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SEP-0720-2018 TOWN OF QUEENSBURY 742 Bay Road, Queensbury, NY 12804-5904 (518) 761-8201 Community Development - Building & Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE Permit Number: SEP-0720-2018Date Issued: Thursday, January 3, 2019 This is to certify that work requested to be done as shown by Permit Number SEP-0720-2018 has been completed. 289.13-1-30 Tax Map Number: 51 BIRCH RD Location: Ken Searles, Leigh Searles Owner: Hutchins Engineering Applicant: This structure may be occupied as a: Residential Septic Alteration 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, 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 12804-5904 (518)761-8201 Community Development - Building& Codes (518) 761-8256 BUILDING PERMIT Permit Number: SEP-0720-2018 Tax Map No: 289.13-1-30 Permission is hereby granted to: Ken Searles For property located at: 51 BIRCH 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 Owner Name: Ken Searles Septic Disposal-Residential $0.00 Owner Address: 30 Lyman RD Total Value $0.00 East Patchogue,NY 11772 Contractor or Builder's Name/Address Electrical Inspection Agency Ellsworth&Son Excavating 76 ELLSWORTH LN Lake George,NY 12845 Plans&Specifications Residential Septic Alteration $ 75.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Wednesday,November 27,2019 (If a longer period is required,an application for an extension must be made to the code Enforcement Officer of the Town of Queens before th xpir tion •. -.)� Dated at the Town o Quee ue.• , ,1,'ovember 27,2018 I \ SIGNED BY: for the Town of Queensbury. Director of Building&Code Enforcement SEPTIC DISPOSAL PERMIT APPLICATION ' +-� . nn| �� ° /7�� %}-- ��/w/ | ~~~`�~~~ � s��6��s �� W� a ~^e V/� �\ - ~ ' ~ ' « | Tax Map/D#: 289.13-1'29 W� � � r it �$ � �, (J[); Invoice#: ," y uo ? Project Location: 61@�cb Road'Q�.�� '^ ^var� e. _ Yes No Primary Owner(s) Ken»k Leigh Searles BUD DING&CODES ' Mailing Address 3V Lyman Road,East Pa ^°. . ~^ 1773 � Phone & Email beu.ynor&o@mycadesgcapbisy.cmmu � Installer/Builder Ellsworth&Son Excavating,Inc. Mailing Address 10302 State Rt. l49.Fort Ann,NYz2827 Phone 0' Email (518)792'9246'diggiog0eDm°ortb=xcuvotiogcono ' - -'--- Engineer Hutchins Engineering Mailing Address 109 Havibod Road,Qoeenohuqxwr128N4 Phone 0' Email (518)745'0307'LWDobietDbutcbiuoonginecriog.cwnu / Contact Person for Building&k Code Compliance: Ruben Ellsworth Phone' (518)361'1993 _ RESIDENCE INFORMATION: - Year Built ' GaUnns #ofbedrooms - X gallons pe total daily Uow perday bedroom | � Garbage Grinderno 19DDoro|de, 1 150 installed? (circle one) . -- -- ------- `1981'1991 230 6peor Hot Tub ' Yes '--~ installed? (drdcnne) 1992'Pnesent 110 110 4);V PARCEL INFORMATION: Topography Flat Rolling Steep Slope 96Slope Soil Nature ~y Sand Loam Clay Other Groundwater At what depth? >4'ft Bedrock/Impervious material At what depth? 4'ft Owme�ticVVater�upp)m�-�� Municipal ^�VVeU (if m/eU' water suppk/�om any septic system abso,pbmn)s��QftJ _ �� , E� _ Percolation Test �� r minute per inch (test tmbecompleted by licensed engineer/a,chae#) PROPOSED SY� KN SYSTEM NEWVc6NSTN �� Ux��ILL - Tank size X00 gallons(min. size1'0�>Qamns. add �50gaUonu for each garbage cyUndaror spa/hot tub _ ' _ System Absorption field with#2stone Total length ft.; Each Trench ft� Seepage Pit with#3stone How many: Size: Alternative System Bed or other type: 86'x5'Preoby Bed Holding Tank System Total required capacby? � �ankxize �#nftanxu _ NOTES: 1. Alarm system&associated electrical work must be inspected byaTown approved electrical inspection agency; 2.We will no longer allow systems to be covered until such time as an as-built plan is received and approved. The installed system must match the septic layout nn 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: Ken Searles DATE: 11/8/2018 � ~�~~^~- SIGNATURE:__ Town v/o"oen^uury Building m Code Enforcement Revised March mm INSPECTION WORKSHEET (SEP-000033-2019) Town of Queensbury - Building and Codes - Fire Marshal 742 Bay Road - (518) 761-8256 Building (518) 761-8206 Fire Marshal SEP-0720-2018Permit Case Number:Case Module: Wed Jan 2, 2019Passed Inspection Date:Inspection Status: John O'BrienSeptic Inspector:Inspection Type: 51 BIRCH RD289.13-1-30 Job Address:Parcel Number: Lake George, NY 12845 Contact TypeCompany NameName EngineerHutchins Engineering Primary OwnerSearles, Ken ApplicantHutchins Engineering Primary OwnerSearles, Leigh ContractorEllsworth & Son Excavating Granted PermissionSearles, Ken Checklist ItemPassedComments Building Inspector NotesYES12/13/18 Septic System Partial Approval Remaining Items: - Submit Engineer's Final Report & As-Built - Install rock barrier and establish vegetation. 1/2/19 Septic System Approved - Ok to Issue CC! - Received Engineer's Final Report & As-Built - Installed Rock Barrier and seeded. Type of Water: Municipal / Well WaterYESWell Well separation distanceYES100' to all Wells Absorbtion Fields: Total LengthYES270' Presby AES Laterals Jan 02, 2019Page (1) INSPECTION WORKSHEET (SEP-000033-2019) Checklist ItemPassedComments Length of Each TrenchYES9@30' Depth of TrenchesYES18" - 24" Size of StoneYESSand as per Presby specifications Building to TankYESExisting Tank to Distribution BoxYESExisting Pumpstation 2" forcemain to new 2" forcemain increased to 10' of 4" pvc entering the d-box. Distribution box to Field / PitYES4" pvc to Presby AES Pipe Laterals InletOutlet Pipes & BafflesYESExisting Foundation to TankYESExisting Foundation to AbsorptionYES- Submit Engineer's Final Report & As-Built Engineer Report and As-BuiltYES12/13/18 Septic System Partial Approval Remaining Items: - Submit Engineer's Final Report & As-Built - Install rock barrier and establish vegetation. System Use StatusYES12/13/18 Septic System Partial Approval Remaining Items: - Submit Engineer's Final Report & As-Built - Install rock barrier and establish vegetation. 1/2/19 Septic System Approved - Ok to Issue CC! - Received Engineer's Final Report & As-Built - Installed Rock Barrier and seeded. O'Brien, John (Inspector) Jan 02, 2019Page (2) INSPECTION WORKSHEET (SEP-008722-2018) Town of Queensbury - Building and Codes - Fire Marshal 742 Bay Road - (518) 761-8256 Building (518) 761-8206 Fire Marshal SEP-0720-2018Permit Case Number:Case Module: Thu Dec 13, 2018Partial Pass Inspection Date:Inspection Status: John O'BrienSeptic Inspector:Inspection Type: 51 BIRCH RD289.13-1-30 Job Address:Parcel Number: Lake George, NY 12845 Contact TypeCompany NameName Primary OwnerSearles, Leigh ContractorEllsworth & Son Excavating ApplicantHutchins Engineering Granted PermissionSearles, Ken EngineerHutchins Engineering Primary OwnerSearles, Ken Checklist ItemPassedComments Building Inspector NotesNO12/13/18 Septic System Partial Approval Remaining Items: - Submit Engineer's Final Report & As-Built - Install rock barrier and establish vegetation. Type of Water: Municipal / Well WaterYESWell Well separation distanceYES100' to all Wells Absorbtion Fields: Total LengthYES270' Presby AES Laterals Length of Each TrenchYES9@30' Dec 13, 2018Page (1) INSPECTION WORKSHEET (SEP-008722-2018) Checklist ItemPassedComments Depth of TrenchesYES18" - 24" Size of StoneYESSand as per Presby specifications Building to TankYESExisting Tank to Distribution BoxYESExisting Pumpstation 2" forcemain to new 2" forcemain increased to 10' of 4" pvc entering the d-box. Distribution box to Field / PitYES4" pvc to Presby AES Pipe Laterals InletOutlet Pipes & BafflesYESExisting Foundation to TankYESExisting Foundation to AbsorptionNO- Submit Engineer's Final Report & As-Built Engineer Report and As-BuiltNO12/13/18 Septic System Partial Approval Remaining Items: - Submit Engineer's Final Report & As-Built - Install rock barrier and establish vegetation. System Use StatusNO12/13/18 Septic System Partial Approval Remaining Items: - Submit Engineer's Final Report & As-Built - Install rock barrier and establish vegetation. O'Brien, John (Inspector) Dec 13, 2018Page (2)