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historical dataOffice No.(518)761-8256 Septic Inspection Report juest received: Queensbury Building &Code Enforcement ©.7am/pm,,Depal am/pm742BayRd.,Queensbury,NY 12804 Inspector's Initials:2-C~ NAME:ul PERMIT NO.2B = LOCATION:MASSA IRS INSPECT ON:Z 7 RECHECK: diagram Soil Type:Sand /Loany/Clay|LAK 73 E2. ‘Type of Water:Municipal /Wefl Water ‘Waterline separation distance ia ‘Well separation distance ft. Other wells:ft. Well Casing Length 50’+/-|__Y__N__NA Absorption Field:Total length Length of each trench|%2 3429 Depth of trenches ft ft. ft. Size of Stone|Geen?99S - ‘Seepage Pits:_Number Size:x Stone Size: Piping Sze,|Type Building to tank 4 Fe FV Tank to Distribution Box je om Distribution Box to Field/Pit LZ Opening Sealed:a End Cap|_¥7¥ Inlet/Outlet Pipes &Baffles|_VY Location/Separations Foundation to tank Foundation to absorption ‘Separation of Pits Conforms as per Plot Pian Engineer Report and As-Built Location of System on Property: ‘System Use Status: Last revised 06/18/07 Front Rear Left Side —_Right Side proved artial Approved and needs to be re-inspected,please call the Building &Codes Office Disapproved Bbw Eu.APAQVAL “Fite Erec Middle Front Middle Rear LL\Building &Codes Forms-OLD\Bulding &Codes\Inspection Forms\Septic Inspection Report.doc Septic Inspection Report Office No.(518)761-8256 Date Inspection request received: ‘Queensbury Building &Code Enforcement ar £55"am/p parts742BayRd.,Queensbury,NY 12804 5 Init veyees——PERMIT NO.:LoeaTION: Maou)PQ INSPECT ON: RECHECK: Soil Type:Sand /Loam/Clay ‘Type of Water:Municipal /Well Water Waterline separation distance ‘Well separation distance Other wells: Well Casing Length 50’+/-YN WA FP P| ‘Absorption Field:Total length | Length of each trench | Depth of trenches | Size of Stone Seepage Pits:_Number Size:|x Stone Size:| lal Piping Size Type Building to tank Tank to Distribution Box Distribution Box to Field/Pit ‘Opening Sealed:y End Cap YON Inlet/Outlet Pipes &Baffles Y. Location /Separations Foundation to tank Foundation to absorption ‘Separation of Pits Conforms as per Plot Plan iEngineerReportandAs-Built |_i/'Y Ewe.AniRwac ov Fice 2\2|F PP) Location of System on Property: Front Rear Left Side__Right Side Middle Front Middle Rear approved Partial Approved and needs to be re-inspected,please call the Building &Codes Office Disapproved Last revised 06/18/07 [L\Butlding &Codes Forms-OLD\Bullding &Codes\Inspection Forms\Septic Inspection Report.doc —nt ht .Ly ENVIRONMENTAL DESIGNOf-fb PARTNERSHIP,LLP August 6,2009 ‘Town of Queensbury Community Development Department 742 Bay Road Queensbury,NY 12804 Attn:Craig Brown,Zoning Administrator Dave Hatin,Director of Buildings &Codes Re:Kelly Residence 43 Mason Road Gentlemen: In compliance with application approvals granted by the Town of Queensbury I offer the following regarding the referenced project. The design plans reviewed and approved bythe Town as associated with the wastewater system application are as follows: Wastewater and Stormwater Systemsfor the Residence of Mark &Penny Kelly43MasonRoad Town of Queensbury Tax Parcel 226.16-1-17 ©Sheet S-1 ‘Site and Wastewater Plan revised 9-30-08 ©SheetS-3 Design,Details &Notes issued 9-5-08 During the course of construction I was on the job site to observe key components of the systeminstallationculminatingwiththe‘start-up’of the pump assembly and control panel system on July 15, 2009.Based on my inspection of the system start-up 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,hewn roMACEiKoy Dennis MacElroy,PE Ce:Mark &Penny Kelly ‘Wayne Williams 900 Route 146,Clifton Park,New York 12065 phone (518)371-7621 -fax (618)371-9540 For an EPA homeowner's guide:.les/pubs/hor 1er_quide fon.hilpvwwwepa.cc OFFICE USE ONLY ‘TAX MAP NO.PERMIT NO.OSAS PERMIT FEE 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 VALIDPERMIT. omer:MARK Keriy Inotater “BD ADDRESS:eoT Eo ADDRESS:oPHONENos.435-454 PHONE Nos.=)7—HO7H LOCATION OF INSTALLATION:ey =-RESIDENCE :-Ts INFORMATION:vearsutt|geprooms |*|coMPuTaTion=|=|TOTAL DAILY FLOW 1960 orelder_|[-——]|X|150 galon per bedroom 0 GARBAGE GRINDER —ee e INSTALLED?1961-1991|L——]|x|1209atonper bedroom|=0 oor Tea Se ReC BSS IG SPAOR HOT TUB,}992-present|[E>]X|110 gation per bedroon S50 Reereon PARCEL INFORMATION: ¥TOPOGRAPHY:FLAT ROLLING_Y STEEP SLOPE.‘SLOPE,eA % Y SOILNATURE:SAND,LOAM.cuay,OTHER uw 1¥GROUNDWATER:AT WHAT DEPTH?>41%)BEDROCWIMPERVIOUS MATERIAL:AT WHAT DEPTH?_>(> v pomesticwater sup:LAKE GeorakMUNICIPAL,WELL____(ifwelt:water supply from any septic system absorption i:mM Y PERCOLATIONTEST:RATE IS_€~-|@>_PER MINUTE PER INCH (TEST TO BE COMPLETED BY A LICENSEDPROFESSIONALENGINEERORARCHITECT) PROPOSED SYSTEM FOR NEW CONSTRUCTION:Ail individual sewage disposal systems must be designed by a licensedprofessionalengineerorarchitect(unless installed in a Planning Board approved subdivision). TANK SIZE:DOOGALLON (MIN.SIZE IS 1,000 GAL.)Add 250 gallons to the size of the septic tank foreachgarbagegrinder,spa or whirlpool tub. SYSTEM TYPE: LJABSORPTION FIELD (WITH NO.2 STONE)Total length ft.Each trench x [SEEPAGE PIT(S)(WITH NO.3STONE)—How many?Size?a Tee SYSTEM Bed or other type? AMEN TRENCH3LATERALS ABLEHOLDINGTANKSYSTEMTotalrequiredcapacity?Tank size?Number of tanks? NOTE:ALARM SYSTEM AND ASSOCIATED ELECTRICAL WORK MUST BE INSPECTED BY A TOWN APPROVED ELECTRICALINSPECTIONAGENCY,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‘anted which is based upon or is granted in reliance upon any material misrepresentation or failure to make a material fact orircumstanceknownbyoronbehalfofanapplicant,shall be voi. QUESTIONS ?CALL 761-8256 OR EMAIL ‘sodes@aueensbury.net VISIT OUR WEBSITE FOR MORE INFORMATION www.queensbury.net ‘ave read the regulations with respect to this application and agreeabidebytheseandallrequirementsoftheTownofQueensbury nitary Sewage Disposal Ordinance. -D-OfinatureofPersonResponsibleDate. “own of Queensbury *Community Development Office =742 Bay Road,Queensbury,NY 12804