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2015-254 41 TOWN OF QUEENSBURY 742 BayRoad,Queensbury,NY 12804-5902 (518) 761-8201 ��� rY Community Development - Building & Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE Permit Number: P20150254 Date Issued: Monday, July 06, 2015 This is to certify that work requested to be done as shown by Permit Number P20150254 has been completed. Tax Map Number: 523400-309-006-0001-045-002-0000 Location: 13 MALLORY Ave Owner: JAMES HILL JR Applicant: JAMES HILL JR This structure may be occupied as a: Septic Alteration Residential By Order of Town Board TOWN OF QUEENSBURY Issuance of this Certificate of Compliance DOES NOT relieve the ( e400 / 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&Co!Enfo\ement Planning Board or Zoning Board of Appeals. TOWN OF QUEENSBURY 4111111hi 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development- Building& Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20150254 Application Number: A20150254 Tax Map No: 523400-309-006-0001-045-002-0000 Permission is hereby granted to: JAMES HILL JR For property located at: 13 MALLORY Ave 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. Type of Construction Value Owner Address: JAMES HILL JR Septic Alteration Residential 13 MALLORY Ave Total Value QUEENSBURY,NY 12804 Contractor or Builder's Name /Address Electrical Inspection Agency Plans&Specifications 2015-254 residential septic alteration $40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Wednesday,June 15,2016 (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 T n o ueen rye/ J o/i , une 15,2015 /vl i SIGNED BY for the Town of Queensbury. Director of Building&Code Enforcement 1 SEPTIC DISPOSAL APPLICATIO N. rE _ Office Use Only Received DATE: 12 2015 Tax Map ID I J ld TAX MAP ID: Permit No. '2015 if, fa 3� ' . - � 5�� TOWN OF OUEENSE Permit Fee ZONE: BUILDING & CODE APPLICANTS f��// PHONE/E-MAIL -ig)33 g -33 cj �}� ADDRESS j 11"2.911OPy /� / /7!/s uc,49NSu,2 y, N� INSTALLER/ PHONE/E-MAIL BUILDER Of,,At"( G147 I / l)�. /� lSl� 10 .`7�1,71�' -/07� o.JsfeuGfefFaluA,lcam OWNER ( QA/S -eaC 17DA. CO - LL.C ADDRESS (2.UC -6'/6,,'Lck / 1✓c- /i�/macsV•l/� /7V .2/aC8 CONTACT PERSON FOR BUILDING&CODE COMPLIANCE: joAbv,z /i // PHONE/E-MAIL 07g)a 1 O- 10 7/ RESIDENCE INFORMATION Year Built #of bedrooms X gallons per bedroom =total Daily flow 1980 or older Garbage grinder installed _Yes , No 1981-1991 Spa or Hot Tub installed Yes No 1992-Present /• p a7s PARCEL INFORMATION Topography Flat rolling Steep slope %Slope Soil Nature and Loam Clay Other Groundwater At what depth: Bedrock/Impervious material At what depth: Domestic Water Supply )X Municipal Well(if well,water supply from any septic system absorption is ft.) Percolation Test Rate: 1 per minute per inch(test to be completed by licensed engineer/architect) PROPOSED SYSTEM FOR NEW CONSTRUCTION 1# rr 012,4\i QV/ Tank size 7,5a)gallons(min.size 1,000 gallons,add 250 gallons to size for each garbage cylinder or spa or hot tub System Absorption field with#2 stone Total length '7 p, ft.;Each Trench� Q Seepage Pit with#3 stone How many: ;Size Alternative System Bed or other type: 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 known by or on behalf of an applicant,shall be void. I have read the regulations and agree to abide by these and all requirements of the Town of Queensbury Sanitary Sewage Disposal Ordinance. PRINT NAME: O` /o�vi✓/L //i Z L DATE: 6/9/� l.� SIGNATURE: K ) Q AQ DATE: 6/5/.2i'/.5 Town of Queensbury Building&Codes Principal Structure Application Revised September 2014 Tov;n of Queensbury Building & Code Enforcement Office No. (518) 761-8256 Septic Inspection Report Inspection request received: Name: X11 LL Inspected on: — Location: 1 -j M iMLpckq AvF Arrive: % ad .m.1 p.m. Permit No.: v5 - Z5y Inspector's Initials: I'� Comme-and/or dia•ram Soil Typ • Sandi Loam/Clay Type of Water. Municipal l/Vell Water F Qom - Waterline separation distance ft. Well separation distance ft. Other wells: ft. Well Casing Length 50'+/- Y N N/A [150'to well required if NO] Absorption Field: Total length 7 4 Q ft. Qv1CAIN y EQv(PLt 2.E_ 34t Length of each trench Ie.Aft. Depth of trenches 5 ft. F 1 ,tbpc0 1O\ A CA9kPc3c\\ Size of Stone Seepage Pits: Number Size: x --�� Stone Size: Piping Size Type Building to tank Tank to Distribution Box �EJ►J1 L- ` 1C-N- 10 \ -\5 Distribution Box to Field/Pit / IA 1 60P\ Q_o`GV` ` EQ1A\ `,� 6210 Opening Sealed: �/Y N �,`\ `"� End Cap t Q LA) Tc C VI Inlet/Outlet Pipes&Baffles Manholes 12"or less below grade f/Y(%/N [provide extension collar if Yes] N Location/Separations Foundation to tank Ey_v67-xa6 D ft. tJ v.uJ T RtMK "~ TO R3 t\Es- Foundation to absorption '.. ft. -t To t3A8E.t.\ — Separation of Pits Conforms as per Plot Plan YNiN Engineer Report ands-Buil) VY N ETU Maintenance Contract provided Y N Location of S stem on Prose : Front R-,r Left Side Right Side Middle Front Middle Rea S stem Use Sta ,s: Approved Partial Approved and needs to be re-inspected, please call the Building &Codes Office Disapproved Septic Inspection Report -,.... ir, r/•• (5-31 %-c:-.7- /41 / i i /--. ii 1 6 ri.,,(.,/.. ri !'..1'5'. SEPTIC PLOT PLAN ./ I HAVE SEEN OR OBSERVED ALL OBJECTS . • ; SUCH AS HOUSES, MLLS, TREES, FENCES, ETC ., . .. j s.,. ei- 7 e'' -1 -.7,-. •- . '.t - ' " / SHOWN ON THIS DOCUMENT I HAVE PERSONALLY , FILE COPY MEASLVE DISTANCE S•T 0,, H ON THIS DIAGRAM. - ' ,.-- (---.7 , . ,_____„\ E,--,,- . ---;--,_._ :::".... /--:,'/e•-y/,,i. ) SIGNATURE -DATE ' As BUILT Qau. E.4".D;444A614,/,,,, . .... ._ _ . K,.6.o.•...4,-. --,•' I , f' 'i'. r. ' ; • TOW LDN .. . f• j ': - 1°NGF 1 o‘,.v1.4 1.,.)'• ',),',,,,,,:',r,:!-'-:::,,:.!•..i:,)/ ' E't.Ji! I:), L'iG :!'. C(....'1: :•' i; , ...... .-----, ;. .x. ill\ , //' Arti,/ Reviewed By 41 p.. Amirifirl _ Date: c , ..„) .....r: v 1...;,... 1.,ft. ..._ ki.,--, t - 1O 0 • , 11 C: It--4-4--... , .., ' , * - . .Ak fi--,70 .S. ef FILE CORI __ L E.4,3(...-,' fr,. ; i tiai . , t....,, _ .,,..„. _....,--„•-,—,.....-----„,..-„, /1 A'oc...., .--7,7,..,- -:.-i-, ....i.-. .--:: . - ,-.-,-_-.:.= -•-•"74 • / 6.-'1 Jr. ,, , ,, .-- ..-.. .....,,--.- - - . 4.„--- ipc...lb ' .„,- =:::::- .,-.::iiak., --,,J-.,,...:.!--,-----," ....,2_:.;... ......_--- -- - -- . CLot:-A- 7 F&..0isLAZ % ‘11 + 0-A÷ LA - .CMC'tkii-1.8: —•, --. I11 i ; c) LT.: J:- O --r- ..6-- 1 _ r---f i' :. L--- =.- . . __.. 2DR c) • • Town of Queensbury Building &Code Enforcement Office No. (518) 761-8256 21 Septic Inspection Report Inspection request received: P4/\Al i5 Name: t Inspected on: q1"21 Lot 5 Location: \3 \.40 tc'V..() Arrive: .ta,Ap a. ./p, Permit No.: I'D -25/ v Inspector's Initials: Co , ents and/or dia•ram Soil Typ : Sandi /Clay Type of Wate Munici a 1 WPJI Water Waterline separation distance ft. Well separation distance ft. Other wells: ft. Well Casing Length 50'+/- Y N N/A [150'to well required if NO] Absorption Field: Total length V*7% ft. Length of each trench 1 0 ft. Ce 0.0 M— )37.- 7-0 S. v Depth of trenches L q" ft. Size of Stone Seepage Pits: Number Size: x Stone Size: Piping Size Type Building to tank Tank to Distribution Box Distribution Box to Field/Pit L ' - -- .-v- Q) 1.% U LE(2. 3(Q Opening Sealed: _Y N End Cap _Y ✓ ` �- 1%' 1VJTL‘ Inlet/Outlet Pipes&Baffles _Y_N b TO eA CA4FVLL. Manholes 12"or less below grade Y N [provide extension collar if Yes] Y N Location/Separations Foundation to tank ft. Foundation to absorption ft. Separation of Pits ft. Conforms as per Plot Plan Y N Engineer Report and As-Built Y N ETU Maintenance Contract provided Y N Location of System on Property: Front Rear Left Side Right Side Middle Front Middle Rear System Use Status;) VApproved Partial Approved and needs to be re-inspected, please call the Building&Codes Office Disapproved Septic Inspection Report GRAVELLESS and ALTERNATE AGGREGATE PRODUCTS February 2015 The NYS Department of Health has determined that the following products comply with 10 NYCRR Appendix 75-A. This Department does not approve proprietary products,but will review products as a courtesy. Manufacturer Product Trench Length Design (75-A: Tables 4A or 4B)""2 Advanced Drainage Systems(ADS) GEO-Flow Pipe Leaching System 25% www.ads-pipe.com GEO-Flow geotextile sand filter system 6.0 ft2/ft rating Cultec Contractor EZ-24 Chamber 1:1 www.cultec.com Contractor 100 Chamber 25% Contractor 125 Chamber 25% Eljen Corporation Geotextile Sand Filter(Type B) 6.0 ft2/ft rating www.eljen.com Geotextile Sand Filter(Model A425) 6.0 ft2/ft rating Infiltrator Systems ATL System 25% www.infiltratorsystems.com ATL Geotextile Sand Filter System 6.0 ft2/ft rating Equalizer 24 1:1 Quick 4 Equalizer 24 1:1 Quick4 Equalizer 24 HD 1:1 Quick4 Equalizer 24 LP 1:1 Quick 4 Equalizer 36 25% Quick4 Plus Equalizer 36 LP 1:1 Quick4 Standard 25% Quick4 Plus Standard 25% Quick4 Plus Standard LP 25% High Capacity H-20 25% EZ Flow 1202H 1:1 EZ Flow 1203T 25% EZ Flow 1003T 25% BioDiffuser 15"Narrow(Bio 2) 1:1 BioDiffuser 22"Narrow(Bio 3) 25% ARC 18 Chamber* 1:1 *ARC Chambers may be marketed as ARC 24 Chamber* 25% Advanced Drainage Systems(ADS) ARC 36 Chamber* 25% products;ADS is owned by Infiltrator. ARC 36 HC Chamber* 25% ARC 36 HC H-20 Chamber* 25% BioDiffuser 11"Standard(34"wide) 25% BioDiffuser 16"High Capacity H-20 25% Flowtech by Infiltrator:FTS 122H-1 1:1 Flowtech by Infiltrator: FTS 123T-1 25% Flowtech by Infiltrator: FTS 103T-1 25% Geomatrix LLC GST Leaching System 1:1 www.geomatrixsystems.com Presby Environmental Enviro-Septic System 25% wwwpresbyeco.com AES geotextile sand filter system 6.0 ft2/ft rating Modern Landfill Tire Derived Aggregate(TDA)3 1:1 www.moderncorporation.com Casing,Inc. Tire Derived Aggregate(TDA)3 1:1 Jim.fabrizio@casingsinc.com Reductions in total linear feet based on criteria in Appendix 75-A, subsection 75-A.8(c) 2 The trench length reductions are not applicable at properties located within the New York City Watershed 3 The TDA product meets criteria established in Section 75-A.8(b)(3)(v) Note: The above list is not an endorsement of any of the products by the NYS Department of Health, nor is it intended to represent a comprehensive list of all products that comply with 10 NYCRR Appendix 75-A. This list will be occasionally updated as new product specifications are reviewed. The use of these products may be subject to approvals by local government agencies, including local health departments, watersheds or other local agencies. Quick4. , c5 The Quick4® Equalizer 36 Chamber INFILTRATOR® water technologies •Quick4®Series `( F ttijjjil .--0 >+ .i A f.\:x44 �I \\"4: ' I a-' - -'' ' ''' '1. • •, .. '. •C' ' )11'.4_1..' l'i:ikA ..may" '.`! rte - `ai`•.5. :[ n _ :4.. :.. r- as �. ." •� 'c .+!" _ // • ... 4 s f. " r a .. . • s - Ittii\r„ jr- _I ,. ,-;,- .rfrio„ .. • . -•- , riI .-I . , �... The Quick4®Equalizer 36 Chamber fits in a 24" wide trench s' = " 7 and is ideal for curved or straight systems. It features the _ patent-pending Contour Swivel Connection- which permits '-- ) r ' - turns up to 15°, right or left. The MultiPort- endcap allows , , multiple piping options and eliminates pipe fittings. :The • vidi chamber's four-foot length provides optimal installation ,r�:� � •--flexibility. w,.` . _ '► Chamber Benefits: ,. •Advanced contouring connections swivel up to 15°, 00101P- - v; right or left ` •. /ar' . • Latchingmechanism allows forquick installation - i►. • Compact nesting provides more trench length in an , 1 •r, • equivalent stack height ...... . ..,„,41A, .t . w • Four-foot chambers are easy to handle and install _ ...e •The Quick4 Equalizer 36 Chamber supports wheel loads 1 • •f`. 1 `"-',?' ` of 16,000 lbs/axle with only12" of cover ; A • Certified by the International Association j4 .a, 1' of Plumbing and Mechanical Officials (IAPMO) \R •�'- x r MultiPort Endcap Benefits: .- , .,. . e . _-- - •Tear-out seals on inlet ports provide a tight fit to the pipe a • l- 2 • Six molded-in inlets/outlets allow for maximum piping flexibility Quick4"Series • Fits on either end of the Quick4 Equalizer 36 Chamber Because installations are faster with Quick4 chambers, you save on heavy equipment APPROVED in operation and labor. Quick4®Series .0/ick4. Quick4 Equalizer 36 Chamber • I 1 ii . 1111111111111111. 12n I-. 48" 22" EFFECTIVE LENGTH MultiPort EndCap R .� 1110 _____ __011 � pa* ts" VIP ,z" _ o7.or—oP 1 1' / 22" FRONT VIEW SIDE VIEW TOP VIEW INFILTRATOR WATER TECHNOLOGIES STANDARD LIMITED WARRANTY Typical Trench View (a)The structural integrity of each chamber,endcap and other accessory manufactured by Infiltrator("Units"),when installed and operated in a leachfield of an onsite septic system in accordance with Infiltrator's instructions,is warranted to the original purchaser("Holder")against NATIVE BACKFILL TOPSOIL defective materials and workmanship for one year from the date that the septic permit is issued for the septic system containing the Units;provided,however,that if a septic permit is not required by 111101111.1111111 OW applicable law,the warranty period will begin upon the date that installation of the septic system ��� II- COVER BY/� II commences.To exercise its warranty rights,Holder must notify Infiltrator in writing at its Corporate Ill DESIGN 11,./ Headquarters in Old Saybrook,Connecticut within fifteen(15)days of the alleged defect.Infiltrator —. will supply replacement Units for Units determined by Infiltrator to be covered by this Limited + �- 12 - � Warranty.Infiltrator's liability specifically excludes the cost of removal and/or installation Iriltal 6"INVERT of the Units. 1 (b)THE LIMITED WARRANTY AND REMEDIES IN SUBPARAGRAPH(a)ARE EXCLUSIVE. THERE ARE NO OTHER WARRANTIES WITH RESPECT TO THE UNITS,INCLUDING NO 22" SPACING PER CODE 22"--{ IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE (24'WOE TRENCH) (c)This Limited Warranty shall be void if any part of the chamber system is manufactured by anyone other than Infiltrator, The Limited Warranty does not extend to incidental,consequential, special or indirect damages.Infiltrator shall not be liable for penalties or liquidated damages, including loss of production and profits,labor and materials,overhead costs,or other losses or Quick4®Equalizer 36 Chamber Specifications expenses incurred by the Holder or any third party. Specifically excluded from Limited Warranty coverage are damage to the Units due to ordinary wear and tear,alteration,accident,misuse, Size 22"W x 53"L x 12"H abuse or neglect of the Units;the Units being subjected to vehicle traffic or other conditions which (559 mm x 1346 mm x 305 mm) are not permitted by the installation instructions;failure to maintain the minimum ground covers set forth in the installation instructions;the placement of improper materials into the system Effective Length 48" (1219 mm) containing the Units;failure of the Units or the septic system due to improper siting or improper sizing,excessive water usage,improper grease disposal,or improper operation;or any other Louver Height 10" (254 mm) event not caused by Infiltrator. This Limited Warranty shall be void if the Holder fails to comply with all of the terms set forth in this Limited Warranty,Further,in no event shall Infiltrator be Storage Capacity 32 gal (121 L) responsible for any loss or damage to the Holder,the Units,or any third party resulting from installation or shipment,or from any product liability claims of Holder or any third party.For this Invert Height 6" (152 mm) Limited Warranty to apply,the Units must be installed in accordance with all site conditions required by state and local codes;all other applicable laws;and Infiltrator's installation instructions, (d)No representative of Infiltrator has the authority to change or extend this Limited Warranty. No warranty applies to any party other than the original Holder. Ir The above represents the Standard Limited Warranty offered by Infiltrator. A limited number of 4 Business Park Road states and counties have different warranty requirements. Any purchaser of Units should contact P.O.Box 768 Infiltrator's Corporate Headquarters in Old Saybrook,Connecticut,prior to such purchase,to Old Saybrook.CT 06475 obtain a copy of the applicable warranty,and should carefully read that warranty prior to the •FaxINFILTRATOR`° 18-800-2211-4436 60-577-7000 86 5"-700' purchase of Units. water technologies www.infiltratorwater.com U.S-Patents:4,759,661;5.017.041:5.156,488:5.336.01i;5,401.116:5 401.459;5,511,903:5.716.163;5,588.778;5.839.844 Canadian Patents:1,329,959;2,004,564 Other patents pending. Infiltrator,Equalizer,Quick4,and SideWinder are registered trademarks of Infiltrator Water Technologies.Infiltrator Is a registered trademark In France.Infiltrator Water Technologies Is a registered trademark In Mexico. Contour,MicroLeaching,PolyTuff.ChamberSpacer,MultiPort.PosiLock,0ulckCut,OuickPlay,SnapLock and StraightLock are trademarks of Infiltrator Water Technologies. PolyLok is a trademark of PolyLok,Inc.TUF-TITE is a registered trademark of TUF-TITE,INC.Ultra-Rib Is a trademark of IPEX Inc. ®2013 Infiltrator Water Technologies,LLC.All rights reserved.Printed In U.SA. 009 0813 Contact Infiltrator Water Technologies' Technical Services Department for assistance at 1-800-221-4436 'Town'.f Queensbury Building & Code Enforcement °V-oo oo Office No. (518) 761-8256 Septic Inspection Report Inspection request received: Name: 1--k\ LL_ Inspected on: 7.A111 Location: t \ i=11:AAq \le- Arrive: MEV a.m •.m. Permit No.: -ZZ L\ Inspector's Initials: VPLVIIRL C,9 mments and/or diagram Soil Type San- •- _Clay Type of Water. Municipal Well Water O IJ\ `l,{ji?_S Waterline separation.` ance ft. Well separation distance ft. Other wells: ft. Well Casing Length 50'+/- Y N N/A [150'to well required if NO] Absorption Field: Total length ft. Length of each trench ft. Depth of trenches ft. Size of Stone Seepage Pits: Number Size: x Stone Size: Piping Size Type Building to tank EX .11 -Aa, --- L1 f 6 DR x35 Tank to Distribution Box > oGR_ ?'K ' 1 �� Distribution Box to Field/ L{ t% 1 Opening Sealed: Y N End Cap � N Inlet/Outlet Pipes&Baffles > X � - 51--VJ } ©�� ` `, � E9 �_ � Manholes 12"or less below grade Y N �� hI.�� f�`� C�e" / � [provide extension collar if Yes] N �� €� ,N`� Location/Separations (`� 'rb BfC— j L _ Foundation to tank ft. eat-, Foundation to absorption ft. �l Separation of Pits ft. Conforms as per Plot Plan Y N Engineer Report and As-Built Y N ETU Maintenance Contract provided Y N Location of System on Property: Front Rear Left Side Right Side Middle Fro( Middle Rear System Use Statu • Approved Partial Approved and needs to be re-inspected, please call the Building&Codes Office Disapproved Septic Inspection Report • Town of Queensbury Building & Code Enforcement 1 ' z oO •Office No. (518) 761-8256 I (- Septic Inspection Report Inspection request received: Name: 6 Pi-'1Elj kA\ Inspected on: • — r Location: N1 LA___0R`A Arrive: � . O, a.m.( -71 Permit No.: 13I��� Inspector's Initials: W�jr; �c- ?-\"\-\ Com, ents and/or dia•ram Soil Type: Sand/Loam/Clay Type of Water: Municipal/Well Water Waterline separation distance ft. Well separation distance ft. Other wells: ft. Well Casing Length 50'+/- Y N N/A [150'to well required if.NO] D%5C-6 5/7 ESis ��l0OV Absorption Field: Total length ft. Length of each trench ft. Depth of trenches ft. L�" C.\ L-\ ti3E 3 Size of Stone Seepage Pits: Number 5c\v\c\F\f \LD1 Size: x CPL Stone Size: >��� o vEz tm-\ Piping Size Type ey---E_05\1� , Building to tank 133\ Tank to Distribution Box Distribution Box to Field/Pit Opening Sealed: Y N End Cap Y N Inlet/Outlet Pipes&Baffles Y N Manholes 12"or less below grade Y N [provide extension collar if Yes] Y N Location/Separations Foundation to tank ft. Foundation to absorption ft. Separation of Pits ft. Conforms as per Plot Plan Y N Engineer Report and As-Built Y N ETU Maintenance Contract provided Y N Location of System on Property: Front Rear Left Side Right Side Middle Front Middle Rear System Use Status: Approved Partial Approved and needs to be re-inspected, please call the Building&Codes Office Disapproved Septic Inspection Report Town of Queensbury Building & Code Enforcement 3c9 e(z 1 - 5" Office No. (518) 761-8256 Septic Inspection Report Inspection request received: Name: iNt\ Inspected on: Location: 'tA izA LA_ \)E_ Arrive: , _'.m 1 p.m. Permit No.: PE t: 7 t��-� Inspector's Initials: w/ Com 'ents and/or diagram Soil TypeSand oam/Clay Type of Wate�. M/unici al I` ell Water E 'A DO WOO Waterline separation distance ft. {�1�o b' Ncm Well separation distance ft. A —L7 - Other wells: ft. 0 Z l7 5 LVo {`� \t�\ t"`L,Mo Well Casing Length 50'+/- Y N N/A L [150'to well required if NO] RLR ( 1 AN 1 Q Absorption Field: Total length ft. `FL A16. 0 Length of each trench ft. \Ab v 1DL Depth of trenches _ ft. t` ti Size of Stone Seepage Pits: Number Size: x Stone Size: Piping Size Type Building to tank Tank to Distribution Box Distribution Box to Field/Pit Opening Sealed: Y N End Cap Y N Inlet/Outlet Pipes&Baffles Y N Manholes 12"or less below grade Y N [provide extension collar if Yes] Y N Location/Separations Foundation to tank ft. Foundation to absorption ft. Separation of Pits ft. Conforms as per Plot Plan Y N Engineer Report and As-Built Y N ETU Maintenance Contract provided Y N Location of System on Property: Front Rear Left Side Right Side Middle Front Middle Rear System Use Status: Approved Partial Approved and needs to be re-inspected, please call the Building&Codes Office Disapproved Septic Inspection Report A7/ 11 I l3 �'2 .1 / a rzt/ il` U SEPTIC PLOT PLAN I HAVE SEEN OR OBSERVED ALL OBJECTS SUCH AS HOUSES, WELLS,TREES, FENCES,ETC �} C� C. F 1�..1 S (4w2. \, , //, - 'Q (-p'` SHOWN ON THIS DOCUMENT.I HAVE PERSONALLY .��/ MEASUg1HE DISTAW ON THIS DIAGRAM. C__S-Et) --/'4._ C--- F//5 A/ ) . SIGNATURE DATE 7 j . E .t -0: - - =R. {', Rs' TOWN OF QU le.,,,, / p {`�11 `� L '` I ., ids rn BUILDING & • ( l ��, (� • 0 ire rl i JUN 122015 12 Reviewed BY ir,F./ TOWN OF i.1UE NSSURY �----- SUILDING Px CQD SPr-f - ' // i is �-ie o; _. ,4,?) ::!... r :•________ ilt ,� I 1 o 3 r-r r ._ 7-7 ' .- 14 ,NE LJ S r4"r G / LEEc,A FIEde Ii dr . ----► , s FILE COPY 4NA77t,/,t-4-0 tec , E- 1 „SEs 6 - ,ZAwfx1-4k 46 'QC- 1 4-77-,,5 et', -_ /-1)/, :) / , ,,. (-- 1 /-';?"--'-'1i/Cf- Ef E),(3),( &Or.Az6. - 0 +' L/9/4P-1 .-