2014-619 .,fir TOWN OF QUEENSBURY
ra742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20140619 Date Issued: Friday, December 05, 2014
This is to certify that work requested to be done as shown by Permit Number P20140619
has been completed.
Tax Map Number: 523400-308-005-0001-045-000-0000
Location: 49 LAUREL Ln
Owner: ANTHONY& ROBERTA BRUNETTA
Applicant: ANTHONY& ROBERTA BRUNETTA
This structure may be occupied as a:
Septic Alteration Residential
• By Order of Town Board
TOWN OF QUEENSBURY
GSt /Fr`
Issuance of this Certificate of Compliance DOES NOT relieve the y
l
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
W� 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20140619 Application Number: A20140619
Tax Map No: 523400-308-005-0001-045-000-0000
Permission is hereby granted to: ANTHONY& ROBERTA BRUNETTA
For property located at: 49 LAUREL 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: ANTHONY& ROBERTA BRUNETT
49 LAUREL Ln Septic Alteration Residential
QUEENSBURY,NY 12804 Total Value
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans&Specifications
2014-619
Res. Septic Alteration
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Thursday,December 03,2015
(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(917sbualW:, ,e) a 1 ecember 03,2014
SIGNED BY + V - 1 for the Town of Queensbury.
Director of Building&Code Enforcement
Office Use Only
Town of Queensbury Building & Codes Rearrivaa
SEPTIC DISPOSAL PERMIT Tax ID
A petal must be obtained before beginning c rlein i) / -
Pj1 , 1. ;. 2 ; ,Aim* $ tI 1 !/
1- .014 fAPprovMs: r.
•..uRY
�A' UN.t7 - his�dBunder 1),g-it's --k lCu.e2
MPI ,,/A
Address: 9' v Arine 44"c Address y4_ 4,0 7 ax
Hees-J174.y G/&t- / a- ✓Y ZZPa/
Phone: Phone 7 7,2— 7 2r
OwnerLocation of Installation Y9 Znet-ems( /i0-"e
Address:
Phone 791 - O V 9JT
Contact Person for Building&Code Compliance: 60"e 'Jt Day Phone: A'S-flCa
n (/
Residence Informatio
Year Built #of Bedrooms x Gallons oar bedroom =Total Dab Flow
1980 molder x 150 = Garbage Grinder installed? A-0
1981-1991 77 x 130 = 39t Spa wHot Tub installed? N°
1992-Present x 110 =
Parcel Information:
Topography /k Hal Robe _St�)Slope _%Slope
Soo Nature .4 Sand _Loam _Clay Other
Groundwater Atwhatdepih? /1-4
Bedrodsilmperviorm Material At what depth? N Si
Domestic Water Supply SMunkapel _well(if well,water supply from any septic system absorption is tt)
Percolation Test Rate-/3 per minute per inch(Test to be completed by a licensed professional engineer or architect)
Proposed System Mr New Construction: All individual sewage disposal systems must be designed by a licensed professional engineer or architect
(unless installed era Planning Board approved subdivision).
Tank size -gallon(minimum size 1,000 gallons),add 250 gallons to size of septic tank for each garbage grinder,spa or whirlpool tub
System Type: Absorption Field(wih#2 stone) Total length dap ft. Each trench yo` x -s—
Seepage
Seepage Pti(S)(with#3 stone) How many? it/o Sae?
Alternative System Bed or other type? ,`tee
Hotting Tank System Total required capacity? r° Tank size? #of tanks?_
NOTE: 1)Alarm system and associated electrical work must be inspected by a Town approved eiectricl inspection agency-see Certified Etaddrai form
on Town saheb;2)Effective as of Meda 23,2006 Septic System-As Built PIM Ram The Building Department will no longer allow systems to be
covered until such time as an As-Built Piot Plan is received and approved by the Building inspector. The installed system must match the septic system
layout on Be. There sill bre no exceptions.
For your protection,please note that pursuant to Section 138-29 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 an behalf of an
applicant,shall be void.
11 have rad the regulafions with respect to this application and agree to abide by these and all requirements of the Town of Queensbury Sanitary
Sewage Disposal Ordinance.
a--1
//
Print e: �1 D'V""'� Date /a -z-.y
Signature: t/ - Date: /a L- /k
Town of QueenzMay Budding&Codes Se*Disposal Pennk 518-7814256
ri
Town of Queensbury Building &Code Enforcement Trf
Office No. (518) 761-8256 C�� '. 3 p ?)
Septic Inspection Report
Inspection request received: L
Name: 13 J'u A€'C7 o.- Inspected on: 2k -S
Location: 1. 9 Zruslvei L, n Arrive: It ,,m,
Permit No.: / '—ta/ 9 Inspector's Initials:
L .o ments andlor diagram
Soil Typ<Sand/Lo /Clay
Type of Wate(Municipal/Nell Water F Ar2
Waterline separation distance ft.
Well separation distance ft.
Other wells: \7C7 ft.
Well Casing Length 50'+/- Y N N/A
[150'to well required if NO]
Absorption Field: Total length 7-4-30 ft.
Length of each Trench!
Depth of trenches 2.— ft.
Size of Stone
Seepage Pits. Number
Size: x
Stone Size:
Piping Size Type
Building to tank U1/4" Q<\ t�L,_,`\
Tank to Distribution Box iN c\ 1-�e, ?'.5 ..-D1
Distribution Box to Field/Pit 4" ,O� _ 4 L1 SSM—Te� —
Opening Sealed: �L N
End Cap Y N
Inlet/Outlet Pipes&Baffles ✓YN
Manholes 12"or less below grade 1./(71;
[provide extension collar if Yes] _Y
Location/Separations
Foundation to tank Ely_1.%1 L ft. c'.c `q
Foundation to absorption
Separation of Pits ft
Conforms as per Plot Plan _N
Engineer Report and As-Built Y N
ETU Maintenance Contract provided Y N
Location of System on Property:
Front R 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
Septic Inspection Report
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� DEC 02 2014 ,
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SEPTIC PLOT PLAN
I HAVE SEEN OR OBSERVED ALL OBJECTS
,�I\\`\ SUCH AS HOUSES, WELLS, TREES, FENCES, ETC p
`N.. 1 SHOWN + HIS DOCUMENT.I HAVE PERSONALLY t
M . E SET ON THIS DIAGRAM. 4
SIGN PURE DATE
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