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DEMO-000396-2017 TOWN OF QUEENSBURY 742 Bay Road, Queensbury,NY 12804-5904 (518)761-8201 Community Development- Building & Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE Permit Number: DEMO-000396-2017 Date Issued: Wednesday, May 30, 2018 This is to certify that work requested to be done as shown by Permit Number DEMO-000396-2017 has been completed. Tax Map Number: 266.3-1-11 Location: 977 State Rte 149 Owner: Stewart's Shops Corp. Applicant: Stewart's Shops Corp. This structure may be occupied as a: Demolition Only--Stewart's Shops Asbestos Report Received By Order of Town Board TOWN OF QUEENSBURY Issuance of this Certificate of Compliance DOES NOT relieve the (7 4t property owner of the responsibility for compliance with Site Plan, Variance, or other issues and conditions as a result of approvals by the Director of Building&Code Enforcement Planning Board or Zoning Board of Appeals. TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201 Community Development-Building&Codes (518)761-8256 BUILDING PERMIT Permit Number: DEMO-000396-2017 Tax Map No: 266.3-1-11 Permission is hereby granted to: Stewart's Shops Corp. For property located at: 977 State Rte 149 In the Town of Queensbury,to construct or place at the above location in accordance with application together with plot plans and other information hereto filed and approved and in compliance with the NYS Uniform Building Codes and the Queensbury Zoning Ordinance Tyne of Construction Owner Name: Stewart's Shops Corp. Demolition-Commercial $0.00 Owner Address: PO Box 435 Total Value $0.00 Saratoga Springs,NY 12866 Contractor or Builder's Name/Address Electrical Inspection Agency Plans&Specifications Demolition Only--Stewart's Shops Asbestos Report Received $30.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Tuesday,July 10,2018 (If a longer period is required,an application for an extension must be made to the code Enforcement Officer of the Town of Queensbury before the expiration date.) Dated at the Town of ueensb /�fon y J , 7 SIGNED BY: �VJ for the Town of Queensbury. Director of Building&Code Enforcement S r Office Use Only DEMOLITION APPLICATION Permit hC • Q ~'.��Jb� ��4- Permit Fee:$_ 16wn dQgcensburn^ Invoice:#: ZOD 742 Bay Road,Queensbury, NY 12804 P: 518-761-8256 www.gueensbury.net Demolition Location: 977 Route 149 Tax Map ID #: 266.03-1-11 **ASBESTOS REPORT IS REQUIRED FOR STRUCTURES BUILT PRIOR TO 1974** CONTACT INFORMATION: ) G LE goil 4 0 3-2- JUL � Applicant: ; - ,� i OAIN Ot�,�E�,-""r��M( Name(s): Stewart's Shops Corp. E31�f _ " 1i< Mailing Address, C/S/Z: PO Box 435, Saratoga Springs. NY 12866 Cell Phone: ( 518 ) 301-1466 Land Line: ( 518 ) 581-1201 ext. 4246 Email: cpotterCcD_stewartsshops.com • Primary Owner(s): Name(s): _ Same as Applicant Mailing Address, C/S/Z: Cell Phone:_( ) Land Line: _( ) Email: • Contractor: Business Name: Same as Applicant Contact Name(s): Mailing Address, C/S/Z: Cell Phone:_( ) Land Line: _( ) Email: Contact Person for Building & Code Compliance: Chris Potter Cell Phone: _( 518 ) 301-1466 Land Line: _( 518 ) 581-1201 ext. 4246 Email: cpotterastewartsshops.com Demolition Application Revised May2017 DEMOLITION INFORMATION: 1. Where will demolition material be disposed? Landfill 2. Type of structure to be demolished: a. Residence b. Garage c. Business X d. Storage Building ADDITIONAL INFORMATION: 1. Two inspections are required. A rough-in inspection, prior to installation and a final inspection,after installation. 2. Manufacturer's installation manual must be available at the time of inspection. 3. Masonry fireplaces& chimneys require plans to be submitted. 4. Twenty-four(24) hour notification is required for inspections. Declaration:Construction/installation must conform to NYS Fire Prevention &Building Code and/or manufacturer requirements. The applicant or owner agrees to comply with all applicable laws,ordinances,regulations and all conditions that are part of these requirements and also will allow the inspector to enter the premises to perform the required inspections. I have read and agree to the above: PRINT NAME: Chris Potter SIGNATURE: Gam. DATE: 6/26/17 Demolition Application Revised May2017 iARCHITECTURE � ENGINEERING ENVIRONMENTAL LAND SURVEYING ASBESTOS SURVEY REPORT Project Location: 266.3-1-11 DEMO-000396-2017 Stewarts Shops Stewart's Shops 977 Route 149 Lake George, NY 12845 977 State Route 149 Demo Only (asbestos report recvd) Prepared for: E C E 0 V E Mr. Chris PotterJUL Q 3 2017 Stewarts Shops I 2907 State Route 9 -----�-a -4��--�--� Ballston Spa, NY 12020 TOWN OF QUEI:NSBURY BUILDING&CODES �J Prepared by: GYMO Architecture, Engineering, & Land Surveying D.P.C. 18969 US Route 11 Watertown, NY 13601 (315) 788-3900 www.gymopc.com GYMODPc Project # 2017-133V June 23, 2017 GYMO Architecture, Engineering,&Land Surveying D.P.C. 18969 US Route 11. Watertown,NY 13601 (315)788-3900 www.gymopc.com ARCHITECTURE � � .. ENGINEERING ENVIRONMENTAL LAND SURVEYING Edward G.011ey,Jr.,AIA June 23, 2017 Patrick J.Scordo,PE Ryan G.Churchill,PE Scott W.Soules,AIA Mr.Chris Potter Brandy W.Lucas,MBA Stewarts Shops Hayward B.Arthur III,MPS,IE 2907 State Route 9 Howard P.Lyndaker III,PLS Ballston Spa, NY 12020 Gregory F,Ashley,PLS Thomas H.Ross RE: Asbestos Survey In Consultation Leo F.Gozalkowski,PLS Stewarts Shops Stephen W,Yaussl,AIA 977 Route 149 Lake George, NY 12845 Dear Mr Potter, As requested, GYMOOPc completed an Asbestos Survey at the above referenced site. Our NYS Certified Asbestos Building Inspector, Jonathan Riley Cert# 14-10573, visited the site on April 3, 2017 and collected samples of building materials suspected of being asbestos containing. These samples were sent to Paradigm Environmental Services for laboratory analysis. Based on laboratory analysis of the samples collected,none of the samples tested positive for the presence of asbestos. Report Note — In the event that other building materials are identified and shall be disturbed during the course of the upcoming renovation project, the materials shall be presumed to be ACMs until examined by an appropriately trained / certified individual and laboratory analysis proves otherwise. If you have any questions pertaining to this report, please contact me directly at(315)7883900. We thank you for the opportunity to work with you on this project. Sincerely, GYMO Ar act , Engineering & Land Surveying, D.P.C. Jo han Riley rvironm ntal Project Manager ttach ant A: License and Certifications Attachment B: Asbestos Bulk Sample Laboratory Results Attachment C: Drawing with Sample Locations Attachment C: Site Photos GYMODPC Project # 2017-133V June 23, 2017 GYMO Architecture,Engineerng,&Land Surveying D.P.C. 18969 US Route 11, Watertown, NY 13601(315)788-3900 www.gymopc.com ATTACHMENT A LICENSE AND CERTIFICATIONS GYMOoPC Project # 2017-133V June 23, 2017 GYMO Architecture,Engineering,&Land Surveying D.P.C. 18969 US Route 11. Watertown,NY 13601(315)788-3900 www.gymopc.com STATE OF NEW YORK-OEPARTjv€N i`OF LASOR r-. ASBEsros aMFICAIT JONATHAN L RILEY CLASS(EXPIRES) CATEC(02/18) D INSP(02/t8) H PM (02/18) MUST BE CARRIED ON ASBESTOS PROJECTS . niflPl61 r@ tfll`6t111i faf 1111111111 iull lltlilill 110 IF POUND RETURN TO: m IYES BAZ NYSUOL - LOC UNIT BAIR O ROOM 161A BUILDING 12 _L g 86T 5' 06" STATE OFFICE CAMPOS =r ALBANY NY 12240 o New York State—Department of Labor Division of Safety and Health License and Certificate Unit State Campus,Building 12 Albany,NY 12240 ASBESTOS HANDLING LICENSE Gymo Architecture, Engineering & Land Surveying, P.C. FILE NUMBER; 99-0170 LICENSE NUMBER: 29355 220 Sterling Street LICENSE CLASS: RESTRICTED DATE OF ISSUE: 11/09/2016 Watertown, NY 13601 EXPIRATION DATE: 11/30/2017 Duly Authorized Representative—Hayward Arthur This license has been issued in accordance with applicable provisions of Article 30 of the Labor Law of New York State and of the New York State Codes,Rules and Regulations(12 NYCRR Part 56). It is subject to suspension or revocation for a(1) serious violation of state,federal or local laws with regard to the conduct of an asbestos project,or(2)demonstrated lack of responsibility in the conduct of any job involving asbestos or asbestos material. This license is valid only for the contractor named above and this license or a photocopy must be prominently displayed at the asbestos project worksite. This license verifies that all persons employed by the licensee on an asbestos project in New York State have been issued an Asbestos Certificate,appropriate for the type of work they perform,by the New York State Department of Labor. Eileen M.Franko, Director SH 432(8112) For the Commissioner of Labor NEW YORK STATE DEPARTMENT OF HEALTH WA09WORTH CENTER = Expires 12:01 AM April 01, 2018 Issued April 01, 2017 CERTIFICATE OF APPROVAL FOR LABORATORY SERVICE Issued in accordance with and pursuant to section 502 Public Health Lew of Now York State MR. STEVE DEVITO NY Lab Id No: 90958 PARADIGM ENVIRONMENTAL SERVICES INC 1.78 LAKE AVENUE ROCHESTER, NY 14008 is hereby APPROVED as an Environmental-Laboratory-for the category ENVIRONMENTAL ANALYSES SOLID AND HAZARDOUS WASTE All approved subcategories and/or analytes are listed below. Miscellaneous Asbestos In Friable Materiel Item 198.1 of Manuel - - EPA 800/M4182/020 Asbestos in Non•Friable MatedahPLM item 198.8 of Manual(NOB by PLM) Asbestos In Non-Fdable Materlal-TEM Item 198.4 of Manual Lead In Duet Wipes EPA 80100 Lead in Point EPA 80100 Sample Preparation Methods EPA 3050B Serial No.: 55857 Property of the New York State Department of Health. Certificates are valid only at.the address shown,must be conspicuously posted,and are printed on secure paper. Continued accreditation depends on successful ongoing participation in the Program. Consumers are urged to call(518)485-5570 to verify the laboratory's accreditation status. Page 1 of 1 United States Department of Commerce iVational Institute of Standards and Technology a Certificate of Accreditation to ISO/IEC 17025:2005 NVLAP LAB CODE: 200530-0 Paradigm Environmental Services, Inc. Rochester, NY is accredited by the National Voluntary Laboratory Accreditation Program for specific services, listed on the Scope of Accreditation. for. Asbestos Fiber Analysis This laboratory is accredited in accordance with the recognized International Standard IS017EC 17025:2005. This accreditation demonstrates technical competence for a defined scope and the operation of a laboratory quality management system (refer to joint iSO-ILAC-IAF Communique dated January 2009). 10E�r 2016-07-01 through 2017-06-30 Effective Dates For the National Voluntary Laborato Accreditation Program sTArma� ArrACHMENT B Asbestos Bulk Sample Laboratory Results GYMODPC Project # 2017-133V June 23, 2017 GYMO Architecture,Engineering,&Land Surveying D.P.C. 18969 US Route 11. Watertown,NY 13601(315)788-3900 www.gymopc.com i PARADIGM 179 Luke Avenue,Rochester,NY 14608 Office:(585)647-2530 Pax:(585)647.3311 tevreoxwsxut stavress, ren, ELM& TEM BULK ASBYESTOS ANAL YS/ REPO T via NMOH FLAP Method 198,1 198.4 and 198.6 Client: GYMO Job No: 4804-17 Location: 977 State Route 149#282 Page: 1 of 4 2017-133v Sample Date: 4/3/20117 _ PLM Asbestos PLM N TEM Asbestos TEM PLM Non- Fibers Type& Total 0 Fibers Type& Total Non-Asbestos Fibrous Client lD Lab ID Sampling Location Description Percentage Asbestos 8 Percentage Asbestos Fibers Type& Matrix Percentago Material a 1A 39599 `rhroug nut White Joint Nono cteste 0% Not Requited N/A None Detected 10 % Compound 1B 39600 Throughout White joint None Detected Ooh Not Required N/A None Detected 100% Compound 1C 39601 Throughout Whitt!joint None Detected 0% Not Required N/A Name Detected 1009/6 compound 1D 39602 Throughout White Joint None Detected Doh Not Required N/A None Detected 100% Compound 1)3 39603 'Throughout White joint None Detected U% Not Required N/A None Detected 100% Compound 2A 39604 'Throughout White Drywall Norte Detected 0ah Not Acquired N/A Cellulose 3% 96% Fiberglass 1% 2B 39605 Throughout White Drywall None Detected 0% Not Required N/A Cellulose 3% 96% Fiberglass 1% 2C 39606 Throughout White Drywall None Detected Doh Not Required N/A Cellulose 3% 96% Fiberglass 1% 2D 39607 Throughout White Drywall None Detected Ooh Not Requiter! N/A Cellulose 39/0 97% 211 39608 Throughout White Drywall None Detected 0% Not Required N/A Cellulose 3% 96% Fiberglass 1% KEY TO NOD COLUMN SYMBOLS No Symbol In the NOB column denotes sample analyzed by ELAP Method 198.1(PLM). V NOS(non-friable organically bound)denotas material analyzed by ELAP Method 198.6(PLM)and 1911A(TEM)as noted, 0 denotes material analyzed by ELAP Method 198.6(PLM)per NYSDOH.This Method does not remove vermiculite and may underestimate the level of asbestos present In a sample containing greater than 10%vermiculite. #denotes friable material analyzed by FLAP Method 198.6(PLM)and 198.4(TEM)as noted. X denotes sample prepped only by ELAP Method 198.6. •.Polarized-light microscopy is not consistently reliable in detecting asbestos in floor coverings and similar non-friable organically bound materials. Quantitative transmission electron microscopy is currently the only method that can be used to determine If this material can be considered or treated as non-asbestos PLM Bulk Asbestos Analysis by New York State Departmentof Health,ELAP Method 1913.1,149.4 and 190,6("Polarized Light Microscopy and Transmission Electron Microscopy Methods for Identifying and Quantitating Asbestos In Bulk Samples and In Nnn-FrNhh,Organically Bound Bulk Samples..")or EPA 600/M4.02-020 per 40 CFR 763 and/or EPA 600/R-93/116(NVLAP Lab Code 2000530-0-0), a E&MG ELAP ID No.: 10958 Lab Cade 200530.0 for PLM Analysis PLM Date Analyzed: 5/9/2017 TEM Date Analyzed: 5/9/2017 Microscope: Olympus HH-2#221797 TEM Analyst: M.Lochner Analyst: T Ma Laboratory Results Approved By: Asbestos Operations Manager or Designee Mary F O)1C Paradigm Environmental Services,Inc.Is not responsible for the data supplied by an independent inspector.National Institute of Standards and Technology Accreditation requirements mandate that this report must not be reproduced except in full without the approval of the laboratory.This PLM report relates ONLY to the Items tested.This report must not be used to claim product endorsement by NVLAP or any agency ofthe U.S.Government.Quality control data(including 95%conridence IImILs and laboratory and analysts'and precision)Is available upon request. 4804-17 5/10/2017 • '.r PARADIGM 179 Lake Avenue,Rochester,NY 14609 Office:(585)647.2530 Pux:(585)647.3311 E11Vi nae Nt"TAi t1aV1 tit, hat. ELM& TEM e MAS .sTos ANALYSIS REPORT vier NYS'DOH ELAP Method.1913.1.198.4 and 198,6 Client: GYMO Job No: 4804.17 Location: 977 State Route 149#2112 'ages 2 of 4• 2017-133v Sample Bate: 4/3/2017 PLM Asbestos PLM N TEM Asbestus TEM PLM Non- Fibers Type& Total 0 Fibers Type& Total Non-Asbestos Fibrous ClientlD Lab 1D Sampling Location Description Percentage Asbestos 0 Percentage Asbestos Fibers Type& Matrix Percentage Material % 3A 39609 Main Retail Area Tan Pebble 12"xl2" Inconclusive OOA Norte Detected <.l.0oto Nene Detected 1004 PloorTiia No Asbestos Detected 30 39610 Mala Retail Arco Tan Pebble 12"x12" Inconclusive O% None Oateeted r1,0% None Detected 100% Floor Tile NoAgbestos i/ Detected 4A 39611 Main Retail Area Tan Mastic lnconriusive ObA None Detected e16% None Detected 100% No Asbestos Detected 48 39612 Main Retail Area Tan Mastic Inconclusive 00/0 None Detected 41.0% None Detected 100% No Asbestos y Detected SA 39613 Throughout Brown Cove gage <l.O%Residue N/A NIA N/A N/A N/A Remaining.PLM and TEM Not 5B 39514 Throughout Brown Cove Base <1A%Residue N/A NIA N/A N/A N/A Remaining.PLM X and TEM Not 6A 39615 Bathrooms Cray Calling Tile inconclusive U% None Detected <1,0% None Detected 1000/o No Asbestos # Detected 6B 39616 Bathrooms Gray Coiling Tile Inconclusive 0% None Detected cl'o% None Detected 1004yo No Ashestox # Detected 7A 39617 Exterior Brown Caulk Inconclusive 0% None Detected 41.0% None Detected 100% Windows/Doors No Ashestos 1J Detected 70 39618 Exterior Brown Caulk Inconclusive 0% Nona Detected <1.0% None Detected 100% Windows/Doors No Asbestos Detected KEY TO NOR COLUMN SYMBOLS No Symbol in the NOB column denotes sample analyzed by ELAP Method 198A(PLM), V NOB(non-friable organically bound)denotes material analyzed by ELAP Method 198.6(PLM)and 198.4(TEM)as noted, Q denotes material analyzed by ELAP Method 198,6(PLM)per NY5DDH.This Method does not remove vermiculite and may underestimate the level of asbestos present in a sample containing greater than 10%vermiculite. d denotes friable material analyzed by ELAP Method 198.6(PLM)and 198.4(TEM)as noted. X denotes sample prepped only by ELAP Method 198.6. •1 Polarized-light microscopy is not consistently reliable in detecting asbestos In floor coverings and similar non friable organically bound materials. Quantitative transmission electron microscopy is currently the only method that can be used to determine if this material can be considered or treated as non-asbestos PLM Bulk Asbestus Analysis by Newyork Stare Department of Health,ELAP Method 198.1,190.4 and 190.6("Pnlarized Light Microscopy and Transmission Electron Microscopy Methods for Identifying and Quantitating Asbestos in Bulk Samples and in Non-Friable Organically Bound Bulk Samples.`)or EPA 600/1,14-02-020 per 40 CPR 763 and/or EPA 600/R-93/116(NVLAP Lab Code 2000530.0),[, FLAP ID No.: 10958 Ian Code 200530-0 for PLM Analysis PLM Date Analyzed: 5/9/2017 TEM Date Analyzed: 5/9/2017 Microscope: Olympus B11-2 4221797 TEM Analyst: M.Lochner Analyst: T.Ma Laboratory Results Approved By: Asbestos Operations Manager or Designee Mar:yvtlowr Paradigm Environmental Services,Inc.is not resnunsible for the data supplied by an independent inspector.National Institute of Standards and'rechnningy Ace ditatian requirements mandate that this report inust not be reproduced except Lt full without the approval of the laboratory.This PLM report relates ONLY to the items tested.'Ihis report must not be used to claim product endorsement by NVLAP or any agency of the U.S.Government.Quality control data(including 95%mnfid—,e limits and laboratory and analysts'and precision)is available upon request. 4804-17 5/10/2017 aF PARADIGM 179 Lake Avenuc,Rochester,NY 14600 Office:(585)647.2530 Paz:(585)647.3311 ` r 14 V I.aNMlNtAl s AV'C l3, INe. PLM& BULKASBESTOSANAL YSI5 RL'PORT via NYS-DOH L'.APMethod 198,1.198,4 send 198,6 Client: GyMn Job No: 4804-17 Location: 977 State Route 149#282 Page: 3 of 4 2017-133v Sample nate: 4/3/2017 PLM Asbestos PLM N TEM Asbestos TCM PLM Non- Fibers Type& Total 0 Fibers Type& Total Non-Asbestos Fibrous Client ID Lab ID Sampling Location Description Percentage Asbestos B Percentage Asbestos Fibers Type& Matrix Percentage Material BA 39619 Roof Black Plashing Intone ustos fib/n Norio Detsetel '1'0"M None Detected 100% Nn Asbusns Detected 8B 39620 Roof Dlack Plashing Inconclusive 'd1.0% 'Grace Chrysotile <1.0% None Detected 100% Trace Chtyeatle V a1.0% Detected 9A 39621A Roof — — Black Roof Care inconclusive 0ya None Detected c1.0% None Detected 100% No Asbestos Detcaud 9A 1396218 Roof Black Fibrous Roof None Detected 0% Not Required N/A Cellulose 911% 'L% Care 9B 36922A Roof Black Roof Cora Inconclusive 0% None Detected <1,0% None Detected 100% No Asbestos V Detected 9B 396228 Roof Black Fibrous Roof None Detected 0% Not Required N/A Cellulose 98% 2% Core HEY TO NOB COLUMN SYMBOLS No Symbol In the NOB column denotes sample analyzed by ELAP Method 198.1(PLM). V NOB(non-friable organically bound)denotes material analysed by ELAP Method 199.6(PLM)and 198.4 tTEM)as noted. 0 denotes material analyzed by ELAP Method 199.6(PLM)per NYS00H.This Method does not remove vermiculite and may underestimate the level of asbestos present In a sample containing greater than 30%vermiculite. 0 denotes friable material analyzed by ELAP Method 198.6(PLM)and 198.4(TEM)as noted. X denotes sample prepped only by ELAP Method 198.6. '•Polarized-light microscopy Is not consistently reliable In detecting asbestos In floor coverings and similar non4fiable organically bound materials, Quantitative transmission electron microscopy is currently the only method that can be used to determine if this material can be considered or treated as non-asbestos PLM Bulk Asbestos Analysis by New York State Department of Health,ELAP Method 198.1,198.4 and 196.6("Polarized Light Microscopy and Transmission Vection Microscopy Methods for Identifyingand Quantitating Asbestos In Bulk Samples and In Non-Friable Organically Bound Bulk Samples.")or EPA 60Q/M4-82.020 per 40 CFR 763 and/nr EPA 600/R-93/116(NVLAP Lab Code 2000530-0), ELAP ID No.: 10958 rasngc Lab Code 200S30.0 for PLM Analysis PLM Date Analyzed: 5/9/2017 TEM Date Analyzed: 5/9/2017 Microscope: Olympus SH-2#221797 TEM Analyst: M.Lochner Analyst: 'I'.Mn Laboratory Results Approved By: Asbestos Operations Manager or Designee Mary Do u Paradigm Environmental Services,Inc.is not responsible for the dao supplied by an independent Inspector.Natnnal Institute of 5tandw ds and Technology Accreditation requirements mandate that this report must not be reproduced except in full witheut the approval of the laboratory.This PLM report relates ONLY to the items tested.This report must not be used to claim product endorsement by NVLAP or any agency of the U.S.Government.Quality control data(including 95%confidence llmitx and laboratory and analysts'and precision)Is available upon request. 4804-17 5/10/2017 U OF C�TS?'G�DYFOIit.�UZ����ESSrY)S WALYSIS 179 lake Avenue,Rochester New York 136M Office:585-647-2530 1815 love Road,Grand island,New York 14072 Client: Office:716-775-5777 GYMO Cootat t Asa Arthur �Vltlg 138 � Phone R`nmber: Emmu Address for Data: 315-788-3900 ob#: C, -4 Client Mailing Adds en omental@gymopc.com liesults To 220 Sterling Street Arad Arthur urn Around fine. age of �' I 2 3 Oth, Date Sampled; Material T Watertovrll,NY 1St Ol 3 aH Date Logged In: -- l Project Location '..r —, r a Friable N()B Tr_,qY,pgged In P, I Tient ID �. ID Samplingl,ocation Color Material Size Type of Material 2 .4G5, � — 3 3/ i du }it j'. �AQ �>;t t, /�� �. Tyra V0 �" ve 14 fzc Al t VW 9 �� R G;k ; jA� .. sampled By: Date: V (199.1,I98A and 1 M4/oath a c 1 . - 1�, aftaiTzed F °6OWa s ep o l A� y�P,,40 CNA 2'� or EPA 6W/R-93/116 methods are and/ Transpo �to aradigm 1: regaested. Date: CHECK TO AUTOMATICALLY PB RFOItM TEM ON NOBS Received By: iar provide TEM contact name: Date: TOTAL NUMBER OF SAWLF,S ON ALL CHAINS OF CUSTODY: ATTACHMENT C [drawing with Sample Locations GYMODPc Project # 2017-133V June 23, 2017 GYMO Architecture,Engineering,&Land Surveying D.P.C. 18969 US Route 11. Watertown,NY 13601(315)788-3900 www.gymopc.com D a) W D D J W N OW A W aW gw� � R �Q �Y,) n Y. O> W v - N v w co m m EWARTS 282,077 ROUTE 146 ^ _ a!r s 1,5L:STOS �acwlr[crua J SURVEY [tY �NECalNaCD 5r RTS SHf�P;3 P�LANPSVKVLVIM4C�EOR F—, NY 92845 _ ATTACHMENT d Site Photos GYMODPC Project # 2017-133V June 23, 2017 GYMO Architecture,Engineering,&land Surveying D.P.C. 18969 US Route 11. Watertown,NY 13601 (315)788-3900 www.gymopc.com t � a a i WPUHNI All t , .rwM1�IW0 No* , AP XA, x w tM f a; �;�,,� '� ,` �¢ '+ .�: �� ,.. _� . , : �. � �� L �i'„x�� �-- ,�. . _� � i 'y i ;.:ir!�. � � -�i�:. } f.. v .. .� s •.^” � � '� • ��I . . :� ��. # ,.. a�'�' � ��`al � .- ,_. ;;,;, ., � � ml � � ..�a �. r, t;. »� i �. �: fir.� _ �.� � :. � ,�._.w�� .,. � ;. � �.. � a _ .:. ,�.:.'� �� a ,.r' �� � ,. .. ,.z .. .. x. :W � .'f _. �V t IP` �. '�F $; � __ .! `� ,. _.�,• , Mr. a �I^ �- • r � �� Y� '�, � 7�,�� "�'��+1 ,. �,. �! + , .. .,,.—,., �!1 �.. a v.. � � ���?ss .. ��� ,�t 1. � f..{a� Y"� u r -.. :.. .. 4 `. • �,. ,: y.e i. _ .+ . . z. _.__.- 4 , _ _ _ .-,a,-. ,. - -- _ _ .. �/ I - ?tri PIPE FouND r _ _ A ) fin ss --8 _ L= Zbo.o3 I OF t II i 0.1=1'FkfJM CORNER a)EB68URY - I - - ,0 GGIR{1RY GLUE,INC r 1 �`� _ �-p-_`p !370?524!L 319 P505 I `a'''6 »_Qi - o - per° f = : 1 E 265.4$, -�� QQ�__�O O w t Q- -'O " . z `.: N r % -- - f ,O-�Q--._;gip �#� .r =te., . _ _ , 1 0 O ' .g IRON PI � ir�,,r ' GOUNIT2Y ! - GLUE SIGN - a r . r r_ . /' r y , I r _,u,� { y, ,G � �. f e ' ! r _ 1W I =a � - , rry #: 3 w, D3 -- \ t I y ? d- Az E- c r 0 N _. JSP r 1 . __ _,� - _ . r _.._, : - - x , - .. - PI - %; f r I '" , 5I T LOG TION MAS' ' f '' r ,, ', ° `' ., .-' ,. . -ALL TREES/? %1 \, :...• IN HATGHF�AREA ' l I TO BE REMOLD ` I -: -. .. - :.._. ,' ' • ,, I - DI �� I =�--, ,........._ ............................. . ................... FIRE HYDRANT ,: _ . - EXI5TIr1G LEACH FIELD I „. .................................I..... . `, wA rER VALVE 4 ALL A550GIATEP E I TI G t FA FIE D `�`' / - I ,: ............... GOMPONENT5 TO BE ......................»....,.... .._.. __ . ... :... _ X 5 N GH L , , C VALVE .3 ALL A550GIAT=D `,; / / REt4UVED =. / ( GOMPorLNTs To 1=F ANHOLE / 5FEV.. ' / - I SEWER M .....7o EE' SEWER GLEANOUT C3 REMOVED � `^-'� : - - , I ' \ , i- .. _ �. RII.1=420.6x' : ..,-.. t ............... CURB INLET r __,....,- 413 0 INV=418.55' E �,-�'a ,�,\ U ' ,:. :' - . :' I ,,,,,,,,,,,,,,,,,,, ...I.....-. ..,,,........,,.--.-...... ... �� _ Rp1y PIPE OUND 0.12' `\, ,..,,•.- - _) �, - GUY WIRE - S --. ' :!'� ". :' sv EXISTIriG / INV I TGH B 5 FROPI C�RNER ---- .. '(`J; L tOHT POLE To i �_ 1 UTILITY POLE'. � I / EX,STIrIG GATGH BE REMoED t t / I SBL#266.03-1-10 i 8A5iN d ALL PIPE i i t ; ' iii EXI571NG LANDS OF (�i _ TO BE REMOVED i r. I: S : i i LIGHT POLE TO �ICiNPOrJT I . . U I IOHP!J WALKER O N82 i i �� „!2' i i 8E REMOVED I d 21°7W 6x.6- �` EXISTINGGATGt{ I r TRAFFIC SIGNAL CONTROL' BOX . ;: 3 I -:...., : \ r \ r ,, -.. <_ I _ - - - - - - LOAN 5.WALKER :,..,.:... r s•........ BA51N d AL PIPE Lb7I P.448 / r r _:u... / __ BE REM I I OLE LIGHT �■ GAPPED-' � (}� i i EXISTING- EXI5TIr1G SEPTIC ti J TO OVcD I I; I `�. r ,r . LIGHT POLE TO TANKS TO BE / -EXISTING UTILITY i t: i �- IRON PIN ,r; ELL SE /� i.• BE REh'UVED P-Et�OVED POLE 8 OVERHEAD . i i! I^l O I %i SERVICE TO BE t 1', +OLLARD. I ii REMOVED - I I '�J ti :; { 41 --' _�r__ I IREIGATION SLEEVE (4" PYG) fR :1 r NI!=4 555' f I t l /� �'• _ - _ _ _ _ _ _ -` :r, / ' _ { 1�1 1 I •----_, -I OVERHE,4D UTILITIES - OHW---I ::............. - ::,.,1 : 1! rER:5ERV IGE,1° TYPE I K'. Wr - I t................... :: ro� ., ,....-.1 - 11 G '• :; � j C :r r ......: .....:r FlLL PAVErrErrr FROM I j 5E ER SERVICE, 4° , SDR 26 I I r r IN PA NG - 1 1 vi / k. :I r :' LU7 TU BE.REMOVED 7T( rr 1 S ii n ) {J .air i ,; !}................... Ii t / EXI IPE, HD I - : P ., . . , 1I ( : GHA NLI K FENGEE • .y f ; ' - r . _, ' :; i t l :: '.. I I \ x ST E L- } . _ 11 _ _ OGKADE F NGE - , . _ . C _. t - I ` /t� - _ _. „ _LL� _ , - CR _ _ - _ _ ,. _ a 5P I ENGE - _ ..,,. �.,- '. M - L TRAIL 1= .-_ w � , . - -- - - _ - - _mK ac ru - : a t i c_ Y .', _ _ .- - - - . . _._ ,_ . .. .a-- , ,.,-.,_. _ _ a - - .a - _,- - _.. - - _ .. .. -._ _- . .. ._.- _ _ `;-fes'„. _ - - _. : _ .._._._ a._.� , .. : _. __. ..-..K--.«_- .. . .. s _. ,w c _ EX15T N6 f ILDING 1 _ _.:. - _: F` i' 1t - U/�, ELECTRICAL LE SRVIGE DENT _ _ �C'r 1 ,..:. °' SID .AKS ..MISG _.. „ _ . . . �'� / r, TIN SHOP . , ,t - _. _ _ _ N TE PAD - ,... CO CrRE S ,. a ,. _ '1 t " r ......,,... , t• _ TO 6E REMUVED `; i. F - 3 ,. _ _ / ELECTRICAL_CONDUIT U ,:_. 1 . TO B_. OVE 1 t - I r.. r-#22.10 , f F - rr S .. -- .. _ f I -"-.""- _ - - _ _ _. O : - - _ _ _ __. , .1 _ _ _ - - - - - --,_ _ -. f i _ _ - ., .._ _ - _ _ :� - _ - _ i _ _ - - - _ - -. { TING. m U/G OA511NE - . EXIS y �'� .,..... LIc�HT POLE O _' : i Q ;v „_,. �' iL r r ..,. ....... :: :1 t, 1 1 - U Gft i , BE REMOVI - 1 ,I : I a. rt r_: i - , 1{ »J .. -„I, VENTS _ "c: - :,_ �` .. i - p G GA ERA u�OND DSL to 1 ' : I1 EX15rING SEPTIG� r r, M UIT_ . _ . r . : :,....-.... - RIM=42CJ.15- VSEL PRO T.LINE ' n ,r TAtvK TO BE ;1 . ;..... r i_ REMOVED_ - , :. INV=414:75' ` . �JU�ER .UP. __-., . I = �' PRODUCT INE :` I : . ,. .r : -_. L w < ,r r LEADED PRQDUGT LINE , . .. UNL_ m :...::.. ' ...-.... r r '' J --... ,. : r 1 (SrINe MAJOR„G©NTOUR roo� N EX15TIN5 GATGH e': r e . :. r t I .�' , v I dd r P > I B A5it L_ r r x I. STING MIO GOT R v N N OlJ TI UNDER- 1 r r 3 R XI5 NG CiRCJ1J!D g- E \ U �, F :i,. %y='•:: Ex!5 INC°No . - 1 1 - TO BE RrMOVED -�� , , - t : ;- ,,, FU__STORAGE TAN(.5 ?' r i O P IN6 SIGN" 3 : 11 rr I- I PROP05E17.MAJOR GCJNTOUR Qo . t, _ : ; : : ;_ : :'• TO BE REMOVED EXISTING GATGH r e TO MIAN t t RINi_420.63, 't r �j 11 - BA51N 3 ALL PIPE ;, l - _ 1° E ,, INi 11.43 <. ;;:':;:'.. o I PROPOSED MINOR CONTOUR` 1 : , t I 1 TO BE RENOVF. r r t'S _ - _ i .rr _ _ _ - - - - - - _ _ _ _ _ _ i, _ _ - - - - I y r, ., :: r 1. T ` A ...... 5C1htE FE TURES IN LEGEND MAY tIAVE BEErr USED. _' iii 2.DA I RI u r / RKEtz LINES It�IGATE NEH I^t?R1C. \ i I -`_ .- +` :,r 3.IX>TTE_D LINES INDICATE REMOVED ITEMS i ( _ I_ i 11 :r1 - - - •/r 1 1 `. . - _ - I 'I i Y 4 Ft , r Y 4 !{ ' . III r' , , _ :. _ r - --.. _ __ _ - _ - .- :1 ALL-PAYEMErYr rROM , : , 1 I �) _ / 1 _ _� - t Mpg I 11 EXISTING PARKING , - _ . L33 I I. LOT'rU BE REhfOVED si�/ �°� _.. m' _ 1 i tt .. - - I - f 11, RIN1=420.4b' .:: ! t - a }_Y w. � _ .r I : It INV=4152b "�:h; � .� ,� . t, ,Y I 1 ,t f/ i. I ® I _ - I It - a tl - . i ire 1 u v f i -__ I 1 - . I - -- - , .-, %/ - - - - I -- EXI5TING GA5-GANOPY, / - I ;. - ,, TOWN_OF�QUEENS$U€�Y I ISLANDS d DISPENSERS ,/ .; I . `-. d VED SgB,7o �UIt WING n�Pa�T�nIrNT ' TO I EXI5TIN5. I TO BE REM O .; - - ��_GONG �, _ , Rtt4=4{9.44 _ - . RErE I Lt�rlT POL=To ': _ // : - Bned On our limited eXamina#ion com tianc8 ENr F. I INV=416.e9 /, -- _ I B;R d fO!D t - �. ---__ -.,.: _, rxlsTtNG f I L. _ /, r rvitti ouT comments.shall,no..t b2 construed as `----.�_ � - ,.:.,. : I ,, ; inclicatint the lnns.an s cification� are:in _ - -I - - 1 i rt TO KEMAIN -: I J. -_ -A _ _ _ / < I _ _ -1 - Rlrr �t .3I �'_ppe T full com Hance �vlth th, �ulldin ode _------- � LL I I = / P C . .of - 1 20-0 413.61' -' I- I t Ir1V=4I6.4t _' // I '' �,- _- - i 1 INV=4!n.01 // Ne��Yore Stat -� i e - - � / 5TENART 5 : ----- '-- RIM=419.42 / �. / 516N TO BE I GAPPED : --------- _ INV=415,32 / ---- / -._ __rte ------ --=<,->_ � I/ r. / REMOYFR IRON PtN "' -� ---.�:-A: :: ------_____-•_-�_____ , , BE - • -- / _7 -- - t0 N8°t2' -- ------ 19 r - ---- ----- A M I 66,1 ' / ---------`-__----- % �. , _ "' 1 9 , /, ---- { : ,r _� / - ` `• := =EXISTING GATGH' EXIaTING / . BA51rM 8 ALL PIPE LIGHT POLE TO / 9 I - _ " F - - - - - - - _, - - - - - TO BE REr ovE II BE tZt oVED F - . ' r . - , _ - - - �_�. - , . EXISTING r4o .-. - EX15TINO GATGH I I - _ PARYJri6 SIGN' _ - IN d ALL PIPE. GONGRETE - _ S` BAS_ TD REMIAN- '^ --•�.� _ TO BE REMOVED MONIA-e r i- ® - 1C1 = FOIR� - -- i 1 �rING I - - _ S5 5` i 6 `' RESS - i -_' _ -- '�� - • - EXISTIN6'NO I '� • ;. - _ - PARKING 51GN" ' - O � l TO REMIAN - - V a - a 1 {{ [1 :4 - Z _ - _ - I . - I - r - -. . - . _ _ c - 1 ' - . - r STORE NAME.ABBREVIATION d P7Ca, k .. 1 >i SURVEY NOTES: - -`- - UN5UR1' G7U 22 -- € . . . JUNE I6 - I - SITE LOCATION . I. DEED REFERENCE: MADELINE DREI5COLL TO STEWART'5 ICE CREAM COMPANY, INC.,DATED - . FN 0 EW- Iq&q AND FILED IN THE WARREN COUNTY CLERK'S OFFICE IN LIBER 758 OF DEEDS AT PACE 225. I �F, y I '` 1 Eo�vw�, o �� RDUT f 4� LAi�G CG Ofi�G , 1�1Y I2g I _ . y 'L� - , - 2, TH15 SURVEY WA5 PREPARED WITHOUT THE BENEFIT OF AN UP-TO-DATE ABSTRACT OF TITLE, AND 15 THEREFORE SUBJECT TO ANY AND ALL COVENANTS,EA5EMENT5,RE5TRIGTION5 AND RICH'CS-GF-WAY - - r' DATE- NO. REVISIONS:- - - . - _ - _. G OF RECORD A5 WELL A5 ANY OTHER FAGT5 WHIGH 5AID A55TRACT WOULD D15GL05E. _ . - - _ I�J�J�A�I� DRAWN BY: P _ ? 111 _ 20' i SCALE I • p 6 DATE: .. .: 2/1/17 OPRIATION III 2Q07 I 3. BMN05 OF N.Y.5.ROUTE 14q ARE 5HOWN A5 E5TABL15HED BY N.Y.S.D.O.T.APPR ; A p ' 9109 ��FESSIaN�� AND DEPICTED ON MAP NO. 123, PARCEL NO. 150 FOR THE HARRI5GENA-FORT ANN STATE f(iLSI IYiAY _ - g35q,DATED JULY 23,2007 AND FILED IN THE WARREN COUNTY GLERK'5 OFFICE ON APRIL 2q,2008 _ �p -:. - -... . RAWINC� Na. IN VOLUME 3538 AT PAC'�E q6. BOUND5 OF N.Y.5. ROUTE qL HAVE BEEN 5URVEYED TO CONI=,qRi'I TO - I SARATOOA 5PR{NGS, NY"12866 _. GJ.. EXISTING MONUMENTATION. 1 TEL:(518)581.-1200; . FAX (518)581-120a� 4 . 4. ELEVATION5 5HOWN HEREON CONFORM TO NOVD Ig2g A5 DETERMINED FROM 5URVEY CONTROL DATA OBTAINED FROM THE NEW YORK 5TATE DEPARTMENT OF TRAN5PORTATION. I ALTERATIONS TO TH15 DOCUMENT BY OTM�R THAN AN TITLE: AUTHORIZED LICENSED PROFE5510NAL ENGINEER 15 ILLEGAL EX(.STI I O 51TEjPEM0. PLAT I AND A VIOLATION OF THE NEW YORK STATE EDUCATION LAW - , I r . l ,