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RC-000180-2015 TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201 at Community Development-Building& Codes (518)761-8256 CERTIFICATE OF COMPLIANCE Permit Number: RC-000180-2015 Date Issued: Friday, December 4, 2015 This is to certify that work requested to be done as shown by Permit Number RC-000180-2015 has been completed. Tax Map Number: 226.12-1-20 Location: 85 MASON RD Owner: JOSEPH CLEMENTE Applicant: JOSEPH CLEMENTE This structure may be occupied as a: Residential Septic Alteration By Order of Town Board TOWN OF QUEENSSBBURY Issuance of this Certificate of Compliance DOES NOT relieve the property owner of the responsibility for compliance with Site Plan, pppyjj�lYYY �-j7w 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: RC-000180-2015 Tax Map No: 226.12-1-20 REVISED Permission is hereby granted to: JOSEPH CLEMENTE For property located at: 85 MASON RD 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 Address: Other-New $0.00 Total Value $0.00 Contractor or Builders Name/Address Electrical Inspection Agency JOSEPH CLEMENTE 85 Mason Queensbury,NY 12804 Plans&Specifications Residential Septic Alteration PERMIT FEE PAID-THIS PERMIT EXPIRES: Wednesday,July 6,2016 (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 qF(uc t ury; / I �/ Mo d y, 15 SIGNED BY: (\ (��'/_�1{// /a/ for the Town of Queensbury. Director of Building&Code Enforcement 189 Haviland Road Queensbury, NY 12804 Hutchins Engineering Phone: (518)745-0307 Fax: (518)745-0308 November 19, 2015 Town of Queensbury Building Department 742 Bay Road Queensbury, NY 12804 Re: Septic System Installation Joseph Clemente, 85 Mason Road Tax Map ID: 226.12-1-20 Our office prepared a replacement wastewater design for Joseph Clemente at the above- referenced property. The system consists of a 1,250-gallon precast concrete septic tank, an E- rne Extreme IH091 Indoor grinder pump station, and a Presby absorption bed containing eight 25-foot-long AES rows. A representative from our office visited the site during system installation. Based upon our site inspection and our discussions with the installer, Lakeside Contracting, it is my opinion that, with the exception of surface finishing and turf establishment, the system was installed in general conformance with the approved plan and the attached record drawing. Please contact me if you have any questions or if you require additional information. Best Regards, G. Thomas Hutchins, P.E. Enclosure RECEIV E D Cc: Mr. Joe Clemente �Z)t�� Q-C Z-11' G.Thomas Hutchins,P.E. SEPTIC DISPOSAL PERMIT Office Use Only _ DATE 7 1 20 `=' Eh u Received Tax Map ID TAX MAP ID 226.12-1nil +� l� ®� 2U1hrmit No. 2W)-- . Z Permit Fee \0 cX LOCATION OF INSTALLATION 85 MASON OADI OWN OF QUEEN V pprovalS: BUILDING& CODES APPLICANT JOSEPH T.CLEMENTE PHONE/E-MAIL (518)281-7690 ADDRESS 124 MAXWELL ROAD,LATHAM NY 12110 INSTALLER/BU/LDER: (TO BE DETERMINED) PHONE/E-MAIL ADDRESS: OWNER (SAME AS APPLICANT) PHONE/E-MAIL Address CONTACT PERSON FOR BUILDING&CODES COMPLIANCE: JOSEPH T.CLEMENTE PHONE (518)281-7690 RESIDENCE INFORMATION Year Built #of bedrooms X Gallons per bedroom =Total Daily Flow 1980 or older 4 110 440 Garbage grinder installed _Y ✓ N 1981-1991 Spa or Hot Tub installed Y ✓ N 1992-Present PARCEL INFORMATION Topography ✓ Flat rolling Steep slope %slope Soil Nature Sand ✓ Loam Clay Other Groundwater At what depth? >58" Bedrock/Impervious Material At what depth? >58" Domestic Water Supply LAKE WATER Municipal Well(if well, water supply from any septic system absorption is ft.) Percolation Test Rate: 11-15 per minute per inch(test to be completed by licensed engineering/architect) PROPOSED SYSTEM FOR NEW CONSTRUCTION Tank Size 1,250 gallons(minimum size 1,000 gallons,add 250 gallons to size for each garbage grinder or spa or hot tub) System Type Absorption field with#2 stone Total length ft.; Each trench x Seepage Pit with#3 stone How many: ;size Alternative System Bed or other type? PRESBY ABSORPTION BED Holding Tank System Total required capacity? Tank size #of tanks Notes: 1)Alarm system&associated electrical work must be inspected by a Town approved electrical inspection agency;2)We will no longer allow systems to be covered until such time as an As-Built plan is received & approved. The installed system must match the septic system layout on file—no exceptions. DECLARATION: Any permit or approval granted which is based upon or is granted in reliance upon any material representation or failure to make a material fact or circumstance know by or on behalf of an applicant, shall be void. I have read the regulations and agree to abid- . .-se and all r-,s irements of the Town'f • --• b anitary Sewage Disposal Ordinance. Print Name: _ `., i. .. , , r ► A Date: Signature: _ Date: Town of o: - cyl. g "es Septic Disposal Permit Ju 2014 BOATtipUSE DoCo LAK WATER 'GEORGE 62'± ALONG SHORE 9.5'±-. e -61- z C�- Qo M WASTEWATER SYSTEM INSTALLATION NOTES WATER CONSTRUCTION SHALL BE AS SHOWN ON THIS DRAWING AND IN ACCORDANCE WITH THE N.Y.S. DEPARTMENT OF HEALTH INDIVIDUAL HOUSEHOLD SYSTEMS AND ASTM F481 INSTALLATION OF THERMOPLASTIC PIPE AND CORRUGATED TUBING IN SEPTIC TANK LEACH FIELDS. SYSTEM TO BE INSTALLED IN ACCORDANCE WITH PRODUCT DESIGN AND INSTALLATION MANUAL, STATE AND LOCAL REGULATIONS. FOR PRODUCT INFORMATION OR THE NEAREST DEALER CONTACT PRESBY ENVIRONMENTAL, INC. 143 AIRPORT ROAD, WHITEFIELD, NH 03598, PHONE 1-800-473-5298 WWW.PRESBYECO.COM FOR 774E NEAREST AUTHORIZED DEALER CONTACT MORNING STAR DISTRIBUTING, 60 COBBS LANE FAIRPORT, NY 14450, PHONE (585) 598-0019, WWW.moRNINGSTARDIST.COM AFTER EXCAVA77ON OF TRENCHES TO THE DEPTHS REQUIRED, THE WALLS AND FLOOR OF EACH TRENCH SHALL BE CLEANED AND RAKED IN ORDER TO LOOSEN SMEARED SEC71ONS OF TRENCH. PLACEMENT OF PRESBY SYSTEM SAND, PRESBY ENWRO-SEP71CO PIPE AND FILTER FABRIC SHALL BE AS SHOWN, AND CARE SHALL BE EXERCISED TO AVOID INCLUSION OF FINE GRAINED SOILS AND WASTE MATERIAL IN THE PIPE. MINIMUM OF 6" OF SYSTEM SAND, WITH LESS THAN 2% PASSING A 1 200 SIEVE, REQUIRED AROUND CIRCUMFERENCE OF ADVANCED ENWRO-SEP71C PIPES. (SEE DESIGN AND INSTALLA77ON MANUAL FOR COMPLETE SAND AND FILL SPECIFICATIONS) INSTALLER TO PROVIDE SIEVE ANALYSIS FOR PRESBY SYSTEM SAND TO DESIGN ENGINEER PRIOR TO TRANSPORTING SAND TO THE SITE. THE PIPE SHOULD BE LAID AT THE GRADES INDICATED, MAINTAINING STRAIGHT CONTINUOUS GRADES WITHOUT SAGS, HUMPS, SEPARATED JOINTS, OR OTHER UNSUITABLE CONDITIONS. ALL DISPOSAL FIELDS SHALL BE GRADED TO SHED RAINFALL AND DIVERT SURFACE RUNOFF AWAY FROM THE DISPOSAL FIELD. DO NOT USE HEAVY EQUIPMENT WITHIN THE ABSORP7ION AREA AFTER PIPING HAS BEEN INSTALLED. THIS SYSTEM IS DESIGNED FOR WATER CONSERVING FIXTURES AND IS NOT DESIGNED TO ACCOMODATE EXTREME WATER USE OR EXTREME ORGANIC LOADING DEVICES SUCH AS JACUZZI TYPE SPAS OR GARBAGE GRINDERS. ROOF, FOOTING, GARAGE, CELLAR AND SURFACE WATER DRAINAGE MUST BE EXCLUDED FROM THE WASTEWATER SYSTEM. INSTALLER ADVISED TO CONTACT DIG SAFELY NEW YORK PRIOR TO CONSTRUC77ON Z- I 12' BIRCH TREE5 O LANDS N/F OF WILLIAM B. KIMMONS, et. al, THOMAS A. KIMMONS REVOCABLE TRUST 4476/241 ADJOINER'S HOUSE 3 QWATER SUPPLY VENT WITH FROM LAKE GEORGE z z GOOSENECK TO -. z - OUTSIDE PER � � � • >- r MANUFACTURER ASPHALT SURFACE _ r - PROP. 22k28' SHALLOW ABSORPTION BED CEDAR HEDGE O WITHPRESBYADVANCED IRP - AC ENVIRO-SEPTIC@ TREATMENT U SYSTEM LATERALS / r n. WI(S) 25' PRESBY ROWS S86°20'59"E, 4" VENT PER 43. dr METAL •.'. p -z.'. �',',. .DETAIL 6 l� Ia 143.41 ' C 51 � OO N AREA $I� P COVERAC O m 9,215± SQ. FT. CEDAR HEDGE �) ' rQ 0. 21± ACRES PROP, 4"MANIFOLD I l --- PROPOSED INTERIOR PIPING & VENT /I I GRINDER PUMP STATION r LOCATED IN BASEMENT. I Q ,{�� — — -- — — r SEE DETAIL 1 °/4"SCH. 40 I (J I __7' 1) LEAN OUT S PVC FORCEMAIN ROUTED THROUGH 40 BASEMENTfr e l I I I I I I I l I l l l l l l l l r r WOOD FRAME „l II 1111 11 11 11 11 1j r coNc I HOUSE r .12 TP -1 r r Z �I 9 II II IIII 11 11 �� r 1 O O FXI5TING5dPTICof 1 1 1 1 1 1 1 1 1 l -I 111 j j I I I I Ir Q N 3 r ._. IIIlIl 1 1 IlIlI lI �r o`b DECOMMITANKPE rry ONED co �J 1 I SLATE PATIO CONCRETE 23 N r I SLA WALK I r —CEDAR HEDGE I L - O'P,L. SETBA ASPHALT SURFALIE I A5 PIT lwasrewarERj - - - -I r 150,00' N86"20'40"W �E F zQ6 CONC. - PATIO IPF ADJOINER'5 HOU5E O LANDS N/F OF SARAH WHEELER 1048/38 WATER SUPPLY FROM LAKE GEORGE WASTEWATER SYSTEM SETBACK SCHEDULE SIEVE PROPERTY LINE HOUSE WATER WELL LAKE GEORGE SEPTIC TANK 10' 10' 50' 50' ABSORPTION FIELD 10' 20' 100' 100' WASTEWATER SYSTEM MATERIAL SPECIFICATIONS HOUSE SEWER PIPE PIPING TO BE 4" SDR -35 OR SCH-40 PVC. INSTALL WITH 1/4" PER FOOT MINIMUM SLOPE EFFLUENT SEWER PIPE PIPING TO BE 4" SDR -35 OR SCH-40 PVC. INSTALL WITH 1/8" PER FOOT MINIMUM SLOPE PRESBY SYSTEM SAND SEE "SYSTEM SAND GRADATION" FOR SPECIFICATIONS FILTER FABRIC FILTER FABRIC TO BE 4.8 OZ/SY NON -WOVEN SEPARATION FABRIC, TENCATE MIRAFI 140N OR EQUIVALENT. FILL MATERIAL FILL MATERIAL TO BE GRANULAR SANDY LOAM MATERIAL WITH NO PARTICLES GREATER THAN 3" AS DESCRIBED IN "FILL MATERIAL NOTES." TOPSOIL PLACE 4" MINIMUM TOPSOIL OVER EN77RE ABSORP71ON FIELD AREA. SEED, MULCH AND ESTABLISH TURF DETAILED SITE PLAN SCALE: 1"=10' - 22/34 SCALE 1"=20' - 11/17 PRESBY SYSTEM SAND GRADATION SIEVE PERCENT PASSING 3/8" (9.5 -mm) 1009 No. 4 (4.75 -mm) 95-1005v No. 8 (2.36 -mm) 80-1007 No. 16 (1.18 -mm) 50-859 No. 30 (600 -pm) 25-609 No. 50 (300 -pm) 5-309 No. 100 (150-µm) 0-109 No. 200 (75 -pm) 0-27 (MUST BE OBTAINED BY WASHING) CONTRACTOR SHALL SUBMIT SIEVE ANALYSIS TO ENGINEER FOR APPROVAL PRIOR TO PLACEMENT OF SYSTEM SAND. CONCRETE PROP. DIST. BOX PROP. EFFLUENT SEWER -PROP, 1250 GAL PRECAST CONCRETE SEPTIC TANK PROP. 1-114" HDPE SDR -9 FORCE MAIN FROM BASEMENT GRINDER PUMP STATION. INSTALL TO PROVIDE FROST PROTECTION OR DRAIN -BACK SITE LOCATION LOCATION MAP TEST PIT DATA TEST PIT \ TP -1 - 12/3/2014 BY: T. HUTCHINS, P.E. \ I WITNESSED BY THE CHAZEN COMPANIES \ 0-4" TOPSOIL 4-28" MEDIUM BROWN SILT LOAM, FEW COBBLES & BOULDERS ® 28-50" MEDIUM BROWN SILT LOAM, FIRM I 50-58" SILT LOAM, VERY FIRM ROOTS TO 42" NO IP MOTTLING OBSERVED BOUNDARY CONDITION 0 50" - VERY FIRM LAYER WASTEWATER SYSTEM DESIGN 4 -BEDROOM RESIDENCES WATER SAVING FIXTURES (1.6 GPF MAX. FLUSH, 3.0 GPM MAX. FAUCETS) FIXTURES TO BE VERIFIED AS WATER SAVING & REPLACED AS NECESSARY DESIGN FLOW - 110 GPD/BEDROOM SYSTEM DESIGN FLOW - 440 GPD GRINDER PUMP STATION - E -ONE EXTREME IH091 INDOOR SEPTIC TANK - 1250 GAL PRECAST CONCRETE TANK LEACH FIELD - PRESBY ABSORPTION BED REPLACEMENT CRITERIA DESIGN PERCOLATION RATE = 11-15 MIN/IN SAND BED AREA REQUIRED = 600 SF SAND BED AREA PROVIDED = 22 x 28' = 616 SF AES PIPE LENGTH REQUIRED = 50 LF/BEDROOM 50 LF/BEDROOM X 4 BEDROOMS = 200 LF NUMBER OF AES ROWS REQUIRED = 200 LF/25' ROW LENGTH = 8 ROWS NUMBER OF AES ROWS PROVIDED = 8 ROWS POTABLE WATER SUPPLY TO BE EXISTING LAKE WATER -� SUPPLY/EXISTING WELL, SEE PLAN FOR DETAILS r JUL 0 2 815 LJ TOV_vN F OUEENSBUP,Y C3uILC ;: t; e� UODES SEPTIC PLOT PLAN H�VE SEEN OR OBSERVED ALL OBJECTS J H AS HO ES, WELLS, TREES, FENCES, ETC OWN ON S DOCUMENTI HAVE PERS��AL Y A EO TANCE SEIFORTH ON THIS DIA RAY / TOWN OF Q BUILDING & Reviewed Date: TAX P FERATION OF THIS DOCUMENT EXCEPT BY A LICENSED SIONAL ENGINEER IS A VIOLATION OF NYS EDUCATION LAW. n Do N CD N IL m o :_ m CL Q O 0-0 o Q �0o TO CV Vi CCD N m.2 r d� N0 U`m 0=CCN 0 ISSUED FOR PERMIT 7/1/15 No. Revisions Dcte MAP REFERENCE: WASTEWATER REPLACEMENT PLAN BASE SURVEY INFORMA77ON TAKEN FROM: "MAP OF A prepared for: SURVEY MADE FOR JOSEPH T. CLEMENTE,- ® DATED OCTOBER 15, 2014, Joseph T. Clemente Dig Safel ■ PREPARED BY, • 85 Mason Road NewlYork M call Before You Dig Q is -' D u S eh Town of Queensbury, Warren County, New York M Walt The Required Time St Drawn LWD ® Confirm Utility Response eve s Checked: GTH I Scale: NOTED Date: 11 /17/14 E Dig pectWith The Mark: ® Dig with care Land Surveyors 169 Haviland Road 800.96`2.7962 159 Haviland Road Queensbury, New York 12801 (516) 792-5474 Queensbury, NY 12804 y 29873-01 -SI www.digsafeiynwwyorLoom New York Lie. No. 50195 Hutchins Engineering (518) 745-0307 Phone (518) 745-0308 Fax :717 GEOTEXTILE FABRIC COARS FIBER BIO-ACCELE I VENT, SEE DETAIL VENT MANIFOLD ccum, crev \ACCELERATOR FP 6 ENVIRO-SEPTIC PIPE SECTION NTS 1 1/4" HDPE FORCEMAIN GEOTEXTILE FIBER WRAP RANDOMLY - ORIENTED FIBER MAT ENVIRO- SEPTIC PIPE 4" MAX INTO OFFSET ADAPTOR ZLBOW PLAN VIEW RAISED CONNECTION DETAIL NTS TRANSITION TO 4" OUTSIDE SEPTIC TANK 4" PVC INLET MIN. SLOPE 7 1/4" PER FOOT WATERTIGHT SLEEVE AND SEAL (TYP) EXISTING 1250 GAL. PRECAST CONCRETE SEPTIC TANK 12" MIN. COVER 7 r 2" 16" SPACE EFFLUENT _UDGE ELBOW LEVEL WITH TOP OF OFFSET ADAPTOR 2"-4" rj/ LEVEL SIDE VIEW APPROXIMATE FINISH GRADE LEVEL OFFSET ADAPTOR q - a 1250 GALLON PRECAST CONCRETE SEP77C TANK --- ENWRO-SEPTIC PIPE (TYP.) ABSORPTION FIELD SECTION NTS GEOTEXTILE FIBER WRAP RANDOMLY ORIENTED FIBER MAT ENVIRO-SEPTIC PIPE SYSTEM SAND VENT DETAIL NTS HDPE BASIN HDPE COVER -\ INLET GATE VALVE 4" SOCKET WELD, PVC 35" POLYETHYLENE EXTENSION TO GRADE WITH TAMPER RESISTANT ACCESS COVER 19" DISCHARGE 14" BALL VALVE, PVC 114" FPT CONNECTION TO ALARM PANEL 14/6 CABLE SEMI -POSITIVE DISPLACEMENT TYPE PUMP DIRECTLY DRIVEN BY A 1 HP MOTOR El ONE IHO91 GRINDER PUMP ASSEMBLY DETAIL NTS DISTRIBUTION BOX 4" PVC OUTLET __MIN 1/8" PER FOOT BAFFLE USE SPEED LEVELERS TO ASSURE ALL OUTLETS ARE AT EXACTLY THE SAME ELEVATION 4" PVC SOLID HEADER TO PRESBY PIPE SEPTIC TANK DETAIL NTS 2" MIN. DROP BETWEEN INVERTS 12" MIN. COVER 4" MIN. DROP SEPTIC TANK NOTES ALL UNITS SHALL COMPLY WITH THE REQUIREMENTS OF THE NEW YORK STATE DEPARTMENT OF HEALTH AND SHALL BE OF PRECAST CONCRETE AS MANUFACTURED BY UTOPIA ENTERPRISES OR EQUIVALENT. ALL STRUCTURES SHALL BE PLACED ON FIRM, COMPACT SAND OR GRAVEL BASE. WHERE EXISTING SOIL CONDITIONS ARE UNSUITABLE, CRUSHED STONE SHALL BE PLACED AS NECESSARY TO ACHIEVE A STABLE BASE. SEPTIC TANKS INSTALLED IN TRAFFIC AREAS SHALL BE OF EXTRA HEAVY CONSTRUCTION DESIGNED FOR H-20 WHEEL LOADING. EXISTING TANKS TO BE REUSED ARE TO BE PUMPED AND VERIFIED THAT ALL PENETRATIONS AND TANK STRUCTURE ARE WATER TIGHT. ALL JOINTS MUST BE SEALED GRINDER PUMP NOTES AN ELECTRICAL INSPECTION BY CERTIFIED ELECTRICAL INSPECTION AGENCY IS REQUIRED PRIOR TO START-UP OF PUMP STATION. ELECTRICAL INSPECTION SEAL IS TO BE AFFIXED TO PUMP STATION CONTROL PANEL. ALL INTERIOR PLUMBING TO GRINDER PUMP STATION TO BE COMPLETED BY OTHERS. Dig FSafely. New/York E Call Before You Dig M Walt The Required Time 0 Confirm Utility Response IN Respect The Marks E Dig With Care 800.962.7962 s .digsafeiyaesryork. MAP REFERENCE: BASE SURVEY INFORMATION TAKEN FROM. "MAP OF A SURVEY MADE FOR JOSEPH T. CLEMENTE," DATED OCTOBER 15, 2014, PREPARED BY.• TAX MAP # 226,12-1-20 ALTERATION OF THIS DOCUMENT EXCEPT BY A LICENSED PROFESSIONAL ENGINEER IS A VIOLATION OF NYS EDUCATION LAW. ANTI-SIPHON/CHECK VALVE ASSEMBLY (NORYL) 2B' IN— SLAB Fn BURIAL DEPTH14.4" 11.9 19.4" ALARM PUMP ON PUMP 63 GAL 111 38 GAL 47 GAL 1 SEMI -POSITIVE DISPLACEMENT TYPE PUMP DIRECTLY DRIVEN BY A 1 HP MOTOR El ONE IHO91 GRINDER PUMP ASSEMBLY DETAIL NTS DISTRIBUTION BOX 4" PVC OUTLET __MIN 1/8" PER FOOT BAFFLE USE SPEED LEVELERS TO ASSURE ALL OUTLETS ARE AT EXACTLY THE SAME ELEVATION 4" PVC SOLID HEADER TO PRESBY PIPE SEPTIC TANK DETAIL NTS 2" MIN. DROP BETWEEN INVERTS 12" MIN. COVER 4" MIN. DROP SEPTIC TANK NOTES ALL UNITS SHALL COMPLY WITH THE REQUIREMENTS OF THE NEW YORK STATE DEPARTMENT OF HEALTH AND SHALL BE OF PRECAST CONCRETE AS MANUFACTURED BY UTOPIA ENTERPRISES OR EQUIVALENT. ALL STRUCTURES SHALL BE PLACED ON FIRM, COMPACT SAND OR GRAVEL BASE. WHERE EXISTING SOIL CONDITIONS ARE UNSUITABLE, CRUSHED STONE SHALL BE PLACED AS NECESSARY TO ACHIEVE A STABLE BASE. SEPTIC TANKS INSTALLED IN TRAFFIC AREAS SHALL BE OF EXTRA HEAVY CONSTRUCTION DESIGNED FOR H-20 WHEEL LOADING. EXISTING TANKS TO BE REUSED ARE TO BE PUMPED AND VERIFIED THAT ALL PENETRATIONS AND TANK STRUCTURE ARE WATER TIGHT. ALL JOINTS MUST BE SEALED GRINDER PUMP NOTES AN ELECTRICAL INSPECTION BY CERTIFIED ELECTRICAL INSPECTION AGENCY IS REQUIRED PRIOR TO START-UP OF PUMP STATION. ELECTRICAL INSPECTION SEAL IS TO BE AFFIXED TO PUMP STATION CONTROL PANEL. ALL INTERIOR PLUMBING TO GRINDER PUMP STATION TO BE COMPLETED BY OTHERS. Dig FSafely. New/York E Call Before You Dig M Walt The Required Time 0 Confirm Utility Response IN Respect The Marks E Dig With Care 800.962.7962 s .digsafeiyaesryork. MAP REFERENCE: BASE SURVEY INFORMATION TAKEN FROM. "MAP OF A SURVEY MADE FOR JOSEPH T. CLEMENTE," DATED OCTOBER 15, 2014, PREPARED BY.• TAX MAP # 226,12-1-20 ALTERATION OF THIS DOCUMENT EXCEPT BY A LICENSED PROFESSIONAL ENGINEER IS A VIOLATION OF NYS EDUCATION LAW. COMMONWEALTH ELECTRICAL INSPECTION SERVICE,INC. Main Office 176 Doe Run Road-Manheim,PA 17545 MUNICIPAL CERTIFICATE - ELECTRICAL APPROVAL 1�0-ZO.1S Permit No.ADI.......-C-1...........Cert. N® 42957 Cut-in Card No.......................... Owner............. 3... .................. .................................................. .. .......................................... Location... -�' ...., s. N... ae ............Cs�-,[Cd...`;../ .. l . .......... ..... ........ ...... Installation Consisting of.. ............. ..:.................. ................. .................................................................................................................................................................................... .................................................................................... ............................................................................................. InstalledBy....134...�.�j��..4........................................Lic.No................................................... The conditions following governed the issuance of this certificate,and any certificate previously issued is cancelled:- This certificate only covers the electrical equipment and installation conditions as of date. Upon the introduction of additional equipment or alterations,application shall be promptly made for inspection. Inspectors of this Company shall have the privilege of making i tions at any time, and if its rules are violated,the Company shall have the right to revo this . ... rz��Date... - "'.......... INSPECTOR.... ............................................ .... Member N.RP.A.,I.A.E.I.