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2012-589 TOWN OF QUEENSBURY 742 Bay Road, uccnsbu NY 12804-5902 (518) 761-8201 3 Q rY> Community Development - Building & Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE Permit Number: P20120589 Date Issued: Wednesday, April 03, 2013 This is to certify that work requested to be done as shown by Permit Number P20120589 has been completed. Tax Map Number: 523400-308-017-0001-044-000-0000 Location: 16 TINA Ln Owner: JANET DE CHICK Applicant: GARY CONSTANT 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 property owner of the responsibility for compliance with Site Plan, c �„r°,,, ,� 11,/,./Ct 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 7 C Bay tioacl,Quccnsburv,NY 12804-5902 (518) 761-8201 Community Development- Building& Codes (518) 761.-8256 BUILDING PERMIT Permit Number: 1120120589 Application Number: A201.20589 Tax cNlap No: 23400-3 $-X117-0001-x)44-000-0000 permission is hereby granted to: GARY CONSTANT For properry located at: 16 TINA Ln in thc Town of Queenshnry,lo,construct or place at they above location in accordance with application together with plot plains and other infaartnatton 11c.retofiled and :approv cd and in compliance with the NYS Unifa:)rua l3u.ilcliog Codes and the Quecnshurr Zoning Ordinance. "Type of Constrttctiolt 'Value Owner Address: .1ANEI" DE CHICK Selatic Alteration Residential 16 TINA Lii Total Vslate QUEENSBURY, NY 12804-0000 Contractor or Builder's:`*.;ame /" .\ddre:ss l JeCtricstl lat:»laect otta.-\gera(7,}' Pl,artis&Specifications 2012-589 Res. Septics Altel-atioii $40.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Friday, December 27, 2013 (If as longer period is required,an anlrol)tication for an extension must be made to the code Enforcennent Officer of the Town of Queensbury before the expiration mate.) Dated at the Town of Queensbury; Thursday, December 27, 2012 SIGNED BY for the Town of Queciislatary. Director of Building& Code l:nforcenaent Community Development Office __ Town of Queensbury - 742 Bay Road • Queensbury, New York •12804 DEC 2012 Office Use Only t� �f TAX MAP NO. ...3O S .I / —1` 4-1 PERMIT NO. 0---5 VPERMIT FEE J D APPROVALS: ZONING TOWN CLERK APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT: A PERMIT MUST BE OBTAINED BEFORE WORKBEGINS. APPLICATION IS SUBJECT TO REVIEW 1BEFORECISSUANCE OF A VALID PERMIT. OWNER: (Doi( 1 (�O/1 S'ACA c\� INSTALLER: .L1 S S p tI <,,- ADDRESS: !LIT I r CA�'^ ' ADDRESS: �q Lo W Pr�('V V�/'f(fir, 3)- . PHONE NOS. �L L !1 PHONE NOS. !gA 1, �" LOCATION OF INSTALLATION: RESIDENCE INFORMATION: YEAR BUILT NO.OF X COMPUTATION = TOTAL DAILY FLOW BEDROOMS (Gallons per bedroom) GARBAGE GRINDER 1980 or older I f p X 150 = N N INSTALLED? 1981 -1991 'v3 X 130 = ) SPA OR HOT TUB \ 1992-present X 110 0 INSTALLED? V PARCEL INFORMATION: ✓ TOPOGRAPHY: FLAT ROL ING J STEEP SLOPE�,j v k %SLOPEe- ✓ SOIL NATURE: SAND LOAM Iv ' 1 CLAY OTHER N A ✓ GROUNDWATER: AT WHAT DEPTH? \\II ✓ BEDROCK/IMPERVIOUS MATERIAL: AT WH T DEPTH? 'V ✓ DOMESTIC WATER SUPLY: MUNICIPAL WELL\\I ' 1(If well:water supply from any septic system absorption is:N ft) ✓ PERCOLATION TEST: RATE IS \\I PER MIINUTE PER INCH[mpi] (Test to be completed by a licensed professional engineer or architect) 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: \@n(\ 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 T PE: ABSORPTION FIELD(WITH NO. 2 STONE) Total length ft. Each trench Lf X S D ❑ SEEPAGE PIT(S)(WITH NO. 3 STONE) How many? N Size? W 1- 0 ❑ALTERNATIVE SYSTEM Bed or other type? N. ❑ HOLDING TANK SYSTEM Total required capacity? Tank size? V sh Number of tanks?N 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 requir nts of the Town of Queensbury QUESTIONS? CALL 761-8256 OR EMAIL Sa ita �•e Di posal r ance. �L_I 1 codes(@aueensburv.net 1/ VISIT OUR WEBSITE FOR MORE INFORMATION Signature of P.r , e don fit Date wvrw.queensbury.net ,. , - it, -UCH) q Septic Inspection Report Office No. (518) 761-8256 Date Inspection request received: Queensbury Building &Code Enforcement Arrive: am/pm Depart: '.-, am/pm 742 Bay Rd., Queensbury, NY 12804 Inspector's Initials• i - )p . NAME: dl e, Or iC.k PERMIT NO. 1 • ,- S 8 LOCATION: /CQ -r /1 dt, kv1 INSPECT ON: - ,3-/3 RECHECK: Comments and/or diagram Soil Type: Loam/ Clay Type of Water: Mu cipal/ Well Water Waterline separation distance ft. Well separation distance i- . Other wells: i - ft. Well Casing Length 50' + / - Y N N/A [150'to well required if NO] Absorption Field: Total length 'LL ft. Length of each trench _r".)ft. Depth of trenches "2 -k- ft. Size of Stone - "Z Seepage Pits: Number Size: P3L---gY-- Stone Size: ' Piping fize Type Building to tank '^c... -V.y..V `ri Tank to Distribution Box Artv ,54A--7.1)` Distribution Box to Field/ Pit lk' -9j,„'.Ofe--2,t---- Opening Sealed: _N End Cap ✓Y_ N Inlet/Outlet Pipes&Baffles TY . N ---%___6L� ,v-"(,-- 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 Conforms as per PI Iaan T_) N Engineer Report an As-Buil '✓Y— N ETU Maintenance act _Y_ N provided Location of System on Property: Front L.Rea Left Side Right Side Middle Front Middle Rear S stem Use Stat . Approved 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 Report03 29 10.doc ,1.$. 5 s em\-`t e -7\V,c, cine 0\Deo Jr..I V)s.,fit\-001 is\ria e • 'IN,z \000 (x&ov).-\° . . Vo -V‘nG \cn v,t ,n ev•J Zoo \eo,(ti i..\\ (c),, \-0,..\:;, e(--• t..G c „.4\ I ,iiio" 0 tc. 1000 UGC a c,....1/45._ — t\n\ �Stere ., 7a Oeach,N,Ne,FQ .e` et.r, 4,\crnt \eaAr, ' \ r, i it... 1 b" 4 V 5a;'` S T Septic Inspection Re• • Office No. (518) 761-8256 Date Ins.- ion ue7 - : ••: Queensbury Building &Code Enforcement Arrive: a • a4prpart: am/pm 742 Bay Rd., Queensbury, NY 12804 Inspector's Initi:Is:� � NAME: dG' (�'l(C�� P:y7'IT 1 •.: / .— 5 �J LOCATION: / �1 ��/1 dad L4l1 '`=PELT ON: "77 - z-7 -� 5 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 ` y l [150'to well required if NO] — .L_ 4 `\ Absorption Field: Total length _ .ft. y � `G l ���>� O V27 g Length of each trench ft. Depth of trenches ft. C-p 1--1'V 1 7v\ \ 5 Size of Stone ��� � t Seepage Pits: Number � \©� EQ�iJ�� Size: x of ,ht o' Stone Size: c ? \ \�� Piping Size Type 2 p Building to tank � \ ��1��-�� D'� 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 _Y_ N provided Location of System on Property: Front Re.r Left Side Right Side Middle Front Middle Rear S stem Use Sta .s: Approved 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 Pipeline Specialists JOB: 6 PId- 5 0 1E3 SHEET NO.:P4 OF CALCULATED Am. BY: DATE: Everett J.Prescott, Inc. SCALE: SEPTIC PLOT PLAN DEC 2 € 2012 I HAVE SEEN OR OBSERVED ALL OBJECTS SUCH AS HOUSES, WELLS, TREES, FENCES, ETC SHOWN ON THIS DOCUMENT.I HAVE PERSONALLY ME.SU' ! H/�,/+,�i I ANCE SET FORTH ON TH S DIAGRA . SIG ATU•%' ' DATE TOWN OF QUEENSBURY BUILDING & COD". �. 'T. Reviewed n y: M k vI f\1 A ' I 0 _ Date: ' Z— Z - r i i '-. ' ---N mkt r< s s f + - - ..._._ � . r ZOPA' 5 (-4'.0 0 ,a o c. — VI 11 s TOWN OF QUEENSBURY BUILDING DEPARTMENT Based on our limited expmination,compliance with our comments shai' not be construed as indicating the plans ana specifications are in full compliance with the Building Codes of New York State. r ierviinc. The North._ �� En.. _ Midwest www.ejprescott.cor