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creas CalRecycle ProrecTo8 C 2 e eee July 14, 2017 Mountain Ranch, CA 95246 RE: Invoice for § RAILROAD FLAT RD ‘The attached invoice isfor the debris removal conducted ai § RAILROAD FLAT RD by the utte wildfire Structural Debris Removal Program, which is also referred to as the Right-Of Entry {ROE) program. The Structural Right-Of-Entry (ROE) program was Initiated to safely remove potentially hazardous burn debris from private property created during the Butte Wildfire of September 2015. The State and Federal governments have pald for the debris removal costs @\ § RAILROAD FLAT RD and regulations require the County to verify insurance and coverage for properties that received debris removal and to receive and deposit payments from property owners when a duplication of benefits has been discovered. The County Is conduit for these funds, collecting these insurance funds from property owners and transferring them to the State and Federal government. Your financial responsibility is limited to remitting the lower amount of either the insurance proceeds that your policy specifically provides for debris removal or the actual governmental reported costs associated with your property. calRecycle, the State agency responsible for the ROE program, has reported that the cost of the Butte Wildfire Debris Removal Services associated with your Property was $74,541.31. Based upon the County's insurance contractor assessment of your insurance documentation it appears that your insurance coverage was responsible for $1,970.00, Therefore $1,970.00 is the amount of duplication of benefits of the debris removal cost, and therefore you are being invoiced for this ‘amount to satisfy the State and Federal duplic n of benefits regulations. Calaveras County PO Box 668, San Andreas, CA 95249 Phone 209-221-4807 CalaverasButteWildfires@sites.tetratech.com = & Aoencr FEM. Please provide the balance of the invoice by August 14, 2017. if you believe any of the cost ‘or insurance allowance information in the invoice is incorrect or unclear, please contact us immediately. We will remain available to provide information and a! finalization of nce through tt this process, at which time we will be forwarding your remittance information to the sponsoring State and Federal agencies for their records and follow-up. If you have any questions or concerns, please contact us by calling the Hotline at (209) 221-4807 or by e-mail at CalaverasButteWildfires@sites.tetratech.com Sincerely, Mel Knight Mel Knight Butte Wildfire Community Liaison Calaveras County PO Box 668, San Andreas, CA 95249 Phone 209-221-4807 CalaverasButteWildfires@sites.tetratech.com ‘CALIFORNIA S ENVIRONMENTAL ys PROTECTION Aaexcr FEMA Payment due by August 14, 2017 INVOICE # Debris Removal Conducted at: ‘S RAILROAD FLAT RD Socal ene Mountain Ranch, CA 95246 July 14, 2017 209-754-4081 Policy Number: Customer ID. Invoice Summary Property owner's responsibility of the Debris Removal Services as sue set by the Insurance Debris Duplication of Benefits " Payment received by the County from the property owner $00 l Invoice Amount: $1,970.00, ‘Debris Removal limits and clalm amounts obtained from policy documents provided by property owner and/or insurance provider Make all checks payable to Calaveras County Environmental Health Department --+-Cut Here- invoice with your payment Please return this portion of the Payment due by August 14, 2017 INVOICE # Debris Removal Conducted at: S RAILROAD FLAT RD Railroad Flat Rd ‘Mountain Ranch, CA 95246 Policy Number caistanait INVOICE AMOUNT: $1,970.00 Calaveras County PO Box 668, San Andreas, CA 95249 Phone 209-221-4807 CalaverasButteWildfires@sites.tetratech.com : : a ee ee ee Ce ee Butte Incident Individual Property Final Summary Report S Railroad Flat Rd This report presents the property site assessment, debris removal activities and other work completed ‘on the above listed property. This property was significantly damaged or destroyed in the Butte Fire in Calaveras County, California during September 2015. Debris was removed from this property, by the CalRecycle Contractor between 4/ /16and4/ /16. On September 23, 2015, the Governor of California, Edmund G. Brown Jr. declared a state of emergency in Calaveras County as a result of damage caused by the Butte Fire. The governor issued an Executive Order that directed CalRecycle to work with local officials and implement a comprehensive structural debris removal plan. CalRecycle deployed an incident management team to oversee the removal activities and developed a Debris Removal Operations Plan with Specifications to describe how the activities would be carried out as a single, organized project. In order to have access to private Properties, a Right of Entry (ROE) permit was obtained from each property owner prior to ‘commencement of debris removal activities (Included in the ROE Sub-Folder).. Site assessment and debris removal activities on each property were in accordance with procedures described in the Butte Fire Debris Removal Operations Plan and included the following: Site Assessment After the DTSC conducted their hazardous materials assessments and removed the obvious hazardous materials, CalRecycle Contractor(s) determined the dimensions of the structures and ash/debris footprints, identify any hazards, wells, septic systems or other sub-surface hazards, conducted radiological sweep, and take photographs of the property prior to debris removal. Asbestos Survey and Abatement: Each property was then visually inspected by a Certified Asbestos Consultant for gross asbestos containing material (ACM). Suspected material was sampled and sent to a laboratory for testing. if the sample results were positive for ACM, an abatement contractor was deployed to remove and bag the ‘material and was sent to a landfill that is permitted to accept ACM. Debris Removal: All ash, debris and metal was removed by CalRecycle’s construction contractor. Each property had a debris monitor assigned to track all types and quantities of material that was removed from the property and recorded on dally activity logs. Conere indations, Slabs, and Si Removal: All foundations were removed from each property and tracked separately from the ash, debris and ‘metals. Concrete was recycled and used as road base for county roads. Impacted Soil Removal: Approximately 2 to 6 inches of soil was removed from each property from within the footprint of the debris field, after the ash and debris was removed. Soil Sampling and Analysis: Soil from within the footprint of the debris field on each property was sampled and analyzed for Title 22, metals to determine that all of the ash was effectively removed. Erosion Control: Erosion control measures were installed at each property. This included hydro-seeding, waddles, and straw mats where needed. Debris Removal Costs and Tonnages: Z 2 » | Disposal | Trucking Material Labor* | Equipment* | Tonnage’ ase aos ‘Ash/Debris 818757 | 6,906.13 119.46 | _3583.80| 8,625.00 Metals 483.88 408.15 7.06 =388.30| 4,805.00 Soil 0.00 (0.00 0.00 0.00 (0.00 Concrete (Ineligible) 795.73 671.19 i161 719.82 810.00 DEBRIS REMOVAL SUBTOTAL $9,467.18 | $7,985.46 138.13 | $3,915.32 | $14,240.00 Debris Removal ineligible Costs $795.73 | $671.19 ii61[ $719.82 | _ $810.00 Debris Removal Claimed Costs $8,671.45 | $7,314.27 12652 | $3,195.50] $13,430.00 * Supporting documentation for these costs are located inthe sub-folders for this propery. Cost tracking for each of these activities and the amount of material removed from this property is summarized in the table below: Activity Cost Health, Asbestos Inspection, & Air Monitor ig Site Assessment & Soil Sampling 600.00 Asbestos Abatement = Debris Monitoring 2,315.86 Erosion Control 1,045.86 lot Fee 7,200.00 Debris Removal Costs by Material Ash/Debris 27,302.50 Metals 5,308.73 Soil z Concrete (Ineligible) 2,996.74 Pro-Rated Community Costs 27,771.63 Site Work Subtotal 46,769.68 ‘TOTAL PROPERTY COST $74,541.31, Total Ineligible Costs $2,996.74 Total Claimed Costs $71,544.57 "Supporting documentation for these costs are located inthe sub-folders or this property. | ey | Rif ntry Permit | APRA 4 2015 { (For Providing Debris Removal on Private Property) ENV This form must be completed and submitted by: ne HE | Friday, November 6, 2015 in order to participate in this clean-up program. | Coan of ores Environmental Health Department bate Lisa“ {81 Mountain Ranch San Andreas cA 95249, propetyaddres_ _Rai\oack Pasko MAO. Raney ‘Assessor's Parcel Number (APN);__ he (Owner), hereby permit the County of Calaveras (County) ts officers, employees, agents, contractors and subcontractors (County), to enter the Owner's property located by the ‘above-referenced address, subject to all licenses, easements, encumbrances, and claims of tite affecting the Property upon the following terms and conditions: 1. GrantofRight-of-Entry, Permission is hereby granted and Owner hereby grants tothe County, its officers, employees, designees and/or permittees a right of entry ("Permit") to enter upon the Property, and | all related appurtenances thereto, for the purpose of inspecting, testing materials on, removing and clearing any oral wildfre-generated debris of whatever nature incding but nat limited to ash, vehicles, trailers, ‘miscellaneous debris, construction debris, waste or other materials from the Property, subject to the terms | {and conditions set forth in this Permit, and to perform all incidents necessary thereto. Owner understands and | accepts that the entity performing debris removal on behalf of County will determine on 2 case-by-case basis | what matertals ually “debris” to be removed from the site pursuant to the removal program and that structural foundations and trees deemed hazardous may also be removed pursuent to this program. Its fully Understood that this Permit does nat create any obligation on the County to perform inspection, testing or debris clearance. Owner understands that the County wil undertake no cleanup action unt this Right-of- Entry Permit is signed and returned. Owner understands that participation in thir rogram shall nat operate to either require or prohibit County from later deeming a condition remaining on 2 property a public nuisance. ‘This is nota request for a permanent easement and/or right-of-way . athe permission granted will ) automatically terminate upon completion of sald work. 2. eaves Coven. Most homeowner insane pols hve cree pate casts of removal of wildfire-generated debris. Owner understands that in the event state financial assistance is } received by the Owner for purposes of inspection, testing or removing debris hereunder, state law (Title 19, Don 2 Caloris Coma fect Emergency secs, Caper Darter Aone steer | ‘Owner to reimburse the County forthe cos of removing wilfie-generated debris tothe extent covered inthe | Ohms mane poly. Owner ai undestansthat when rested ane rt rondo othe insurance policy, proof/statement of loss and settlement agreement from Owner's insurance company to the | coun. owner X does, does at have homtoune sorter arse. Owner nts tht owner oct aves, Owe! carte de ea of perry a ere ws ro imurance nef the me of he wre whch may prone evergs forthe crs open testing | arremovng dts Page 10f5, 3. Duplication of Benefits, Owner S hace fas tel aged recelve(4) any compensetion for debris removal from afrother source including Small Business Administration (SBA, Individual and family grant program or any other public asistance program. Owner will advise County in wing within ten (20) days of receipt of any insurance settlements for debris removal. Owner further agrees to reimburse the County within thity GO) days of reel rom such insurance proceeds, forthe cost ofthe debris removal conducted by the County. In the event the insurance proceeds are less than the cost of debris removal incurred by the County, Owner wil nt be responsible forthe difference. if the insurance proceeds trceed the County's cost of debris removal, Owner wl keep any excess proceeds. Owner understands that all disaster related funding, Including that for debris removal from private property is subject to aud. 4, County’s Obligations. In consideration of the permission granted, the County agrees to the following: 2, No permanent structure that appears safe and habitable to the entity performing debris removal wil be disturbed or damaged. Work will be performed in such a manner that it will not ‘materially affect ingress or egress to or from property. This determination shall not operate to either require or prohibit the County from later determining that a public nuisance exists on the property. ‘Owner is present at time debris removal team ente's the property and demands that certain debris ‘not be removed, this debris will not be removed. Owner understands and acknowledges that if he/she refuses to allow removal of debris deemed hazardous by federal, state, or loca officials, Owner shall still be legally responsible to timely and lawfully remove the hazardous debris at his/her own cost. b, Gates shall be closed and/or locked at all times. & _Anyimprovements on property, fences, gates, etc. which are damaged or temporarily removed will be repaired and/or replaced. 5, Indemnification ~ Hold Harmless. County shall not be liable for, and Owner shal indemnity and hold harmless the County, the State of Calfornia, California Governor's Office of Emergency Services (CalOES), California Environmental Protection Agency (CalEPA) California Department of Resources Recycling and Recovery (CalRecycle) and any of hei officers, agencies, agents, contractors, subcontractors, employees and volunteers, against any and all claims, deductibles, self-insured retentions, demands, ibility, judgments, ‘awards, fines, mechanics’ lens or other lens, labor dlsputes| lasses, damages, expenses, personal injury, charges or costs of any kind or character, including attorneys’ fees and court costs (hereinafer, collectively referzed to as “Claims"), which arise out of or are in any way connected to actions arising out af this Permit, tnd hereby release, discharge, waive any claims or any action, In law or equity, arising therefrom. Over shall ‘make Owner's best efforts to mark any sewer line, utilities (electrilty, es, cable, et.), septic tanks and water lines located on the Property. 6. No County Assumption of Liability for Remediation. In consideration ofthe assistance County Is providing to Owner under this Permit at no cost to Owner and subject to the Section 4 ofthis Permit, County ‘assumes no liabllty or responsibility, and Owner shall not seek to recover from County, the County, CalOES, CCalEPA, CalRecycle, or any of their officers, agencies, agents, contractors, subcontractors, employees and volunteers, the costs of any remediation of damages to the Property incurred due to actions taken pursuant to this Permit. 7. Cqunty’s Agents. Any person, firm, or corporation authorized to work upon the Property by the County shall be deemed to be County's agent, including but not limited to the State of California, CalDES, CCalEPA, and CalRecycle and shall be subject to all applicable terms hereof. Page 2 of S| | 8. Authority, Owner represents and warrants that ft has full power and authority to execute and fully | perform its obligations under this Permit pursuant to its governing instruments, without the need for any further action, including but not limited to any further action, notice to, of approval from any co-owner(s), leaseholder(s), enant(s), lenders), or lenholder(s), and any person(s) executing this Permit on behalf ofthe Owner(s s the duly designated agents of Owner(s) and Is authorized to do so, and that fee title tothe | Property vests solely in Owner(s). If this Right of Entry Permit is executed by anyone other than Owner(s), it shall be accompanied by a complete and legible Authorization Form (attached) signed by Owner(s) Incomplete or illegible Authorization Forms will not be recognized as a lawful designation of authority. 3. ‘This Permit constitutes the entire agreement between the parties with respect to ‘the subject matter hereof, and al prior or contemporaneous agreements, understandings and representations, | ‘oral or written, are superseded, 10. Modification, The provisions of this Permit may not be modifi signed by both parties, cept by a written instrument | 11. Partial invalidity, if any provision of this Permit is determined by a court of competent jurisdiction to bbe invalid or unenforceable, the remainder ofthis Permit shall not be affected thereby, Each provision shall be valid and enforceable to the fullest extent permitted by law. 12. Successors and Assigns. This Permit shall bind and benefit the parties and thelr successors and assigns, ‘except as may otherwise be provided herein. 13. Notices, Any notice required hereunder shall be provided as follows: ‘Contact information for the County: ) Calaveras County | Environmental Health Department ‘891 Mountain Ranch Road, San Andreas, CA 95249 209-754-6399 Email Address: 14. Submission by facsimile or email attachment. In lieu of personal delivery, Owner(s) may elect, at his/her own option and at his/her own risk, to transmit to the County by facsimile or ema attachment 2 | ‘complete, legible, and fully executed Right of Entry Permit and (as applicable) an Owner Authorization to Designate Agent form. Owner(s) is responsible to ensure complete, legible, timely, and accurate transmission | ‘of such documents, and County shall not be held responsible for any errors or omisions related to electronic. ‘or facsimile transmission, including but not limited to errors resulting from failed or delayed transmission, | delays resulting from SPAM fiers, technical malfunctions of facsimile machines or electronic communication | ‘equipment, inability to open attached documents, or other failure of the County to timely receive and act upon these documents. a Fax: 209-754-6722 \ b. Email (attach as pdf shmaweb@co.calaveras.co.us Page 3 ofS IN WITNESS WHEREOF, Owner nd County have executed this Permit effective | \ tsa by: a voner Signature Oumer2 Sinature County Agent/Witness: By: Printed name ‘Slenature eA Please supply the following insurance information: ——— —_ dain 3 naan halts fe es Please check all that apply on the Property: ‘Large item | Quantity | Kee Description Remove Comments Vehicles \ \ OO dae Boats Trallers/RVs Ze ta, AD _Quone™ _| Other: 1 Trees identified by a Certified Arborist as dead ot dying may be deemed hazardous. Hazardous trees a) deemed to constitute an imminent hazard to public, heath, safety, and welfare; 2) deemed to constitute a hazard to the debris removal program; and/or 3) deemed to be a threat to county right-of-ways or residential structures that would require a permit to rebuild may be cut down ‘and removed through this Permit. Owner understands and accepts that the debris removal team may ‘ot remove all trees on the property that are hazerdous (or may later prove hazardous} ands advised to independentty consult an arborist about any remaining trees that the Owner is concerned may be Potentially hazardous. Tree stumps will not be removed. age 4 of 5 Underrourd Tanks | __wcton | amano commen Septic! Nie + Fuel/Oi fea hea eee gear 5 part of the debris removal project. 1. Septic tanks will be pumped ofall wast { Underground Structures — Construction Date (itknown) basso ae I Basement Root Cellar Other: | ‘Special instructions | (le. directions to contractors to access Property or notable items Owner wishes to try to recover): | | ss SE ce en TIEN a Ce eI Fane a ee ee ee One ener er | SS Re eee tena ee neers eee nena nea ee ene Ene Page Sof 5