Loading...
2012-412 O� ► TOWN OF QUEENSBURY WO742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201 Community Development - Building & Codes (518) 761-8256 CERTIFICATE OF OCCUPANCY Permit Number: P20120412 Date Issued: Friday, May 24, 2013 This is to certify that work requested to be done as shown by Permit Number P20120412 has been completed. Location: 28 GUNN Ln Tax Map Number: 523400-227-017-0001-019-000-0000 Owner: ROSEMARY FAULKNER LE Applicant: ROSEMARY FAULKNER LE This structure may be occupied as a: Septic Alteration Residential By Order of Town Board Test Pit/Pere Test Review TOWN OF QUEENSBURY Issuance of this Certificate of Occupancy DOES NOT relieve the property owner of the responsibility for compliance with Site Plan,Variance, or �d other issues and conditions as a result of approvals by the Planning Board Director of Building&Cod Enfor ment or Zoning Board of Appeals. TOWN OF QUEENSBURY 742 Ray Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development-Building&Codes (518)761-8256 BUILDING PERMIT Permit Number: P20120412 Application Number: A20120412 Tax Map No: 523400-227-017-0001-019-000-0000 Permission is hereby granted to: ROSEMARY FAULKNER LE For property located at: 28 GUNN Ln 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: ROSEMARY FAULKNER LE Septic Alteration Residential DAVID FAULKNER TRUSTEE Test Pit/Perc Test Review 1562 BAKER Ave Total value NISKAYUNA,NY 12309-0000 Contractor or Builder's Name /Address Electrical Inspection Agency CRANDALL EXCAVATING 793-0431 63 WOODCHUCK HILL Rd LAKE GEORGE NY 12845-0000 Plans&Specifications 2012-412 Septic Alteration Residential Pere Test by Chazen Engineers $240.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Thursday,August 22,2013 (If a longer period is required,an application for an extension must be made to the code Enforcement Officer of the Town of Queensbury before the expiration date.) Dated at the Town of Queensbury; Wednesday,August 22,2012 SIGNED B7' for the Town of Queensbury. Director of Building&Code Enforcement VAT 1f'1 r _� 7 own of Queensbury• Building&Codes Enforcement Office•742 Bay Road•'Queensbury,NY 12804 , i7 b P ) a--9 4 DEEP HOLE/PERC TEST I ''i AUG 2012 L 1ill clan. I g-•i-1 °I Request for Town Engineer Review' L TO. h1 _ ,.c,-_,.0iu Property Owner. BUIL,^'Nc,° sr- s cys eil.v'��Y V +Rt.k�hl Phone: (O-* l 0.."1- Z Property Owner's Address: 1 -)Q_›-g- E i.. AJ€ NI,rAC4Yv,.NA ,TAY t2.5d9 Location of Test: -D8 C t.9-N1-b 1--dfCeriCe Tax ID ft: al... 17- I - YR *Applicant's Engineer. \h T1A1 t7 1 V�G� C3�( � Phone: 7(M - 0-5t7 ) '74 -9455 Applicants Agent r/1�,.�1-c> C-- Phone: 76;;;;$\ -0'3( 7 Additional Notes: 1.Reason for Request? New Septic System Replacement Septic System Failed Septic System ri Subdivision 1-1 11lSite Plan Review X i 2.Are Wetlands present? YES i NO UNKNOWN *Note: Applicant is required to engage an engineer for design and testing of the system. The Town Engineer's responsibility is to witness system testing only. PLOT PLAN: Plot plan, to scale, to be submitted with application FEE SC 0 • a. $ 200 Flat Fee Date Paid: V a c/1 a, Check No.: U n er r` Na Kir /� b. OR Fee to be determined during To Be Determined: �' Site Plan /Subdivision review process SIGNATURE: In carrying out the provisions of Article IV, the Local Board of Health or the enforcement officer may engage the services of a qualified professional consultant for expert review and recommendation arising from the carrying out of the provisions of Art IV, including but not limited to the review of plans, specifications and reports, attendance at inspections, dye tests, deep hole test pits, septic related deep hole and percolation tests, system installations, and any other aspect of any matter contained in this Art. IV, and any costs incurred in such review shall be paid to the Town by the owner of the property before any approval can be granted under this Art. IV shall become effective within 30 days of presentment of an invoice for same, whichever is sooner. Such costs shall not exceed $1,500 without prior written notice to the party to be charged with same. My signature below indicates I have thoroughly read and understand the instructions, agree to the submission requirements and have completed the application. I also fully understand that additional engineering fees may be necessary per Town of Queensbury Local Law 136-14D. SIGNATURE OF APPLICANT: ,,,,\K, W nrr Date: R-at-t L SIGNATURE OF AGENT: )e.a,1-4A tY\A-c cl_L '(Date: Original (B&C Ale) Canary(Planning) Pink (Applicant) Gold (Town Clerk) n Community Development Office O�}} E � E L1 W E r� Q Town of Queensbury • 742 Bay Road • Queensbury, New York • 2804 II `ii OCT oa2012 I IL Office Use Only - L. _TOtrCI� ea._ _.,______i TAX MAP NO. PERMIT NO.,__L: Jo( PERMIT FEE o �r_ ni j& CODES APPROVALS: ZONING TOWN CLERK APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT: A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJECT TO REVIEW BEFORE ISSUANCE OF A VALID PERMIT. OWNER:-ROOEt,&AQ.'t FALU.4s4E. . INSTALLER:(w.t.�7'6.t.3- Scc.A VAT t-N4 vire."z... -P?.v(ESZ AVe, ADDRESS: tAt--i «.`(t_tnA 1 y•-r< 12309 ADDRESS: Cor�7. 1. c rstcstttOic, i3/4.1..4.:V1). LG t Waste 128.4 PHONE NOS -57 2-- Ca09O PHONE NOS 7c4 -o 4 1 LOCATION OF INSTALLATION: 2. 5 t_.ltJ�f`l-t L1-.44-C. RESIDENCE INFORMATION: YEAR BUILT NO.OF X COMPUTATION = TOTAL DAILY FLOW BEDROOMS (Gallons per bedroom) GARBAGE GRINDER 1980 or older X 150 = INSTALLED? ►.So 1981-1991 X 130 = SPA OR HOT TUB 1992-present 44 X 110 = `414 Gat INSTALLED? 4Vo PARCEL INFORMATION: / ✓ TOPOGRAPHY FLAT ROLLING v STEEP SLOPE %SLOPE I SOIL NATURE: SAND ty" LOAM ✓ CLAY OTHER I GROUNDWATER: AT WHAT DEPTH? >6-'1 1 I BEDROCK/IMPERVIOUS MATERIAL: AT WHAT DEPTH? 'Co I DOMESTIC WATER SUPLY: MUNICIPAL WELL ' (If well: -LAYGg acrE cSlP?1--"C water supply from any septic system absorption is ft) ✓ PERCOLATION TEST: RATE IS 7-z-'4 PER MIINUTE PER INCH[mpp est to be cprgpleteedlicensed rofessional engineer or architect) 71,44.41: ,NfU t7 C-Li PROPOSED SYSTEM FOR NEW CONSTRUCTION: All individual sewage disposal systems must be designed by a licensed professional engineer or architect(unless installed in a Planning Board approved subdivision). TANK SIZE: tz GALLON (MIN. SIZE IS 1,000 GAL.)Add 250 gallons to the size of the septic tank for each garbage grinder, spa or whirlpool tub. SYSTEM TYPE: o ABSORPTION FIELD(WITH NO.2 STONE) Total length ft. Each trench X ❑SEEPAGE PIT(S)(WITH NO.3 STONE) How many? Size? ALTERNATIVE SYSTEM Bed or other type? E>LJevA Gibr IPENcct--n-taca ❑ HOLDING TANK SYSTEM Total required capacity? Tank size? Number of tanks? NOTE: ALARM SYSTEM AND ASSOCIATED ELECTRICAL WORK MUST BE INSPECTED BY A TOWN APPROVED ELECTRICAL INSPECTION AGENCY. PLEASE REVIEW LIST PROVIDED. For your protection, please note that pursuant to Section 136-29 of the Code of the Town of Queensbury,any permit or approval granted which is based upon or is granted in reliance upon any material misrepresentation 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 with respect to this application and agree to abide by these and all requirements of the Town of Queensbury QUESTIONS? CALL 761-8256 OR EMAIL /' ry Sewage Disposal Ordinance. codes(aqueensbury.net \-'^• - •'1f V-✓ 9= -2-+n- VISIT OUR WEBSITE FOR MORE INFORMATION Signature of Perso Responsible Date www.oueensburv.net Septic Inspection Report Office No. (518) 761-8256 Date Inspection request received: Queensbury Building &Code Enforcement Arrive: am/pm part: 4) am/pm 742 Bay Rd., Queensbury, tt NY 12804 Inspector's Initials: r NAME: ' J 'pJr Z PERMIT NO.: 2_c-CLi-4Ct._ LOCATION: f-`'7 C_aJI"--1/1/4. L INSPECT ON: �-Z-- RECHECK: Comments and/or diagram Soil Type: Sand/ Loam/ Clay Type of Water: Municipal/ Well Water Waterline ration distance ft. Well ration distance ft. Other wells: ft. Well Casin Leng 50' +/ - Y_N N/A [150'to ell uired if NO] Absorptio Field: tal length r ft. L;ngth of ch trench ft. Depth o trench=. ft. Size f Sto - --page Pits: m.-r Si e: x _ 0 t- Stone • re: � Piping Size Type t R°268--- '��zr Bui ling to tank Tank to Dist 'button Box .t.-------- Distribution Box . Field/ Pi Openi g Seal:, —Y N End .,• _Y N Inlet/Outlet Pipes t Baffl" Y N Manholes 12"or less bel. g ..- Y N [provide extension colla if i.] Y— N Location/ Separations Foundation to tank ft. Foundation to absorption ft. Separation of Pits ft. Conforms as per P •n _N Engineer Report a . Y— N ETU Maintenan.- •• . •ct Y N provided — — Location System on Property: Front Rear Left Side Right Side Middle Front Middle Rear System Use S s: App Partial Approved and needs to be re-inspected, please call the Building &Codes Office Disapproved L:\Pam Whiting\2010\Building Codes Forms\Inspection Forms\Septic Inspection Report_03 29 10.doc 111111111111110 7 IIIIIIIIIIIIII ENVIRONMENTAL DESIGN PARTNERSHIP,LLP May 14, 2013 Town of Queensbury Community Development Department 742 Bay Road Queensbury, NY 12804 Attn:Dave Hatin, Director of Buildings & Codes Re: Faulkner Residence 28 Gunn Lane Dear Dave: In compliance with application approvals granted by the Town of Queensbury I offer the following regarding the referenced project. The design plan reviewed and approved by the Town as associated with the wastewater system application is as follows: Proposed Replacement Wastewater System for the . Estate of RosematyFaulkner 28 Gunn Lane Town of Queensbury Tax Parcel ID 227.17-1-19 • Sheet WW-1: Site Plan with Wastewater System Setemberber 14, 2012 • Sheet WW-2: Design Details&Notes September 14, 2012 During the course of construction I was on the job site to observe key components of the system installation. The location of the proposed septic tank and pump tank has been modified from the design plan. These revisions are now reflected in the attached `as-built' drawing, Sheet WW-1. All other aspects of the work were constructed as designed and using the materials as specified. Based on my inspection of the system installation it is my opinion that the wastewater system is in compliance with the intent of the approved design plan and is ready for operation. Please contact me should you require any further information. Sincerely, ESN t A►G2LzgGt Dennis MacElroy, PE Cc: Rosemary Faulkner 900 Route 146, Clifton Park, New York 12065 phone(518)371-7621 -fax(518) 371-9540 SITE LOCATION MAP SCALE: 1" = 2,000' SOIL ANAYSIS — INVESTIGATION OF ONSITE SOILS ON AUGUST 29, 2012 CONDUCTED BY DENNIS MacELROY, PE FOR THE PURPOSE OF DESIGNING A NEW WASTEWATER SYSTEM. DUE TO THE DATE OF THE INVESTIGATION, A REPRESENTATIVE OF THE TOWN ENGINEER'S OFFICE (CHAZEN — DEREK MITCHELL) WAS PRESENT TO OBSERVE THE TEST PITS. N TEST PITS: — ADJACENT T.P.#1 — TOP OF SLOPE — MID LOT 24 MIN/INCH 0-4" SANDY TOPSOIL — ADJACENT 4-40" SAND TO FINE SAND, BROWN WITH SOME COBBLES 40-72" FINE TO SILTY SAND, BROWN WITH SOME COBBLES FIRMER WITH DEPTH 7 MIN/INCH NO OBSERVATION OR EVIDENCE OF GROUND WATER T.P.#2 — ADJACENT TO NW CORNER OF SHED 0-4" SANDY TOPSOIL 4-40" SAND TO FINE SAND, BROWN WITH SOME COBBLES 40-72" FINE TO SILTY SAND, BROWN WITH SOME COBBLES FIRMER WITH DEPTH NO OBSERVATION OR EVIDENCE OF GROUND WATER T.P.#3 — BETWEEN BEDROOM COTTAGE AND SHED 0-4" SANDY TOPSOIL 4-70" SAND TO FINE SAND WITH COBBLES NO OBSERVATION OR EVIDENCE OF GROUND WATER LANDS N/F OF DOCK GUY C. JOHNSON AND PAMELA ALTMAN BOOK 1289 OF DEEDS AT PAGE 253 7 ADDRESS: 24 GUNN LANE \(J LAKE WATER SUPPLY DOCK L O O O (HARRIS BAY) I DOCK PERC TESTS: THE FOLLOWING PRESOAKING TESTS WERE CONDUTED BY DENNIS MacELROY, PE ON SEPTEMBER 7, 2012 AND OBSERVED BY CHAZE (DEREK MITCHELL) N PT#1 — ADJACENT TO TP#1 STABILIZED RATE — 24 MIN/INCH PT#2 — ADJACENT TO TP#3 STABILZED RATE — 16 MIN/INCH PT#3 — ADJACENT TO TP#2 STABILIZED RATE — 7 MIN/INCH L A O O (HARRIS BAY) © 2012 BY ENVIRONMENTAL DESIGN PARTNERSHIP, LLP, ALL RIGHTS RESERVED UNAUTHORIZED ALTERATION OR ADDITION TO THIS MAP IS A VIOLATION OF SECTION 7209 SUBDIVISION 2 OF THE NEW YORK STATE EDUCATION LAW. COPIES FROM THE ORIGINAL OF THIS SURVEY MAP NOT MARKED WITH THE LAND SURVEYOR'S EMBOSSED SEAL SHALL NOT BE CONSIDERED A VALID TRUE COPY. GOLD XG DOCK DOCK SILT FENCE (TYPICAL) REMOVE EXISTING SEEPAGE PIT AND BACKFILL DOCK DOCK DOCK EXIS77NG BUILDING REPORTED SEEPAGE PIT W Q J Z Q) 189'f AREA = 0.38E ACRES / REPORTED WASTEWATER #1 TANK W N !, LLBC07S7AGE 3p c PT #1 E-4 TP #3 0 O 0 P #2 EX151ING BUILDING TP #2 PT,f3 1: :1 SHED 146'--L LANDS N/F OF CARMEN & CORNELIA ELETTO BOOK 1416 OF DEEDS AT PAC=E 236 ADDRESS.* 30 GUNN LANE_ LAKE WATER SUPPLY EXISTING CONDITIONS J SCALE: 1" = 20' LANDS N/F OF GUY C. JOHNSON AND PAMELA ALTMAN BOOK 1289 OF DEEDS AT PACE 253 ADDRESS: 24 GUNN LANE lc�T�oN 5 PUMP OUT EXISTING PROPOSED 1000 TANK AND BACKFILL GAL. SEPTIC TANK I 189'f DOCK DOCK EX/STING BUILDING I 0 ok 3W O 4" PVC AT 27. SLOPE (MIN.) 1� SHED `I OI0 1 146f BUDDING 5XIBnNG LANDS N/F OF CARMEN & CORNELIA ELETTO BOOK 1416 OF DEEDS AT PAGE 236 ADDRESS: 30 GUNN LANE SE TE PLAN SCALE: 1" = 20' n PARKING AREA AREA = 0.38.E A CRSS EXISTING BEDROOM COTTAGE ^'1 Lo N PARKING AREA h° h PROVIDE BARRIER (BOLLARD OR 2' ROCK) TO PREVENT PARKING OVER FIELD AREA ABSORPTION FIELD TO CONSIST OF 108 LF ELJEN GSF MODULES IN A TRENCH CONFIGURATION NO WELLS WITHIN 150' OF FIELD LOCATION xC\2 C> H 0 i ca W Ha zW ars Jam? Jew °w IL U) _..U) z �UW� WW z/�J a w W W ZOJ F -NW >LLI v Qi W ZY L1. L) W HO — Aza U) UJ U�WOz II woo Q U Ati � JLLN 'I Wy00A� z � ZvQ W �QE 6 W� zitz WSJ AAf�W 00 �D �� �Fy ZW Z WW spy 0�- ►-I (� O W a x W � �o w Z xx�w Q O Z0z -4w NEo HH WO)W 0 W N c H E-4 0 Lij 1-4 wy�pyy�� Ve ~ '144 k 0 N c 0 k m wW b� a oW 0 I� 2 m� hm A 6 4 o z I w LLJ N J S U II W U) Z r U) i '- Septic Inspection Report Office No. (518) 761-8256 Date Inspection request received: Queensbury Building &Code Enforcement Arrive: am/pm partT QC am/pm 742 Bay Rd., Queensbury, NY 12804 Inspector's Initials:/f NAME: ray I K 9i e r PERMIT NO.: LOCATION: d& R G feign Lh INSPECT ON: RECHECK: Comments and/or diagram 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] Absorption Field: Total length ft. L Pv E ) yt Length of each trench ft. YZi�,� � � Depth of trenches ft. \/Y� ' `� t Size of Stone Seepage Pits: Number _ Size: _x La r4(714-7 Stone Size: �, �L Piping Size Type °{,,1i�� r4 �; "`SC')-(Z Building to tank �� 2° 17 Tank to Distribution Box G Distribution Box to Field/ Pit Opening Sealed: _Y_ N _„ O E End Cap Y_ N - "7� Inlet/Outlet Pipes&Baffles Y NC. 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 ftf Conforms as per Plot Plan _Y �v Engineer Report and As-Built _Y +,/N ETU Maintenance Contract Y N provided — — Location of System on Property: Front Rear Left Side Right Side Middle Front Middle Rear System Use Statuy. Approved ' Partial Approved and needs to be re-inspected, please call the Building &Codes Office Disapproved L:\Pam Whiting\2010\Building Codes Forms\Inspectlon Forms\Septic Inspection Report_03 2910.doc • Septic Inspection Report Office No. (518) 761-8256 Date Inspection request received: Queensbury Building &Code Enforcement Arrive: am/pm rt: 'am/pm 742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: J �� �TTTq NAME: f`����:AJfa PERMITNO.: 21c�lZ-�1CZ LOCATION: 2 Ccc31CT/� j,-4--- INSPECT ON: 1 S`t'd RECHECK: Comments and/or diagram Soil Type: Sand/ Loam/Clay Type of Water: Municipal/Well Water `r•,,-r"' Waterline se-:ration distance ft Well ration distance ft. . Other wells: _ ft. / — �- Well Casi • Len • 50' / - _Y N N/A l [150' •• well =•uired If 0] II v. . Absorp•• Field. Total le'gth ft. 7 Length o each tach ft... ' De•• of tre es fk: e of • oneQ page : N ber •' P . Size: i x 5•• Size: / / Pipi o _/Size Type :wilding to to i W 1-•(. C- Tank to I istribution c,• - l Distribution x to Field/ 'it �_ 0. -ning Seal-•: Y_ N I End -p _ Y _N Inle12''oretsi• & • - = __- Y—N fr )L � Manholes 12'or less below • ade Y—N �\ � — C = [provide extension\collar i Yes] —N ! Location/Sepanaons i Foundation •• tank ft. Foundation to .rption __ _ _ ft Sepa • r• of Pits ft Conforms as pe Plan _Y N Engineer Report a • As-Built _Y N ETU Maintenance Contract Y N provided — — Location of System on Property: Front Rear Left Side Right Side Middle Front Middle Rear System Use Status: a. .• App • -• .nd needs to be re-Inspected, please call the Building &Codes Office L•1Pam Whiting\2010\Building Codes Forms\Inspection Forms\Septic Inspection Report03 2910.doc COMMONWEALTH ELECTRICAL INSPECTION SERVICE,INC. Main Office 176 Doe Run Road-Manheim,PA 17545 MUNICIPAL CERTIFICATE - ELECTRICAL APPROVAL Permit No........................................Cert. NO 19101 Cut-in Card No.................................... Owner................................ < ............4�... .......... k ....... ....... .................................................e /V Location.... Installation Consisting of ......... ..................................................I................................................... ..................... ................................. .............................................................................................................­.......... ...................­........... InstalledBy.,.......�ff�.... .........................................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 bt privilege of mak' g L-arorriptly made for inspection. , Inspectors of this Company shall have the ins ��tions at any time, and if its h* ce ev e , rules are violated,the Company shall have the right to (th' _�t' ate, .......... Date...., .................... INSPECTOR.. ........ ... ........ Member N.F.P.A.,I.A.E.I. l 5 `D Septic Inspecction Report Office No. (518)761-8256 Date Inspection request received: Queensbury Building&Code Enforcement Arrive: am/pm part: /;5t) am/pm 742 Bay Rd., Queensbury, NY 12804 Inspectors Initials: NAME: ( PERMIT NO.: 2.0 1' A Q.. LOCATION: '2.4' INSPECT ON: Qa '— RECHECK: Comments and/or diagram Soil Scud Loam Water 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] . n ,o Absorption Reid: Total length ft. ����v ��� Length of each trench _ ft. M✓�^ct t S -— Depth of trenches Size of StoneBGQC' `2 - 1- 5 Seepage Pits: Number �1 ��� ` Size: x C Stone Size: Piping C�",`�`_' nk Size Type �����' Building to tank Tank to Distribution Box Distribution Box to Field/ Pit Opening Sealed: Y_N End Cap . Y T N Inlet/Outlet Pipes&Baffles Y N ` irFaAi L/ � �1/4 �/l Manholes 12"or less below grade _Y_ N �- l [provide extension collar if Yes] Y_ N Location/Separations �� 1� j $ t Foundation to on ft. — 3-V z ' C1 t Foundation to absorption ft. Separation of Pits Conforms as per Plot Plan _Y `lv{�`,vN7 t — Engineer Report and As-Built _Y " / ETU Maintenance Contract Y N provided Location of System on Property: Front Rear Left Side Right Side Middle Front Middle Rear -mU - as: Approved Partial Approved and needs to be re-inspected, please call the Building&Codes Office Disapproved L•\Pam Whiting\2010\Building Codes Forms\InspeUlon Fon s\Septic Inspection Repor�03 2910.doc ur's Septic Inspection Report Office No. (518) 761-8256 Date Inspection request received: Queensbury Building&Code Enforcement Anive: am/pm Depart:/t_ am/pm 742 Bay Rd., Queensbury, NY 12804 Inspector's Initials:/i��� r�� (( ���/ NAME: PG 11 Kc, er PERMrr NO.: ID- II Q2 LOCATION: ('r run n Lorna INSPECT ON: / RECHECK: Comments and/or diagram 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 . /1 -, u �- [150'to well required if NO] �/!� `J"t� n ��y� Absorption Field: Total length ft. v` ° ` -S Length of each trench ft. (y7 s Depth of trenches ftp Y fig t'►�' Size of Stone Seepage Pits: Number Size: ^ � �, Stone Size: Scc 0 L.- 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 abso • '.n ft. Separation Pits /ft. Conforms as per Plott Pian _Y Engineer Report and As-Built Y ETU Maintenance Contract Y N provided — — Location of S on-Property: Front Rear Left Side Right Side Middle Front Middle Rear stem U - 1 Approved Partial Approved and needs to be re-inspected, please call the Building &Codes Office Disapproved L:\Pam Whiting\2010\Building Codes Forms\Inspection Fom s\Septic inspection Report_03 2910.doc Septic Inspection Report Office No. (518)761-8256 Date Inspection request received: Queensbury Building&Code Enforcement Arrive: am/pm Depart: jti•`tsr am/pm 742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: 749 NAME: /��- PERIT NO.: Z0(L--A ��- LOCATION: 'L?5 Co- 1s t„u} INSPECT ON: 0 RECHECK: • m-n. .n. • .'.•i.:11 Soil Loam/Cay Type of Water: Municipal/Well Water c^ % / 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] 1.frXç) rboAbsorptiLe Figeld: Teatalch lentrench ft. Length of each trench ft. �-';-���-°'�re� Depth of of trencheson / <�� /` "'" ' 9 Size of Stone ` v Seepage Pits: Number Size: - X x � Stone Size: 5 CGv(�C„---c7liZA ) Piping Size Type Building to tank Tank to Distribution Box Distribution Box to Feld/ Pit �! Opening Sealed: —Y—N ?RD V-fr �i�/ vt End Cap „Y— N Inlet/Outlet Pipes&Baffles Y N Manholes 12"or less below grade —Y—N [provide extension collar if Yesj Y .N Location/ Separations Foundation to tank ft. Foundation to absorption ft. Separation of Pits ft. Conforms as per Plot Plan ‘40 N Engineer Report and As-Built _ _N E11J Maintenance Contract Y N provided — — Location of System on Property: Front Rear Left Side Right Side Middle Front Middle Rear - S A••. ••.. • �pproved and needs to be re-inspected, please call the Building&Codes Office ' sapproved L:\Pam Whiting\2010\Building Codes Forms\nspection Foma\Septic Inspection Report03 29 lot Septic Inspection Report Office No. (518) 761-8256 Date Inspection request received: Queensbury Building&Code Enforcement Arrive: am/pm Depart: 2•4,,Dam/pm 742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: /fit NAME: PERMIIT NO.: 0 2_- l 2- LOCATION: LOCATION: £.L9c.0.3" LA- INSPECT ON: 'Z, RECHECK: Comments and/or diagram 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] f' k-f-1 Absorption Field: Total length ft. Length of each trench _ft. Sa5 Depth of trenches ft. Size of Stone Seepage Pits: Number ^ Ca x ] Z p Stone Size: l� � � ) Piping Size Type [ 000 Building to tank ( , .-4 <.--- ` Tank to Distribution Box _ • Distribution Box to Field/ Pit Opening Sealed: _YN End Cap __Y__N Inlet/Outlet Pipes&Baffles Y N A, , ` ,`-1-al r^'� Manholes 12"or less below grade _Y_N — l '�✓d'� [provide extension collar if Yes] Y N �/1)1\A- Location/Separations � /52) 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 Y N provided Location of System on Property: Front Left Side Right Side Middle Front Middle Rear stem Use S . �� Approved Partial Approved and needs to be re-Inspected, please call the Building &Codes Office Disapproved L:\Pam Whiting\2010\Building Codes ForrnsWspection Fams\Septc Inspection Repoit_03 2910.doc