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HomeMy WebLinkAbout2001-P04732 - demo t ' � PERMIT CI�`Y OF ORONO Permit Number: i750 Kelley Parkway - PO Box 66 P04732 Crystal Bay, Minnesota 55323 Permit Type: Demoi�t�on (952) 249-4600 Date Issued: 12iis�2oot SITE ADDRESS: 3770 Shoreline Drive(City Park) Wayzata,MN 55391 P I D: 17-117-23-3 4-0003 DESCRIPTION: UBC Occupancy R3 Proposed Use: Permit Class: Building Census Code 645 Permit Type: Demolition Permit Sub-type(s): Demo-Principal Structure Demo-Accessory Structure DETAILS: Approved per resolution#: Separate permits required: NOTICES/REMARKS: F��uuuniiu�isiaii uc�iiu ucori� iu�e rcuiuvcu iruui�i�uuuu c� uispu�cu ui uii siie pei�FCr�reguia�iun�. h%eiis m�st be abondoned. Insnection before backfilline. FEE SUI111MARY: Permit Fee: $ 80.00 Valuation: $ 0.00 State Surcharge Fee: $ 0.50 TOTAL FEE: $ 80.50 APPLICANT: Kevitt Exc. Inc. OWNER: City of Orono 3335 Pennsylvania Ave No 375 Old Crystal Bay Rd Crystal, MN 55427 Long Lake, MN 55356 THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED AND AGREES TO DO ALL WORK IN STRICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE OF MINNESOTA BUILDING CODE REQUIREMENTS. �J • � `�i'/ ��/� /���,� Zz� l-��u-y �'���`"�GC l�l'��CC���_ ( �_��'� APPLICANT PERMITEE SIGNATURE ISSUEDBYSIGNATURE Copies: 1-File(SiQnitures Required). 1-Aoolicant 1-Monthlv Reports. 1-Assessin�, 1-Finance Page 1 , �ITY OF ORONO APPLICATION FOR DEMOLITION PERMIT P.O. Box 66 (2750 Kelley Parkway) Crystal Bay, MN 55323 SPECIAL CONDITIONS & HOLD HARMLESS AGREENIENT General Instructions 1. You may be required to obtain other permits, i.e. well abandonmment, etc. 2. Work must not begin unless the permit card is available on the job site. 3. A 24 hour notice is required for all inspections. Call (612) 249-4600. JOB SITE ADDRESS• � � 7 r� S � `` �-�' /�.' ` �� �� <� � Occupancy Type: �_Residential Commercial �.,,t� ��, r�, N OWNER'SNAME: C�` f-.� �> � G�,-.� .t G Phone: `� �"�_ � `/ Y_ y� � � Mailing Address: City: CONTRACTOR'S NAME: K'� "�; t f Fx c `` ``� �'n�`" Bus.No.: ��e 3 - j—v s-- � s-i- 7 Mailing Address: �� 's f�' h���-� <�4 ^ � °- �"�- �''� City: C�--�f � -� I Demolition if planned by means of: manual disassembly � heavy equipment Permits Issued: # Well Abandonment In return for issuance of said Demolition Permit,the undersigned owner hereby agrees as follows: 1. The structure(s) shall be kept enclosed and/or secured until such time as demolition is complete. ?. Demolition debris will be kept off adjoining property and/or the public rights-of-way unless specific prior approval is obtained in writing for temporary use thereof. 3. Foundations shall be completely removed from the ground. 4. All demolition debris shall be completely disposed of off site in accordance with all applicable PCA requirements. 5. Water �vells must be abandoned in accordance with State Health Departrnent regulations. 6. Inspection required�vhen all debris has been removed, before backfilling. 7. Within 5 workin?days of superstructure removal,a final inspection shall be requested. The site shall be left clean and clear of all debris,with any excavation filled w-ith earth level with the adjacent ground elevation (except when such excavation is to be used as part of a new building and such new building is actually under construction). 8. The undersigned owner shall and hereby does indemnify and hold harmless the City of Orono, its agents, employees and assigns from and against all claims, damages, losses or expenses,including attorney fees,against the City,its agents,employees and assigns arising out of or resulting from the demolition described herein as performed by the property owner, his employees, agents, subcontractors or assigns. 9. Septic systems must be abandoned per Minnesota Rules Chapter 7080. All septic tanks must be pumped,crushed and filled with native soils. An inspection is requued after the tanks are pumped and before the tanks are crushed and filled. PERMIT TYPE A.�iD FEE CALCULATION $50.00 - Principal Structure $30.00 - Accessory Structure 1. Subtotal of above permit requested S 2. State Surcharge S .50 3. TOTAL PERMIT FEE (add lines 1-2 above) S The undersigned hereby applies to the Cit��of Orono for issuance of a Demolition Permit, a�rees to do all �vork in strict accordance �vith the ordinances of the City and the regulations of the State of Minnesota, and certifies that all statements made on this application are complete,true and conect. �APPLICANT'S SIGNATURE: ZZ� ���`G' Date: � �� — � � ��`� � O`VNER'S SIGNATURE: Date: -�(�, / ) APPROVED BY: cJ ' C��''..°-�--- Date: ! 2- i � � c� f , ' Y� ` _ - M i n nesota Pol I ution Controi Agency ; _:, J�.� 9 October 4, 1996 Dear Sir/Nladam: The Minnesota Pollution Control Agency(MPCA) is writing to request assistance in informing the general public of federal regulations and state rules regarding demolition projects. Recently MPCA staff have encountered numerous instances in which a demolition contractor had obtained a permit from a city or county office and commenced the demolition unaware of the state and federal rules and regulations governing demolitions. Often contractors believe that by obtaining a city or county demolition permit they have satisfied all requirements. In an effort to address this problem,the MPCA would appreciate it if}'ou could hand out the enclosed documents along with your demolition permits. If the demolition permit applicants have additional questions,please ask them to contact the MPCA Asbestos Team at the telephone numbers listed below. The MPCA is aware that many cities may already supply contractors with this information and we appreciate your efforts. Phone Num6ers (612)296-7300 or 1-(800)857-3864 Enclosures 520 Lafayette Rd.N.;St.Paul, MN 55155-4194;(612)296-6300(voice); (612)282-5332(TfY) Regional Offices: Duluth•Brainerd•Detroit Lakes•Marshali•Rochester Equal Opportuniry Employer•Printed on recycled paper containing at least 10%fibers from paper rerycled by consumers. 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M1.;.;r�:.: 3 :l{..... Scaocaa�c:::::.''Aux.`:...�-:���'>:w}:.;f,',•.:;;'.:••',•f. x�::�:.`..:. ;�;:.y,;..y+::.:.:.. �. :.� r ..`j.t ' :,;:::+`•:� {..�.;;.:.f..;::r•:.;-::: t +�+�W.vCv:C%<�v'viviiK'Y. ••• � ?, :S:'•.�,+. F.f..r . '��'M'4w'�+n i.4:iF+:«::+ry:4%��rr'•��'�'N.i:l.�: . iLiGiYHi Hazardous Waste is any waste that displays one or more of the following characteristics; • Ignitable (will ignite at less than 140°�,solvents,petroleum products, thinners r • . . Corrosiv��pH of 2 or less or 12.5 or more), concrete cleaner,paint stripper,bleach • Toxic Characteristic Leaching Procedure(TCLP) a test to determine if a material will leak heavy metals or other toxic materials • Reactive, esamples include carbides,sodium hydrosulfide, magnesium, potassium Hazardous Wastes must be removed prior to demolition and can not be disposed of at a demolition or sanitary landfill. If you identify any containers or materials that you believe may be hazardous you must have them tested before proceeding. If you have any question please contact the MpCA Hazardous Waste Division at the number below. }?Y,.r} yi{};{{n}}y_.;{jo:;}:.}v.i}iS?iii:?:±:N.:: V:�i}:V�i'rii'�'>�ii::Cv:�i:�:i:t%: :;i:;�•i'i:};i:;iY}'r'ri:>.:i:;:?;:i.i:;:;:ji';i.;:;::;:j;`��?:i?ii?::;i':;:;:{;�i:ti:{{y�:i:;:;.:j::;r:?:j::-i�:':'?:i:iN:::::::i'iiV::j;iv:}:it,v,•::v:C+.{i{yi::.ii?}iii::.�:.::v:.:x:......... x ......:........�::::. w:..::.:�:•:�v:•:. ... i.�l.�y:*..�::...::::::w::...::.:�:::i ............::...:.:.....::::x:.:::n•::::. ...vn...vn.r... 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Special Hazardous �Vastes must be identified and removed prior to demolition. ♦ Dry Cell Batteries (button, nickel cadmium, small lead acid recharaeable and other dry cells ♦ Antifreeze ♦ Circuit Boards (old electrical equipment) ♦ Polyclorinated Biphenyls (PCB) found in light ballasts, small capacitors in old appliances, and transformer oils ♦ Mercury(fluorescent lamps, mercury s�vitches, mercury vapor lamps, thermostat probes, metal halide lamps, relays, high pressure sodium lamps, thermometers, neon lamps, thermostats, manometers, and gauges). Many mercury containing materials K�ere used i� appiiances, or industrial switches or controls. If you have any questions regarding the identification, transport, or disposal of special hazardous tivaste contact the Hazardous Waste Division at the phone number belosti•. 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In a demolition any underground storage tank(UST) must be identified and removed prior to demolition. In most facilities the presence oi USTs tivill be i:noti�•n from the types of operations performed at the facility. The most common type of UST that you tir�ill be concerned with is old fuel oil tanl:s that have been abandoned. The follotiving are some clues as to hotiv to identify a potential UST. fi � 2 1 ' A site walkover may provide clues as to the presence of an abandoned UST. Heating oil tanks usually exhibit spillage during filling, especially if the tank is old and has been filled repeatedly over . a�umber of years. Staining of the soil with or without the characteristic odor of fuel oil may be an indicator of the presence of an abandoned fuel oil tank. If the soil appears to be undisturbed, check for the presence of a fill pipe or a fill pipe that may have been cut off below ground level and covered over. Fuel oil tanks are generally buried near the foundation of the building. Check the basement of the structure for the placement of the furnace and any piping to an outside wall that may remain. If the piping has been removed, look for a hole or patched hole in the wall in the general vicinity of the furnace or the area where the furnace once resided. The fuel oil tank, if present,should be on the other side of the wall, near the foundation. Fuel oil tanl:s of greater than 1,100 gallons capacity should be registered by the tank owner with the MPCA. Contact the Tanks and Emergency Response Section at (612) 297-8679 to see if there is any information that indicates the presence or former presence of a tank at this site. USTs are generally buried 36"-42" belotiv ground. Metal detection devices such as those used by NSP to locate metal gas lines and electrical tivires may be capable of detectina the presence of an UST if it isn't buried too deep. Soil borings in an area of the site suspected to contain an UST can be conducted, but this can be a costly option. If the soil is sandy or other�•ise relatively porous, a metal rod may be driven into the ground to a depth of 48" or so in areas suspected to contain a buried UST. Escavation may also be an option, however, this is labor intensive, may be costly and will be disruptive of the integrity of the site. ��:e;:s^:::�s::::�a<:s::; ,.,.«�::::::;::•:,.<::;:.;•„::.:;:>:.�;;> :�:�.o.............. ..... •:•..::.:..::.:...:.,....::..v..,.,•.,'•..,..�•y.;...;:;;,.,•..�,.....n.•. ..,..,.�...• ::n•.:�:o:e.w.. � ,�,.:::::.,•:::.:::....:.:.:r•r:r:::r:.:>::�:•... 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The presence of unsealed wells is a concern in many older buildings. Any unsealed or improperly sealed wells need to be identified and a licensed well contractor needs to be contacted to properly seal the well(s). The following information includes some clues on how you miaht locate an unsealed well and who to contact to learn more about them. � Locating unsealed�vells is a combination of research and educated guesses. There are three areas where records of old wells may be located: ♦ 1�Iinnesota Geological Survey (612) 627-=�78-�,`ti•ater�j•ell records by section, to�vnship and range, and sometimes by address, ♦ Minnesota Department of Health �Yell l�Ianagement Unit (612) 21�-0311, Pre-1990 the wells are classified by}'ear and the contractor that drilled the rvell, f � � ♦ City Inspections Department and local well contractors. • ' • A Another way in which to identify unsealed R•ells is to look for clues: some clues are: . ♦ tivindmills, usually would use wind power to draw water out of a well ' - � ♦ unaccounted for pipes or areas in the foundation where pipes used to run ♦ the building was constructed and occupied prior to municipal water being available to that area ♦ well pits or shacks a magnetometer may be used to identify metallic objects within 3-4 feet underground •�;,Y.:9M:�. .^� ..Y.?:{m:{;{ :%...-:v,..� {'{�:ti}�. :�.K�n;. • ••::•:v.�nv:.:r:�i " .vn..�v.xvx:.�:,r.vn.nvrN.v:��nw+w.ti�... ::. :.......:.........::.......v.�:.::..,-...;.,; :..v....�.:ii..wx:. •.:�:.wer� :n..�:V• �•" .. ....::.::........y...,-....Y.,x}};pwr;�!pi:H:n....l r.;::::.;�{:.}��.r.ti:.f.v::i•v,:irt:::n •:.vi•:�?i:iti::•,:;:;:;:•:ii:::titi::v�:i::}x:�' ....... ti�ii:.. vv:.•.. � • ,- �'- . .:: :.,...:�......:......:... v,ti!M:;}:q.w..xi:.Y.;!iiiy,xxr.vx:re:nv. �...... . „n:.vst�. :Lii.?:i:i.{.i:C:'�:v:.::titiv::r>.!i:?ii�i:::f:y•:•{t;.;1..:}::::.�:::?iii:�iiiiiiii�:;:;:j. � . ... ............:.........:::... .... .��w:::.'•::iti.}:w w.�::::::.�.�::::... ?ti;if+::;n;np;•y;. .r ....�........ .. . - .:.. ., .., . :.,�. 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TSEC�`. ...,::::::::...:���:,;ry;��;: ..:>::::>::�::::.,::...:>;,:.;:. .�..,r�<�..:� ............... -.,.:.:::.:�::::::::....::,.:::.,.:;:::-:,.:.;<:<:>::».;::<.::..,. ..�::. w�.\A.'.r.;.....p,..L%ry:vy�ry0.•.:?�::l2iC::.'.i4T:i:.,�....:...... . � .;,I1�:�3?nii?iii:v'•ii:}ii;nv:: ' {.n:iiii .{.,.r4:::.^:�i:�ii;i:;:;:�'�•:•,:v:•i'•i::C�'•'i:8��S:'+iY�;':.;:•;::i:::n�:::.. �:i\i5..�:v...v: ..... ....v.Y.,r4,..A.�.hr��.�b?CiH:.:ir..'l. �ty'•:':L!i:i:ti:::::�:•:�::�i:''•r�':':•ii`:�:•:::•::•::yi:rv:!:v::;i::'-:}ti�ii::jy:;i:�%i�:•i::i::•1•:�:ti•: ..... ... . :�.............. ::n•:•.:i:•i�^:}:� '- .r..±.....�..n......�x.v i:i'v.'i:•:'iR:i2i:<�ii:iri�i:r::5:•::t •CFCs (chlorofluorocarbons) and HCFCs (hydrochlorofluorocarbons) are man-made refrigerants that destroy the ozone layer. •CFCs and HCFCs must not be released into the atmosphere. These refrigerants must be recovered by technicians certified by a U.S. EPA approved program using proper refrigerant recovery equipment. • Esamples of appliances that contain CFCs and HCFCs include: ♦ refriaerators ♦ dehumidifiers ♦ central air conditioners ♦ room air conditioners ♦ vending machines ♦ heat pumps ♦ freezers ♦ chillers ♦ ice machines ♦ food display cases ♦ water coolers •Refrigerant substitutes (including HFC-13�a) must also be recovered and not vented to the atmosphere. . ............. :np�r;xxti�;n,v,n•.�::::ry}vi:A.M1^ '(:i��lyi4i:tiAi.:iiiiiiii:.ir:i:ii:::•..iv::::n�.: :�r.J ...�i:• :vSfLii'':':ti::�?i':''C;i:i::i:i:;:o}ii?i:.::ii:i�ii <::y�:;•`.;:i;::•.• .;,k::<p:::�r;:%�ii::?:�::;�:i;::.>:a::�::::�i:::::,.;: ;•:>:�:;:.ti::•:a. :::: ....::.�::::..: :....v.:•:•::�.,�. ::::._.:::::::.�:::.� ..::::;.;...::.::::::::::::::.::::::.:,::::::.:::::::.,�: ......:... .......... .•..•::::::: �.. .. ,..•::::,.�.;.....:•:•:'::.::•::::�:.r::::::::• -'o. , i!:�:�:::+.:r... :.:c:•:t.;...-..-::-:.r:.:,. _......_ _ . .::.::.:::...:...: . ..........:.::................. ..;:::.w:.,.r...;•�;,:::.:�:.ti.y:.:.�-:.. ................ .•:: ...... . �::•........ .:...•:::::::.•:.........o.. � . ..... .-::':::;:::.':�:• ...t . . .:.: . .. . � -. � ::::.x.;::::ar:::r::; .<•::s:::::::.::•.:;::•::,::.:.:r............i.;.::.r;.;.:::.::5;�.::a:•:�:::::::::.>•.:r:.::>:: � ��� �: : . ,..... .... ., .�.. i::r:: :+x:.: .::::..............�..:.. .,.... .:.::::::.�:t.>;.........?:::.�:>;::::.. � ::: .�. ...,.....:::>::::.»:a:::::::..... ......:::::::>.::�:..r. .:::.::::.:::.::.:.. ......w..y. ..E� <..................:::::;;�h�.::::::.�::.�:......:...:::;�::::::>:..::..........::v«.;.: ...::..._:::.:.�.......>.�::::�,k,...:.,<.>:«.::..:.,.._::.�:. ,.::.:::. �`I�Y� . .::.... ........ U��� ................................:::::::::::::::::.�:.�::::::::::::::::::<.:r:;>:.:>:>�:»>::::>; �>::::::::.::>:.::.:�»>::»»::>:::>:�»;:>::>:<:»::>.;::::<.:>:;.�:.::........... _..... . . �RS.;;;.::;.:::.>:.;:.::.::.:.::::.::.:::.::,:::::...........:.::..........::::...........::..:........ .. . ..:.........:::....::::.�._::::._:::::;:::::::<.::;::;::::<:,:::>::::><.:>::<;.::::>::::>r>:::<:::::;:».»:: ................:..:::::::::::::::;:::::�::.>:;:>....:..:::.............:::::::::....:._.:.�:::::.:..�::.., n.�........................................................:r:<::>::<.::::<::::.:...........Y...r......,.K�..v... •Some fire estineuishers contain halons which destroy the ozone layer. •Halons must be recaptured when recharging,sen•icing, or retirin�the unit. There are a number of companies in Minnesota that have the proper halon recovery equipment. ' •Halons can be used as total flooding agents in areas such as computer rooms, libraries, spaces floors, and near electronic and medical equipment. •Halons are also found in some portable fire estinguishers. . . Halon fire extinguishers must be removed from the facitity prior to demolition. .:::.:::::....::. v:::::. .....,,:..,,.::.,....:....,.......,h:..�::. ...fi.:::��.:::.:.;;:.;.::.�.�::::::Y. :..>,.:.::.v.�. . ::.::::::::.::....::....:.::::::.... .... . ........... ....................... .:....:.:.>::::.:�:.�:.::.�:::;::.::.:.:::..:;::::.:::,.;:..;:.::;._:�.,,::.::.:;:...:::;.;:�;�.::.:�.:.�;.:.::::.:;�.:;;;;::.::;:.:;;:.::..::;:,;.::.::;:�:;:::.:::::::.:::::..�.::.:.:.;::::::.... .... ......... ::,.�:..:.;::.:�:::: >:�<>::::::::::::>::::;::;::>::>::::: .:. DEI� OL : ::::. :. :.v::,:.:.::::::::::.> >::::::::.::>�<:>:::<::>::::>::>;:.__ .�.._ . �T7OI� :: . .> >::.:.....:�.:::;<..;;:.;>;::�.�:>,»:>:.::::;�:::::::<�,;:�,;:.v..;;>;>:..:;::�:;:::.::::. L�'V'III��.L ��CEPTABLE: . ., .: . .:: . .. ...... ><::;::;:>::::.:: .......::::::v.;.,w:••. %•n•:4:v:::iCiii:::ii:.:::�ii:4:i:< •: ........ ...... �n Y�Aee�:T�BL�:ti�as .............h.::::::.:. ........ ... ..:::..�:::.�.�>......:.�::::::::..::.:::_:::: . :.: .::::. In the disposal of demolition debris, certain materials may or may not be acceptable at the Demolition Land Disposal Facility (Demo LDF). Certain Demo LDFs ha�•e Industrial Solid tiVaste �Ianagement Plans (IS�VI�IP) that allow them, under special provisions, to accept some of the following materials. � � 4 � F cceptable Materials: ♦ drywall (demolition only) ♦ untreated wood ♦ ceramic Fixtures ♦ plastic ♦ conduit ♦ glass ♦� insulation (fiberglass/cellulose) ♦ wiring ♦ roofing,shingles ♦ tile (ceramic,floor,vinyl) ♦ metal ♦ built-in cabinetry ♦ asphalt ♦ butiminous concrete ♦ masonry ♦ concrete (including rebar) ♦ masonry/bricks ♦ tree stumps Burned out buildings: must be sure that no hazardous materials or asbestos-containing materials remain and that the threat of smoldering or reigniting is controlled. Some Demo LDFs may not be able to accept burnouts because of the potential for hazardous materials to be present. In addition burnouts pose a serious threat of smoldering or reigniting at the landfill. Check with the Demo LDF before bringing the material to the landfill Unacceptable Materials: ♦ infectious waste (needles, body parts, dressings, etc. from hospitals, mortuaries, nursing homes) ♦ untreated sesvage (sewaae sludge, sludge compost, and septic tank pumpings) ♦ street stiveepings (should be tested to determine if they are hazardous (TCLP)) ♦ tires (compaction difficulties, floating effect, and waste landfill space) ♦ major appliances (all hazardous materials must be removed including mercury, PCBs, and chlorofluorocarbon (CFC) refrigerant gas, commonly l:nown by the trade name FreonO ♦ yard�vaste (creates leechate, gas, settlement problems, and�ti•astes landfill space) ♦ household «•aste ♦ paint cans ♦ construction waste ♦ cardboard ♦ caulk tubes ♦ agricultural chemicals ♦ machinery or engine ♦ mattresses or ♦ treated lumber parts furniture ♦ railroad ties Some types of Industrial tiVaste may be accepted at a demo LDF depending on the individual landfill's permit. Industrial�Vaste typically accepted at Demo LDFs includes, ♦ asbestos-containing materials ♦ construction`vaste that is the same as demolition ti�•aste, such as tivood or insulation If you have any questions about acceptance of any���aste at a Demo LDF please contact your nearest NIPCA Solid �Vaste Specialist. ,:,:::..::: .�..v.v,::.:.:::.:.>:.::::;;:.:.;:.;;:.:<.;:.:.;�.;:;;.;:.;::;:.;:;.>;:.;>;::.;;..;::::::::::.::::::.:::.:::,:.�:::........... ............................ . . .. .:,,:.;:>:.:;.:......;:....,�............... ...................:..:..:::::..................... .::::.�::....,..........,.......................,x..,w......:.:...::::::..................... ...... ... ................. ........ .:::::.:::::::::..................:............................ ,.......,.>:>vn::>::::.�.;w.:::,,..,...... ............ ................::.:�:::::..�::::.:.�:::,::::.::::::::.:.:.::::::::::::...::::::::::::::::.::..:.::::::.�::::,::...:..........:,:::::::._::::::::.:_,,::::::.�:::.:�::::::.:::._:::::.�::::..:.....:::::........:. ..:::::::.:............::. ....:.�::.:::::::;:;;�,.::::.:..............................:..........r,;.:::.:;:.:.::::::.:;>;;>;;;;;:.;>;>;: ,:._ _. _ ...................................::::::.;�::::::::::::::::::::.:::::.�:.::::.;�::::::::;::::::::::::::::.;�:.;�::: ,.:.............:. .......:::::::n..::.:.:.:_:::::::::,::::.:::::.::. >...... ......................,......:....:.... ..................,.:.:::::...................::.:..:...:,:.......:.............:::::.::........... ;;O THE ::::::,>:::.;:.:�:.:<>::>:<:::;::<:�;;<�::<:�:::::::<>::<::::><>::<:<::::<.>;::>::<::<::>:;:h,>:::::::„:<:>=::t:�:�:<>:::::;::>::::>:::>:�; :::........ ,..�:::. . ....�::::..::�.:::::::.:.:.::.::.:. ,::.:.:..::::.�:::. .... .... . ....:::..::.;:;:...:::..... ............ ..:.::.�:.;:;:::... ���:::�::�:::::�>:,�M:;>hv:�:<,:x�>i>::>:;�>::::::>�»;:::::<:»;:>:::::;::::«<:>:::::::::;:::::::::>::»::::::::>:::;::»:.;::.;.:.::..:.::.:..... ::::.�::. ;>;::.:.: �::::::. ........... �.�w.�� ,� _..::.....:........................:...........:::::::.�:::::,.::.:.............::::::::.::..::. ..n....... .,...............................:::.:::::.::::.�..:.,�.>:::;:.:<::>:>:.:��::...�....:..::::::.:::.:::.�:...::::.:..:;.... . ........... ............... ......:.::.<�<v:-v::::::�, ..r.�:.�.•..::n•.s::nyvav.+vx:nr�vhvi.�.:•:<L'i:i:t�:i?0:4:fiiii::n\�:CA4:i:i::4:SY:i::i:i::i+:i:tri•:�i�ii:::i::. :.•••.:iY� ' f 5 Other issues that may arise include local demolition permits, gas lines, and eIectrical con � ^ The Gopher one-call can be used to identify gas lines. Also,you are reminded that for aIl echons. demolitions,whether asbestos is present or not, the notification form must be sent to the MpC asbestos team. A '�`:�x:�: :�,�:.>,:::<;::�.;..,:.,....�.. :'c°6�.�,'t�'�;� .:�c;:»{;.}'••4,::?::;:.;{:;..::::•:.::;::•::::;'x':':;:",?::a;.y:^::5:'s::;:;:�.;^.`;s:::.;..wn,;...;..;:,,.,,;.>•,. • �n'•' :ti�;.::.::•..�:t'v�.•: + `•5:•.•<++ F...,..r.+>:•::•i::�:?�:�:>•:�:;::?•:::::�:o:•>:�::�::::::?;::•::;:::s::.,,,.;,..r;.�.>;:>::::;;::.:::.....:::::`:Y:;:;:,x,.;..>:.vo:•>t::.::.;,y:. `.,'••'.. > t,-.: ........�• .... .............::::::::::::..•::•:••`•.;.;.v.;:wy;v t...; .,••....<u?•.•:,;;a.r::.;••:.:::>:�»:?•:.'•::�::•::+..;:>s:•::•:•:::.�:::::;:•t:.:::::::: :1. :. :. .�..,-.......... •{::..,-.,.,,:. ,..w.; e5�...:....a.,.,;. ( .. . . :.:. ............:...:....M1:;.:.� r:r�: •::•...,:.y:..:::. ..;,... .�.:.,. :�.::•:•••,•:::.:::.:.:,••::�.:::.�:.::r::•::�:.t::::::;:.:. �j �+�} . ...+,;..; . :�,a•.as.N.a„�.. {�� :-.rn��.,.., • •�tw:CL• � +S..M..d::•.;,.... � :. :.: � � . ....:.:::........�_:yi::;::::.::.;i�::;;'":y::�>::��:�::�::2%'2':::::;::':•`•?c<.;•r`;'v::... �.ni.::i:;r>:::i::.:r:::�.:i:�:�:��:�>:k;:�:%;:;�V��Q f � "�`yY^+' r;.n ..:�..:.:�..�::•:::..•i.:i::..:.v.::� ..a.�+x.�:++:�F:��;/��, .::� .' ��.��'?i�:ti^:'.:_{vii'•iYi:i::::i:i:iiii::i::i:.y.;Svi.'•:i.'•ii.•.�:jvi:`?{":`v:}i} '{'�i'A'r'�"�ii:rl.i r:$ � m..vnrnvrv.�q%'Y.•if:i�i:::i:�i:J::i::{•'-:f'.:+i::ri4:4ii:i:vi:':ii'�ii-Y?i:;!;:i�`iiiiiiii::;::.i"i::�:::::y:},�{�}ii:r.}}^.:i}.4:��•;i;•}:.�r!'l.4:y:;:i::;';v.::ii:;:.�i: ,-......; N..n.r.t.....:x � .......::: ..... ..x.x.:n:?l�.�.-:..Yyty . rr..r................r....n.Yr ...{;::-.,:��. .......::::::::::w:::::.�.}i•::-ii:?Ni:'ii::�iiii:ii•:•:i... . . .........v...�...s..rv.•.rviri:J:•i�:.:i}ri: For more information about any of the above listed programs please feeI free to contact tbe individual program or call the MPCA at 1-800-657-3864. Asbestos Team: (612)297-86$� Underground Storage Tanks: (612)297-8679 Hazardous ��aste: (612)297-8�11 Refrigerants/CFCs/HCFCs: (612)297-7153 Demolition Debris Disposal: 1-800-657-3864 (identify the location in question for the•proper region) 1�Iinnesota Department of Health `'Vell l�Ianagement Unit: (612) 21�-0813. • This guidance document is not intended as a substitute for readina the rules or regulations and mal:ina your own independent determination of its applicability to your demolition. E�camples in the guidance document do not represent an eshaustive listing of types of materials or projects to which the rules or regulations might apply. f 6 , � - ' Minnesota Pollution Control Agency Notification of Intent to Perform a Demolition 1 : v �� Type of NotiGcation [ J Original [ ]Amended [ ]Project Cancellation ` Demolition Contractor: Building Informatinn� Name: Building Name: Address: Address/Location: Ciry,State,Zip: Ciry,State,Zip: County: Contact Person: � Phone Number(s): Phone Numbor(s): Age of Bldg.(yean): Size of Bldg.(sq.ft.): Number of Floors Including Basemont Level(s): Building O�vner: PresentUseofBld s• Name: Prior Use of Bldg.: Address: Dates when demolition or intentional burning will Begin & End City,State,Zip: Notification must be pomnarked or rcceived ten(10)working days Contact person: before demolition begins. 'See item#S for emergency demolitions. Phone Number(s): Both Beginning and Ending dates should be amended in writing as nzcessary to rcflect current project dat.s. If there is>2601inear feet or>160 square feet of Regulated Asbestos-Containing Material (RAC� in the building to be demolished,it must be removed by a licensed asbestos contractor prior to demolition. The State of NI�Y- Notice of Intent to Perform an Asbestos Abatement Project must be used to notify for the asbestos removal. Is nonfriable AC�I present in the structure to be demolished ? [ ] YES [•J NO If YES complete items 1-9. If NO complete items 3-9. 1. If ACM will be left in place for the demolition indicate the amount of Category I and/or Category II nonfriable ACI�I left in place. Categ.I Linear Feet Categ.II Linear Feet Square Fcet Squarc Feet Cubic Feet Cubic Feet CateQo�y_,j nonfriable ACM means asbestos-containing packings, ateQ�ii nonfriable A .M means any material,excluding gaskets,resilient floor covering,and asphalt roofing products Category I nonfriable AC�1,containing more than one percent containing more than one percent asbestos. asbestos that,when dry,cannot be crumbled,pulverized,or •Category I nonfriable ACIi is not allowed to remain in place rcduced to a powder by hand pressure. foc demolition if it is in poor condition. •Category II nonfriable AC`f is not allowed to remain in place for demolition if it has s high proba6ility of becoming crumbled, pulverized,or reduced to a powder during demolition,transport, • or disposal. (ez transite,cement,slate roofing) 2. Description & Location of AC�I remaining in place (including floor#and room#): � , 3. Company and/or individual that conducted the building inspection and the procedure used to determine�the presence or absence of ACM(including analytic method): 'Prior to demolition alI buildings must be inspected by sn LPA accredited inspector. 4. Description of planned demolition and the specific method(s) that will be used: 5. If the demolition was ordered by a government agency, ptease identify the agency and attach a copy of the order: Name: Title: Authority: Date of Order(M/D/�: Date Ordered to Begin(M/D/1�: * Notification for an emergency demolition must be submitted as early as possible before demolition begins,but not later than the following working day. A demolition is considered an emergency ONLY when the facility has been deemed structurally unsound and in danger of imminent collapse. If the structurally unsound building is known to coatain any reeulated ACbf or is suspected to contain any regulated AC�f,special procedu�es bIUST be followed. If you are unaware of the special procedures, instructions/regulations can be obtained by contacting the 1�iPCA at Ehe address or phone number listed below. 6. Description of procedure to be followed in the event that unerpected RACNI is found or Cat. II nonfriable ACNI becomes crumbled,puIverized or reduced to powder: 7. �Vaste Transporter Information: 8. �Vaste Disposal Information: Transporced Name: Landfill Name: Transporter Contact: OwnedOperator: Transporter Address:_ Address/Location: City,State,Zip: Ciry,State,Zip: Phone Number: Phone Number. ' ' 9. I certify that the above information is correct and I am a bonafide representative of the demolition contractor or building owner and have authority to enter into agreements for my emploper. Si�nature of Con�actor/Owner Date Send or Far to: For questions call: Asbestos Coordinator-Air Quality Division 612-296-7300 �i�T Pollution Concrol Agency 1-800-657-3864 520 Lafayette Road North Fa.r: 612-215-1593 St. Paul,1MI 55155-4194 * MINNESOTA DEPARTMENT OF HEALTH - WELL MANAGEMENT SECTION -- SEALING VERIFICATION This is to verify that this office has received notification that a well (Minnesota Unique Well Number H0178297) is to be sealed by T.L. STEVENS WELL COMPANY, INC. at: County: HENNEPIN Township Name: ORONO Received: O1/10/2002 Township No. : 117 Range: 23 Section: 20 1/, NWl/, SEl/, NWl/a Street Address: 3790 SHORELINE DRIVE, ORONO 55391 This well must be sealed in accordance with the Minnesota Rules on Wells and Borings. MDH staff may be on site to inspect the well sealing. ORONO, CITY OF P.O. BOX 66 - `' ` ' .x�� CRYSTAL BAY, MN 55323 , ' � � r;.�,� C11 Y Vr �j,�V�;�O