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Home My WebLink About2018-0113 Final Packet ZONING ONLYOF pp OF 1.7,, ° Certificate of Orrupaurp �°� 1E 21 It is hereby certified that an inspection at the building(s) or structurc(s) noted below was conducted pursuant to the Code of the Town of Ithaca, as the same have been amended from time to time. Such inspection revealed no apparent violation of Chapter 270, the Zoning Ordinance at the lime of the inspection. If this certificate is issued in connection with new construction, it is further certified that such inspection revealed no apparent uncorrected deficiency or apparent material violation of- the New York State Uniform Fire Prevention and Building Code (Building Code) with respect to the work performed at Such building or structure pursuant to the Building permit identified below, and that such construction or work appeared to be in substantial conformance with plans and/or other information on file at (lie Town of Ithaca Code Enforcement Office in connection with such Building Permit. The matters set forth in this Certificate are based upon one or I1101'C visual inspections of the property and improvement by Town Officials and do not mean the Town Code Enforcement Officer has made exhaustive or continuous on -site inspections of the work nor does this certify in any manner to the quality of such work. This Certificate is revocable in the event information comes to the attention of the Town of Ithaca authorities that would render the certifications made herein inaccurate. Certificate No.: 2018-0113 Building Permit No.: 2018-0113 Electrical Pe ntit No.: Building Permil Issued: 4/27/2018 Description: permit for Zoning purposes only Build 24' x 50' shed. Date of Last Inspection: 1/28/2019 Propertl• Name: Tax ID No.: 32.-2-3.221 Building Address: 429 Bostwick Rd Oti,ner of Building: Casper Real Estate Trust Oti,ner's Address: PO Box 40 Ithaca, NY 14851 Use Occupancy Classification: U - UTILITY and U - UTILITY Sprinkler Required by Building Code: N Sprinkler Pre.cew., N Special Conditions: agricultural use, meets zoning only This certificate is limited solely to the work performed under Building Permit #: 2018-0113 and Electrical Permit #: 1/29/2019 Date Issued Code Enforcement Officer "UHLMNG PIFERAKAF of rT TOWN OF ITHACA oy� 215 N. Tioga Street, Ithaca, N.Y. 14850 H A. - 41 9 www.town.ithaca.ny.us - 18 21 -v Yo�� CODE ENFORCEMENT - BRUCE W. BATES, DIRECTOR Phone (607) 273-1783 Fax (607) 273-1704 codes@ town. ithaca.nv.us Date of Pe��rr�ii: 4/27/2018 Pcrrrai� No.: 2018-0113 EA,piraflon late: 4/27/2019 9Jhis serves as the OFFICIAL BUILDING PERMIT issued to Casper Real Estate Trust to erect, move, demolish, or repair a building as indicated, in accordance with all Laws and Regulations applicable thereto. All work shall be performed in accordance with the construction documents submitted and accepled as part of the appl"cation. The Town of Ithaca Code Deparinient MUST be notified h-nmediately in the event of any changes occurring during constrllCtlon. Scope of vijork: permit for Zoning purposes only Build 24' x 50` shed. Projeci Address: 429 Bostwick Rd Property Ovvne : Casper Real Estate Trust Owner Address: PO Box 40 Ithaca, NY 14851 Occupancy Class: U - UTILITY Tax Parcel #: 32.-2-3.221 Construction Typ^e:V-B Sprinkler. Signature: "tode Enforcement Officer THIS PERMIT MUST SE POSTED ONSITE PRIOR 1-0 WOR,C COMMENCING. SUPPLEMENTAL NOTES AND PLANS PROVIDED WITH BUILDING PERMIT MUST BE ONSITE AND AVAILABLE DURING INSPECTIONS. Cori i-nents: additional sheet(s) may be attached. INSPU ON INIFORKATION NEW YORK STATE LAW REQUIRES THAT CONSTRUCTION INSPECTIONS BE MADE BY THE BUILDING INSPECTOR TO ENSURE BUILDING CODE COMPLIANCE, AND ... ANY SPACE MODIFIED OR CREATED IN ASSOCIATION WITH A BUILDING PERMIT CANNOT BE OCCUPIED OR USED PRIOR TO A CERTIFICATE OF OCCUPANCY BEING ISSUED This Building Permit is issued with the understanding that all work will be done in accordance with the latest standards of the New York State Uniform Fire Prevention Code and the Code of the Town of Ithaca as well as generally accepted building standards. To schedule an inspection: Call: 607.273.1783 Minimum of 24-Hours' Notice is Necessary BELOW IS A LIST OF REQUIRED INSPECTIONS: X FINAL CER TIFiCA T E OF OCCUPANCY will be issued after all applicable inspections Have been conducted and deemed satisfactory. NOTICE TO PERMIT HOLDER NOTE: THIS PERMIT IS ISSUED IN THE NAME OF THE PROPERTY OWNER. THE OWNER IS RESPONSIBLE FOR OVERSEEING THE CONSTRACTORIBUILDER AND ENSURING THAT PROPER INSPECTIONS OCCUR IN A TIMELY MANNER. ADDITIONALLY, ANY CHANGES FROM THE PLANS SUBMITTED FOR A BUILDING PERMIT, PARTICULARLY AFTER A BUILDING PERMIT HAS BEEN ISSUED, MUST BE APPROVED PRIOR TO BEGINNING OR CONTINUING CONSTRUCTION. � OF 12% TOWN OF ITHACA �, 0 f, � 215 N. Tioga Street, Ithaca, N.Y. 14850 'B" - wwwAown.ithaca.ny.us I ��& YQ;t ❑ CODE ENFORCEMENT- BRUCE W. BATES, DIRECTOR Phone (607) 273-1783 ■ Fax (607) 273-1704 cod es@town. ith aca. nv. us APPLICATION APPROVED Date: CEO Int Permit Number .20 16 0115 APPLICATION DENIED section Date: Date of ZBA Hearing: Date Received y - j 7 - 16 Decision: Date of Planning Approval: Type of Approval: BUILDING PERMIT APPLICATION FORM New BuilaQ Addition Alteration Change of Use Demolish `�� Residential ❑ Commercial Brief Description of Work aL r x SD i 5�- C� C Value of Improvement $ rZ-- I (_) C) Property Information c 1 Street Address: `l Z 0 s Tax Parcel Number: Property Owner(s): vac,- \ Other d 2z"; '�at Primary PhonAC7 7-S4 _ �3�� 2"Phone: LCY Mailing Address: Email Address: 0--'r� If owner is a corporation, names and addresses of responsible officers must be included. Builder/Contractor Information Company: ��t 1 �Ei�' 7 � I ` Ivy -} Main Phone: L't,'� — Mailing Address: ~�, (] C.x �� -"I��i 1�e�-r ` 1LI (sI Project Manager: Ui�Rl-, 1CS Primary p�nef Email:I%k�4n3(lp C"_ �4'4 'Lt��U� (If there are additional companies involved, plbase give contact information on a separate sheet) Project Contact Person (Pri aary pollpvt of contact for all lcoommmunications regarding the building permit) Name: �"\lC_ �l Company: Primary Phon� Email: M PROJECT INFORMATION Existing Proposed Gross Square / Footage of: # of Stories # of Dwelling Units �j + Basement i / �� First Floor Building Height Water Private ❑ Private Second Floor Town ❑ Town Over Second Sewer Private ❑ Private ❑ Total # of Rooms Town ❑ Town ❑ Total # of Bedrooms Sprinkler Yes❑NaE] Yes❑No❑ Lot Coverage Occupancy Class Existing Proposed FOR ADDITIONS AND NEW CONSTRUCTION I(lncludinq decks) In what flood zone is the property located? A❑B❑ C❑ (flood map httC,s_l/msc.fema.goviportal) Is topsoil or fill material going to be moved onto or within the site in excess of 50 cubic yards? Yes❑ Ng If Yes, SWPPP application submitted? Yes❑ No 1-1 IL� Is topsoil or fill material going to be moved onto or within the site in excess of 500 cubic yards? Yes No If Yes, Fill Permit submitted? Yes ❑ No '} APPLICATION CERTIFICATION :• (Initials) I understand that if a building permit CANNOT be issued within 90 days of my initial application because I failed to provide information requested or because I failed to comply with any Legislative Board Conditions, my building permit application will be withdrawn without further action and I will need to reapply and pay a new permit application fee. The UNDERSIGNED HEREBY APPLIES for permission to do the above in accordance with provisions of the Zoning Ordinance and other Laws and Reguiations of the Town of Ithaca, or others having jurisdiction, AND AFFIRMS that all statements and information given herein are correct to the best of his/her knowledge and belief, AND FURTHER AFFIRMS that all work shall be performed in compliance with the Codes of the Town of Ithaca, the NYS Uniform Fire Prevention and Building Code, and all other applicable state and local laws, ordinances, and regulations, I ALSO CERTIFY that the structure for which this permit will be issued, ar has been issued, will be built, or has been built, according to the latest standards of the New York State Uniform Fire Prevention and Building Code, AND FURTHER CERTIFY that the approved plans will not be deviated from without prior approval from the Arch itect/Fngineer of record, if applicable, and the Town of Ithaca. I also ACKNOWLEDGE that have read and understand the "Instructions for Submitting a Building Permit". Signature of Property Owner* or Authorized Agent * * Date 'Applications for properties owned by a business or corporation must be signed, and title given by an individual that has been granted the authority to sign on its behalf. "Authorized agent must provide wriften contract or authorization letter signed by property owner. 1"'N TOWN OF ITHACA �, 0 215 N. Tioga Street, Ithaca, N.Y. 14850 www.town.ithaca.ny.us CODE ENFORCEMENT - BRUCE W. BATES, DIRECTOR Phone (607) 273-1783 ■ Fax (607) 273-1704 codes@town.ithaca.nv.us Buildinq Permit Application Checklist This checklist must accompany all applications Incomplete packages will not be accepted INITIAL EACH LINE OR WRITE NIA TO ITEMS THAT DO NOT APPLY 1. Completed application form 2. Proof of Insurance — General Liability, Workers Comp & Workers Disability 4. copy and 1 digital copy of all drawings and specifications "May need to be stamped — see � Ihstructions; digital copies can be sent to codesa-town.ithaca.nv.us 5 Code of NYS Compliance Forms — ResCheck, ComCheck or other approved compliance dpp rt nt. Approved forms are available at httosa/www.energvcodes.aov/software-and-web-tools 6. Survey Map or Plot Plan . Town of Ithaca Electrical Permit Application 8. Copy of Plumbing Permit from Bolton Point (public water & sewer) or Plumbing Isometric Diagram (private water Wor sewer ONLY) _9,-S'ept Permit or Sewage & Water System acceptance from Tompkins County Health Department / (privalpwater Wor sewer ONLY) 10. Well Driller's Certificate — New construction with private water ONLY 11. Culvert Wor highway work permit T2. Outdoor lighting details 13. Statement of special inspections C 14. Stormwater Permit (Simple, Basic or Full) Completed application packets should be submitted to the Code Enforcement Department located in Town Hall at 215 N. Tioga St Monday thru Friday 8am-3:30pm Town Hall hours are Monday thru Friday Barn-4pm Attached instructions should be retained for your records. Rev. January 2016 Town of Ithaca EFFECTIVE SEPT. 1, 2016 Code Enforcement Fees Revised May 2017 BUILDING PERMIT (projects other than the installation of heating units) FIREWORKS Value of Improvement Fee VaiLle of Dosplav FPe_ $0 - $20.000.99 $100.00 $1 - $50,000 $300.00 $20.001 - $100,000.99 $300.00 Over $50,000 $500.00 $100.001 - $350.000,99 $1,400.00 $350.001 - $750.000.99 $2.200.00 Installation of Heating Unit $750,001-$1,000,000.99 $3.000.00 Heating Unit Size Fee $1.000.001 - $2.500.000.99 $5,000.00 Up to 1,000,000 BTU $200.00 $2,500,001 - $4,999,999.99 $6,500.00 Over 1,000,000 BTU $300.00 Over $5.000,000,00 $1.35 per $1,000 value of improvement Tht.re is root a sepsra'c c-�. ctrical permit fee f;r alectrical work OPERATING PERMIT dune with a bu r,:r f permit Tvpe of Buildina Fee Mobile Home Park $200.00 annually ELECTRICAL ONLY PERMIT Multiple dwelling, 3 to 5 units $100.00/building Residential Multiple dwelling, 6 to 10 units $150.00/building Application fee $150, includes 3 site inspections. Additional Multiple dwelling, 11 or more units $200.00/building inspections and in -office time, $35 per'/, hour. Ikon -Residential use $100.00/building Commercial Application fee $200, includes vehicle mounted generators. Includes 4 inspections. Additional Inspection and in -office time, $35 per'/] hour. Portable generator $50 for 1 visit, $70 per hour thereafter. TENT PERMIT $75 BEFOREIAFTER NORMAL BUSINESS HOURS AND HOLIDAY INSPECTIONS (with prior approval) SIGN PERMIT $100 Before/After- $150 an hr/2 hour min followed by'/z hr increments Holiday - $200 an hr/2 hr min followed by hr increments (fees include standard 1 hr travel time) WORKING WITHOUT A BUILDING PERMIT The fees set forth shall be doubled if work is commenced prior to the issuance of a necessary permit or if work exceeds work permitted by an issued building or foundation permit. BUILDING PERMIT EXTENSION The first extension shall be the greater of $50.00 or 50% of the building permit fee. Subsequent extensions shall be equal to the original building permit fee. FOUNDATION WORK ONLY The greater of $100.00 or 50% of the fee for the building permit, calculated on the estimated full value of the entire building. (Non- refundable and is not credited towards building permit fee.) TEMPORARY CERTIFICATE OF OCCUPANCY The greater of $100.00 or 50% of the building permit fee. CERTIFICATE OF OCCUPANCY FOR EXISTING BUILDINGS $100.00 with letter from property owner requesting certificate. FIRE SAFETY INSPECTION AND RE -INSPECTION $50.00 for the first hour (1-hour minimum), $30 per additional hour. ZONING BOARD OF APPEALS APPLICATION Area, Sign, and Sprinkler Variances and Special Approvals -- $150 and Use Variance -- $250; $30.00 additional meeting; $50.00 additional public hearing. FILL PERMIT $100.00; additional fees apply if Zoning Board of Appeals and/or Planning Board approval is necessary. LETTER OF COMPLIANCE - $60 per letter Revised 03/07111, 08/08/11, 10/17111, 03112. 12/14. 12115115. 4119116, 5122/17. 6120/17 Owner: Casper Real Estate Trust Located At:429 Bostwick Rd Applicant Information Casper Real Estate Trust PO Box 40 Ithaca NY 14851 Inspections Town of Ithaca 215 N. Tioga Street Ithaca, NY 14850 SBL #: 32.-2-3.221 Building Permit #: 2018-0113 Permit Type: ZONING ONLY Date: 4/27/2018 Expiration Date: 4/27/2019 Page 1 of 1 -FINAL PASSED BBATES 1/28/2019 Notes: permit for Zoning purposes only Build 24' x 50' shed. Results: Agricultural building complies with setbacks and dimensions of the building submitted with the permit. -PLAN REVIEW - BUILDING COMPLETED BBATES 4/27/2018 Notes: Agricultural building zoning review only Results -PRE-BP SITE INSPECTION Notes: Results COMPLETED BBATES 4/27/2018 Affidavit of Exemption to Show Specific Proof of Workers' Compensation Insurance Coverage for a 1, 2, 3 or 4 Family, Owner -occupied Residence *,This.form cannot be used to ;vaive the k nrkers' corurerr.erttiurr rights or ohlinutions of'arty partr. " 11nder penalty of perjury. I certify that I am the owner of the 1. 2, 3 or 4 famiiy, owner -occupied residence. (including condominiums) listed on the building permit that I am applying for. and I am not required to show specific proof' of' workers' compensation insurance coverage for such residence because (please check the appropriate box): ❑ I am performing all the work for which the building" permit was issued. ❑ I am not hiring, paying or compensating in any way, the individual(s) that is(are) performing all the work for which the building permit was issued or helping me perform such work. / I have a homeowners insurance policy that is currently in effect and covers the property listed on the attached building permit AND am hiring or paying individuals a total of less than 40 hours per week (aggregate hours for all paid individuals on the jobsite) for which the building permit was issued. I also agree to either: ♦ acquire appropriate workers' compensation coverage and provide appropriate proof of that coverage on forms approved by the Chair of the NYS Workers' Compensation Board to the government entity issuing the building permit if I need to hire or pay individuals a total of'40 hours or more per week (aggregate hours for all paid individuals on the jobsite) for work indicated on the building permit. or if appropriate, file a CE- 200 exemption form; OR ♦ have the general contractor, performing the work on the 1, 2, 3 or 4 family. owner -occupied residence (including condominiums) listed on the building permit that I am applying for, provide appropriate proof of workers' compensation coverage or proof of exemption from that coverage on forms approved by the Chair of the NYS Workers' Compensation Board to the government entity issuing the building permit if the project takes a total of 40 hours or more per week (aggregate hours for all paid individuals on the jobsite) for work inOigated'prihe building permit. (Signatufe of Homeowner) (Date Signed) `C Home Telephone Number t4 (Homeowner's Name Printed) Swarm to before me this day of Property Address that requires the building permit: `f (Coanty Clemm - j Notary Pubic State o` New York No. D1 DEC1-t8Q35 Oui fiorf in Tompkins. County My Commission Explms June 19, 20 Once notarized, this BP-1 form serves as an exemption for both isorkers' compensation and disability benefits insurance coverage. BP -I (12/08) NY-WC'B LAWS OF NEW YORK, 1998 CHAPTER 439 The general municipal law is amended by adding a new section 125 to read as follows: 125. ISSUANCE OF BUILDING PERMITS. NO CITY, TOWN OR VILLAGE SHALL ISSUE A BUILDING PERMIT WITHOUT OBTAINING FROM THETERMIT APPLICANT EITHER: 1. PROOF DULY SUBSCRIBED THAT WORKERS' COMPENSATION INSURANCE AND DISABILITY BENEFITS COVERAGE ISSUED BY AN INSURANCE CARRIER IN A FORM SATISFACTORY TO THE CHAIR OF THE WORKERS' COMPENSATION BOARD AS PROVIDED FOR IN SECTION FIFTY-SEVEN OF THE WORKERS' COMPENSATION LAW IS EFFECTIVE; OR 2. AN AFFIDAVIT THAT SUCH PERMIT APPLICANT HAS NOT ENGAGED AN EMPLOYER OR ANY EMPLOYEES AS THOSE TERMS ARE DEFINED IN SECTION TWO OF THE WORKERS' COMPENSATION LAW TO PERFORM WORK RELATING TO SUCH BUILDING PERMIT. Implementing Section 125 of the General Municipal Law General Contractors -- Business Owners and Certain Homeowners For businesses and certain homeowners listed as the general contractors on building permits, proof that they are in compliance with Section 57 of the Workers' Compensation Law (WCL) is ONE of the following forms that indicate that they are: ♦ insured (C-105.2 or U-26.3), ♦ self -insured (SI-12), or ♦ are exempt (CE-200), under the mandatory coverage provisions of the WCL. Any residence that is not a 1, 2, 3 or 4 Family, Owner -occupied Residence is considered a business (income or potential income property) and must prove compliance by filing one of the above forms. 2. Owner -occupied Residences For homeowners of a 1, 2,3 or 4 Family, Owner -occupied Residence, proof of their exemption.from the mandatory coverage provisions of the Workers' Compensation Law when applying for a building permit is to file form BP-1 (12/08). Form BP-1 shall be filed if the homeowner of a 1, 2,3 or 4 Family, Owner -occupied Residenceis listed as the general contractor on the building permit, and the homeowner: 0 is performing all the work for which the building permit was issued him/herself, 0 is not hiring, paying or compensating in any way, the individual(s) that is(are) performing all the work for which the building permit was issued or helping the homeowner perform such work, or 0 has a homeowner's insurance policy that is currently in effect and covers the property for which the building permit was issued AND the homeowner is hiring or paying individuals a total of less than 40 hours per week (aggregate hours for all paid individuals on the jobsite) for the work for which the building permit was issued. ♦ If the homeowner of a 1, 2, 3 or 4 Family,�Owner-occupied Residence is hiring or paying individuals a total of 40 hours or MORE in any week (aggregate hours for all paid individuals on the jobsite) for the work for which the building permit was issued; then the homeowner -may not file the "Affidavit ofExemption.'form, BP-1(12/08), but shall either: 0 acquire appropriate workers' compensation coverage and provide appropriate proof ofthat coverage on forms approved by the Chair of the NYS Workers' Compensation Board to the government entity issuing the building permit (the C,105.2 or U-26.3 form), OR 0 have the general contractor, (performing the work on the 1, 2, 3 or 4 family, owner -occupied residence (including condominiums) listed on the building permit) provide appropriate proof of workers' compensation coverage, or proof of exemption from that coverage on forms approved by the Chair of the NYS Workers' Compensation Board to the government entity issuing the building permit. BP-1 (12/08) Reverse www.wcb.ny.gov i - r ilT� I � i � _. • - li '�LT'N. ` I• , .•. 'P W�ti 4 q i • j r 4 , A y l- . S• rT�l�. t• {�F' � _ _ � pJrCll A �{ r w. .i Aw, In � • � � • � � , � r aviYoriT-- 1 rLik.� PAACIZ s I �V NEW YORK-STATE l3EPARTMf=NT OF EHVIRONMENI'AL CON$ER1/AT[O!V .� - � - - -. r �.� � fir- • _ 4 ., .. i (1) COUNTY I ( re,40 rs �. '� ` (3) DEC Well Number f (2)-TOWN cs—. WATER'1NELL COMRLE¢T DN REPORT �T`f�i ch;P (4) OWNER WELL LOG (5)ADDRESS '' : Dept 'Be ; (ft: below'~; land surface) . i 1`Y"�rr�'i .�i C�{ i`vr� - A"1�_('�� '�i k"t. ��`"'1 ��} �•* � x ` '.r. .. ., r f r:: y- - `, � ,, ,:-o:. (B) LOCATION t]F 1NEl L (See Instructions On Reyerae) I " (Check here is 'if address Is samo as above) Ground ElevatlOn -1 ;)3:(-ft. above sea level) } (7) LATrrObEILONGITUDE AND METHOD USED of Casing 1 (it: 'atiove + Oi (e) TAX 14L4P NO. 11 GPS'El Map y {' below (-)'larid'surface) ��f i },. (9) DEPTH OF I WELL BELOW r, (10) EIEPTH TO GRQUNDWAI ER • DAT MEASURTOP OF WELL RED c ' LANO SURFACE (feet) , I f BELOW LAND SURFACE (teat) ., f '�_ - ' - •� � � ;,F .., _ .. � A I7tr`` Y;w�",errn adzrnsF t jm 7'Ra:3a�Fy�ae� k a;r�xTi£ 2 Fj r _ a :4 % i (11)DIAMETER �> in. < ' in..I xrI r3' - in 3 Iri r # i gs • Z ;� ,ti .a,;� (lZ} I.,E111GT1-(::; ,,..,.- :'Ls F "" � y +,`; ,� wr .. . i$ � z - r i ' C F+ a., w 'v � � t �,r'. a1 f, ..M ,5,�,;e,�,••.'�� L'� �.� �- I u {,e� � �•- -• - "' I ' Il• �• sata..rn-r� ..iwG .R"`i_��4 e E I(13) GROUTSYpE! SEALJNGGROUT1SEAyNG INTERVA(t 771�.t., �;,'�'y�r � - #k.r�P-,F - '' •�;�. x{66Q.- ? r ' �'" vr''• 't,`ir¢ "tom . � � � � ;� „_ ,_ ,, ` _ ,- • '`M�e`.,''+^, y��.�.� 4 2 wrq' 191 3¢ .l �•�.?ra� __,CF�iY•-.°fk iP ,,,•t7 ,nt�:,ro v. I MAKE 15 () E & MATERIAL FF: �(16)OPENINGS` i (17) DIAMETER- t in.� in. _ in.'+ (18) LENGTH • ft. ft. qq ! I (19) DEPTH TO TOP OF SCREEN. FROM tOP'OF CASING (Feet) - (20) DATE (21) DURATION OF TEST 22 LIFT METHOD ( ) (2a) STABILIZED DISCHARGE (GPM) f` ❑ Pump (l)Airl_ill ❑ Baller FkA, 4 �- (24) STATIC LE,/EL- PRIOR TO TEST . (25) MAXIMUM DRAW DOWN (SYat„Hied) -{reetrinches be10W 10p of caSing) 4 (feetlnches below tap of casing} IN - a (26} RI_COVF}2Y. (Tima,in hourslminutea) r i ,� - ., {27} Was iho water.,produced daring the teat l � _ `4 • x - �M - .,,, w'i9. ;4 r' .'-.*,-.,-^N.-ecarrs re:�f -:,.} •y _tw.1v"^,:=� +. iT discharged awoyftam iitimediate oleo? Yes No (28) PUMP INSTALLED? (29) DATE (30) CERTIFIED PUMP INSTALLER M NoIM (31) TYPE (32) MAKE (33) MODEL i 1 (34) MAXIMUM CAPACITY (GPM) (35) PUMP INSTALLATION LEVEL FROM TOP pF CASING (Feet) - _ 311 �. ,a,! n '�, • .a _ _ .-+i, 5,!':•' ' ry'� - , t .,C X.;�. - ..... ._.�n�� i1ME RFiNFOfMAlC1N,��' I(36) METHOD OF DRILLING O dam~ r s� I (37} USE OF WATER [ Rotary ❑ Cable Tod El mar (See Inatructlons for d ims) 1(38) DATE DRILLING WORK STARTED �(39) DATE DRILLING WORK 1 COMPLEtED (40) OATE,REPORT,PILED (m) REGISTERED COMPANY (42) DEC REGISTRATION No. NYRD N in (43) CERTIFIED DRILLER (prim name) (44) CrERTIFIED DRILLER SIGWj—URE'- . By signing this document I hereby affirm that: (1) [.am cert'ffied to-supenrise water.weil drilling activ)ties as ' def[ned by Envlronrrientai Conservation L'aw 1.51502' (2) this water'well vlras oonsiruc{ed in,accor[fanCe with" ' - -BOTTOM OF -HOLE'. '�-•�-_-�- water -well sta`rldards�proriliilgated-by'tiea:EVerti Yoik:State:!]epa�hri'snt�c€.l:iesith;m(3).undertha;pepaltY the Information provided.in this WelllCompfetion Report is true, accurate and,complete,.and I understand that; (.: any false statement matte herein is puntsFiable as°a`;'Class_A MiscJemeariar'tiniie� OTHER 4 . �y OF PP TOWN OF ITHACA- STORMWATER MANAGEMENT PROGRAM 215 North Tioga Street + Ithaca, NY 14850 e 607-273-1747 • www.town.ithaca.ny.us Simple Erosion and Sediment Control Plan AM OF421--' r OC� [-•> 918 �� Jt� The Town of Ithaca Stormwater Management & Erosion and Sediment Control Law requires property owners and/or contractors to complete a Simple Erosion & Sediment Control Plan for small projects that do not require a formal Stormwater Pollution Prevention Plan (SWPPP). The purpose of the "Simple Plan" is to ensure that proper erosion control measures will be implemented during your project to prevent pollutants and sediment from entering our streams, wetlands, and Cayuga Lake. Type of Land Development Activity: Building Construction E], Excavation or Filling ❑ Utility Work ❑ Other ❑ Brief Description of Project: LA C c_ 5he� Project Information Owner/Developer Information Street Address/Location: [��'"`� Company Name: c r Contact Person: Tax Parcel # _ ? Z- - �� t Address: 1 (_ 1- I (C� , =. { f.�, Si ;µ Total Area of Land Disturbance (square feet): / ? - square feet Total Volume Soil Excavation/Fill (cubic yards): cubic yards Email Distribution Li t for SWPPP Report Notices (in addition to owner notification): r Required Submittals: PI•ionel�r`= ' J Fax: Contractor Information SL Company Name: f ' Contact Person: Address: Phone: Email: Fax: ❑ Description of existing site conditions either in a narrative or shown on a drawing. Note adjacent areas in relation to potential erosion and sediment control problems including sloped areas and locations of on -site and off -site streams, ponds, and wetland areas. ElDrawing showing the total site area or parcel. Include delineation of areas to be disturbed and location of erosion and sediment control practices. ❑ List of erosion and sediment control practices to be implemented, including maintenance procedures and re -vegetation plan. Erosion and sediment control practices include but are not limited to silt fence, rock check dams, slope stabilization, and seeding and mulching. See back of form for tips on erosion and sediment control practices. Developer and Contractor Certification: "I certify under penalty of law that I understand and agree to comply with the terms and conditions of the submitted Simple Erosion and Sedimenf Control Plan. I also understand that it is unlawful for any person to ca se or contribute to a violation of water quality sta! rips." Owner/DevelopbDate Contractor s - tlur2 ` Date Print Name Print Name OFFICE USE ONLY Reviewed by Engineering Department: Initials Date Erosion Control practices shall be installed prior to the beginning of land disturbance. An Erosion Control inspection is required by the Town of Ithaca before any land disturbance to ensure that erosion control practices have been installed correctly. Regular erosion control inspections by the Town of Ithaca are required and will continue throughout the construction process until the site is completely stabilized and re -vegetated. In case of deficiencies, inspection report comments will be emailed or mailed to the Owner/Developer. These comments shall be addressed within 7 days to avoid penalty. You may provide additional email addresses so that Contractors, Subcontractors, or others involved with the project will also receive copies of the inspection reports. Erosion Control Tips: • Stabilize access points by installing a stone construction entrance to prevent off -site sediment tracking. • Prevent erosion by placing silt fence along the contour of the land to prevent sediment from washing off the site. Silt fence should be toed -in to the ground 6 inches and stakes should be stapled to the downhill side of the silt fence. • Stabilize all soils, including stockpiles that are temporarily exposed. Place silt fence around downhill side of stockpiles to limit sediment migration. • Use inlet protection to prevent sediment from entering all storm drains that receive runoff from the disturbed areas. • Temporary seed and mulch all bare areas that have not been worked on in 14 days, including stockpiles. • Place rock check dams in ditches or other waterways to prevent erosion and limit sedimentation. Do not place silt fence in areas of concentrated flow such as ditches and waterways. • Use erosion control blanket on steep slopes and in disturbed ditches to limit erosion. • The final inspection will occur when permanent vegetative cover is established on the entire site and the entire site is stabilized. For more information on erosion and sediment control practices, pick up a packet on Erosion and Sediment Control at the Town of Ithaca Town Hall or check out the following websites: vvvAv.town.ithaca.ny.us http_i't_�wvv.deC._nygovlcheni.cai'8694 html