: 149793 Bill #: 112696 refunds to reduce your property tax. REFUNDS? Read the back of this statement to find out how to apply. OAKGREEN VILLA LLC PO 80X 2118 T axes PayableYears >, t'` r' r'j2408 '.; - ;::..2008 STILLWATER MN 55082 -3118 Estimated Market Value: 234,200 232,600 New Improvements/ - Desc: OAKGREEN VILLAGE Lot -OOC OUTLOT SUBJ TO EASE Expired Exclusions: Taxable Market Value: 194,100 - -223,200 Pro perty 5762 OAKGREEN AVE N Property Classification: ,,. RES NON -HSTD RES NON -HSTD Address: STILLWATER MN 55082 1. Use this amount on Form M1PR to see if you are eligible for a property tax refund 0.00 ■ File by August 15. If this box is checked, you owe delinquent taxes and are not eligible.... _ X _ .... __._..... _ _... _ 2. Use this amounts on Form M1PR to see if you are eligible for a special refund. 0.00 Your Prooerty Tax and How It Is Reduced By The State - .. - -..- w� ,- s- --. -_._. ... _ ..� ....__. -- _.....�.. ;_.._.. ...... ... 3. Your Property taxes before reduction by state -paid credits 1,861.00 2,211.00 -4.--- Credits paid by the State of Minnesota to reduce your property tax: - w- - .._.._ A. Homestead and Agricultural Market Value Credits 0.00 0.00 _..... 0..._- ...- ,.._......__.. _.........- _._-B. Credits .�y_...___. 5. Your property tax after reduction by state -paid credits 1,861.00 2,211.00 � gperty Tax by Jurisdiction 6: County `s.... ....... _ ------ B. COUNTY TO COUNTY-'- u__ -� �':� w� .:;�.:.., _.._ 503.90 _.. 588.68 -_ 1.49 1.67 I 7. City or Town OAK PARK HEIGHTS I ' M 705.42 864.50 8. State General Tax 0.00 0.00 9. School District 0834 A. Voter Approval Levies 312.94 347.37 B. Other local Levies 268.35 329.76 10. Special Taxing Districts A. METRO DISTRICT • 49.41 56.34 B. OTHERS 19.49 22.68 C. 0.00 0.00 D. 0.00 0.00 11. Non - school voter approved referenda levies 0.00 0.00 12. Total property tax before special assessments 1,861.00 2,211.00 Soecial Assessments on Your Prooertv 13. Special assessments Int: Principal: 3.00 3.00 3.00 CO ENVIRMNT 3.00 14. YOUR TOTAL PROPERTY TAX AND SPECIAL ASSESSMENTS 1,864.00 2,214.00 FIRST HALF DUE MAY 15 1,107.00 SECOND HALF DUE OCTOBER 15 1,107.00 PAYABLE 2009 2nd HALF PAYMENT STUB Detach at perforation & mail this stub with your 2n half payment in the enclosed green envelope RES NON -HSTD TO AVOID PENALTY PAY ON OR BEFORE: OCTOBER 15 1 Property ID: R 05.029.20.11.0059 SECOND HALF TAX AMT J 1.107.00 Bill #:112696 Taxpayer: 149793 MAKE CHECKS PAYABLE TO: ❑ CHECK Washington County P.O. Box 200 ❑ CASH OAKGREEN VILLA LLC Stillwater MN 55082 -0200 O BOX 2118 TI LLWATER MN 55082 -3118 No Receipt sent. Your cancelled check is proof of payment. Do not send postdated checks. 02 007 05029201100590 0000110700 4 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 MPCA - "Intent to Perform a demolition" 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 No.: 2009 -00072 Licensee BUELOW EXCAVATING Date: 06/12/2009 13254 20TH ST STILLWATER, MN 55082 - License Expires 12/31/2009 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 30.00 Total Fee Paid 30.00 - NOT TRANSFERRABLE - 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. J JUIJHultman, Planning & Code Enforcement co%ov Tree City U.S.A. May 24 09 11:00a p.3 Vin I - i �- c-vo� a.J • r) f T.7V� dG`I'r CONTRACTOWS LICENSE APPLICATION City of Oak Park Heights 14168 Oak Park Stvd. N. P.O. Box 2007 Oak Park Heights, MN 55082 TELFPHONC DRECT: (651) 351,1661 GENERAL: (631) 4394439 —FAX: (651) 439-t}574 Email: JhEuMmnVtkyofoskparkheigFiscom Business Name: 17p g IELDISI r ;!Ichvftiv 6 Address: Telephone: ( - ` 3 2 ! Fax: E -mal DENSE REQUIREMENTS • Fee based on trade. State ke>se is requked for residendat gerierai contracting, roorng, pWmbing and fare prot"jon. Medwical Coraracto s require MN Stan Surety Bond. • Cerfffirate of tnsurarm minimum coverage, $100,000 per person. Public Liable r $250,000 Per arxlcle-K Bodily lrrA'rry; and S1W WD Property Damage- CITY OF OAK PARK HEIGHTS MUST BE NAMED AS AN ADDITIONAL jN5MIE on this noW . • AWwnem to hold CM' OF OAK PARR HEIGHT5 Nameless for ALL clautrs of damage 4abilk that may come against the licenselpetmt holder. • Roof of WORKERS COMPENSATIQN IN i'regd" by law. to be carried. • State and Federal Tax Went iraticn mmters pursuant to MN STATE STATUTE 270.72. • The CONTRACTOR tuniter agrees Ic adhere to all OSKA STANDARDS, UNIFORM TRAFFIC COOES and any CITY CODES MD STANDARDS that may apply to this license. • License perlo& January 1 to December 31 of eadt veer. C will occur upon f ty)ure to provided canitw nrrxrf of irmnnce cov 0CENSiE CLASSIFICATIONS: Commercial General Contractor - $50 � V \a Btacktopping - $30 Heating, Ventilation & A/C - $30 Building Having .330 "Aff eb t ape of NN Afechanfo) Bond Concrete and Masonry - $30 Outside Sew & Water -$30 ExcavatingfGradirtg . $30 Sidling - $30 Pool installation -130 Signs & Billb ands • $30 irriiplion System Inmiation - $30 :x: Other: x30 RD MUMM CONPI IDN OF THE WORKERS COt311PENSATION INSURANCE ANDTAX I.D. FORMS IS REQUIRED BEFORE A LICENSE CAN BE ISSUED. THESE FORMS ARE ATTACHED AND MADE PART OF THIS APPI.ItATIOM. Office Use Only: UaNky Insurance Expiration: Worker's Comp. Insurance Expiradorw Mechtertiral Surety Band 10 Mechanical Surety Band Expkaeorr . Date License Issued: No. May 24 09 11:00a p LICENSE APPLICANT pursuant to Minrresm Stmttrte 27o.u Tax Clearance: Imsumwe of Ucenses, Me licensing avthunly is required to provide the Wrnesota Comdmissinner of Revenue your Minnesota business tax identification number and the social security number of each license appil mnt. Under the Minnesota Govemmeru Dare PracWes Au and the Federal Privacy Aci of 1474, we are required to ad*e you of the following 'regarding ft tise of Ok Wannation: - 1. This Info rOon may be reed to datydta lsmane% reftewral or to n ter of your iceree in the event ym on Ube slfnnesom Department of Revenue dNatptent mm, penakbes or karest: 2. Upon mecelvM brie Wwmatim the Vcwtslrg autfta * will 3uFOy it o my tD the Minnesota Departtttent ob Revalue. However, under dte Federal Etocharge of Wwmaaon Agreetnettt ate Departrnertt of Reve W may supply this irtfartroton to dte Internal ReveniA Service. 3. Fan w supply ails khrmariorrmtay or delay the processing of yourtinensarg issuance or renewal appticatton. Please provide the following WOrnation and return along wkh your application to the agency isstdng the license. Do not raturn to the Department of Revenuer Licensing ApOt - Cky of Oak Park Heights License Per d: Annual: January 1 tit m* December 31 Personal information: (Complete anlr if apptcabiej Applicants Name: Applican s Address: Cky Slag ZO cOft Social security No.: 9usirms Information: mampiete ably y appticaw) Business Name: � �•.�ovaallt 1'32S4� 2O Staff N Business Address: Stt!lwate4,pdW 556 Ot r p SU r> Cc* Minnesota Tax Identification No.: IY© - [ e ent Y -1 Federal Tax Id radon No.: W l I - i �f 7:� If a Minnesota Tax Identification number is not required, please explain: Date: vt� f Signature; Title: i May 24 09 11:01a p,5 m a., awe i ✓"vv r'.l7y /G, r ' Y PROOF OF WORKERS' COMPENSATION INSURANCE C OVERAGE re videwa Stelae. Secrim� 176.182, requires every state and local licensing agency to withhold the issu l of a license or permit to operate a business in Minnesota wail the applicant presents acceptable of compliance with the workers' compensation insurance coverage requirement of Chapter 176. ation required is. the name of the insurance company, the policy number, and dates of coverage mit to set insure, This infixmai w 1 be collected U t &gm ag aerrcv and retained within th eir fil es This information is required by law. Licenses and permits to operate a business may not be issued or renewed if it is not provided andfor is falsely reported. Furthermore, falure to provide or falsely reporting this information may result In a $2,0W penalty assessed against tits applicant by tits Commissioner of the Deparmtent of labor and Industry. Provide the information specified above, in the spaces provided, or artity the precise reason your busness is excluded from compliance with the insurance coverage requirement for workers' compensation. Insurance Company (not the Insurance ABeil): Policy Number 040 of Coverage: • OR I am not required to has Workers' Compensation insurance because: (check ono l have no employees covered by law; ( ) I am self- insured (inchrde permh to si F itt5tn ; or ( Other (specdy) I have read and understand my rights and obl'galions with regards to business licenses, permits and Workers' Competwdon coverage and hereby certify by my signature below that ID the best of my kmwl ge, the inform tim provided is true and correct q once: ^ 1 sig e Printed Name of Signature TillOosition of Person Slgnfng May 28 09 10:07a P.2 1 • VJ- W Cr I - 17 - CLIV7 -L FJJ INbEMNRC QN A GREEMENT To: (Ay of Oak Park He" 14169 Oak Park Boulevard, N. P.O. Box 2007 Oak Park Heights, MN 55082 NOTE The following tract be s" by an Offitier of the Corporation or b the Orwtler arat notarized. In consideration for the granting of this License. the license applicant agrees to hold the Cry harmless from as damages and claims of damage which may arise by reason of arty negligence on the part of the Conlraclor or the Contractor's ageft or emptayees engaged In the performance of this ContractMermit, and will indemnity the City for the amount of all daims, liens, expenses and dairns for Gens of work, tool, machinery, materials or insurance premiums and for the amt>o of all ems by masun of the fakire of the Corxractor to fully perfatm its obiiggon under tfds ContradPerm t indal*g but not flmlted to attorney fees and cogs kvirred retattve to such c ims and losses, By! r Gate Oftr or te► Wduaf Pmprlelo ship Owner Subsc and sworn to before me this day of C U o 1. f Notary Public. f� �VU County. My Commission expires: 131 la s;;O' of I -- TEDRA J. MCALPINE NOTARY P aLIC - MINNESOTA t My ;,ommissior, Expires JarL 31, 2612 S•.Sh&reNfM 4 ftU= onVCWrotlors tkew AppN 26w Ol- 3p -200s TOTAL P.05 May 24 09 11:00a p.2 :.v To. Cly of Oak Park F{WgW 141 SO Oak Park Botrk+rard, N. P.O. flux 20U7 Oak Park HdOU MN SW fim The bllWkV must be sfgrW by en OtfW d the C, ", m lo, or by dw O*w aid dotat [o& In conWem*m fa dre Vdng of ltds ik wm the kom appkam agrm to tW the City harmless from IM damages aAd delm of damage w ch mq win by rum of vM tteglgertce an the pat of the Corltracior or the C � W i aged or aeptay= er 24" In ttrt perlb ww= of fhis co m opom t: and "ll kift K+q the Chy for the ar sow! of all claim f m expenses and sdaims tr tm d work toot, maddnoy, =Wbis or inwrmm ptWdtlms and for fire an wi of a0 Iris by t+eeson of the f a of the col+rrador tolidly perfixm its obligation cinder dUs CorsradlPesm�, indudug but r� lEndoed m amorneytees W 005ts ftMd rek*9 m suds d3kN and 1asM Cer�oriyr OAberatndtgf P�oprieti .'.', Owner Snbsaibed wW swan ID betae na 1115 oe2 ' this day of My canmission Mon �lfsl�fc� s�oelr«es i i� f TOTAL, P.05 May 28 09 10:07a P•1 BUELOW EXCAVATING 13254 20TH STREET NORTH STILLWATER, MINNESOTA 55082 (651) 436 -5326 FAX (651) 436 -2244 DEMOLITION • STRUCTURES • HOUSE FIRES • CONCRETE & ASPHALT • DEBRIS EXCAVATING • BASEMENT EXCAVATION & BACKFILLII`G • UNDER HOUSES • PONDS • COMIvLERCIAL • INSIDE BUILDINGS • SWIMMING POOLS — DIGGING AND FILLING • GRADING • COMPACTION • ROADS, DRIVEWAYS, & PARKING LOTS UTILITIES • SEPTIC SYSTEMS —MOUNDS, AT- GRADES, TRENCHES, FILTERS, • PERCOLATION TESTS, SOIL BORINGS • LIFT STATIONS — PUMPS & ALARMS • BORING, TUNNELING • LOCATING PIPES & LNES • STORM & SANITARY SEWER • WATER LINES -WELL, & CITY • REPAIRS WATER PROBLEMS • INSIDE & OUTSIDE OF BUILDINGS ANTD HOMES • DRAINAGE • DRAIN TILE CLEARING & GRUBBING • MOWING • STUMPS • BRUSH • TREES WINTER WORK • SNOW PLOWING, SANDING, HAULING • FROST RIPPING • FROZEN LINES REPAIRED TRUCIM i G • SAND • GRAVEL • ROCK • FILL SITE EXPLORATION • BORINGS • ARCHEOLO May 29 2009 11:43 McGarry - Kearney Rgenc9, I 651- 439 -6350 P.1 1 DATE (MM/DDlYYYY) ACORD,, CERTIFICATE OF LIABILITY INSUR NCE ( 05/29/2009 PRODUCER THIS CERTIFIC I E IS ISSUED AS A MATTER OF INFORMATION MCGARRY KEARNEY AGENCY INC ONLY AND CO FERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS ERTIFICATE DOES NOT AMEND, EXTEND OR 450 N MAIN ST ALTER THE CO RAGE AFFORDED BY THE POLICIES BELOW 40 STILLWATER, MN 55082 INSURERS AFFOR LNG COVERAGE NAIC# INSURED JOHN BUELOW I INSURER A: STATE AUTO M)LBANK INS CO 41653 13250 20TH STREET N I INSURER B: STATE 4UTO PROPERTY & CAS INS CO 25127 STILLWATER,MN 55082 (INSURER C: I INSURER D: iIN°URERE . COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWTTHSTANDIMG ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY 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. D INSR'ADO'L TY OF POLICYEFFECTIVE POLIC EXPIRATION LIMBS LTR +NSRD WSiIBANS POLICY NUMBER DATE rrAMIDO/YYI A A GErIERALLU►BarrY SOC2466540 09/01!08 O_ /01 /O9 EACHOCCURPENCF i s 1,000.000 DAMAGE TO RENTED COMMERCL4 GENERAL LIABILITY � PREMISES (EaoccurencM S 300,000 CLAIMS MADE OCCUR I MED EXP (Any one Person) S 5,000 PERSONAL& AOV INJURY $ _ 1.000,000 GENERAL AGGREGATE E 2.000,000 GEN'L AGGREGATE UNIT APPLIES PER: I PRODUCTS - COMPIOP AGG $ Z,000,000 PR 7 POLICY I I JWT F� LOC i B AUTOMOBLELIABLITY BAP2216221 0910'1/08 04/01/09 COMBINED SINGLE LIMIT S 1,000,000 • {Ea eceidenl) _ ANY AUTO _ ALL OWNED AUTOS BODILY INJURY S (Par person) X SCHEDULEDALITOS X HIREDAUTOS BODILY INJURY S (Per accident) X NONOWNEO AUTOS PROPERTY DAMAGE S -- (Per accident) GARAGE LUIBIUTY I AUTO ONLY - EA ACCIDENT S ANY.AUTO I OTHER THAN EA ACC S AUTO ONLY: AGO I S E7CCESSAIMBRELLA LIABILITY EACH OCCURRENCE S I OCCUR FI CLAIMS MADE I AGGREGATE i S i � s DEDUCTIBLE $ S RETENTION S i INCSTAT I I FR WORKERS COMPENSATION AND I 75 ER EMPLOYERS' LIABILITY E.L. EACH ACCIDENT S _ ANY PROPRIETORIPARTNERIEXECUTIVE j OFFICERMEMBER EXCLUDED? E.L. DISEASE • EA EMPLOYEEi S h descrBe under ( El. DISEASE - POLICY LIMIT E S SPECIAL PROVISIONS below I OTHER t DESCRIPTION OF OPERATIONS I LOCATIONS t VEN(CLES t EXCLUSIONS ADDED BY ENDORSEMENT/ SPECL PROVISIONS i t E I I 4 ` CERTIFICATE HOLDER CANCELLATION 1 SHOULD ANY OF THE A DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE 14SUwG RER WILL ENDEAVOR TO MAIL DAVE WRITTEN City of Oak Park Heights NOTICE TO THE CERTIFIC E H DIER NAMED TO THE LEFT. BUT FAILURE TO DO SO SHALL 14168 Oak Park Blvd IMPOSE NO OBUCIATI D Hen OF ANY KIND UPON TIN INSURER, ITS AGENTS OR PO Box 2007 ' REPRESENTATIVES Oak Park Heights, MN 55082 AUTHORIZED REP A ACORD 25 (2001 /Q8) 0 ACORD CORPORATION 1988 .4 M I May 29 2009 11:43 McGarry - Kearney Agency, I 651 - 439 -6350 p•2 i I f I IMPORTANT { if the certificate holder is an ADDITIONAL INSURED, the policy(ies) Lst be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of 4h endorsement(s). If SUBROGATION IS WANED, 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 Ileu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does nc It constitute a contract between the issuing insurer(s), authorized representative or producer, and th4 certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage affo" by the policies listed thereon. f t t ii E I i I 1 f f ( i 1 i I i i ACORD 25 (2001108) i f May 24 09 10:59a P Mill I IIII 11, ii 1 1 1 City .I of 0sk Pak Htiglft 14369 Oak Park Btvd. N. Box 2047 Oa3i P" Height;„ UN SSM Phone (651)43%-1939 Fscshwit (651) 439 -0514 f acsim-ile transmittal T.. bleu fronc Ame Jwev(:� Fanc Pages: ,- T AI, Phone l ROSS ❑ UrSeW Review 0 Ph ow Comment 13 Please Reply E3 Phan Racycle Message: L•C CITY OF OAK P�ARK� HEJGHTS May 11 09 12;46p P•1 1 1 B U ELOW EXCAVATING 13254 20TH STREET" NORTH STILLWATER, MINNESOTA SSD82 (651) 436 -5326 FAX (651) 436.224 -4 i s 1 I r May 11 09 12;46p p. �. �esota pogit tion Control Agenc lqodfiealdan ©fIAftnt to perform P. Typ of Ne"MaR : [ 3 Urt sl I 1 Artest [ ] fesi #adcetlafiou Control AggenCY Demolition Contractor:, �� Ia 'or atirsaw: C� 6. Name: tv Addrew, t3 �'� &3°�2. , sue, ��� FAI?� f� city sraoq. DF 1361 =d1j g#i� otFi�txsra�ad�$Bat�evetts): 2 lr-& C us , I Add --, ' Y' Dates whm d or bUst y t b urnmff �re�.u,�.x� - -r�� �iN,�� eras, B �►�,� goamrtn: - rta,rmestpsoi+eeta - �. If timrCis >260liaear &et or >16Bsq*Mm f�ttOf �C v L-- 4 ., t ,,D em1 (AA,CIf ) in the wing be dem+oM1k d, # mast W >r a� aid a #>r r rtn . ThaStaft dMW of Intent to Peeorm an Anbadn Ahaftwest PmJcct M t d%- aSd to note for the sabestas m9novsal. in nsufflable ALCM presMt in the btu 62 demss193hed g I I YM i ] NO tVW awe ACK be ewmmt i1a &0 at &0 Ome Of d I I YES I I NO If TES to bothgaestioas above saFleft fl e m 1-9. YNO to cM=won comply tite9ns'3 3 L Yf ACM wM be lent in *m for tlae d=wUffm tie tk. sOwnt erCafagosy I "r CstWry H monf Uble ACM left is pta cat W, i !An= Fc z II ISnear Feet Sga=f et SgaeraFat C31hrCFect �lbic�ee3 no�7able A� means:.w'i,.a,w .,.,data�iugi�$S. L�resarvll aaafii,Tblt ACM p3CA#B aay matevsl. eaclwf'm$ wouets, mere $oar covmngmd asphalt mofmg Foam= (wry I aoalgable ACK coaW=,g mare &m ow percent com wnimn mm. em we perew ads AsbcsJns fiLft, whin' &yY ...:. o * CafiegaryrlaoBAinfdeAG ?ffbustmOVwedtar=etainpbev rsdw=dmapmderbyl=rlpffC%smre-- for damordram if itib is poereooMmm eCs orlII friabx A4 fsaai rgaaad fa reamia tm pbee for de norska T itbes a bigb probaMy of be awft m=bled, pe#v=tr4 ar reduced is a powder darbrg demolidam, transport, or d tv=aL , (m Tnmsde, deft rmfing) 2. DescmSption & Location afACM rMatning In place PAduding Amr a od arwrlm fi)c [DTnUfs ca Wjah nt w Pcr&m s D=Wid = form (waw4-UAoc) Ra iAed 08106 May 11 09 12;46p p.3 Mi nneso t a pannf on Control Agency Notme tz" Of ]ht t to Perform r. Dent on PrAuft Type aiNntjF=tlou. � j j. � [ j Project Cauceftt'sau Control AgenCY Demolition Coatractar. B u fl diW NIMC A�' d rOb Z . Ci�Y. fir.. aF ' - }C F ARY city slate zip: contactpusw Number ofFla�rs � Btevel�s): = Addirl— Dates wban del meli 1f°11l Bed & End -1? "r „ Oty, sty "�'Gr fl, Z - � - �J� ,� ; Nadfisatiaa meat bs padmarlad orre«Sgea feu 00) WO MM days Lleutact i 1 l /1 )V& -66` b�edtsmtt u t *mss: •soe #�3 fiar d eli na. N there Is >260 pmasr feet Dr ;;-i60 squaft $at of Regubtad RAM) in tbx 6nitdiaag to be drexnaWhed, it mmt bs remote try a � � M $ €� e�emo'�"t t T6 Sftt& of M - of latent to Perform no Asbesfis,s AbMt0tt"atI'roJV3 mast be tod 18 900 for *0 usbeumm rmaO"L L narafriabM ACM preseat to the sumetnres to be demeft red ? I I YES 1 3 No vrdi monfilabb AC?I be present in the . � - -- St the Om OfdMr n$ 1 I YES € ] NO if yES tD both gaestious above ea mpboa itmw 1 -9. HNQ W t N= guesthm compkft item-3-9. M 1. V ACM wM bele?tt isi pie 6or eta tbE a aatat of Cafoe 1< emcVor warp II oet€riuebte ACM left to plow» g I.m Fast C'ateg. II fia= Feet $gweFed Cubic Ted Grtbic feet Csteeary I zzon5riable aCM means x�bc#os- amsa'�� S. carxa..an•n a�ia'�?eAC2+�d,a�as aqy matmis}, a�g gastts, r zilieat floor covering and asphalt root~ngpndLw s Cagmy1mmOebleAM cnntav h8 maze zhea OW p==t aosasm;egmae rhea oar penceat as�os. A�srh�, v�rhea dry, canao[ be c�bIod, gutveti�. ar «Cktegory 3 dortfis3 I.-Acm b nut numettoremb is p! ---to ndaued to a pnmUrbPy hmd for dente if it i9 In poor cesmi tom rCstego3TH ba—mWabde ACM Is oat;eHowe d to rand® is place Qr dgnaR if it bes * " pxoImbYlfty of bwomisg mmbled, palweztaed, or redneed to a powder dorms ttecnolilfan, traasporr, ur &WOUL (rtc Trx=24 elate n ofto 2. DOScr➢gtion & I.otation Of ACM rig in Pace (#Mdu&2g $cwr 0 rid roortt Al: tNaffic mooa[k tuFedm +aailaarwmfmm(W- sa4•xl.ax) itgvlsedMM May 11 09 12A7p p.4 Minnesota FoUntion Control Agency Notification of Intent to Perform a Demolition 1 0Minnesata Wltitiott TyM of Notification: [ ; Ori&tl [ ] Amended [ ] Project Caueelt&001131 Control Agency li?amolition Contractor., Blftdbw Infennation: Name: i30�'ou exczel Q� �z zo 14!'dew3 AM � f 3 S c Z o e Add i ACS 1'7� City, Ste, Zip: county: conlactPersos: ���?�� "MoNumba(a): Phoac N�bet(sj: 5I 5Y� Z AV of B14 (r=): j sr,= ofBW (s 4 1 / t Numbrs of Ftooas Tncfad�ng Same» F�+'ri($)= Sail Uwner. ftsertft9l &•.A .UVVII Bates trben de:r ehh" F or ioutentioas� b " g • - sv�l >E3egiQ , l- ( & End IZ — " City. sty 74 �� c� ? Not atioa must be pod marked or reenhed tan (10) WORMG days CotKact person: I / /`- C L befte demolil4as begins, -sea itcw Os far emmgency dcxnuMns. Q -1 R g and Fndtgg dates Amdd be amended is writing as 3PhoaeNtm�bcr(sY '"l ff n@eet egrtent prnied daUL, If there is >269 linear feet or >160 square feet of Regulaled As twining Mat)MW (RAC" in the building be demolbbek it>anstbe removed bya licen d sabestvs prtw dame . Tl:e�tabt: o#MN- otiee of Intent to Perform ao A%gbeffM Abatement Project tonal be used to notify for the asbestos remaval. U notnfriable ACM pres"t in the street m to be demolished ? (] YES [ ] N O Will mg afriabte ACM b e present ea dw straeture at tile thne of demolition? 4 j S (] NO If YrS to both questions above complete items 1A. If NO to either question c7ompteto itet 0 9. 1, if ACM py� be left in play for�tht demetolltim Ldicate the amonnE of Cstegoty i andlor Cftficgory II nanfri>tbh ACM left in PIWP- fi I ))tats- Feet. Caug. la Unew Feat Square Fat SquemFed Cubic Feet Cubic Feet I C s*eory I noafiiable ACM streams asbestos-ooAWxeI e,8 P&WVBM `atev U noafrfable A..CM, m=w any wawrK escludiug gas]W3, nmitza $oar covering and asphek tooling pmduAs c degoty I nazMabte ACM, eontsmrog mom than one percent cede, hft mom thm ox percent asbesaos. Asbestos tbmt when ft, "not be arumbJ4 pvlva A, or +C dcpry i nunffiOk ACM b rob allowed to remain in pine- mduced to a powderby hand pnmvv-- far d"Oution ifit is is poor floadifim *C 11 noafi iaW ACID is not allhwed to remain la place for demolition ifitbtu a bigb probabiftyofbecoming crumbled, poWeenuA or reduced to a powder during demolMoo, Uumpart, or dbp=L (ex't'ranshe, ctment, Ade roofing) 2. Description & Location of ACM remlMning in place (including floor # and room #): [MoO dtioa of Wh=oa PCftM n Acmo®tiaa ft= Cw4w4- 2I.d0c? Revised OM a May 11 09 12:47p p.5 `�! : •, Minnwot a PoDuflon Cont ml Agemy r, Notfsatwu of lktmt to P'erforin a Dem€oWon Ia nesaia %UI* ,~ T91g d fXG ffWd6s: I I ar4pai I ) Av=de l I l Pra$eet t neellaticu Coned Agency Demolition CQA ttrSctor., Ireltn; Names B()L -7�t, L) Addtcss: / 2 S� Z DYE S� ri •' �1 �� i' '�- I Contaatpesson: Nmnber afRo its kdaditsgBammm L.eveiis), $ald fDsvaer' till (✓ f.•-L. G- Ptes � rt ' c °. � ,a .`� {T.G� /'tip Dates whm dW or intentional buging WM Begin & End — CKY. staC, z�= ,t�l N*GBc I be, _::w.,. _3 orrmismd ten (.$) woRMG days Pros - 91 q1- �a �a�d4d � 7ither�c iia X260 �etsr �et.aa >26ll=srlsr� Ibet�$e��3 Asks- E..G.:�.��tt�rial tBAG`MJ� imtts b�dnog be deeds &ham it a=t W removed by a apse aim � .,_ per ix� hem sr�: Tf S to c�t�111- ellaatent to Perform an Asks Abak&twtPrAjft9 jntM be &WA fa nt for 1ht wbesW nemovaL U monfx'iabie ACM present in the dUvwWrS tO Ice denmfthed 3 I I () N4 WW 260fi -W -4CM beprasasat In the at tha time a, 6=6Uftla? [ J YM [)NO ff YES to both qoeWcws abova cons bft items 1-9- ENO to n com pletu itamv3 -9. L VAC M will be UR In gtr_ae for the deaWNUM [ax1Wb tic aunt *FC akgw7 I avA%r Cary tI nesh -hbte ACM left In glace - Ap I Limav"d Linear Feet SgwmFod 5q}uamPeet COMIC Fea Cubic Feet Caceen<v I noa�h]e AC.1d mrans r::.,i ...,etas tVzd Rgs, means any aerial, CxCjQftg gada�M ntssnisa flow covering. and aspheltxoo$ng podnm Cat tawy Ir:Gnfimble A04 a nu akff== ftm ono Pment co®tamasg anon: than cabs perewtasbmws Amu Brat, %ban dry, ca war ba c ra tebled pub eti ced, or *CategeryI .BEM b notn2bind in ret~etn m giaee xdnced ts►a pmmftr by hand Pm=vv-- ry -f r^N-` ACM ts ant zRawed to steam in e e fnr clecaalifrms fcfftis is poorc= dfdin<t - pla fur dertolW&a iFIf h w a NO prebabMiy a £b,,,m ms ,tumble patwerittd, or redoeed to a powder dartng demolidoa, tmasport, ar disgaxa3. (ea Transit-, cmwt, state reafing) 2. Deemiptian & )i oceiian of ACM rentabling Ift gaaxe (indadiag fir# and rsm m t ibiatili iomoff ttoPt�smgDastQF atefiomaEsysaw0�ld�c} RevasdOM May 11 09 12:47p p.6 WnneS®ta POUR60D Caaatml Agmey No canon of Imtent Ito Perform a Demolition J� of NatiiStjQW [ 1 ftl [ 3 wed t ] PrGJCCt C,snceiiatioa CnnW Agemy Del tolilion Contmetor: Buildina fiaformatim Nrtrne: 4 L��1.Q1� �'t�C�f `i� v gn�ngNar� L�J �� �z � � � f � Add,= �4ddrev/f oc3Qiaa 6 t 7 W� I�TL��� cim SWC6 Zip: carsaare.soo: Phone Numbed(sl +: 6 G - 1 6 Z r ia�, ( �- tf sin 'CM& (51 ILx..1 , Nurnber�h�rllingSr3rxlrcvei(sj: � BuikUnw Owner: rre;.r�at �:,,•� : -G=l '� �� ivtm,' � i �t fir L•.L. C' Dam Wh= ice#? or h*wftemal b cry, sty �r"t LL -�l,• a S,� .7��'� xM,iad bellm aem9i6ao besks. 1 8m Um 05 1hr enmegum dcavlHYtrm. P�Q6 bCLt51' • ' ` ! . 7!� ^ C 6 ( �1 sand �g tuft& t null be sm dad to y1� as RdC�II+f t0 fti�p;C6�.6[t aE�' . If there is > 260 iiamr fbet or >16iD aqua a fia of Ftegulaftd (RAC in ** berg to be demorwhed, it roust ba red bye lcmmd sabcAm .- 6 . pear tlD deu=:slifieft. The State of mw ice of Ioteatt+u Perforw to A tas Abutsexamt Pmjta mast be wed to nado !or tlse asbesms tnema=L is assfriable AGM pmt is the strt wWrete be d ed Y t ] YES [ ) NO WM newh iWe ACM bo pressut in the star+ me at *-e ftm of dammffifim? I'YES )NO ff'YlEss to both gaesdoms above comnpldc items I-1 L VACM wiR be ftft is pica for the tbaa is&vub the *=amt of Qiaga 7 I aWar t after$ H amtriable ACM Left CateC I Listrn Poet +'s8, YI Umeer Feet I Squ=*Fx# CUTACFes; UrbicFcei I L nou 6dablc ACtdm=ansasit9os- owdmbdug pew, t�3L c ,Cmou anymater=4 eschxumg gaslce� rm'liras� oar oov & and a�halt :oofmg aoc is COY Y media le AGES, contdmizaamm dam one p=eat ennbainitsgmom tLaan arcs pemeai Asbcstmibat wbcn dry. emu= bcaumbICEI,pnlxaj=A of Nnutegorylen *ACW aaoinpbee m tosponderbyhwW 'for demaliioe if ii is zt poor ar fffies� satyr R n bla ACM is cot suowed to remain in place for dMallika if kbm in hitb prodrabMy atbeooming armsbted, patve* Z4ortedacedtoa powder dareeg+deme d6x,transper4 W&q=l (es Truxur, "Mena, elate raafi:44 2. DescAption & f ocstlan of ACM re mskleg In pite (nsluahig $nor k and room #): ENeificeanofkd=a aPccrb taD=orWo fbm(w-srA,2 Apul Ktr�sedU8ro6 Y May 11 09 12;48p p.7 nDesoto PeRuden Contml Agency Not& on Or lHtmt to Perform a (Demolition ftnesets Paftdkn TM ofpre &SM& t: i l O rVnal 1 AOMM [ I P►#ert C"oeUatcott Catitrol Agetity DemeRtioo Cow -d0r:, BidNia cInformation: Noma d G-- Bnt1[ditn 2i�t (� �`' ®2 2 ) t I' ,. Nkwb= ofRwMkdQ AMM-Ot ; � - r ]Wes whea derasM or ioieai wid b x tl(m cmd he posboarled or recdqed ten tIo) wowMG asp b de�souttw `Sac ttrrra�rgmryde lFtfaas, Ph000 Nu>s fs?` • I l z �7 ' Ba& wd Xndt_tig J(-s shrotd tee aoseat�ci fn wsitiag rn .rybo raElect�t�rcngxxt awes. �£ there is }1.60 tlina�r fset ar >16� �ta�ne tr st a€� Ash _ �_,'..�� 1�r�1(�l.C'Zyt) iaoe, tea 6�;�g be ietuolesbmd, it t�ttgt b� > e [z'y e . pt k:::L:• . �.: ThaStuth of mRL of Iletemt W Performs rtm -At besbw AbaftmeE3t Pr oft my z t be mmd to taod & for the � - rewe aL L 7nour risbe ACl1g prevent t o the a±...... w -AD is d*u"V ed ? I IVES [ NO W1li awe ACM ba present ia tw W. d at the tha& a= tma rrg [ I AYES j j N Tf YES to both gaestib= abwie comp3fa items 1-3_ O icr a lhargttestie3a...,�. ite�as 3 -9. L lfACM W1 bs k t im pftu far the c a iaskate tiro amount ofC'aftory I and/or COMONY It immWabbc ACM lert in place. €:rte$. i Lmewy= Line$rFeet SRuaee Feet sgme Fee CL6k FCCI Cubic Fed Cxet�orvl amiable ACMmcazs sshasDOS -oor ng W s. Cotwmv D awiriinble ACM mcmxs aW notarial, adding Osj%AA jesaie ntften coarsbng sand asgbeSt ivaftg probm s Cakam I amble A:C K cnteit®xg mm'&ea one pmceat caubiningmnre Wan one percent asbesos. Ashastea at, when dry. amaai be a=3bl* ppYrx to or +Ckftw y I soahriableACM is rAl altar toremtdn W pbee erdum dtoa patxUrbpha3d preasm for dewlifim if it is is poor eeadiiiev. *Categmyll , -r On - I Ph ACM i aot gPowc d to, rtmWn in place for deanal'"Mm Wit bas a Ugb probabMty tMeandng ammWA pulvarft4 er reduftd to a powder dwbg desnolteen, bmuport, or dlspard, (Cl l5rata tlr cemenat, date raafiag) 2. Description & L "floc of ACU lemMulng In pDate (0140diug Boor # and roam 9): [NoMCdCm Cf bt l WPCE&M sDzwl'r6aaibam:(wiw4 -UAw4 RevNed O&U U May 11 09 12:48p p• 3. Company and /or individual that conducted the building inspection and the procedure used to determine the resence or absence of ACM (includiag.analytic method): ''Prior to demolition all buildings must be Inspected by U S. Environmental Protection A ( EPA) accredited inspector. M El' 4. Description of planned demolition and the specific method(s) that will be used: Ri,'pl-� i-ve - G' ai.tzl w vp bra-- s ,-- D6 k/5 5. If the demolition was ordered by a government agency, please identify the agency and attach a copy of the order: Name: Title: Aurhority: Date of Order (M/D/X): Date Ordered to Begin (M/D/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 OJKLY when the facility has been deerntd structurally unsound and in danger of imminent collapse- Ifthe structurally unsound building is known to contain any regulated ACM or is suspected to contain any regulated ACM, special procedures MUST be followed. If you are unaware or the special procedures, iustructions/regnlations can be obtained by contactingthe MPCA at the address or phone number listed below. 6. Description of procedure to be followed in the event that unexpected RACM is found or Cat H nonfriable ACM becomes crumbled, pulverized or reduced to powder: 4 Ar VC( 4 7. Demolition Waste Traasporter(s) Info r rmation: S. Demolition Waste Disposal Information: Transporter Name: r .l rli+'ll °� IJI S L Landfill Name: .�7�1 A 14+AAr 1 Transporter Contact: Owner /0perator. Transporter Address: Itltw 'i' b ao AddressUcation: 'Z9 5�6 //7'rlt 5e City, State, Zip: � ' ,c' � ss•r zr t� City, Statc, Zip: 11— A P Phone Number: 1 4 1- f - I Phone Number: e 4./.S'Z�) geIiZ- 9. I certify that the above inforwation is correct and I am a bonafide representative of the demolition contractor or building owner and have authority to enter into agreements for my employer. Signature; of Contractor /Owner IV �4.� Date Send to: Minnesota Pollution ControIeney For questions call: Municipal Division 651- 296 -6300 or 1-800-657-3864 520 Lafayette Road North FAX: 651.215 -1593 or 651 - 297 -2343 St. Paul, MN 55155 -4194 PCB Removal Information Polychlorinated biphenyls ('PCBs) must be removed from the buildingprior to demolition, PCBs may be found in light ballasts, - small capacitorsfound in old appliances, and transformer oils. For questions call the MPCA Hazardous Waste (HAP) business assistance unit at 1- 800-657 - 3724. PCB remover name /address /phone number, PCB receives nameladdress /phone number: Mercury Removal Information Mmwwy containing material must be removed from the buildingprior to demolition. Alercury containing materials may include fluorescent, metal halide, high pressure sodium, neon, mercury vapor lamps, mercury switches, thermostat probes, manometers, and gages. For questions call the MPC.4 HW husfness assistance unit at 1-800 - 657 -3724. Mercury remover name/address /phone number. Mercury receiver name/address/phone number: Refrigerants /CFCOHCFCs Recovery Information A cent fed technician must recover refrigerants from refrigeration equipment acrd systems in the building prior to demolition. For questions call the CFC program at 1 -800- 657 -3864. Refrigerant recoverer name/address/phone number: Refrigerant receiver name/address/phone nwnber: 10 rfmtion of latmtwPerform a Demolition farm (w- sw4- 21.doc) Rwised 68106 ,May 11 09 12:48p P. B U E LOW EXCAVATING 13254 20TH STREET NORTH STILLWATER, MINNESOTA 55082 (651) 436 -5326 FAX (653) 436 -2244 P C12- '3'?( ��.' � `! � L ° (L •C • /��� tJ L "' �It- C�' (�� � �- �����. G'C/t -C'° -� ell 1�' _ By , Ic �, ft l t N i W ikE AWt w S OAKGREEN VILLA LLC NORMA L VALERI TRS :a VALLEY SENIORtSERV ALLIANCE �e Nolde TIF f a PATRICK L ESTES ,? VALLEY - SENIOR SERV ALLIANCE f I City of Oak Park Heights 14168 Oak Perk Blvd. N • Box 2007 •Oak Park Heights. MN 55082 Phone (651) 439 -4439 • Fax (651) 439 -0574 t _? WSCIADIER; I}IIS NAP AND ITS ASSOCIATED ELEJEM IS AUMER AN OFFICAL SURVEY vac AN L:GL\'EERED OESRiV: THIS NAP SHOULD ONLY BE USED AS A GE MAL REFERECYE FT R '�� PRO\7DED AS A COLRTEsY FOR ITS USER FROM THE CITY. ALL EIEffKCS SHOULD BE \ERWMD BY OFF.CAL SLRCEYS. OTHER ACTUAL SITE CONDITION MIEW ANDOR OFFICAL LOCATE DOCCnONTAT'AV TIff CITY PROVIDES VO WARRANTY THAT THE ITEM OR ELF-\INRT DEPR'TEDAREACCURATE OR CORRECT. ♦. • P'da Section III. • Demolition Permit Document - Additional Conditions Agreement • Letter of Credit $25,000 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 58 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 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: 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 15 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 15 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 15 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. • Initial. 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 al(c:osts 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 local rules, ordinances, laws and requirements of record. Y4 .e,k Date:—� Tifn NoId Presid t Green T ' limb JENNIFER M. PINS �atg C NOTARY PUBLIC MINNESOTA Ot My commmion Expm Jan 31.2012 ( x ary tamp 4) - -- Date nc nson, City Administrator Pe t ly ! signed by City Administrator: �r 1 .ti —Date: o ry JENNIFER M. PINSKI (Affix notary stamp 4) NOTARY PUBLIC - MINNESOTA My Commission Expires Jan 31, 2012 S Page 2 of 2 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 ompleted by September 15th, 2009. It s c essful project and we do appreciate the opportunity. Y c nson Cit�i dministrator Cc: Judy Holst Mark Vierling • City of Oak Park Heights 14168 Oak Park Blvd. N • Box 2007.Oak Park Heights, MN 55082 • Phone (651) 4394439 • 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 Holst Mark Vieriing LAKE AREA BAND Friends Serving Neighbors Since 1915 Irrevocable Letter of Credit No. 124492502 June 12, 2009 To: City of Oak Park Heights City Administrator 14169 Oak Park Blvd. Oak Park Heights, MN 55082 To Whom It May Concern: We hereby 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 prior 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. 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 3. Be accomplished by a certification signed on behalf of the City of Oak Park Heights that either (i) Green Twig, LLC has failed to comply with the terms of the demolition permit, or (ii) Green Twig, LLC has failed to comply with the demolition permit, or (iii) this Letter of Credit will expire within sixty (60) days 18 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 Almelund • Forest Lake • Harris • Hugo • Lindstrom • Maplewood • Stillwater • White Bear Lake 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 will 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 oft 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 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 CITY OF OAK PARK HEIGHTS PERMIT NO.: 2009 -00082 14168 OAK PARK BLVD. N. #2007 OAK PARK HEIGHTS, MN 55082 -2007 DATE ISSUED: 06/25/2009 (651) 351 -1661 FAX: (651) 439 -0574 W 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. APPLICANT OTHER PERMIT FEE 25.00 OTHER PERMIT SURCHARGE, FLAT 0.50 fREEN TWIG LLC TOTAL 25.50 P.O. BOX 19 STILLWATER, MN 55082 - PAID WITH CHECK # 5040 OWNER GREEN TWIG LLC P.O. BOX 119 STILLWATER, MN 55082 - 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 suspended or abandoned for a period of 180 days any time r work has commenced. The applicant is responsible for suring all required inspections are requested in conformance with the Minnesota State Building Code. SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. f OWL- 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 15m, 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 15°t, 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 oNecting 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. • Initial. 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 Applicants 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 sift 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, taws and requirements of record. Date: Ti Nolde, Presid t Green T , I 1....�.... -- -i <: JENNIFER M. PINSKI C NOTARY PUBLIC - MINNESOTA Ot My Commission Expires Jan. 31 2012 ( ta 3) --- _--- - -- ary mp .� f;, 1 5 9 10 . Q'` LY Date *1V Q do nson, City Administrator S V IF Pe ly 0-7—Date: ned by City Administrator: s � ° ry JENNIFER M. PINSKI (Affix notary stamp 4) NOTARY PUBLIC - MINNESOTA My Commission Expires Jan. 31, 2012 • Page 2 of 2 a .. BAy a gliax Fite DE • t - CoN1�c.T . Al A� E�sIN F Oak Park Heights Z4� �• 3RD 'S�' Application for Permit 1��'`f �o r fi �5dD 3 T Owner4a N.%& CLC Contractor# 9 VLDk) EU (a (TORN Bu FLOO Address: N * TA) 1 b Address: .T� . Phone: (4) q3a9 1 1 Phone: ((AV) -U6 - 5 r7 i(p JOB ADDRESS CLASS OF WORK Number Street New Add Sign Alter Repair Move Demolish 4VX A It Front or Width Side or Length Height in No of Area of Type of Occupancy Project iki in Feet in Feet Feet Stories Lot Construction Valuation Occupied / tTZAA VA Legal Description (if no address assigned:- Description of Work Being Done DEMOLISH IO • iQE T"1 - *(,."i'1 C►S BU( t Fa I TG.- CLEA V P It F, NA WN9f ?." ONA - 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 furthgl agrees to notify the Building Official of each the required inspections 24 hours i v n ed upon the Inspection Record Card. Dated: ant Applic's Signature For Office Use Onlv: City Building: City Plumbing: City Mechanical: Jim Butler, Building Official Plan Review: City of Oak Park Heights 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 No Other: Total: WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH Sealing oNow'ell and Boring I H 276514 County Name WELL AND BORING SEALING RECORD Minnesota Unique Well No. Minnesota Statutes, Cha ter 103/ or W- series No. WASHING fON P eava wank a na kno ni Township Name Township No. Range No. Section No. Fraction (sm. -� Ig.) Date Sealed Date Well or Boring Constructed 6AY`I)OWN 29 I20 5 1A ]V Nt 6/9/2009 Latitude _ ___ degrees _.__ minutes seconds Depth Before Sealino t', ft. Original Depth ft. * ION: Longitude degrees____ minutes seconds AQUIFER(S) STATIC WATER LEVEL Numerical Street Address or Fire Number and City of Well or Boring Location ' (] Single Aquifer ❑ Multiaquifer /9/2009 c WELL/BORING Measured El Estimated Date Measured J 9 . 710 Oak Ave N. , Oak Park hieigh t Water- Supply Well ❑ Monit. Well Show exact location of well or boring Sketch map of well or boring I 12g n section grid with °X" location, showing property ❑ Env. Bore Hole ❑ Other bove land surface N lines, roads, and buildings, h.] below ❑ a CASING TYPE'S) jX Steel E] Plastic E] Tile L Other �7 -- ' - ' - - -` -- WELLHEAD COMPLETION W -- E T Outside: [] Well House] At Grade Inside: [] Basement Odset Mile tl Adapter/Unit ❑Buried ❑ Well Pit h v ❑ Pi ess --- --- : --- - - Buried ❑Well Pit ❑ Other �--- t Mile - -- ❑ Other OPERTY Q,IQINER'S COMPANY NAME CASING(S) r een 1 � j��J�L Diameter Depth Set in oversize hole? Annular space initially grouted? Property owner's mailing address it different than well location address indicated above _ 5 in, from _19 1_ t^ ft. ❑ Yes ] No ❑ Yes ❑ No ❑ Unknown 773 Green 'Ajig Way Stillwater g MN 55082 i n. from to ft. ❑Yes ❑ No F] Yes E] No F] Unknown in. from to_ ft. ❑ Yes ❑ No ❑ Yes ❑ No ❑ Unknown WELL OWNER'S NAME /COMPANY NAME SCREEN/OPEN HOLE Well owner's mailing address it different than property owner's address indicated above I Screen from to ft. Open Hole from 1 21 to --U O ___ ft. OBSTRUCTIONS ❑ Rods /Drop Pipe ❑ Check Valve(s) ❑ Debris ❑ Fill X] No Obstruction Type of Obstructions (Describe) go LOGICAL MATERIAL I COLOR I FtF ORMAT O FROM I TO I Obstructions removed? ❑ Yes I FORMATION ❑ NO Describe If not known, indicate estimated formation log from nearby well or boring. i PUMP Type Submersible Sand/ Gravel Varied Varied 0 �T 1211k Removed F1 Not Present ❑ Other 7 ha D imerock Yellow rd 111 1601 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 in. from to ft. ❑ Perforated ❑ Removed Type of Perforator ❑ Other_-- - GROUTING MATERIAL(S) (One bag of cement = 94 lbs., one bag of bentonite = 50 lbs.) Grouting Material _ CeMen from to j6e ft. yards_ 23 bags from _ to ft.___ yards____ bags from to___ ft. yards_._ bags OTHER WELLS AND BORINGS REMARKS, SOURCE OF DATA, DIFFICULTIES IN SEALING I Other unsealed and unused well or boring on property? ❑ Yes [] 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. Mantyl a Well Drilln�;, 1 nE �- Licensee Business Name License or Registration No. �z 583 6/9/2009_ . Certi epre nature �" Certified Rep. No. Date i.c n� RItiron i COPY MINN. 276514 Rob Lyon { fiV. DEPT OF hiEALTFI Name of Person Sealing Well or Boring HE- 01434 -11 IC# 140 -0423 vosR Va &WROMEMUL, Z W. 76 St. Croix Trail N Lakeland, MN 55043 651.436.6559 (F)651.436.2021 I 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, VCI Environmental Inc. has successfully co 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 ak Green Ave, in Oak Park Heights, MN. If y6n have any questions please feel free to contact me. Sincerely, I Dennis Schumann Vice President, VCI Environmental Inc. 651436 -8559 • ASBESTOS MATERIAL SURVEY 5710 OAKGREEN AVENUE NORTH OAK PARK HEIGHTS, MINNESOTA • 1.0 INTRODUCTION Enviro 1 operty Audits, Inc. (EPA, Inc.) conducted a visual survey at the residence locate at 571 akgreen Avenue, Oak Park Heights, MN. The survey for asbestos - containing materia s CM) 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: 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: 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 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 1 02009 EPA, Inc I i Recreation Room i i Mech Room 3/4 Beth "906 NE Bedroom NW Bedroom BASEMENT 5710 OAK GREEN AVENUE N OAK PARK HEIGHTS, MN Not to scale ASBESTOS MATERIAL SURVEY 5710 OAKGREEN AVENUE NORTH OAK PARK HEIGHTS, MINNESOTA 3.0 BUILDING DESCRIPTION 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. 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: • Floor tile • Ceiling tile • Sheetrock/joint 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 C)2009 EPA, Inc ASBESTOS MATERIAL SURVEY 57I0 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. Sample # Functional Space Material Identification Asbestos Content Material p p Amount" 09 -04107 B -01 Living Room Ceiling texture 3% Chrysotile 1200 sq. ft. 09 -04107 B -04 Kitchen /Living Room Paneling adhesive 5% Chrysotile .200 sq. ft. "Estimate of visible material amounts. Require abatement contractors to verify material amount for bidding purposes. NOTE: Samples #13-02 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 # Functional Space Material Identification Asbestos Content 09 -04107 B -05 Hallway Sheetrock/joint compound ND 09 -04107 B -06 Basement Bathroom 12xl2Floor tile (yellow) /mastic ND 09 -04107 B -07 Roof Felt underlayment ND . I 09 -04107 B -08 Garage Siding Felt paper underlayment ND 7.0 NON - SUSPECT ASBESTOS MATERIALS The following materials are present in this building but are not considered as suspect asbestos building materials. Functional Space Material Identification Foundation Concrete Supports /Framing Wood 8.0 ASBESTOS BUILDING INSPECTOR ACCREDITATION Please see the following pages for Minnesota Department of Health certification information. Inspector Jim Lindahl Exp. Date 11/25/09 Minnesota Certification Number — #AI2333 5710 Oakgreen Ave N 3 ©2009 EPA. Inc EMSL Analytical, Inc. 14375 23rd Avenue North, Minneapolis, Mn 55447 .. ' Phones..:.., . Fax: Email: mmneao a o rs a msl.com ., Attn: Jim Lindahl Customer ID: ENVP52 Environmental Property Audits Inc Customer PO: 2701 4th Avenue North Received: 06/01109 1:30 PM Anoka, MN 55303 EMSL Order: 350902600 Fax: (763) 323 -6677 Phone: (763) 323 -6700 EMSL Proj: Project: 5710 Oak Green Ave Analysis Date: 6/2/2009 Asbestos Analysis of Bulk Materials via EPA 600 /R- 93/116 Method using Polarized Light Microscopy Non - Asbestos Asbestos Sample Description Appearance % Fibrous % Non- Fibrous % Type 09 -04107 B -01 Ceiling Texture L. White 97% Non - fibrous (other) 3% Chrysotile 350902600 -0001 Rm Non- Fibrous Homogeneous 09 -04107 B -02 Ceiling Texture Stop Positive (Not 350902600 -0002 SW Bed Rm. Analyzed) 04107 6-03 Ceiling Texture SE Stop Positive (Not 02600 -0003 Bed Rm Analyzed) 09 -04107 B -04 Paneling Adhesive Brown 95% Non - fibrous (other) 5% Chrysotile 350902600 -0004 Non- Fibrous Homogeneous Adhesive Only Tested 09 -04107 B -05 Sheetrock/JT Tan/White 10% Cellulose 90% Non - fibrous (other) None Detected 350902600 -0005 Compound Non- Fibrous Heterogeneous Sheetrock/Joint Compound 09 -04107 B -06- Bsmt Bath Rm Brown/Yellow 100% Non - fibrous (other) None Detected Floor Tile Floor Tile 12x12 Non - Fibrous 350902600-0006 Yellow Homogeneous r Analyst(s)_.0 Heidi Johnson (8) 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 od is 1 %. The above test report relates only to the items tested and may not be reproduced in any form without the e>yress written approval of EMSL Analytical, Inc EMSL's V 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 .risibility 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 US Government NILIP Lab Code 200019 -0 Test Report PLM - 7.12.0 Printed: 6/2/2009 9:26:34 AM 1 EMSL Analytical, Inc. 14375 23rd Avenue North, Minneapolis, Mn 55447 . :<.,......,n... i P hone: (7 449-4922 Fax: (7 63) 449-4924 Email: mmneaoo lislab(a)emsl.com IF - Attn: Jim Lindahl Customer ID: ENVP52 Environmental Property Audits Inc Customer PO: 2701 4th Avenue North Received: 06/01/09 1:30 PM Anoka, MN 55303 EMSL Order: 350902600 Fax: (763) 323 -6677 Phone: (763) 323 -6700 EMSL Proj: Project: 5710 Oak Green Ave Analysis Date: 6/2/2009 Asbestos Analysis of Bulk Materials via EPA 600 /R- 93/116 Method using Polarized Light Microscopy Non - Asbestos Asbestos Sample Description Appearance % Fibrous % Non- Fibrous % Type 09 -04107 B -06 -Tan Bsmt Bath Rm Tan 100% Non - fibrous (other) None Detected Mastic Floor Tile 12x12 Non - Fibrous 350902600 - 0006A Yellow Homogeneous 09 -04107 B -06- Bsmt Bath Rm Black 100% Non - fibrous (other) None Detected Black Mastic Floor Tile 12x12 Non - Fibrous 350902600 - 0006e Yellow Homogeneous 0 4107 B -07 Felt underlayment Black 65% Cellulose 35% Non - fibrous (other) None Detected 350902600 - 0007 Roof Fibrous Heterogeneous 09 -04107 B -08 Felt paper Black 80% Cellulose 20% Non - fibrous (other) None Detected 350902600 - 0006 underlayment Fibrous garage siding Heterogeneous { r� Analyst(s) Heidi Johnson (8) 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 od is 1 % The above test report relates only to the items tested and may not be reproduced in any form without the express wniten 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 risibility 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 NVLAP Lab Code 200019 -0 Test Report PLM- 7.12.0 Printed: 6/2/2009 9:26:35 AM THIS IS THE LAST PAGE OF THE REPORT. 2 350902600 Asbestos Chain of Custody �MS1 At� NU �. 14375�,3 AVENUE EMISL order NUM ber (Lab use Only) mIt t i l,4 ,ua, Mrs 6547 Pwwe. (783)44 "M rrna wMxuma.a urc FAX: (763)449 -4924 ...,..�.... -., EMSL -4111 to Same ' LJ Utl em i. c ompany: - ,$A q 6a w a►agrerert ncote rnstnxAont iry cantrt" Strssrt T1dnd P vex wrfttetr bw IS M IhO tlHrtY Zf tat &ode: 1Yeport To fWame): JLm Lindahl Fax #:. 70-323,6M. Telephone e: 763.323.6700 Email Address: � d��,t�l�► nxn � }ter~ Pro Ct i�!limetl�urrtbar; Please Provide Results: Fax�1 �ntakk P Order: � � U.S. Scats S amples Taken Tutrser+QCr1 Ilrrte A7 a Please Check ` ❑ 3 Houre hours 24 M 48 Mrs 3 Da" " – " a s 5 j 141 a1js AY Y9M Atr 3 haourali9 troi+ra pro c� to su^hederle.' r8 � premium G�hatg8 her 3 Nnur TEM Ait� �v EPA Il T�Yt9tt Mdlrt�t a�kad do a" an authorizafkm bon ror this w&e. Anatvsia �n�Dl�hfad i eca avrlenc�e with EMSt `s Tevms d eandtt�rrtis lY is d in the Am~ PriE bufda T'E14- f3us% 0 N1061i 7400 Q AHERA 40 CFR, park 763 Mfcravec - ASTiVI d 5765 wt OSHA 8hr. TWA ❑ NIOtSH 7402 YVipe - A9TM D6460 • 1114h IMMU011 EPA level 11 Carpet Saner (EPA 600(J-9&16?)_ PUW EPA W&R-M 16 1 0%) [] ISO )V312 �a�llReaelSJVe�E� igr PLM EPA NOB (41°1) TEIVI - BulK PLM CARS 435 - A (0.25% sensitivity) Point Count 0 TEM EPA NUS 0 PLM CARE; 435 - B (4, I% "MOAYI 400 (40.25°1) [1 1000 ' ( -0.1%) C7 NYS NOS 198.4 (non- frlable -NY) Cj TEM CARS 435 - 8 ( 0.1% sensiti+4ty) Point Count wtGGrawmetric L3 Chatffetd SOP TEM GARB 435 - C (tl.Ot% sa0$XWty)- U 400 ( <0.26%) 0 1000 ( {0, 1%) ❑ TEM Mass Analysis-EPA 600 sec. 2.5 © EPA Protocol (Sem;-Quantitative) [3 NY$ 18$.1 (triable in NY) Wry after, EPA 100.2 Q EPA Protocol ( Quartlitative) — 0 WS 198.6 NOS (non - triable -N`) P'Rw$ >10Pm [_"]Waste ❑ Ddr0ting fit Y � as. Nt h 02 <1P✓e Poslltl Fiber Sizes El WaSIO 11 Drinking St t p Clear! dpn ly HO 096flous Gr0U . C heek p'tttr .. P l samplers Name: SoMplers Signature: Yo1 � .. S ampl e , Deepri art F A � D area r) Dgtermme � $"plod - ■" V 4 % a 0 `� Total 4 of $arrtptaa: Relinquished (Client): Date: - (a Tkne: r j vyrl Received (1.ab): �? Date: l(�(� ` Tinter �• (94 Comments pecial trucuons: _. .. , . , comtoa0 ¢,A AwVw"GOG- NI- Y1Vi4d Page I of Pages 350902600 �s� aGrncd►1., INC. Asbestos Chain of Custody 14375 23P AVENUE FEMS4 43fdar NuT§�f Lab use Onfy n a A 543. 3 (ocr) � PHONE: (763) "94922 ,. o, , viv F sic. g63144"924 Acldrtlonal Rages of the Chain of Custody are on ly necessary if needed fo r additional sample lnformstllon VolurnelAraa Iihlr) DatefflM , 9.a oto # Sample Oesmiption _ HA # jt#plk} Sampled _0 M A. 4� Cornm ISpeclal intros tion * erit8 6: Page _ - of - pages 64trsIMd rom - A{MMM cot f st4 . W,&w i *`803 SW *B02 Bedroom SE Bedroom I Bath Closet � Down O Kitchen 80 4* *601 Living Roars Dining Room Exterior Roof Samples 807 MAIN LEVEL BOB 5710 OAKGREEN AVENUE N OAK PARK HEIGHTS, MN Not to scale 5754 O akgreen Issued City Demo Permit & Additional Conditions Application fro Demolition Permit Well Closure Documentation Asbestos Abatement Removal Certification CITY OF OAK PARK HEIGHTS PERMIT NO.: 2009 -00083 14168 OAK PARK BLVD. N. #2007 OAK PARK HEIGHTS, MN 55082 -2007 DATE ISSUED: 06/18/2009 (651) 351 -1661 FAX: (651) 439 -0574 AADRESS 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 CLOSED OR ABANDONED PER ESTABLISHED CRITERIA. 4 APPLICANT OTHER PERMIT FEE 25.00 OTHER PERMIT SURCHARGE, FLAT 0.50 GREEN TWIG LLC TOTAL 25.50 P.O. BOX 119 STILLWATER, MN 55082- PAID WITH CHECK # 5040 OWNER GREEN TWIG LLC P.O. BOX 119 STILLWATER, MN 55082 - 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 uspended or abandoned for a period of 180 days any time work has commenced. The applicant is responsible for Suring all required inspections are requested in conformance with the Minnesota State Building Code. SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. 5 t75 04146U1 A) 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 58 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 f(• construction does not commence by August 15 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 15 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 15 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 Xcei 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. 0 Ilnitial: Page 1 of 2 r r 7. The Applicant shall reimburse the City for costs associated with water -use for training exercises and . 1 • 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. S. 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 Appilcarifs 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 sift 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 contra erosion and shall at a minimum follow i • '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, Date:. �6 Ti O A esid t Green T JENNIFER M. PIN SKI NOTARY PUBLIC - MINNESOTA Ot My Commissim Expires Jan. 31, 2012 .._ ( ary tamp 4) Date l �- D I <, f;r 5759 b O G ric nson, City Administrator Pe t y signed by City Administrator: 0 ate: ���l - -- -- - - - - -- o ry ENNIFER M. PINSKI (Affix notary stamp -�) OTARY PUBLIC - MINNESOTA My Commission Expires Jan. 31, 2012 - ----- ._._� Page 2 o12 ' BAY poo p'i tc Dr k co: Ntt~c.T Al Ets1N c r Oak Park Heights ZQq N • 3 Rfl Sr Application for Permit 0 44 Owner:(p /s e0M IT W %PLC Contractors v EtUQ� EU (,TV14N RY EL00) Address: M m 7w 1 b Address: 1 2A 5. Sr1uL NIN Sty LWAr9Q- �N Phone: (rw) 43a 1 1*7 Phone: ((aQ) _q1,0 - 5'3 i&V JOB ADDRESS CLASS OF WORK Number Street New Add Sign After Repair Move Demolish 5`15 , Ave C❑❑❑ ❑❑ F, I t Front or Width Side or Length Height in No of Area of Type of Occupancy Project DC S!! d in Feet in Feet Feet Stories Lot Construction Valuation Occupied R Et-T'VRIM 0y $ 2 Legal Description (if no address assigned:—$1,A Description of Work Being Done DEMOLISH JON " �i Q,�� MtrG"I't C.S 1 t;;LE1 ~VQ 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 applic er agrees to notify the Building Official of each the required inspections 24 h ce a oted upon the Inspection Record Card. 4 0 � Dated: Applicant's gnature For Office Use. Oniv: City Building: City Plumbing: City Mechanical: Jim Butler, Building Official Plan Review: City of Oak Park Heights State Surcharge: Signage: 94168 Oak Park Blvd. N. City Utility Meter: P.Q. 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: MANTYLA WELL DRILLING, INC. • Phone: 651 - 436 -7600 • Fax: 651 - 436 -5106 1392 St. Croix Trait N. • P.O. Box 797 Lakeland, Minnesota 55043 -0797 FAX SHEET THIS FAX CONSISTS OF 6 PAGES INCLUDING THIS COVER SHEETS. Date: May 12, 2009 To: Eric Johnson Company: Citv of Oak Park Height FAX Number: 651 439 -4439 From: Susan 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. \COREL WPWIN\ FAXFORM • -. 1 a ' 76 St. Croix Trail N Lakeland, MN 55043 651.436.8559 (F)651.436.2021 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, 576 Z and 5754 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, 1 ennis Schum Vice President 651436-8559 651436-2021 fax 1 jf Sol Ok& �r ASBESTOS MATERIAL SURVEY 5754 OAKGREEN AVENUE NORTH OAK PARK HEIGHTS, MINNESOTA 1.0 INTRODUCTION Enviro dal Property Audits, Inc. (EPA, Inc.) conducted a visual survey at the residence located 7t5754 dkgreen Avenue, Oak Park Heights, MN. The survey for asbestos - containing materi ) 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: Wall sheetrock/joint compound, floor tile, panel adhesive, ceiling texture, 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 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 I%). • 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 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 is the roof area. 5754 Oakgreen Ave N j CONN EPA, Inc r ASBESTOS MATERIAL SURVEY 5754 OAKGREEN AVENUE NORTH OAK PARK HEIGHTS, MINNESOTA • 3.0 BUILDING DESCRIPTION The project 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 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 Sheetrock/joint 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 I% by weight. Sample # Functional Space Material Identification Asbestos Content Material Amount" 09 -04109 B -03 Kitchen Original floor tile 5% Chrysotile 90 sq. ft. 09 -04109 B -10 Roof (chimney) Plastic cement patch 12% Chrysotile 10 sq. ft. "Estimate of visible material amounts. Require abatement contractors to verify material amount for bidding purposes. 5754 Oakgreen Ave N 2 X2009 EPA, Inc ASBESTOS MATERIAL SURVEY 5754 OAKGREEN AVENUE NORTH OAK PARK HEIGHTS, MINNESOTA 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 # Functional Space Material Identification Asbestos Content 09 -04109 B -01 Wall Sheetrock/joint compound ND 09 -04109 B -02 Bathroom Glue on wall panels ND 09 -04109 B -03 Kitchen Original 9x9 floor tile mastic ND 09 -04109 B -04 SW Bedroom Ceiling texture ND 09 -04109 B -05 Living Room Ceiling texture ND 09 -04109 B -06 NW Exterior Wall Shingles /siding ND 09 -04109 B -07 NW Exterior Wall Paper underlayment ND 09 -04109 B -08 Roof Top shingle (grey) ND 09 -04109 B -09 Roof Original shingle (grey) ND 09 -04109 B -11 Garage Original roofing under metal ND 7.0 NON - SUSPECT ASBESTOS MATERIALS The following materials are present in this building but are not considered as suspect asbestos building materials. Functional Space Material Identification Foundation Concrete Supports /Framing Wood 8.0 ASBESTOS BUILDING INSPECTOR ACCREDITATION 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 (02009 EPA, Inc 1 EMSL Analytical, Inc. 14375 23rd Avenue North, Minneapolis, Mn 55447 Phone: (763) 449 -4922 Fax: (763) 449 -4924 Email: minneaoolislabgDemsl.com J Ann: Jim Lindahl Customer ID: ENVP52 Environmental Property Audits Inc Customer PO: 2701 4th Avenue North Received: 06/01/09 1:30 PM Anoka, MN 66303 EMSL Order: 350902599 Fax: (763) 323 -6677 Phone: (763) 323 -6700 EMSL Proj: Project: 5754 Oak Green Ave Analysis Date: 6 /2/2009 Asbestos Analysis of Bulk Materials via EPA 600 /R- 93/116 Method using Polarized Light Microscopy Non - Asbestos Asbestos Sample Description Appearance % Fibrous % Non- Fibrous % Type 09 -04109 B -01 Wall Sheetrock/Jt TanNWhite 10% Cellulose 90% Non - fibrous (other) None Detected 350902599 -0001 Compound Non - Fibrous Heterogeneous Sheetrock/Joint Compound 09 -04109 B -02 Bathrm Glue on BrownlTan 5% Cellulose 95% Non - fibrous (other) None Detected 350902599 -0002 Wall Panels Non- Fibrous Homogeneous Q o )4109 B -03- Kitchen Original Gray 95% Non - fibrous (other) 5 Chrysotile r Tile 9x9 Grey Floor Tile Non - Fibrous 350902599 -0003 Homogeneous 09 -04109 B -03- Kitchen Original Black 100% Non - fibrous (other) None Detected Mastic 9x9 Grey Floor Tile Non - Fibrous 350902599 -0003A Homogeneous 09 -04109 B -04 Ceiling Texture White 90% Non - fibrous (other) None Detected 350902599 -0004 SW Bedrm Non - Fibrous 10% Perlite Homogeneous 09 -04109 B -05 Ceiling Texture L. White 90% Non - fibrous (other) None Detected 350902599 -0005 Rm Non - Fibrous 10% Perlite Homogeneous 09 -04109 B -06 NW Ext Wall White /Black 55% Cellulose 45% Non - fibrous (other) None Detected 350902599 -0006 Shingle /Siding Fibrous Heterogeneous Analyst(s) - Heidi Johnson (12) 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 od 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 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 US Government NVLAP Lab Code 200019 -0 Test Report PLM - 7.12.0 Printed: 6/2/2009 12:02:13 PM 1 EMSL Analytical, Inc. 14375 23rd Avenue North, Minneapolis, Mn 55447 0* " - 11 1 1 1 , . ­ ,,, J Phone: (763) 449 -4922 Fax: (763) 449 -4924 Email: minneanolislabOemsl.com — Attn: Jim Lindahl Customer ID: ENVP52 Environmental Property Audits Inc Customer PO: 2701 4th Avenue North Received: 06/01/09 1:30 PM Anoka, MN 55303 EMSL Order: 350902599 Fax: (763) 323 -6677 Phone: (763) 323 -6700 EMSL Proj: Project: 5754 Oak Green Ave Analysis Date: 6/2/2009 Asbestos Analysis of Bulk Materials via EPA 600/R- 93/116 Method using Polarized Light Microscopy Non - Asbestos Asbestos Sample Description Appearance % Fibrous % Non - Fibrous % Type 09 -04109 B -07 NW Ext Wall Black 75% Cellulose 25% Non - fibrous (other) None Detected 350902599 -0007 Paper Fibrous Underlayment Heterogeneous 09 -04109 B -08 Roof Top Shingle Gray /Black 25% Glass 75% Non - fibrous (other) None Detected 350902599 -0008 Grey Fibrous Heterogeneous 00 4109 B -09 Roof Original Gray /Black 40% Cellulose 60% Non - fibrous (other) None Detected 2599 -0009 Shingle Grey Fibrous Heterogeneous 09 -04109 B -10 Roof Plastic Black 88% Non - fibrous (other) 12% Chrysotile 350902599 -0010 Cement Patch Non - Fibrous Chimney Heterogeneous 09 -04109 B -11 Original Garage Brown /Black 40% Cellulose 60% Non - fibrous (other) None Detected 350902599 -0011 Roofing Under Fibrous Metal Heterogeneous Analyst(s) -- Heidi Johnson (12) 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 od 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 7 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 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 S 1VLAP G overnment t Lab Code 200019 -0 Test Report PLM - 7.12.0 Printed: 6/2/2009 12:02:14 PM THIS IS THE LAST PAGE OF THE REPORT. 2 r '350902599 Asbestos Chain of /Custody EMsL ANA INC. 14375 23 AVENM EMS Order Number (tab U se OW: MINNEAPOLIS, MN 55447 PHoNE: (763)449 -4922 �«.�� w..wcr,wo+►�, i�ag ''` I � .. ! FAx: (76349 -4924 EMS1. -Dili to: tV , 'Same U Different qom parry ; E ►A Inc. !t %iii to is oilltemnt nos iwoucNaa In C mnwr is Street 2 20 'tth kyerwe Kara Thud P" ,9w r - quits wn ftn auttrart Saw NE fh w C V Ap olca StatelF'rovinee: t« rj tipJPatWl Code: 55303 � Ce�untrY- rte Report To (Name: Jim Lindabl _ . Fax #: 7f.:i,3Z -X -n Tele i NatttelNurnber: 323.6700 Email Address: Ptettlpee► Provide R�ttufibs: t ax Email P I _U.S. State Samples Taken: - Turr+unfkne AonaDayPt +�a�ega,aaa cMrr"rousaerraar .4� U Hours 24 HM d8 Hr 9 s 4 Da � D 10 Da .... . "1=or f�Jtd R rbcura Ploaaa ihdeldtr, se ftaete,fs. TlMatti +s ei f,rreRN dank► _U 3 Hours an suffIlOdIaMM AM form aer�s. Ans,6W ,a jy rn er ooardh" Mh JcM& s Terms and Conti ons kaC�d h the TEM F'taice G�,lda TEM - AID ... ... I Us p Nt4SH 7400 p AHEi2A 40 CFR, Part 763 ❑ Ntierovsc - ASTM D 5755 p wl OSHA ft. TWA p NI SH 7402 p WPe - ASTM D0480 Bul 60Qfa arsorttn o limit) � [j EPA Level li p Carpet Semicadon (EPA 801=- 8C1�'1 LM t37"} 2 1 r .k! 133/116 (4196 p ISO 10312 � SolURgcklli'pMlculft, p PLM EPA NOB (, Bulk p PLM CARS 435 - A (0.25% serts") Point Count D TEM EPA NOS C] PLM CARS 435 .13 (0.1 % senWItiv(ty) C] 400 ( <0.25%) p 1000 ( #0.1' p NYS NOB 1918.4 (non- friable -N1) p TEM CARS 435 - B (0.1% swaitivity) Point Count w/Gravtmetric p Chatfield SOP p TEM CARS 435 - C (0.01% sensitivity) p 400 (40.25%) p 1000 (-0.1 %) p TEM Mess Analysis -EPA 600 sec. 2.5 0 EPA Protocol (Semi- Quantitative) [] NYS 108.1 (irMabie in NY) TENt -- W ;EPA 1002 Q EPA Protocol (Quantitative) I Other: % All Fiber Sizes p Waste ❑ D ng 0 N 1 8 6 2 NOB ( on- fdabkr- Y) Fibers >10{rm Waste Drink LD Check For Pooltive Strap — Clearly Mentlty Homogenous Group Samp lers Name: I Sampl Slgr►ature: V'olurne/Artsa Air) DateM Sample # ( ed Sa mple Descrlvtlo�n HA # (Bulk} sampled 0 1 v 0 e b i Ii % PJ j Tj5 t- T A 4,U S VJ 19 c-O 4r- @.- $ tAe -,c- L Kin, 0 0 , 5 ,, ('} _ l w � v+l - � ;�Sb P � t� t•t r� t,•-r � ± r�..�. }- -_ � ' "`c�i�t ' �' Client sample # et "total # bf Banmptas. Relinquished (Clie nt): i (a�z Time: (;• i � U Qat ., �— Received (Lab): Date: Le { t) ` ) Time: Comments/Special ns'beictionas: owl~ ooft ►ahrWN Coe -RI -v, Page 1 of pages • 351902599 Asbestos Chairs of Custody �r s 4375 � RDAV NU 1.�.37� 23`� �v�NUE EMSL Order Number ("b U50 ()nlY): MINN IS Mr4 55"7 I - 0 I 9� 1 PHONE; (763) 449 -4922 pU ■MBLWR,61MCM, RIC_ - FAX, (763) 449 -4924 MNAMI9A��� Additional Pees of the Chain cat Custody are only necessary it needed for additional sam4ria ift mat& Sample � Sample D .. Vol Ai r) Qateltime escripdo„ _ Bulk Sampled _ _O�(2, 0 0 0 IL u 1 rA 1DA "ComrnerftMpectal lrmtructons: page�z of — pages coftvr" .**- AMWOM R+- 1,' Garage SW Bedroom *804 C Kitchen *803 Bath *flnfi R07 *B02 *801 NW Bedroom Living Room *805 Exterior Samples BOB 809 810 B11 5754 OAKGREEN AVENUE OAK PARK HEIGHTS, MN N NO to scale 5762 Oakgreen Issued City Demo Permit & Additional Conditions Application fro Demolition Permit Well Closure Documentation Asbestos Abatement Removal Certification CITY OF OAK PARK HEIGHTS PERMIT NO.: 2009 -00084 14168 OAK PARK BLVD. N. #2007 OAK PARK HEIGHTS, MN 55082 -2007 DATE ISSUED: 06/18/2009 (651) 351 -1661 FAX: (651) 439 -0574 AORESS 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 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. -10 APPLICANT OTHER PERMIT FEE 25.00 OTHER PERMIT SURCHARGE, FLAT 0.50 OAKGREEN VILLA LLC TOTAL 25.50 P.O. BOX TER PAID WITH CHECK # 5040 STILLWATER, MN 55082 - OWNER OAKGREEN VILLA LLC P.O. BOX 2118 STILLWATER, MN 55082 - 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 Alm ork has commenced. The applicant is responsible for ng all required inspections are requested in conformance with the Minnesota State Building Code. SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. ONLY 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, 3752, 5770, 5800, 5830 and are located west of Oakgreen Ave, south of the Xcel Energy Transmission Towers and north of 58 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, theAppticanrmust 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 15 1 ^, 2009. 4. Should no fire training exercises occur or should not all homes be included in such training exercises, the Applicant shalt 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 15"h, 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 remediatiQn actions, the Applicant shall also forfeit the $25,000 Letter of Credit to the City as penalty. ((• Initial: Page i of 2 7. The Applicant shall reimburse the City for costs associated with water -use for training exercises and I • shall follow standard City water consumption 1 rates tables. The City will not charge the Applicant for I costs associated with additional staff time required by the Public Works Department. S. 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 I, "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. - Date:. Tilh Nolde, PreSid t Green Tom 1 �� JENNIFER M. PINSKI � NOTARYPusuc- MINNESOTA Ot My Commission Expires Jan. 31. 2012 -------------- ( ary tamp 4) Da te ric nson, City Administrator y Pe t ly signed by City Administrator: G � 7 "/ o ry ate: 6 r- - - - - -- ------------------- - JENNIFER M. PINSKI (Affix notary stamp 4) NOTARY PUBLIC -MINNESOTA My Commission Expires Jan. 31, 2012 Page 2 of 2 8AY pwr Fi lltE D r c • c�N1�.T . A, Oak Park Heights 3 r�fl ST. Application for Permit 13pYprDrfi 1N1tU 55oa3 Owner: 1 uj% CLC Contractors 9 MW EG # w. OORN By iE vo Address: N W � 11 Address: 5 *1 . S - rAU w' M#L.iM0 2,. Stiu.wi�rl =12 MN Phone: (W) 43 1*7 Phone: (OV) A - 5*.3 i&V JOB ADDRESS CLASS OF WORK Number Street New Add Sign Alter Repair Move Demolish Front or Width Side or Length Height in No of Area of Type of Occupancy Project lk*19! d in Feet in Feet Feet Stories Lot Construction Valuation tTt4JAj Occupied / R r l / $ZS � ,, Legal Description (if no address assigned: - ,a Description of Work Being Done D EI' OLISH ION " ri Q E N-Ar .T X BV t'm 1 LL- L-E AN "Up a F1 tolL EN& Do Lom RXSTb Q. ONA , 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 inspectionb ho ce noted upon the Inspection Record Card. Dated: �/ Applic4t's Signature For Office Use Onlv: City Building: City Plumbing: City Mechanical: Jim Butler, Building Official Plan Review: City of Oak Park Heights 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: WELL OR BORING LOCATION IVNNNESOT'A DEPARTMENT OF HEALTH Minnesota Well and Boring H 27 � 5 W ELL .AND BORING SEALING RECORD Sealing o County Name Minnesota Unique Well No. I Washington Minnesota Statutes, Chapter 1091 o W series Township Name Township No. Range No. Section No. Fraction (sm. - Ig.) Date Sealed Date Well or Boring Constructed Bavtown 29 20 5 ISE" NE' NE' 6/12/2009 _ Latitude degrees minutes_ seconds Depth Before Sealing 131 ft. Original Depth ft. 4) ON: Longitude_ _ degrees_ . _ minutes_ seconds AQUIFER(S) STATIC WATER LEVEL Numerical Street Address or Fire Number and City of Well or Boring Location IN Single Aquifer 0 Multiaquifer y / 5762 Oakgreen lave N, OaPark tigt Water-Supply Well Montt. Well VIELL/BORING Measured 0 Estimated Date Measured__._ 612 _2 Show exact ideation of well or boring Sketch map of or bonny 125 ❑ in section grid with "X " location, showing g p property (U Env. Bore Hole ❑ Other ft. below above land surface fines, roads, and buildings. N CASING TYPE(S) „ ry Steel 0 Plastic 0 Tile 0 Other - — - - 1 � I I C - -'--- -- -- -- ------- WELLHEAD COMPLETION w E -- Outside: 0 Well House At Grade Inside: Basement Offset I 0 Pitless Adapte, /Unt ❑ Buried 0 Well Pit 1 --�--- - -- - e e Buried ' S - ❑ Weil Pit 0 Other I--t Mne r r r e `" ❑ Other P PERTY O EFJ'S N C CASING (S) NAME CASINS) � 1W "l Diameter /l Depth Set in oversize hole? Annular space initially grouted? Property owner's mailing address it different than well location address indicated above 4 in. from O _ to 122 ft. 0 Yes lk No 0 Yes 0 No 0 Unknown 773 Greed wig Way Stillwater, MN 55082 --in. from _ to ft. ❑Yes L] No L] Yes [] No [) Unknown in. from_,_ to ft. 0 Yes [] No [J Yes 0 No 0 Unknown 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 122 to 131 ft. OBSTRUCTIONS 0 Rods /Drop Pipe ❑ Check Velvets) F I Debris ❑ Fill )k No Obstruction Type of Obstructions (Describe) LOGICAL MATERIAL I COLOR I HARDNESS OR FROM TO Obstructions removed? 0 Yes 0 No Describe - FORMATION PUMP If not known, indicate estimated formation log from nearby well or boring. i Type t il'1bI71P1 - c,"i %,- e _�..o m �7 �' __ Sarni /Gravel var V arLed 0 122 X Removed ❑Not Present 0 Other I Lime Rock Yellow Hard 122 1311 METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS, OR CASING AND BORE HOLE: l No Annular Space Exists ❑ Annular Space Grouted with Tremie Pipe ❑ Casing Perforation/Removal in. from to ft. 0 Perforated [] Removed Il l in. from to ft. 0 Perforated L] Removed Type of Pedorawr Other l GROUTING MATERIAL(S) (One bag of cement = 94 lbs., one bag of bentonite = 50 lbs.) /. Grouting Material Neat Cement from 0 to__ ft.____ yards_ .— bags from.___ - to_.__. R ^ _ ` yards_.__, bags from __ to___ ft.___ yards__._ bags OTHER WELLS AND BORINGS REMARKS, SOURCE OF DATA, DIFFICULTIES IN SEALING I Other unsealed and unused well of boring on property? 0 Yes X 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. Mantvla Well. Orzllin >, Inc 1394 Licensee Business Name License or Registration No. t (� / 583 6/12/2009 CertlnE'O1 .presentalw lure Certified Rep. No. Date H 2 76515 Ip On I .vn.n MINN. DEPT OF HEALTH COPY ` Name of Sealing Well or Boring HE- 01434 -11 IC# 140 - 0423 2/08R • 76 St. Croix Trail N Lakeland, MN 55043 3 651.436.8559 (F)651.436.2021 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 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 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, enms Schum Vice President 651436-8559 651436-2021 fax • r ASBESTOS MATERIAL SURVEY 5762 OAKGREEN AVENUE NORTH OAK PARK HEIGHTS, MINNESOTA • 1.0 INTRODUCTION Environr eKaUroperty Audits, Inc. (EPA, Inc.) conducted a visual survey at the residence located kt 57662 ' akgreen Avenue, Oak Park Heights, MN. The survey for asbestos - containing materialssb4C-n'I) 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: 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 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. 5762 Oak .-reen Ave N ] ©2009 EPA, Inc .. l ASBESTOS MATERIAL SURVEY 5762 OAKGREEN AVENUE NORTH OAK PARK HEIGHTS, MINNESOTA • 3.0 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 • Sheetrock/joint compound • • Panel adhesive • Roofing Materials Of the materials sampled, the following were found to be asbestos containing: • Original kitchen (gold) linoleum backing • Paneling adhesive (kitchen) • Plastic cement patch 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 Oakgreen Ave N 2 ©2009 EPA, Inc ASBESTOS MATERIAL SURVEY 5762 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 I% by weight. Sample # Functional Space Material Identification Asbestos Content Material Amount" 09 -04112 B -02 Kitchen Original linoleum (gold) backing 65% Chrysotile 120 sq. ft. 09 -04112 B -05 Kitchen Paneling adhesive 3% Chrysotile 200 sq. ft. 09 -04112 B -09 Roof Plastic cement patch 5% Chrysotile 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. Sample # Functional Space Material Identification J Asbestos Content 09-04112 B -01 Bathroom Linoleum (white w /lines) ND 09-04112 B -03 Kitchen Linoleum (cream w /black pattern) /mastic ND 09-04112 B -04 Kitchen Sheetrock/joint compound ND 09 -04112 B -06 Roof Felt paper underlayment ND 09 -04112 B -07 Roof New shingle (dark w /white) ND 09 -04112 B -08 Roof Original shingle (green /white) ND 7.0 NON - SUSPECT ASBESTOS MATERIALS The following materials are present in this residence but are not considered as suspect asbestos building materials. Functional Space Material Identification Foundation Concrete Supports /Framing Wood 8.0 ASBESTOS BUILDING INSPECTOR ACCREDITATION Please see the following pages for Minnesota Department of Health certification information. Inspector Jim Lindahl Exp. Date 11/25/09 Minnesota Certification Number — #AI2333 5762 Oakgreen Ave N 3 (02009 EPA, Inc EMSL Analytical, Inc. 14375 23rd Avenue North, Minneapolis, Mn 55447 Fax: of Phone: (763) 449 -4922 F ( 3) 449 -49 4 Email: minneao IslabSemsl.com Attn: Jim Lindahl Customer ID: ENVP52 Environmental Property Audits Inc Customer PO: 2701 4th Avenue North Received: 06/01/09 1:30 PM Anoka, MN 55303 EMSL Order: 350902602 Fax: (763) 323 -6677 Phone: (763) 323 -6700 EMSL Proj: Project: 5762 Oak Green Ave Analysis Date: 6/2/2009 Asbestos Analysis of Bulk Materials via EPA 600 /R- 93/116 Method using Polarized Light Microscopy Non - Asbestos Asbestos Sample Description Appearance % Fibrous % Non- Fibrous % Type 09 -04112 B -01 Bath Rm Linoleum Gray/White 25% Cellulose 75% Non - fibrous (other) None Detected 350902602 -0001 White w /Lines Fibrous Heterogeneous 09 -04112 B -02- Kitchen Orig. Gray 20% Cellulose 15% Non - fibrous (other) 65% Chrysotile Backing Linoleum Gold Fibrous 350902602 -0002 Heterogeneous Analyzed back pad first per client instructions- Stop Positive 0-04112 B -02- Kitchen Orig. Stop Positive (Not Mastic Linoleum Gold Analyzed) 350902602 -0002A 09 -04112 B -02 -Vinyl Kitchen Orig. Stop Positive (Not 350902602 -0002e Linoleum Gold Analyzed) 09 -04112 B -03- Kitchen Linoleum Gray /Black/Cream 25% Cellulose 70% Non - fibrous (other) None Detected Linoleum Cream w /Black Fibrous 5% Glass 350902602 -0003 pattern Heterogeneous 09 -04112 B -03- Kitchen Linoleum Tan 100% Non - fibrous (other) None Detected Mastic Cream w /Black Non - Fibrous 350902602 -0003A pattern Homogeneous Analyst(s) Kristen Lindfors (10) 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 a >press 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 Government NVLAP Lab Code 200019 -0 Test Report PLM- 7.12.0 Printed: 6/2/2009 11:22:22 AM 1 EMSL Analytical, Inc. 14375 23rd Avenue North, Minneapolis, Mn 55447 Phone: (763) 449 -4922 Fax: (763) 449 -4924 Email: minneaoolislab(diemsl.com Attn: Jim Lindahl Customer ID: ENVP52 Environmental Property Audits Inc Customer PO: 2701 4th Avenue North Received: 06/01/09 1:30 PM Anoka, MN 55303 EMSL Order: 350902602 Fax: (763) 323 -6677 Phone: (763) 323 -6700 EMSL Proj: Project: 5762 Oak Green Ave Analysis Date: 612/2009 Asbestos Analysis of Bulk Materials via EPA 600 /R- 93/116 Method using Polarized Light Microscopy Non - Asbestos Asbestos Sample Description Appearance % Fibrous % Non- Fibrous % Type 09 -04112 B -04 Kitchen Tan/White 10% Cellulose 90% Non - fibrous (other) None Detected 350902602 -0009 Sheetrock/A Fibrous Compound Heterogeneous SR /JC Composite 09 -04112 B -05 Kitchen Paneling Gray 97% Non - fibrous (other) 3 Chrysotile 350902602 -0005 Adhesive Non- Fibrous Homogeneous Only tested adhesive per client instructions 1 004112 B -06 Roof Plastic Black 30% Cellulose 70% Non - fibrous (other) None Detected 350902602 -0006 Cement Patching Non - Fibrous (Chimney) Heterogeneous 09 -04112 B -07 Roof New Shingle White /Black 45% Cellulose 55% Non - fibrous (other) None Detected 350902602 - 0007 Dark with White Fibrous Heterogeneous 09 -04112 B -08 Roof Original White /Black 35% Cellulose 65% Non - fibrous (other) None Detected 350902602 - 0008 Shingle green/white Fibrous Heterogeneous 09 -04112 B -09 Roof Felt paper Brown /Black 95% Non - fibrous (other) 5% Chrysotile 350902602 -0009 underlayment Fibrous Homogeneous Analyst(s) -- Kristen Lindfors (10) 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 od is 1% The above lest 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 nsib�lity 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 NVLAP Lab Code 200019 -0 Test Report PLM- 7.12.0 Printed: 6/2/2009 11:22:24 AM THIS IS THE LAST PAGE OF THE REPORT. 2 r I i350902.602 Asbestos Chain of Custody EMSL A At. ICAL, INC. EMS Order Number (4h us e t7nw. 143�(f S, MN 07 n+�tlr , lu�v X8447 xw+rcvir►r�►4 u+c Pty: CMp449 -4= . � _ � _..__.._ ............._. FAX: (763)449-4924 EM-13111 ter Same U DOrent �L:_ o - aal�Y : EPA, x III w ks aanarent Ma vatlana M Ca nta►d�"' Street: 27AD1 Third P&kffiy Mgukvs r rftn "whadon ham Nird,p" City: AUQb EMS ravines W ZiplPostal Cade: 8.( LCoa is art To (Name): Jim LindaM F*X #: 763,321 Tate one# 763.323.6700 E mO Addseus: 'Aft=C ZM'%t ta- PEJ"g Nams/Number -- t� f"a►r�L ? .t ,- 'r'I T�% V ( p 4 Turn State Samples Take m , � E m a il ! Purchase � lane -- Pleas �Cttt►cK sa Rro vld+r .. e` R ! Pt �Haunt �B I�c�uts � 24 Hraa °-°�� am ass Orde . � �a s 1 U .S. 4 �t . S i0 ft " w hours, lease aheed to aerJri i+afe� . is promlum a to fnr How 3 �`t:'�tf AW-R� L ehr+e�+ Yap sold" tie A�'� nor TEM Ak 3 R pr, � an awatrorr tram �► n►�s sue. � � �, aaoo rdenca ,� r11 e+►rsc. a Tarries and caimans bcalosar �, tl�t,9rtaM�al 13�r culaa { - TEM. Dmt MW 74M 0 94ERA 40 CFR, PWt 783 a Mm me, - AS M Q 6765 [} W OSFtA Mr. TWA 0 NIOSN 7402 Wipe - ASTM 06480 _ PLU - Bulk bgg*g �, jQ Q EPA Level li Q Carpet Sonietrtion (EPA 6001,W 11V t #W EPA 60018 -MM 16 (<1%) p IS010312 t��/armlCatttt+e ® PLM EPA NOS ( <I%) ! TEM - Bulk (3 PLM CARS 435 - A (0.26% sensitivity) Paint Court © TEM EPA N Q PLM CARS 435 - 8 (01% ae�#tvity) ( 400 (t0 -Z5%) Q 1000 ❑ NYS NOB 198.4 (non- friiable -NY) p TEM CARS 435 - B (0.1% sensitivity) Paint Count w /Gravimetric [] Chatfield SOP 13 TEM CARS 435 - C (0.01% st nslMy) i Q 400 (<0.25 %) [I 1000 (<01%) ❑ TEM Mass Analysis -EPA 800 sec. 2.5 [3 EPA Protocol (Sem Qu entllatim) r] NYS 1981 (friable in NY) TIM —Water EPA 100.2 Q EPA Protocol (Qua(Mlative) f L] NYS 198,8 NOS (non- frlable - NY) Pibera >lapm p Waste ❑ DrinkN - _ QM2 L. � Nl(}iSF! 902 ( 095) AN Fiber Sixes ❑ Waste 0 Drinking d Check For Positive Stop -- Clearly Identify Homtl"n Gr oup Samplers Name: � Sarrrrplere 83an"urm. , .. " YaluntefArea (i4ir'j tki6ttl'triie Sam ple # Sam ple Description HA (Bulk) Samplod o ti �-c. 00 6%t>. . :•1t3U.-wN 1 V C, Sf Pia ( 5f a. f r i 0 � a � �LO- SS I L c .CAE -w.v _ L 1 9 0 s Client Sam ! : ' Cl - t� Total # of Samples; Relinquished (Client): y f""(., date; Time: 1". 0 n'-V . Received (Lab): date; 9 Time:_ =C7 CorrrrnenbtlSptrcta instructions: . . .. c ,e+.aoeo.n.n- aow,�u�c- A,.snswn. Page 1 of pages r 350902602 Asbestos Chain of Custody EMS. ANra rnM, INC- EMSL 4rdw Wn bec {to use owyt 14376 23 AVENUE MJNN&APOUS, MN 58447 .�:`: t. t " FAX. (is3) 44 494 Addifi6nal Pages of the Chain of Custody are only necessary if needed for additional sample lnfWnakm VolunWAfta AI Ba W (� ` IelTlma Semp sam !� a Ree ctipdon FAA * Bulk liampled —f Oq-Oq 1 11- t 'Commonlslipeclel inetruclb6onsr Page —7,of --Z--mes Co*.Hod M.." - Ai4MMm WC - Rt - 5%!rAW i Garage Breezeway *B02 IB03 � SE Bedroom Kitchen "B05 BOP i 'B0ll Bath S Bedroom Living Room SW Bedroom Exterior Roof Samples Bab B07 5762 OAKGREEN AVENUE BOB N Bog OAK PARK HEIGHTS, MN Not to scale 577 Oakgreen Issued City Demo Permit & Additional Conditions Application fro Demolition Permit Well Closure Documentation Asbestos Abatement Removal Certification O t I CITY OF OAK PARK HEIGHTS PERMIT NO.: 2009 -00085 14168 OAK PARK BLVD. N. #2007 OAK PARK HEIGHTS, MN 55082 -2007 DATE ISSUED: 06/12/2009 (651) 351 -1661 FAX: (651) 439 -0574 SkESS : 5770 OAKGREEN AVE N PIN : 05- 029 -20 -11 -0026 LEGAL DESC : N/A : LOT 0 BLOCK 0 PARCEL 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. APPLICANT OTHER PERMIT FEE 25.00 ' OEN TWIG LLC OTHER PERMIT SURCHARGE, FLAT 0.50 P.O. BOX 119 TOTAL 25.50 STILLWATER, MN 55082- PAID WITH CHECK # 5040 OWNER GREEN TWIG LLC P.O. BOX 119 STILLWATER, MN 55082 - 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 Ift work has commenced. The applicant is responsible for ing all required inspections are requested in conformance with the Minnesota State Building Code. PY SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. 5`7g0 ONE` City of Oak Park Heights — Addendum to Demolition Permit: Additional Conditions Agreement Property Owner Green Twig, LLC (the 'Applioanf) has petitioned the City of Oak Park Heights, (the °City"), for a Do ' ermit to demolish the homes located at the following Oakgreen Ave. addresses: 5710, 5754, 575 5770 800, 5830 and are located west of Oakgreen Ave, south of the Xcei Energy Transmission wets and north of 58e 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: b Terms and Conditions of Demolition Permit: 1. Prior to the commencement of any training exerdse(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 forfuture construction. If construction does not commence by August 15"x; 2009, the Applicant shall remove all in -place septic system infrastructure and shall place a final topsoil application to ail 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 15 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 site 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. � • Initial: Page 1 of 2 7. The Applicant shall reimburse the City for costs associated with wate"se for training exercises and i 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 rlo warranty or guaranty that these properties are in a condition.suitable for fire training exercise. The Applicant agrees to indemnity 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 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 agreos 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 local rules, ordinances, laws and requirements of record. Date: �6 Ti Nolde, Presld t Green JENNIFER M. PIN SKI NOTARY PUBLIC - MINNESOTA Ot My Commission Expires Jan. 31.20`12 { ary tamp � ------ ____-- �r�.._,. -.._,. Date 5 r1 j1D O� 1 ric nson, City Administrator Pe It y signed by City Administrator: r ^— Date: �0°1 .- - - - - -- J � . _emu ° ry JENNIFER M. PINSKI (Affix notary stamp 4) NOTARY PUBLIC - MINNESOTA My Commission Expires Jan, 31, 2012 Page 2 of 2 r: Al stslN`re. CaNrr+c- Oak Park Heights 2q to. 3 ", Sr. Application for Permit aporpor", IMF .55GD-Z T Owner: 6949 lTW%A CLC contractor, v E EUCA VM1N G (ITONN By nau) Address: 173 rGe"N l W 16 Address: . S r�u w�t.M�1 St�u.wF!T rv►N Phone: (W) Phone: VV) 14 2 6 - 5'3 it. JOB ADDRESS ( CLASS OF WORK Number Street New Add Sign Alter Repair Move Demolish 5770 �K F,N Avg I E R D ❑ ❑ ❑ F, t Front or Width Side or Length Height in No of Area of Type of Occupancy Project Dt! -ISJ 6 in Feet in Feet Feet Stories Lot Construction Valuation �} Occupied R f STUR�1 u'A Legal Description (if no address assigned: Description of Work Being Done D EMOLI SH IoM MrL..T1 GS B-V P W l . 1 TE CL'E A a F1 NAL TEN& Do R1,5T0 L" 04 . M 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. Th �plicant r agrees to notify the Building Official of each the required inspections 24 ho as ed upon the Inspection Record Card. Dated: �/ A lica'ht's Signature pp 9 For Office Use Only: City Building: City Plumbing: City Mechanical: Jim Butler, Building Official Plan Review: City of Oak Park Heights State Surcharge: Signage: 14168 Oak Park Blvd. N. City Utility Meter: P.Q. 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: WELL OR BORING LOCATION I MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring � � � � - 1 6 Sealing No. Count Name I WELL AND BORING SEALING RECORD Minnesota Uni Well No. Minnesola Statutes, Chapter 103' or W -senes No. W ashington p IL.— blflnA A W knower Township Name Township No- Range No. Section No. Fraction (sm. - Ig.) Date Sealed Date Well or Boring Constructed Baytown 1 29 � 20 J 5 I SE' NE' NE 5/12/2009 Latitude degrees_ minutes_ seconds Depth Before Sealinu 151 ft. Original Depth ft. ION: Longitude_ _ - - � degrees_ minutes � , seconds - -- IAQUIFER(S) STATIC WATER LEVEL Numerical Street Address or Fire Number and City of Well or Boring Location IK Single Aquifer LJ Multiaquiter 5770 Oakoreen Ave N, Oak L' ark Hgts IN Measured ❑ Estimated Date Measure /1 2/0 ] Water - Supply Well ❑ Monit Well Show exact l of well or boring Sketch map of well or boring 121 in section grid d with "X" location, showing property +❑ Env. Bore Hole ❑ Othel ft. �'] below ❑above land surface { I N iI Imes, roads, and buildings CASING TYPE(S) -, -- - - - I - -- I -- y�'� (K'] Steel ❑ Plastic ❑Tile ❑Other -��... WELLHEAD COMPLETION W E T , y� Outside: ❑ Well House ❑ At Grade Inside: Basement Offset -- -- - -- -- - -. I t Mde Pitless Adapter /Unit ❑Buried ❑Well Pit L� f 1 , ❑Buried s ❑ Well Pit ❑ Other 1- 1 Mile ---1 U Other P PERTY O ER'S NA�t /�.pMPANY NAME CASING(S) green 'wig Jl Diameter ((11 Depth Set in oversize hole? Annular space initially grouted? Property owner's mailing address d different than well location address indicated above _ 5 in. from V i. ft ❑ Yes [N No L) Yes ❑ No ❑ Unknown 773 Green Twig; Way Stillwater, MN 55082 n. from to ft. ❑ Yes ❑ No ❑Yes ❑ No E] Unknown in. from__ to ft. ❑ Yes ❑ No ❑ Yes ❑ No [J Unknown WELL OWNER'S NAMEICOMPANY NAME SCREENIOPEN HOLE Weil owner's marling address it different than property ownei's address indicated above I Screen from to ft. Open Hole from 123 to 151 ft. ! OBSTRUCTIONS U Rods /Drop Pipe ❑ Check Valve(s) ❑ Debris ❑ Fill Xj No Obstruction Type of Obstructions (Descrlbal ��OGICAL MATERIAL COLOR I HARDNESS OR i FROM I TO I Obstructions removed? L] Yes [] No DescrrbP FORMATION It not known, indicate estimated formation log from nearby well or boring. i PUMP Type Su'Ixnersible Sand /Gravel Varied Varied 0 123 . 1 Removed ❑ Not Present L] Other L imerock Yellow Hard 123 151 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 in. from to ft. ❑ Perforated ❑ Removed Type or Perforator L] Other GROUTING MATERIAL(S) (One bag of cement = 94 tbs., one bag of bentonite = 501bs.) Grouting Material Neat Cement from 0 to_ ft. yards 22 bags I I from to_ ft._.__— yards___—._ bags 1I from_ __ to_ ft._ yards___ bags OTHER WELLS AND BORINGS s� REMARKS, SOURCE OF DATA, DIFFICULTIES IN SEALING Other unsealed and unused well or boring on property? D Yes X 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. Mantyla Well Drilling, Inc 1394 Licensee Business Name License or Registration No. • �� �-�. -. 583 0/12/2009 Ce d Repres�lature Certified Rep. No. Date H O H 276516 I Rob L MINN. DEPT "r E.P,LT "i 1 C; ]i3Y Name of Person Sealing Well or Boring HE- 01434 -11 IC# 140 -0423 2I08R t : zMeo 76 St. Croix Trail N Lakeland, illlN 55043 651.436.5559 (F)651.436.2021 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 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, a ennis Schum Vice President 651436-8559 651436-2021 fax r x A' Ehv� 1� `RTH fs � ;�i G�I�I'S� lYI�:lY�iE$:f1TA Yy qq � � 130 I NTRODUCTION A Y Environmental, Property Audits, Inc: (EPA, Inc.) conducted a visual survey at the residence located at 5770 Oakgreen Avenue, .Oak Park He ghts; lkkN The survey for. asbestos cor tainmg materials (ACM) was completed on May9, 2009, for 1VIr 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 (1 CM) as found in or on the residence. This survey included an inspection of all s.%spected asbestos containing building materials and collection :of bulk samples: EMSL Analytical, Inc:, 'Minneapolis MN, analyzed the samples utilizing Polarized Light Microscopy (PL1VI) Method BPA 6Q0/R= 93/116. The pri marymaterials, which were sampled included: wall plaster, sheetrock/joint compound, wah;texture, and ceiling texture. } 1Vlnnesota licensed asbestos inspector from EPA, Inc. conducteda building survey for the 7. ldenfification'and assessme'rt of accessible suspect ACM. at the residence located at 5770 green:Avenue, Stillwater. The following activities have beets completed ,y EPA, Inc.: Awalk� through o.f.the buildings,interior spaces, w th observations of accessible suspect ACM. Raridopi sample collection from suspect ACM building materials with consideratj to 0mogepeous areas and material types. .Mapping and logging bulk samples for future reference. E stimated quantity,ofrnaterial.types identified a, - asbestos g.(gre4te that 1 %). Anal `is of bulk sam les b olarized� li ht'micro.sco y .utihzin ElVISL Anal ical, Inc. of y p: p g� p g nneapols. - , . " l bnratory a� ysis confrmed.matenais that are asbestos ,containing and the, summary des the following infor - ati xi - 3 0 Funding Descrip mi , 4 0 StisPect Buil "ding Materials, & ozitain ng Materials List, 6 0Ikon= asbestos Containing Materials _List, 7.0 Non- t.lvlateri4' and 8.0 Inspector Accreditation. I11 CATIONS . # nade:reasonable attempts to access all, -areas of tlie.reside ice as presented witlui� the �.4, h s work. The following area.,s and/or materials were riot able to be. accessed due to anems or.other hmitatiois. To excavattons_were; rnade,.to identify t`Qundat oneoridittons below grade (i.e. exterior arnp proofing Q. roof samples were collected from the residonee Te roof had newer fiberglass h%n il Baseed on the similar appearance, it . assu -m. that the findings were - consistent. h file remainder of roof aria. f. 0260 Inc. on i in i ASBESTOS MXiEMA S�URVEI' 5770 O AKGltv*' Au N E o RTH OAK PARK $EIGHT S, .1VI >NNSOTA M 3. 10 ftILAI =NG'DESCRIPTION a _ Th e proje ct consisted of a single level resid y fin ence witkt aiarh'alli "shed basement, The eXterior walls of the building :are constructed of wood framing with fiberglass insulation. e The main . floor areas were a mix of hardwood flooring, carpet and ceramic tile. • The interior ceiling was primarily painted sheetrock. • 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 main roof had new 3 -tab fiberglass shingles over a tarpaper underlayment system., • The exterior walls were mainly stucco. Y c Theheating was provided by a forced air furnace system: y 4�O SU SPECT BU PING Z. Representative bulk samples of suspect ACM building materials were collected from the residence. The identified materials that were considered suspect and subsequently sampled include: Wall plaster tr o Ceiling texture + Sheetrock/joint compound Wall texture pr. Of the materials sampled, none were found to be asbestos containing: Please refer to the following section for the analytical laboratory results, including material k' locations, and quantities. x3 z,-&O AS91K OS CONTAININq MATERIAL, INVMTORY Ther - were no asbestos- containing building materials identified i this residence. 5'70 Qakgreen Ave N ®2009 EPA; Inc fi... �Ei:9Jlll B.'d = ASBESTOS MATERIAL SURVEY 5770 OAKGREEN AVENUE NORTH OAK PARK HEIGHTS, lY11NNESOTA 6.0 NON - AS BESTOS CONTAINING MATERIAL INVENTORY The following`materials had laboratory results of "None Detected" (ND) for asbestos content. No special regulations pertain to these building materials. C �. wy y 09- 0411 -1 B -0 1 Living Room Wall plaster (a1.1 layers) ND 09 -04111 B -02 SE Bedroom_ Wall plaster (all layers) ND 09- 0.4111 B-03 Hallway Wall plaster (both layers) ND 69 0.4111 B -04 SW Bedroom Slieetrock/joint compound ND 09 04111 R =05 Basement Wall texture (both layers) ND " 09:=04 °111'B =06 Garage Ceiling texture /sheetrock ND 09.04111 B -07 Garage Ceiling texture /sheetrock ND 09-04111 B -08 Garage Ceiling texture /sheetrock ND 7 0 XON' SUSPECT A:SBESTOSMATERIALS, The following materials are present in this residence but are not considered as suspect asbestos building materials. I L yS� � ,a .,dt �I , . k�; °4s� = - - . : Foundation Concrete Supports/Framing Wood $.0 ASBESTOS BUILDING INSPECTOR ACCREDITATION Please seethe following pages for Minnesota Department of Health certification information. t^ I ` pector Jim Lin'dahl Exp. Date 11/25/09 Minnesota Certification Number — #AI2333 ®2009 EPA, Inc 5770 Oakgreen Ave N 3 i EMSL Analytical, Inc. 14375 23rd Avenue North, Minneapolis, Mn 55447 Phone: (763) 449 -4922 Fax: (763) 449.4924 Email: minneaoolisia.b(@emsi.com Attn: Jim Undahl Customer ID: ENVP52 Environmental Property Audits Inc Customer PO: 2701 4th Avenue North Received: 06/01/091:30 PM Anoka, MN 55303 EMSL Order: 350902601 Fax: (763) 323 -6677 Phone: (763) 323 -6700 Project: 5770 Oak Green Ave EMSL Proj: Analysis Date: 6/2/2009 I Asbestos Analysis of Bulk Materials via EPA 600 /R- 93/116 Method using Polarized Light Microscopy Non - Asbestos Asbestos Sample Description Appearance % Fibrous % Non- Fibrous % Type 09 -0411 B -01 -Skim Wall Plaster Living White 100% Non - fibrous (other) None Detected Coat Rm Non - Fibrous 350902601 -0001 Heterogeneous 09 -0411 B -01- Wall Plaster Living Green 100% Non - fibrous (other) None Detected Green Layer Rm Non- Fibrous 350902601 -OODIA Heterogeneous 09 -041 1 -Tan Wall Plaster Living Tan <1% Hair 100% Non - fibrous (other) None Detected Layer Rm Non - Fibrous 350902601 -0001B Heterogeneous 09 -0411 8 -02 -Skim Wall Plaster SE White/Blue 100% Non - fibrous (other) None Detected Coat Bed Rm Non- Fibrous 350902601 -0002 Heterogeneous � 09 -0411 B -02- Wall Plaster SE Purple 100% Non - fibrous (other) None Detected Purple Layer Bed Rm Non - Fibrous 350902601 -0002A ill Heterogeneous )9 -0411 B -02 -Tan Wall Plaster SE Tan <1% Hair 100% Non - fibrous (other) None Detected -ayer Bed Rm Non- Fibrous 350902601 -00028 Heterogeneous nalys s) 'eidiJohnson (17) Rachel Travis, Laboratory Manager or other approved signatory 7e to ma n 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 ethod is a 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 tbility is limited to the cost of analysis. EMSL bears no re ponsibility for sample collection activities or analytical method limitations. Interpretation and use of test results are the 'sponsibility 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. JLAP Lab Code 200019 -0 t Report PLM- 7.12.0 Printed: 6/2/2009 10:28:52 AM 1 EMSL Analytical, Inc. 14375 23rd Avenue North, Minneapolis, Mn 55447 Phone: (763) 449 -4922 Fax: (763) 449 -4924 Email: min neaoolislabOemsLcom Attn: Jim Lindahl Customer ID: ENVP52 Environmental Property Audits Inc Customer PO: 2701 4th Avenue North Received: 06/01/091:30 PM Anoka, MN 55303 EMSL Order: 350902601 Fax: (763) 323 -6677 Phone: (763) 323 -6700 EMSL Proj: Project: 5770 Oak Green Ave Analysis Date: 6/2/2009 Asbestos Analysis of Bulk Materials via EPA 600 /R- 93/116 Method using Polarized Light Microscopy Non - Asbestos Asbestos Sample Description Appearance % Fibrous % Non- Fibrous % Type 09 -0411 B -03 -Skim Wall Plaster White 100% Non- fibrous (other) None Detected Coat Hallway Non - Fibrous 350902601 -0003 Heterogeneous I ! 09 -0411 B -03- Wall Plaster White <1 % Cellulose 100% Non - fibrous (other) None Detected Plaster Hallway Non - Fibrous 350902601 -0003A Heterogeneous 09 0 04 Sheetrock/J1 Tan/White 10% Cellulose 90% Non - fibrous (other) None Detected 350902601 -0004 Compound SW Non - Fibrous Bdrm Heterogeneous Sheetrock/Joint Compound 09 -0411 B -05- Basmt Wall White 100% Non - fibrous (other) None Detected Texture Texture misc Non - Fibrous 350902601 -0005 Heterogeneous 09 -0411 B -05 -Gray Basmt Wall Gray 100% Non - fibrous (other) None Detected Layer Texture misc Non- Fibrous 350902601.0005A Heterogeneous 09 -0411 B -06- Garage Ceiling White 100% Non - fibrous (other) None Detected Texture Texture Non- Fibrous 350902601 -0006 Heterogeneous I 1nalyst(s) Heidi Johnson (17) Rachel Travis, Laboratory Manager or other approved signatory Oue to L 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 method i e 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 i 'St Report PLM- 7.12.0 Printed: 6/2/2009 10:28:54 AM 2 EMSL Analytical, Inc. 14375 23rd Avenue North, Minneapolis, Mn 55447 Phone: (763) 449 -4922 Fax: (763) 449 -4924 Email: minneanolislab(@emsi.com Ann: Jim Lindahl Customer ID: ENVP52 Environmental Property Audits Inc Customer PO: 2701 4th Avenue North Received: 06/01/091:30 PM Anoka, MN 55303 EMSL Order: 350902601 Fax: (763) 323 -6677 Phone: (763) 323 -6700 EMSL Proj: Project: 5770 Oak Green Ave Analysis Date: 6/2/2009 Asbestos Analysis of Bulk Materials via EPA 600/R- 93/116 Method using Polarized Light Microscopy Non - Asbestos Asbestos Sample Description Appearance % Fibrous % Non- Fibrous % Type 09 -0411 B -06- Garage Ceiling Tan/White 10% Cellulose 90% Non - fibrous (other) None Detected Sheetrock Texture Non - Fibrous I, 350902601 -0006A Heterogeneous 09 -0411 B -07- Garage Ceiling White 100% Non - fibrous (other) None Detected Texture Texture Non - Fibrous 350902601 -0007 Heterogeneous 09- OOB -07- Garage Ceiling Tan/White 10% Cellulose 90% Non - fibrous (other) None Detected Sheetrock Texture Non - Fibrous 350902601 -0007A Heterogeneous 09 -0411 B -08- Garage Ceiling White 100% Non - fibrous (other) None Detected Texture Texture Non- Fibrous 350902601 -0006 Heterogeneous I 09 -0411 B -08- Garage Ceiling Tan/White 10% Cellulose 90% Non - fibrous (other) None Detected Sheetrock Texture Non - Fibrous I 350902601 -0008A Heterogeneous lnalyst(s) Heidi Johnson (17) Rachel Travis, Laboratory Manager or other approved signatory Due ification 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 %. 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. (VLAP Lab Code 200019 -0 st Report PLM -7 -12.0 Printed: 6/2/200910:28:55 AM THIS IS THE LAST PAGE OF THE REPORT. 3 I Asbestos Chain of Custody EMSL ANALYTICAL INC. EMSL Order Number (Lab use Only): 1 437523 R N 55 447 • �`J� MINNEAPOLIS, MN 55447 EMSL ANALYTICAL, INC. I �/ ��� �� I PHONE: (763)449-4922 FAx: (763)449 -4924 EMSL -Bill to: Same ❑ Different Company: EPA Inc ( If Bill to is Different note instructions in Comments - Street: 201 4th Ayenu ( Nnri -h I Third Party Billing requires written authorization from third party City: Anoka I State /Province: Zip/Postal Code: 503 i Country: T Report To (Name): Jim Lindahl Fax #: 763.313 - AA j Telephone #: 763.323.6700 Email Address: lind j@enar��nul tants -corn Project Name /Number: > 7 / o A j u . Please Provide Results: ❑ Fax []Email I Purchase Order: U.S. State Samples Taken: Turnaround Time (TAT) Options* - Please Check ❑ 3 Hours I ❑ 6 Hours I- R(24 Hrs ) ❑ 48 Hrs ) ❑ 3 Days I_ ❑ 4 Days I ❑ 5 Days J ❑ 10 Days *For TEM Air 3 hours16 hours, please call ahead to schedule. *There is a premium charge for 3 Hour TEM AHERA or EPA Level// 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. PCM - Air TEM -Air TEM- Dust ❑ NIOSH 7400 ❑ AHERA 40 CFR, Part 763 ❑ Microvac - ASTM D 5755 ❑ w/ OSHA 8hr. TWA ❑ NIOSH 7402 ❑ Wipe - ASTM D6480 LM -Bulk (reporting limit) El EPA Level 11 El Carpet Sonication (EPA 600 /J- 93/167) PLM EPA 600 /R- 93/116 ( <1 %) ❑ ISO 10312 Soil /Rock/Vermiculite ❑ PLM EPA NOB (<I TEM - Bulk ❑ PLM CARB 435 - A (0.25% sensitivity) Point Count ❑ TEM EPA NOB ❑ PLM CARB 435 - B (0.1 % sensitivity) ❑ 400 ( <0.25 %) ❑ 1000 I%) ❑ NYS NOB 198.4 (non - friable -NY) ❑ TEM CARB 435 - B (0.1% sensitivity) Point Count w /Gravimetric ❑ Chatfield SOP ❑ TEM CARB 435 - C (0.01% sensitivity) ❑ 400 ( <0.25 %) ❑ 1000 ( <O.1 %) ❑ TEM Mass Analysis -EPA 6.00 sec. 2.5 ❑ EPA Protocol (Semi- Quantitative) ❑ NYS 198.1 (friable in NY) TEM -Water: EPA 100.2 ❑ EPA Protocol (Quantitative) ❑ NYS 198.6 NOB (note- friable -NY) Fibers >10pm O Waste ❑ Drinking Other: ❑ NIOSH 9002 ( <1 %) All Fiber Sizes ❑ Waste ❑ Drinking ❑ Check For Positive Stop - Clearly Identify Homogenous Group Samplers Name: + Samplers Signature: Volume /Area (Air) Daterrime Sa # `'� Sample Description / HA # (Bulk) Sampled J� �) Q 01 W ty. it ua sTc-,(L z. e_ (w (2 a - O L4 .1,)(; cr ; (Loc,le /:5- ccvI- F r,.-t.J 5,4 f3J (L—. L " g D J (3 ) �1 1 ell `J� Client Sample # (s): o v) -- ©� '0 - --`� p > V'64 Td al # of Samples: Relinquished (Client): P 1 ff(, Date: /� "��tl� Time: eceived (Lab): 1A ( jl A A Date: �p I i � j� c "] Time: Comments /Speciallnstructions: i Controtled Dmment — Asbestos COC —R1- 3/1812009 Page 1 of 7.- pages Asbestos Chain of Custody EMSL ANALYTICAL, INC. EMSL Order Number (Lab use only: 14375 AVENUE MINNEAPOLIS MN 55447 EMSL ANALYTICAL. INC. PHONE: (763) 449 -4922 FAx: (763)449 -4924 Additional Pages of the Chain of Custody are only necessary if needed for additional sample information Volume /Area (Air) Date/Time Sample # Sample Description HA # (Bulk) Sampled Of Pds *Comments /Special Instructions: I, 'I - I Page 09 Z pages � I Controlled Document — Asbestos CDC — Rt — 3118/2009 I * SE Bedroom 802 Bath Mauer Bedroom 803* ."004 Family Room Listing Room I 801* I 005 was taken in *005 Kitchen the basement at this location *806 807* Foyer TV ,, Roam Garage I 5770 OAKOREEEI AVENUE N OAK PARK HEIGHTS, MN Not to scale U Certificate No: 5LMI 1250802IR 1 Expiration Date: November 25, 2009 This is to certify that James R. Lindahl has attended and successfully completed an 1 0 ASBESTOS INSPECTOR X .REFRESHER TRA iNiNG couRsE 0 ........... permitted by the State of Minnesota under Minnesota Rules 4620.3 702 to 4620.3 722 a i m M W X X 4M and meets the requirements Of .0 g Section 206 of Title II of the Toxic Substances Control Act (TSCA) conducted by I M 17a 4 , ^{ �.. Lake States E vironmen z - I n .9 L tdo in Hinckley N on November 25 YY 2008 Examination Date: Ahvember 25 .2008 y� .��� 14 Lake States Environmental, Ltd .-2 P. 0. Box 645, Rice Lak e, W1 54868 (800) 254-9811 raining Instructor 4 V a � ,/ •, . '� , .�;J ��', ' it ic'�` I• .',5 ; ,1 �r�C3 �v^ , , - �' ,9`� ys / �. N 5800 Oakgreen Issued City Demo Permit & Additional Conditions Application fro Demolition Permit Well Closure Documentation Asbestos Abatement Removal Certification CITY OF OAK PARK HEIGHTS PERMIT NO.: 2009 -00086 14168 OAK PARK BLVD. N. #2007 OAK PARK HEIGHTS, MN 55082 -2007 DATE ISSUED: 06/12/2009 (651) 351 -1661 FAX: (651) 439 -0574 A ESS : 5800 OAKGREEN AVE N PIN : 05- 029 -20 -11 -0065 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 CLOSED OR ABANDONED PER ESTABLISHED CRITERIA. APPLICANT OTHER PERMIT FEE 25.00 OTHER PERMIT SURCHARGE, FLAT 0.50 G EN TWIG LLC TOTAL 25.50 P.O. BOX 119 STILLWATER, MN 55082- PAID WITH CHECK 4 5040 OWNER GREEN TWIG LLC P.O. BOX 119 STILLWATER, MN 55082 - 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 *aing ended or abandoned for a period of 180 days any time ork has commenced. The applicant is responsible for all required inspections are requested in conformance ,, with the Minnesota State Building Code. 0 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. 'Fur 5800 out: City of Oak Park Heights — Addendum to Demolition Permit; Additional Conditions �greernent Property Owner Green Twig, LLC (the 'Applicant') has petitioned the City'of Oak Park Heights, (the "City"), for a DemoliCbn P to 5754, 5i5 demolish the homes located at the following Oakgreen Ave._ addresses: 5710, 2, 577 5800 5830 and are located west of Oakgreen Ave, south of the Xcel Energy Transmission To nd north of 58 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 i construction does not commence by August 15 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 15 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 remediatiQn 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 fortraining 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 Appiicant'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 local rules, ordinances, laws and requirements of record. 0 , O�ke� Date: �6 TIM Noide, PresidpQt Green T ' , ! � JENNIFER M. PINSKI NOTARY PUBLIC - MINNESOTA Ot v My commission Expires Jan. at, 2012 ( x ary tamp 4) -- Date � 5$00 ric nson, City Administrator Pe t y signed by City Administrator: r ate: r� o ry JENNIFER M. PINSKI (Affix notary stamp 4) NOTARY PUBLIC - MINNESOTA My Commission Expires Jan. 31, 2012 Page 2 of 2 'Jk BAy p F c nE • c CoNmcT . Al �tslN F k Oak Park Heights * zqq N. 3", Sr. Application for Permit gAyport 5'50D?h C4 //�� Owner:C*Eem IT W \ &CLC, Contractor, VEI, k� E1C A V" KG (79NN RynallJ Address: '7'73 G,¢ur4Tw I b Address: N E Sr�u w�.2.N / f 11� S.3 rMN Phone: ( ) 43a-q I � , � Phone: W) AU - E . JOB ADDRESS CLASS OF WORK Number Street �w New Add Sign Alter Repair Move Demolish 5�8 v 0 4696FM 4Ve ❑ ❑ ❑ ❑ ❑ ❑ Ft I t Front or Width Side or Length Height in No of Area of Type of Occupancy Project Det,ws) d in Feet in Feet Feet Stories Lot Construction Valuation ♦ Occupied R�5T7�R.Ik1,u'v'1 S� 7� Legal Description (if no address assigned: Description of Work Being Done: DEMOLISH IO • ri QX� P o I TE. CLEAW u p a F% w wry 145ro t By signature below, the applicant hereby agrees to work in accordance with the Ordinances of the Local Municipality, State Building Cbde, and the requirements enforced by the City of Oak Park Heights Building Department. The cant f r agrees to notify the Building Official of each the required inspections 24 hour d s ted upo a Inspection Record Card. Dated. Applic is Signature ' For Office Use- Onlv: City Building: City Plumbing: City Mechanical: Jim Butler, Building Official Plan Review: City of Oak Park Heights 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: MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring WELL OR BORING LOCATION , 7 ELL AND BORING SEALING RECORD Sealin No. f County Name WELL Minnesota Unique Well No. i Minnesota Statutes, Chapter 1031 or W series No. WASHINGTON Township Name Township No. Range No. Section No. Fraction (sm. -� Ig) Date Sealed Date Well or Boring Constructed INO BAYTOWN '29 I20 5 S9 NE 6/9/2009 Latitude degrees minutes seconds Depth Before Sealing 148 ft Original Depth it OON: Longitude_ degrees minutes_____ seconds I AQUIFER(S) STATIC WATER LEVEL Numerical Street Address or Fire Number and City of Well or Boring Location + S rigle Aquifer ] Multiaquiter nr'n C � WELL/BORING Measured ] Estimated Date Measured�j /� 2S.l0i) 58 man Lcrn N Pg� rhl_i -n X, Waite - Supply Well ❑ Montt. Well t G Show exact locatio 7 of well or boring Sketch map of well orb ng l26 in section grid with "X:' ovation, showing property El Env. Bore Hole ] Other ft. below above land surface N lines, roads, and buildings. CASING TYPE(S) I �j Steel ❑Plastic [_ Tile ❑ Other - -'r-- -'— - -- ` ---- xA- WELLHEAD COMPLETION I W E 1 t _ - 9.,t Outside: [] Well House ❑ At Grade Inside: mJ Basement Offset T P We Prt 'h less Adapter /Unit Buried � We II P I ,� a ❑Buried '� ❑ Well Pit S V ❑ Other - ---- - t Mile -� [-] Other P OPERIY 0 ER'S Nff OMPANY NAME CASING(S) Green 1W1- LL� Diameter Depth q Set In oversize hole? Annular space Initially grouted? Property owner's mating address if different than well location addiess indicated above 5 in. from 0 to 12 1 __ ft. ❑ Yes [�j No ❑ Yes [j No ] Unknown 773 Green Twig Way Stillwater, MN 5505 `— - in. from _ to ft. ❑Yes ❑ No ❑Yes (7j No ❑Unknown in, from____ to ft. ❑ Yes ❑ No ❑ Yes ] No (_] Unknown WELL OWNER'S NAME /COMPANY NAME I SCREEN /OPEN HOLE q Q Well owner's mailing address d different than pioperty owner's address indicated above Screen from to ft Open Hole from 4 1 9 q 1 to_ 1 ._ft. OBSTRUCTIONS ] Rods /Drop Pipe ] Check Valve(s) ❑ Debris ❑ FIII Xj No Obstruction Type of Obstructions (Describe) O LOGICAL MATERIAL I COLOR HARDNESS OR I FROM I TO I Obstructions removed? ❑ Yes [] No Describe FORMATION PUMP If not known, indicate estimated formation log from nearby well or boring. i Type SUBMERSIBLE SANWGFUffn VARIE VARIED 0 1 121 IN Removed ❑ Not Present ❑ Other LIMEROCK Y , LOW HARD 121 148 I METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS, OR CASING AND BORE HOLE: x) No Annular Space Exists ❑ Annular Space Grouted with Tremie Pipe [) Casing Perforation/Removal m. from to ft. ❑ Perforated C Removed I in. from to ft. ❑ Perforated J.] Removed Type of Perforator ❑ Othei GROUTING MATERIALS) (One bag of cement = 94 Ibs., one ��bag O of bentonite = 50 Ibs.) Grouting Material NEAT CE�'ENT from_ 0 in 14 L ft. _ yards_2L__ bags from _ to _ ft. - yards_._____._ bags from__ to_ _ ft._ yards,____ bags OTHER WELLS AND BORINGS REMARKS, SOURCE OF DATA, DIFFICULTIES IN SEALING I Other unseated and unused well or boring on property? D Yes X] 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 FOdi fflj� W ELL DRILLING, TN(, Licensee Business Name License or Registration No. 583 6/9/2009 d 6fied Repres afure Certified Rep. No, Date Richard A. Thron J 276517 I Robb/on MINN. DEPT OF HEALTH COPY Name of Person Sealing Well or Boring HE- 01434 -11 IC# 140 -0423 zroeR U . f � 1 � tid •I . n 76 5t. Croix Trail N Lakeland, MN 55043 651.436.8559 (F)651.436.2021 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 5754 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, f ennis Schum Vice President 651436-8559 651436-2021 fax �p ASBESTOS MATERIAL SURVEY 5800 OAKGREEN AVENUE NORTH OAK PARK HEIGHTS, MINNESOTA 1 0.0 INTRODUCTION Environmental Property Audits, Inc. (EPA, Inc.) conducted a visual survey at the residence 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 purpose of the survey was to identify, sample and assess suspect building materials that may contain asbestos concerns. 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 tile, linoleum, wall plaster, and glazing 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 5800 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 Materials List, 6.0 Non - asbestos Containing Materials List, 7.0 Non - suspect Materials, and 8.0 Inspector Accreditation. i 5800 Oakgreen Ave N 1 ©2009 EPA, Inc ASBESTOS MATERIAL SURVEY 5800 OAKGREEN AVENUE NORTH OAK PARK HEIGHTS, MINNESOTA 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. • 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. 3.0 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. • 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. 4.0 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: • 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 Oakgreen Ave N 2 02009 EPA, Inc ASBESTOS MATERIAL SURVEY 5800 OAKGREEN AVENUE NORTH OAK PARK HEIGHTS, MINNESOTA 5.0 ASBESTOS CONTAINING MATERIAL INVENTORY There were no asbestos - containing building materials identified in/on this residence. 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. Asbestos I Sample # Functional Space Material Identification Content 09 -04108 B -01 Upstairs Room Ceiling tile ND 09 -04108 B -02 Upstairs Room Ceiling rile ND 09 -04108 B -03 Upstairs Room Ceiling tile ND 09 -04108 B -04 Kitchen Original linoleum, mastic, felt ND 09 -04108 B -05 Living Room Wall Plaster (white & grey layer) ND 09 -04108 B -06 Hallway Wall Plaster (grey & green layer) ND 09 -04108 B -07 SW Bedroom Wall Plaster (grey & green layer) ND 09 -04108 B -08 East Entry Linoleum (brick pattern) ND 09 -04108 B -09 I Main Window Glazing ND 7.0 NON - SUSPECT ASBESTOS MATERIALS this residence but are not considered as suspect asbestos building The following materials are present in materials. I Functional Space Material Identification Exterior walls Wood Foundation slab /walls Concrete/block Supports /Framing Wood 8.0 ASBESTOS BUILDING INSPECTOR ACCREDITATION, Please see the following pages for Minnesota Department of Health certification information. -- �/ i p or J m Lindahl Exp. Date 11/25/09 nesota Certification Number — #AI2333 5800 Oakgreen Ave N 3 02009 EPA, Inc EMSL Analytical, Inc. 14375 23rd Avenue North, Minneapolis, Mn 55447 Phone: (763) 449 -4922 Fax: (763) 449 -4924 Email: minneanolislabOemsi.com Attn: Jim Lindahl Customer ID: ENVP52 Environmental Property Audits Inc Customer PO: 2701 4th Avenue North Received: 06/01/091:30 PM Anoka, MN 55303 EMSL Order: 350902604 Fax: (763) 323 -6677 Phone: (763) 323 -6700 EMSL Proj: Project: 5800 Oak Green Ave Analysis Date: 6/2/2009 Asbestos Analysis of Bulk Materials via EPA 600 /R- 93/116 Method using Polarized Light Microscopy Non - Asbestos Asbestos Sample Description Appearance % Fibrous % Non - Fibrous % Type 09 -04108 B -01 Upstairs Rm White 85% Non - fibrous (other) None Detected 350902604 -0001 Ceiling Tile Non - Fibrous 15% Mica Heterogeneous 09 -04108 B -02 Upstairs Rm White 85% Non - fibrous (other) None Detected 350902604 -0002 Ceiling Tile Non - Fibrous 15% Mica Heterogeneous 09 -0 B -03 Upstairs Rm White 85% Non - fibrous (other) None Detected 3509 0003 Ceiling Tile Non - Fibrous 15% Mica Heterogeneous 09 -04108 B -04- Original Layer White /Beige 100% Non - fibrous (other) None Detected Linoleum Kitchen Linoleum Non- Fibrous 350902604 -0004 Heterogeneous 09 -04108 B -04- Original Layer Tan 2% Cellulose 98% Non - fibrous (other) None Detected Mastic Kitchen Linoleum Non - Fibrous 350902604 -0004A Homogeneous 09 -04108 B -04 -Tar Original Layer Brown /Black 55% Cellulose 45% Non- fibrous (other) None Detected Felt Kitchen Linoleum Fibrous 350902604 -00048 Homogeneous - Analyst(s) Kristen Lindfors (14) / Rachel Travis, Laboratory Manager or other approved signatory Due o ification 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 /. 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 rest Report PLM- 7.12.0 Printed: 6/2/2009 11:21:38 AM 1 a EMSL Analytical, Inc. 14375 23rd Avenue North, Minneapolis, Mn 55447 Phone: (763) 449 -4922 Fax: (763) 449 -4924 Email: minneaooiisfab(@emsi.com Attn: Jim Lindahl Customer ID: ENVP52 Environmental Property Audits Inc Customer PO: 2701 4th Avenue North Received: 06/01/09 1:30 PM Anoka, MN 55303 EMSL Order: 350902604 Fax: (763) 323 -6677 Phone: (763) 323 -6700 EMSL Proj: Project: 5800 Oak Green Ave Analysis Date: 612/2009 Asbestos Analysis of Bulk Materials via EPA 600 /R- 93/116 Method using Polarized Light Microscopy Non - Asbestos Asbestos Sample Description Appearance % Fibrous % Non - Fibrous % Type 09 -04108 B -05- Wall Plaster Living Gray <1 % Hair 100% Non - fibrous (other) None Detected Gray Layer Rm Non - Fibrous 350902604 -0005 Homogeneous 09 -04108 B -05- Wall Plaster Living White <1 % Cellulose 100% Non - fibrous (other) None Detected White Layer Rm Non - Fibrous 350902604 -0005A Heterogeneous 0 08 B -06- Wall Plaster Gray <1% Hair 100% Non - fibrous (other) None Detected Gray Layer Hallway Non - Fibrous 350902604 -0006 Heterogeneous 09 -04108 B -06- Wall Plaster Pink/Green 100% Non - fibrous (other) None Detected Green Layer Hallway Non- Fibrous 350902604 -0006A Heterogeneous 09 -04108 B -07- Wall Plaster SW Gray <1% Hair 100% Non - fibrous (other) None Detected Gray Layer Bed Rm Non - Fibrous 350902604 -0007 Homogeneous 09 -04108 B -07- Wall Plaster SW Pink/Green 100% Non - fibrous (other) None Detected Green Layer Bed Rm Non- Fibrous 350902604 -0007A Heterogeneous Analyst(s) ���� ;r�L���YLfr'J I/✓'' .__ 4 _ _ _ Kristen Lindfors (14) l/ Rachel Travis, Laboratory Manager or other approved signatory 7 Du Ognification 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 me 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 Zest Report PLM- 7.12.0 Printed: 6/2/2009 11:21:39 AM 2 EMSL Analytical, Inc. 14375 23rd Avenue North, Minneapolis, Mn 55447 t r Phone: (763) 449 -4922 Fax: (763) 449 -4924 Email: minneaoolisfabCEiemsl,com vtn: Jim Lindahl Customer ID: ENVP52 Environmental Property Audits Inc Customer PO: 2701 4th Avenue North Received: 06/01/09 1:30 PM Anoka, MN 55303 EMSL Order: 350902604 =ax: (763) 323 -6677 Phone: (763) 323 -6700 EMSL Proj: 'roject: 5800 Oak Green Ave Analysis Date: 612/2009 Asbestos Analysis of Bulk Materials via EPA 600 /R- 93/116 Method using Polarized Light Microscopy Non - Asbestos Asbestos ,ample Description Appearance % Fibrous % Non- Fibrous %Type 09 -04108 B -08 E. Entry Linoleum Brown/Tan /Green 30% Cellulose 60% Non - fibrous (other) None Detected 350902604 -0008 Brick Pattern Fibrous 10% Synthetic Heterogeneous 09 -04108 B -09 Main Window Brown /Beige 5% Wollastonite 95% Non - fibrous (other) None Detected 350902604 -0009 Glazing Non - Fibrous Heterogeneous i i { I I I ( t l I f } t f /1 ;Analyst(s) 'Kristen Lindfors (14) Rachel Travis, Laboratory Manager or other approved signatory ' Due 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 I 3 'jest Report PLM- 7.12.0 Printed: 6/2/2009 11:21:40 AM THIS IS THE LAST PAGE OF THE REPORT. EMSL ANALYTICAL, INC. Asbestos Chain of Custody 1437523 RD AVENUE EMSL Order Number (Lab use only): MINNEAPOLIS MN 55447 35 b, (00 I PHONE: (763)449 -4922 FAX: (763)449 -4924 ALYTtCAL. INC. ,,p0 ..R000GTf•TRNININO I EMSL -Bill to: ® Same ❑ Different If Biii to is Different note instructions in Comments" Company: EPA, Inc. Street: 2701 4t h nrt:h Third Party Billing requires written authorization from third party City: Anoka State /Province: 'MN zip /Postal Code: _9 _i 1 Country: �Tc Report To (Name): Jim Lindahl Fax #: 763.'A2'1 = r,F177 Telephone #: 763.323.6700 Email Address: lindah 1 narnns 1 i-ani - rrnm C5 (D AY_ ta�& cJ f\v6r Project Name /Number: � O� � U.S. State Samples Taken: Please Provide Results: Lj Fax ❑ Turnaround Time (TAT) options* — Please Check f_1 3 Hours ❑ 24 6 Hours � Hrs ❑ 48 Hrs ❑ 3 Days ) [] 4 Days ❑ 5 Days ) ❑ 10 Days 'For TEM Air 3 hourslhours, call ahead schedule.*There is a premium charge for 3 Hour TEMAHERA orE Level 11 TAT. You will be ask edto sign an authorization form forthis service. Analysis completed in accordance with EMSL's Terms and Conditions oated in the Analytical Price Guide. ig TEM -Air TEM- Dust PCM - AirMicrovac - ASTM D 5755 • NIOSH 7400 ❑ AHERA 40 CFR, Part 763 C] Wipe - ASTM D6480 • w/ OSHA 8hr. TWA ❑ NIOSH 7402 ❑ EPA Level 11 Carpet Sonication (EPA 600 /J- 93/167) PLM - Bulk (reoortino limit) El Soil /Rock[Vermiculite. XPLM EPA 600 /R- 93/116 ( <1 %) ❑ ISO 10312 ❑PLM CARB 435 - A (0.25% sensitivity) '[] PLM EPA NOB ( <1 %) TEM -Bulk Point Count El TEM EPA NOB ❑PLM GARB 435 - B (0.1% sensitivity) TEM CARB 435 - B (0.1% sensitivity) F1 400 ( <0.25 %) ❑ 1000 ( <0.1 %) ❑ NYS NOB 198.4 (non- friable -NY) El TEM TEM CARB 435 - C (0.01% sensitivity) Point Count w /Gravimetric ❑ Chatfield SOP *ONYS <0.25 %) ❑ 1000 ( <0.1 %) ❑ TEM Mass Analysis -EPA 6.00 sec. 2 ntitative) 198.1 (friable in NY) .5 ❑EPA Protocol (Semi - Quantitative) TEM — Water: EPA 100.2 [1 EPA Protocol (Qua 198.6 NOB (non - friable -NY) Fibers >10pm ❑ Waste []Drinking Other: ❑ NIOSH 9002 ( <1 %) All Fiber Sizes ❑ Waste ❑ Drinking ❑ (Check For Positive Stop — Clearly Identify Homogenous Group Samplers Name: I Samplers Signature: _ VolumelArea (Air) Date/Time Sample # Sample Description HA # (Bulk) Sampled ©1- oil I ol�r 6 WO O 04)G 6 a,(—.*_ - /,"u`` Sr" Z� S Po S . - �.3 Ns . } wrw ` rr n r � P ©S - A Total # of Samples: o Client Sample # (s): ( — In 1 41 7 � A 0) - — nn Time: ) �.1 i ON nquished (Client): G P 1 tMv > Date: ( ) '' f � (o (� I Time: �(1� eived (Lab): i') .' \ � Date: Comments /Special Instructions: controlled Document — Asbestos CDC —R1- 3/1812009 Page 1 of ?,-- Pages 1 Asbestos Chain of Custody EMSL ANALYTICAL, INC. 14375 23 AVENUE EMSL Order N umber (Lab Use O nly): MINNEAPOLIS, MN 55447 PHONE: (763) 449 -4922 EMSL ANALYTICAL, INC. FAx: (763) 449 - 4924 � BORATORY•PROONCTB•TMININO Additional Pag of the Chain of Custody are only necessary if needed for additional sample information t g Y Volume /Area (Air) Date /Time Sample # Sample Description HA # (Bulk) Sampled c (Y' 0aY- x *CommentsiSpecial Instructions: Page of ages ( Controlled Document— Asbestos COC — RI — 3118!2009 Y Bedroo m Bedroom _ I *B07 3 Season Parch SUS , Bedroom 1 *BQ5 I I Up uving Family foam foam Kitchen Dawn TO *B09 I MAIN LEVEL 5800 UAKOREEH AVENUE UAL PARK HEIGHTS, MN Not to scale "901 *802 '803 �. UPSTAIRS 5800 OAKOREEN AVENUE OAK PARK HEIGHTS, MN [lot to scale N )j (J i Certificate No: 5LMI 1250802IR Expiration Date November 25, 2009 K o This is to certify that �N James R. Lindahl fully completed an has attended and success ASBESTOS, INSPECTOR REFRESHER TRAINING COURSE permitted by the State ofMinnesota under Minnesota Rules 4620.3 702 to 4620.3 722 6z M and meets the requirements o I a 0 3 x -0 R @ Section 206 of Title 11 of the Toxic Substances Control Act (TSCA) conducted by cL Ir IF Lake al"tates Enviponmenta -Ltas �%' i; in Jovember 25 Hinckley, MM an A ,2008 00 C) Ahvember 25 Examination Date. 2003 "'! / I� Lake States Environmental, Ltd ���'��� P. O. Box 645, Rice Lake, W1 54868 (800)254 -9811 I Training Instructor Vil V �z ;7 b. v I • 1 5 Oakgreen Issued City Demo Permit & Additional Conditions Application fro Demolition Permit Well Closure Documentation - Asbestos Abatement Removal Certification CITY OF OAK PARK HEIGHTS PERMIT NO.: 2009 -00087 14168 OAK PARK BLVD. N. #2007 OAK PARK HEIGHTS, MN 55082 -2007 DATE ISSUED: 06/25/2009 (651) 351 -1661 FAX: (651) 439 -0574 W RESS 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. 0 APPLICANT OTHER PERMIT FEE 25.00 OTHER PERMIT SURCHARGE, FLAT 0.50 GREEN TWIG LLC TOTAL 25.50 P.O. BOX 119 STILLWATER, MN 55082- PAID WITH CHECK # 5040 OWNER GREEN TWIG LLC P.O. BOX 119 STILLWATER, MN 55082 - 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 suspended or abandoned for a period of 180 days any time r work has commenced. The applicant is responsible for ssuring all required inspections are requested in conformance with the Minnesota State Building Code. SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. h t Foie. 5�So CAN Lr 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 15 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 15°', 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. • Initial: Page 1 of 2 I • 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, 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 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. 14. 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 sift 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 practioW. 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. Date: (6 Ti Nolde, Presid t — � Green - - - -- <: JENNIFER M. PINSKI NOTARY PUBLIC - MINNESOTA Ot My Commove Expires Jan. 31, 2012 ( x ary tamp �� -- �r Date �" .c, ric nson, City Administrator Pe t y signed by City Administrator: : J ------- --- -------- - o ry JENNIFER M. PINSKI (Affix notary stamp F PUBLIC - MINNESOTA Commission Expires Jan. 31, 2012 ..------- - - - - -- Page 2 of 2 SAY poax Fi cr. DE • c k CoN1�c,T . Al �l51 N F Oak Park Heights Z4� RS ST. Application for Permit Owner:�jiN (T W%�LC, Contractor, 1) 640 EG # N & (7 By L`L04) Address: M rot TA) Ib Address: A4 5* . STII.lW�t2.IMIJ �jt�.t�J11ItC� �j �1N Phone: (�) �� Phone: ((�) 7 L, JOB ADDRESS CLASS OF WORK Number Street New Add Sign Alter Repair Move Demolish 5 8 3a �K FN hVe ❑ ❑ ❑ ❑ ❑ ❑ _ A i t Front or Width Side or Length Height in No of Area of Type of Occupancy Project Dct�ls� 6 in Feet in Feet Feet Stories Lot Construction V8luation Occupied / R5- - t - TvA 4 $ 2- Legal Description (if no address assigned: —JI Aa Description of Work Being Done DEMOLIS ION " ; *CT1 CSC tr�tj t FPLJ-gW T'E ALE AN U P a F ► N�r WN �f�, TD fe~.>�T1 Dla 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 uuval a as ed po the Inspection Record Card. Dated: Applicant's Signature t For Office Use Onlv: City Building: City Plumbing: City Mechanical: Jim Butler, Building Official Plan Review: City of Oak Park Heights State Surcharge: Signage: 14168 Oak Park Blvd. N. City Utility Meter: P.Q. 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: WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEAi:rH Minnesota Well and Boring H 2 Y 6 5 1 6 County Name WELL AND BORING SEALING REOORO Minl Unique Well No. i or W- series No. WASHINGTON Minnesota Statutes, Chapter 103/ i � , r b ,, u—) Township Name Township No. Range No. Section No. Fraction (sm ig.) Date Sealed Date Well or Boring Constructed B YTO) Al 29 120 S S NEI'- NE I 0/9/2009 _ Latitude _ degrees____ minutes _ _ seconds I Depth Before Sealing 131 k. Original Depth O ON: Longitude_ __ degrees minutes_ seconds I AQUIFER(S) STATIC WATER LEVEL Numerical Street Address or Fire Number and City of Well or Boring Location XJ Single Aquifer F] Multlaqutter �!�(�. -r 5830 0ak�,reen Ave N., Oak Park 1 °1Lts WELL/BORING Measured ❑ Estimated Date Measured GA/2 -009— 7[ X Water - Supply Well ❑ Monit. Well Show exact location of well or boring Sketch map of well or boring in section grid with "X " location, showing property [] Env. Bore Hole ❑ Other _ 1 25_,ft. Y] below ❑ above land surface v Imes, roads, and buildings. CASING TYPE(S) t� Steel ❑Plastic E] Tile ❑Other ...... '- - -- --- - -" -1 ' -- d `,r! WELLHEAD COMPLETION f W Outside: ❑ Well House f'i At Grade inside: ❑ Basement Offset t f ',S Mile J, , [Buried L] Well Pit j I t P ess Adapter /Unit - -- -- -- -- - - -; ❑ Buried S Well Pit [J Other 1--- - I Mil. --, ❑ Other Ppppppp TY OyyE�R'S NAZI/ ''pMPANY NAME I CASINGS} lrr` n 1 W3 LLI I Diameter Depth Set in oversize hole? Annular space initially grouted? Property owner's mailing address rf different than well location address indicated above .5 in. from �) to j Z 1 ft, ❑ Yes `L�J No [ Yes ❑ No [J Unknown 773 Green Twig Way - -- — StlllwaLer M 55082 in. from_ _ to_ ft. ❑ Yes L] No ❑ Yes [] No ❑ Unknown in. from to ft. ❑ Yes ❑ No ❑ Yes [ ] No ❑ Unknown WELL OWNER'S NAME /COMPANY NAME SCREEN/OPEN HOLE ) -I --II Well owner's mailing address if different than property owner's address indicated above I Screen from to ft. Open Hole from 121 to 1 31 ft. OBSTRUCTIONS [] Rods /Drop Pipe [j Check Valves) ❑ Debris ❑ Fill No Obstruction Type of Obstructions (Describe) AW OGICAL MATERIAL I COLOR HARDNESS OR I FROM I TO I Obstructions removed'? [ Yes ❑ No Descnhe FORMATION If not known, indicate estimated formation log from nearby well or boring, i PUMP Type S`)Ii1'*TR S T i` � .T i�Aig j / _..__ � I T ii LL) �T V q (� 4 '� ?�� Removed E] Not Present (] Other LaT, ELrLOW HARD 121 131 METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS, OR CASING AND BORE HOLE: [X No Annular Space Exists ❑ Annular Space Grouted with Tremie Pipe ❑ Casing Perforation/Removal in. from to R ❑ Perforated ❑ Removed I ( in. from to ft. ❑ Perforated (] Removed Type of Perforator Other f GROUTING MATERIAL(S) (One bag of cement = 94 lbs., bag of bentonite = 50 lbs.) (Grouting Material NEAT CEMENT from_ _ t � .31 ft._, yards 18 _ bags I I from ------- __ to ft. yards __ bags from____ to____ ft._ _ yards__ bags OTHER WELLS AND BORINGS REMARKS, SOURCE OF DATA, DIFFICULTIES IN SEALING I Other unsealed and unused well or boring on property? ❑ Yes 7, No How many? LICENSED OR REGISTERED CONTRACTOR CERTIFICATION tl 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. Mantyla Well Drilling, Inc 1394 Licensee Business Name License or Registration No. is Ce fiffed Repre gnature CertRep. No. Date Richard A. Thron H 276518 Rob L A9iNN. DEN i OF HEALTH COPY Name of Person Sealing Well or Boring HE- 01434 -11 IC# 140 -0423 2108R (� Va,; BYVROM04ML, DC. 76 St. Croix Trail N Lakeland, MN 55043 651.436.6559 (F)651.436.2021 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: VCi Environmental Inc. has success y completed the removal of asbestos containing materials identified ' nmental Property Audit's asbestos survey • reports for the houses located 5 30 d 5710 Oak Green Ave. in Oak Park Heights, MN. If you have any questions please feel free to contact me. Sincerely, d . , "�' , I I Dennis Schumann Vice President, VCI Environmental Inc. 651436 -8559 • t 0 ASBESTOS MATERIAL SURVEY 5830 OAKGREEN AVENUE NORTH OAK PARK HEIGHTS, MINNESOTA 1.0 INTRODUCTION Environm �aT'P opert y Audits, Inc. (EPA, Inc.) conducted a visual survey at the residence located 5akgreen 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. 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 5830 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 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. 5830 Oakgreen Ave N j x2009 EPA. Inc ASBESTOS MATERIAL SURVEY 5830 OAKGREEN AVENUE NORTH OAK PARK HEIGHTS, MINNESOTA 3.0 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 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. 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 /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 (c 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. Sample # Functional Space Material Identification Asbestos Content Material 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. "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. Sample # Functional Space Material Identification Asbestos Content 09 -04110 B -01 SW Bedroom Ceiling texture ND 09 -04110 B -02 Hallway Ceiling texture ND 09 -04110 B -03 SE Bedroom Ceiling texture ND 09 -04110 B -05 Living Room Wall plaster (both layers) ND 09 -04110 B -06 SW Bedroom Wall plaster (both layers) ND 09 -04110 B -07 Kitchen Wall plaster (both layers) ND 09 -04110 B -08 Upstairs E Attic Room Sheet flooring (yellow /brown) ND 09 -04110 B -09 Bathroom Upstairs 12 x 12 Floor tile (it green w /spots) /adhesive ND 09 -04110 B -10 SW Attic area Sheet flooring (brown) ND 09 -04110 B -14 Window Glazing ND 09 -04110 B -15 Roof Shingle ND 09 -04110 B -16 Roof Underlayment tar paper ND 09 -04110 B -18 Exterior Wall Tar paper ND 7.0 NON - SUSPECT ASBESTOS MATERIALS The following materials are present in this residence but are not considered as suspect asbestos building materials. Functional Space Material Identification Foundation Concrete Supports /Framing Wood 5830 Oakareen Ave N 3 CO2009 EPA. Inc f 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 Health certification information. Inspector Jim Lindahl Exp. Date 11/25/09 Minnesota Certification Number — #AI2333 5830 Oak -reen Ave N 4 02009 EPA, Inc EMSL Analytical, Inc. 14375 23rd Avenue North, Minneapolis, Mn 55447 Phone: (763) 449 -4922 Fax: (763) 449 -4924 Email: min neaoolislabOemsl.com Attn: Jim Lindahl Customer ID: ENVP52 Environmental Property Audits Inc Customer PO: 2701 4th Avenue North Received: 06/01/09 1:30 PM Anoka, MN 55303 EMSL Order: 350902603 Fax: (763) 323 -6677 Phone: (763) 323 -6700 EMSL Proj: Project: 5830 Oak Green Ave Analysis Date: 6/2/2009 Asbestos Analysis of Bulk Materials via EPA 600 /R- 93/116 Method using Polarized Light Microscopy Non - Asbestos Asbestos Sample Description Appearance % Fibrous % Non- Fibrous % Type 09 -04110 B -01 Ceiling Texture White 100% Non - fibrous (other) None Detected 350902603 -0001 SW Bd Rm Non- Fibrous Homogeneous 09 -04110 B -02 Ceiling Texture White 100% Non - fibrous (other) None Detected 350902603 -0002 Hallway Non - Fibrous Homogeneous & 4110 B -03 Ceiling Texture SE White 100% Non - fibrous (other) None Detected 902603 -0003 Bd Rm Non- Fibrous Homogeneous 09 -04110 B -04 Kitchen Original Gray 10% Cellulose 55% Non - fibrous (other) 35% Chrysotile 350902603 -0004 Linoleum (green) Fibrous Heterogeneous Back Pad tested first, adhesive not tested per stop positive 09 -04110 6-05- Wall Plaster Living White 100% Non - fibrous (other) None Detected Skim Coat Rm Non- Fibrous 350902603 -0005 Homogeneous 09 -04110 B -05- Wall Plaster Living Gray <1% Glass 100% Non - fibrous (other) None Detected Plaster Rm Non - Fibrous 350902603 -0005A Heterogeneous Analyst(s) Nerdy Johnson (23) 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 T yl is l imited 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 sibility 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 P Lab Code 200019 -0 Test Report PLM - 7.12.0 Printed: 6/2/2009 9:05:05 AM 1 r EMSL Analytical, Inc. 14375 23rd Avenue North, Minneapolis, Mn 55447 Phone: (763) 449 -4922 Fax: (763) 449 -4924 Email: minneaoolislab(cDemsi.com Attn: Jim Lindahl Customer !D: ENVP52 Environmental Property Audits Inc Customer PO: 2701 4th Avenue North Received: 06/01/09 1:30 PM Anoka, MN 55303 EMSL Order: 350902603 Fax: (763) 323 -6677 Phone: (763) 323 -6700 EMSL Proj: Project: 5830 Oak Green Ave Analysis Date: 612/2009 Asbestos Analysis of Bulk Materials via EPA 600 /R- 931116 Method using Polarized Light Microscopy Non - Asbestos Asbestos Sample Description Appearance % Fibrous % Non- Fibrous % Type 09 -04110 B -06- Wall Plaster SW White 100% Non - fibrous (other) None Detected Skim Coat Bd Rm Non - Fibrous 350902603 - 0006 Homogeneous 09 -04110 B -06- Wall Plaster SW Gray <1% Glass 100% Non - fibrous (other) None Detected Plaster Bd Rm Non - Fibrous 350902603 -0006A Heterogeneous 1 6 04110 B -07- Wall Plaster White 100% Non - fibrous (other) None Detected Skim Coat Kitchen Non - Fibrous 350902603 -0007 Homogeneous 09 -04110 B -07- Wail Plaster Gray <1 % Glass 100% Non - fibrous (other) None Detected Plaster Kitchen Non - Fibrous 350902603 - 0007A Heterogeneous 09 -04110 B -08 Upstairs E. Attic BrownlYellow 45% Cellulose 55% Non- fibrous (other) None Detected 350902603 - 0008 Rm Sheet Flooring Fibrous Yellow/brown Heterogeneous 09 -04110 B -09- Bathroom Upstairs White /Green 100% Non - fibrous (other) None Detected Floor Tile 12x12 F.T. (Lt. Non - Fibrous 350902603 -0009 Green w /spots) Homogeneous Analyst(s) ILK -A-1 �" _ t - -- ' - Heidi Johnson (23) 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 I m ted 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 srbillty 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 I NVLAI Lab Code 200019 -0 Test Report PLM- 7.12.0 Printed: 6/2/2009 9:05:07 AM 2 EMSL Analytical, Inc. 14375 23rd Avenue North, Minneapolis, Mn 55447 Phone: (763) 449 -4922 Fax: (763) 449.4924 Email: minneaoolistabOemst.com Attn: Jim Lindahl Customer ID: ENVP52 Environmental Property Audits Inc Customer PO: 2701 4th Avenue North Received: 06/01/09 1:30 PM Anoka, MN 55303 EMSL Order: 350902603 Fax: (763) 323 -6677 Phone: (763) 323 -6700 EMSL Proj: Project: 5830 Oak Green Ave Analysis Date: 6/2/2009 Asbestos Analysis of Bulk Materials via EPA 600 1R- 931116 Method using Polarized Light Microscopy Non - Asbestos Asbestos Sample Description Appearance % Fibrous % Non- Fibrous % Type 09 -04110 B -09- Bathroom Upstairs Tan 100% Non - fibrous (other) None Detected Adhesive 12x12 F.T. (Lt. Non - Fibrous 350902603 -0009A Green w /spots) Homogeneous 09 -04110 B -10 Brown Sheet Brown /Black 45% Cellulose 55% Non - fibrous (other) None Detected 350902603 -0010 Flooirng SW Attic Fibrous Area Heterogeneous 4110 B -11 Attic Vermiculite Gold 100% Non - fibrous (other) <1% Actinolite 350902603 -0011 Non- Fibrous Heterogeneous 09 -04110 B -12 Attic Vermiculite Gold 100% Non - fibrous (other) <1% Actinolite 350902603 -0012 Non - Fibrous Heterogeneous 09 -04110 B -13 Attic Vermiculite Gold 100% Non- fibrous (other) <1% Actinolite 350902603 -0013 Non - Fibrous Heterogeneous 09 -04110 B -14 Window Glazing White 100% Non - fibrous (other) None Detected 350902603 -0014 Non- Fibrous Homogeneous 09 -04110 B -15- Roof Shingle White /Black 25% Glass 75% Non - fibrous (other) None Detected Shingle Fibrous 350902603 -0015 Heterogeneous Analyst(s) (j+ (: ° -_ 4 Y _. . - -- Heidi Johnson (23) 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 W t "y is s 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 Government "LAP Lab Code 200019 -0 Test Report PLM - 7.12.0 Printed: 6/2/2009 9:05:11 AM 3 EMSL Analytical, Inc. 14375 23rd Avenue North, Minneapolis, Mn 55447 Phone: (763) 449 -4922 Fax: (763) 449 -4924 Email: minneaoolislabbemsl , com ■ Attn: Jim Lindahl Customer ID: ENVP52 Environmental Property Audits Inc Customer PO: 2701 4th Avenue North Received: 06101/09 1:30 PM Anoka, MN 55303 EMSL Order: 350902603 Fax: (763) 323 -6677 Phone: (763) 323 -6700 EMSL Proj: Project: 5830 Oak Green Ave Analysis bate: 612/2009 Asbestos Analysis of Bulk Materials via EPA 600 /R- 93/116 Method using Polarized Light Microscopy Non - Asbestos Asbestos Sample Description Appearance % Fibrous % Non- Fibrous % Type 09 -04110 B -15 -Tar Roof Shingle Black 100% Non - fibrous (other) None Detected 350902603 -0015A Non- Fibrous Homogeneous 09 -04110 B -16 Roof Black 65% Cellulose 35% Non - fibrous (other) None Detected 350902603 -0016 Underlayment Tar Fibrous Paper Heterogeneous 0 ) 4110 B -17 Plastic Cement White /Black 93% Non - fibrous (other) 7% Chrysotile 2603 -0017 Patch on Chimney Non - Fibrous Heterogeneous 09 -04110 B -18 Exterior Wall Tar Black 75% Cellulose 25% Non - fibrous (other) None Detected 350902603 -0018 Paper Fibrous Heterogeneous Bag not labeled, sample matches description on C.O.0 Analyst(s) _ Heidi Johnson (23) 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 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 Government NVLAP Lab Code 200019-0 Test Report PLM- 7.12.0 Printed: 6/2/2009 9:05:13 AM THIS IS THE LAST PAGE OF THE REPORT. 4 ) 350902603 Asbestos Chain of Custody AwALYrlt�v., lht�. EMSL Order Number (Lab Use tJ: 14375 2Y AVENUE MINNEmous, MN 56A47 PHONE: (763)449 -4922 FAx: (763)4194924 11318L,811111' to: bI Some. u D ifferent' EPA ,-IPC . ' x Bill >o is Diiterant nape wftdm it Ccmmew s N 7ht►d !! 6.regts written eutAarfzetkm Jyor» An+1i' Anoka 8tatedPrBVlncs: Code: 5531) Count : rt FAX * "t6 Rte, fi1i'a'+' Ica Atenree Jim �t,� dam Tobphone #: 753 .323.67(0 Email Addreee: l )nda t M0Pa= � u tant,;_,_,e•w Pra�+r<t NamalNumtser: � +� C� Piease ftvide R+grutts: Fax Emall Purchase Order: U.S. State Samples Taken: Ttunsriry►md flern+a A O orb• - P'lb Check Af VOr MV At ft"t �a e� Hr" c�a a pays ray 1C u g s ys sit a aKx zartov► JF�mr ter M b wf*ae. Malt+ ar�n�%w k a �r arndu>4r C cr �9 d In the l?' ° Am P * d�a sr�n 8 House 2 HI; 40 ea cndur+s wdMr EMSL Temis and Glan cl�Mata 090 In tree Malytlosl.Pttge tukte TEN-Al JE M- Dust NIOSH 7400 AHERA 40 CFR, Part 763 ❑ Microvac - ASTM D 5756 ... �i awk TWA EPA Le ml II [] Carget Sonk tion (E [� p NIOSH 7ao2 w� P gang IRntiti $oniealign EPAB(1p/J- 83157) EPA 8bM831116 ( ,, 1 %) ISO 10312 ( PLM EPA NOB (0 %) 1 Butk ❑ PLM CARS 436 - A (0.28% sonsithri#y) Point Count [] TEM EPA NOB ❑ PLM CARS 435 - 8 (0.1 % sensitlaity) 400 (<0.25% 0 J OW ({+0.1%) [j NYS Nol fee.4 (rron- &Iab"Y) TEM GARB 435 - B (0.1% eeneilivtty) Punt Count vWGrm+imetric Q Chatfield SOP ❑ TEM CARS 435 - C (0.01% sonslllvity) a 400 (0.25%) Q 1000 ( -0,1%) [] TEM M ass Anatysls -EPA 004 sea 2.5 ❑ EPA Protocol (Sernk0tu Mative) Q NYS tslg. (friable in NY) 3M ; ,star: EPA 100.2 m Q EPA Pro(ooai (Quantitst(ve® ) DrI04 Waste [] Drinking Jj NIOSH 9M ( <1%) All Fiber Si Waste z . 0 ['j rig [� WS 108.8 Na$ (Tres- NY) -NYj fit�f's X10 . , VChetk For Posithre sto — Cieacl+� 14 nous Group � Samplers Name: Samplers Signature: Volume/Area (Air) Datemme sample # Sample Description HA 0 (Bulk) sampled ` e; & dU s "tai 0 RD ;1► T. c. x Tu. kc, Sir d - . Ctleot Sem It a): 0 . "14 1 t e)j - t r7 Total a of Samgiee: 1 4 uiaired Clferrt - C i7rrra: t 7I5 ��4' � � l G"G [late: ` Received (Lab): y +�!! Date: oi l( Tl 'Time: ! CommenntalSpeclsl Instnu4tions : pages �.„.- .�..N.cx- n,- 9ner�a� Page 1 h #