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2013-549 ,,A TOWN OF QUEENSBURY OO742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development - Building & Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE Permit Number: P20130549 Date Issued: Monday, December 09, 2013 This is to certify that work requested to be done as shown by Permit Number P20130549 has been completed. Tax Map Number: 523400-278-019-0001-012-000-0000 Location: 14 MARTINDALE Rd Owner: NATHAN & YVONNE FULLER Applicant: NATHAN & YVONNE FULLER 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 r /// /0 :t 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&Code Enforcement Planning Board or Zoning Board of Appeals. TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development- Building&Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20130549 Application Number: A20130549 Tax Map No: 523400-278-019-0001-012-000-0000 Permission is hereby granted to: NATHAN & YVONNE FULLER For property located at: 14 MARTINDALE 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. Type of Construction Value Owner Address: NATHAN & YVONNE FULLER Septic Alteration Residential 14 MARTINDALE Rd Total Value LAKE GEORGE, NY 12845-0000 Contractor or Builder's Name /Address Electrical Inspection Agency IBS SEPTIC & DRAIN ATTN: IVAN BELL 2 LOWER WARREN St OUEENSBURY.NY 12804 Plans&Specifications 2013-549 Res. Septic Alteration $40.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Tuesday,December 02, 2014 (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; Monday,December 02,2013 SIGNED BY for the Town of Queensbury. Director of Building&Code Enforcement umce use univ Town of Queensbury Building & Codes Received: ca SEPTIC DISPOSAL PERMIT Tax Map ID: a 1 $,/ 7 -/-/a Permit No.: / 3�'y A permit must be obtained before beginning construction-, 04201 Permit Fee: $ d Approvals: 1 �. r U1 Applicant: Va.- iG /J c� Installer/Builder Address: / , Address Phone: Phone )PI—a 97 Owner: 0 &r C/C l Location of Installation Address: _/ V . i . _I a 1 Phone a��s Contact Person for Building&Code Compliance: Day Phone: Residence Information: Year Built # f drooms x Gallons per bedroom =ToI Daily Flow XI/ 1980 or older x 150 = t Garbage Grinder installed? /v 1981-1991 x 130 = Spa or Hot Tub Installed? 1992-Present x 110 = Parcel Information: Topography lat Rolling _Steep Slope %Slope Soil Nature Sand Loam 4 Clay _Other Groundwater At what depth? A Bedrock/Impervious Material At what depth? .e II Domestic Water Supply Munidpajl )Well(if well,water supply from any septic system absorption isA9n ft.) Percolation Test Rate- . .- per minute per inch(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 Bo>ar.l pprroved subdivision). Tank size l/1 f00 gallo�tnCCr(frf mum, ize 1,000 gallons),add 250 gallons to size of septic tank for each garbage grinder,spa or whirlpool tub System Type: Absorption Field(with#2 stone) Total length 7a0 ft. Each ench X o2 Seepage Pit(S)(with#3 stone) How many? /vim / �Size? //ir Alternative System Bed or other type? �V Holding Tank System Total required capacity? A49 Tank size? #of tanks? NOTE: 1)Alarm system and associated electrical work must be inspected by a Town approved electrical inspection agency-see Certified Electrical form on Town website; 2) Effective as of March 23, 2006 Septic System-As Built Plot Plan: The Building Department will no longer allow systems to be covered until such time as an As-Built Plot Plan is received and approved by the Building Inspector. The installed system must match the septic system layout on file. There will be no exceptions. 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 Sanitary Sewage Disposal Ordinance.( , �J Print Name: —+"'Gtr- /7/ /lC Date: i 0/3 Signature: / 4- Dater J a 0/i Town of Queensbury Building&Codes Septic Disposal Permit 518-761.8256 Town of Queensbury Building & Code Enforcement W t" tr xiQa nccv) Office No. (518) 761-8256 Septic Inspection Report Inspection request received: Name: fu. [!p r Inspected on: I.- �- -- 3 Location: / [I1 /1"f ,dOff2, R Arrive: /A#� ,.m. Permit No.: /,3—S/9 Inspector's Initials: ifo2�F to• ments andlor dia.ram Soil Type: Sand erigall Type of Watercicfunici,a •S - • .ter Waterline separation distance ft. Well separation distance 'Del ft Other wells: tJA ft. Well Casing Length 50'+/- Y N N/A [150'to well required if NO] Absorption Field: Total lengthy ft. Length of each trench SP.-(QCT ft. Depth of trenches z..— 3 ft. Size of Stone Seepage Pits Number Size: x Stone Size: Piping Size Type Building to tank F ti,f,3ta n 4l" PSL Tank to Distribution Box t,\tt SDR 357 Distribution Box to Field/Pit / 4% o tL 'co y"5DQ35 Peace, Opening Sealed: ✓Y/ N End Cap Vtze±N Inlet/Outlet Pipes&Baffles N Manholes 12"or less below grade N/ [provide extension collar if Yes] _Y Location/Separations Foundation to tank 7_3 ft. Foundation to absorption HO ft. Separation of Pits � ft. Conforms as per Plot Pla ✓Y�N Engineer Report.__ YY N ETU Maintenance ontract provided Y N Location of System on Property: Front Rear Left Side Right Side Middle Fro Middle Rear System Use Sts: Approved Partial Approved and needs to be re-inspected, please call the Building&Codes Office Disapproved Septic Inspection Report MArirrix/ ► . Lc Za J'c0Ir /nc. / Ft`re ,Lid II urs 47E 2A Zs 6nTtr fan /ODD F_ xi`SriA5 -TA Vie w'g// l'r0 c1 recti 7:9 ,v1.1 setr'c /O 9 %r' -7--Zo,v ci/ %e /J .23 tr. /4,/ye Le PT 'c i9,v/e1 I/O Fr /7/e E ?u ,fie/94/- F/E/1 // / 2i. � I I I I I I L I I I I I 1 nunMEI ■uunE■u■u■nuuu II • ,). Q 1 111 VI -41 QCI\ h.N UU■ C : '‘..Sr, $ I - t) i-- 14 i .- P / , ci - 1 1 , I Si'S - . gin r 3p ;Ca i 1 I\ SEPTIC PLOT FLAN _L ' r NAVE SEEN jOR 1OB^.>CRVCD LL OBJECTS •• 'Q �� SJCH AS NOUS S,WELLS, TREES, FENtES,[ETC ©©I I ' S-IOWN 'NTHIS DOCUNEhrT.IIi'V PERbO ALLY 0th, —T j� _..^2ZDORIA .,`dA. .ED �I Ak6// ��I ' CI Z ,DEC U 4e\e,2013 Sag I 1 I I I I -.[ I a JI' e 1 1 1 1