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2008-606 TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development- Building &Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE Permit Number. P20080606 Date Issued: Monday, December 29, 2008 This is to certify that work requested to be done as shown by Permit Number P20080606 has been completed. Tax Map Number. 523400-308-018-0001-065-000-0000 Location: 18 NORTH CHURCH Ln Owner. WILLIAM & KELLE ENGEL Applicant: WILLIAM & KELLE ENGEL This structure may be occupied as a: Septic Alteration Residential By Older 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 12804-5902 (518)761-8201 Community Development- Building&Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20080606 Application Number. A20080606 Tax Map No: 523400-308-018-0001-065-000-0000 Permission is hereby granted to: WILLIAM & KELLE ENGEL For property located at: 18 NORTH CHURCH 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. Tyne of Construction Value Owner Address: WILLIAM &KELLE ENGEL 18 NORTH CHURCH Ln Septic Alteration Residential QUEENSBURY, NY 12804-0000 Total value Contractor or Builder's Name/Address Electrical Inspection Agency Plans &Specifications 2008-606 septic alteration residential $25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Friday,November 13, 2009 (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 T wn of ee:�v November 13, 2008 SIGNED BY for the Town of Queensbury. Director of Building&Code Enforcement o OFFICE USE ONLY n - TAX MAP NO. PERMIT NO. V _ PERMIT FEE lo 1 , APPROVALS: ZONING-'--` TOWN CLERK I `i_ 0 APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT: A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJECT TO REVIEW BEFORE ISSUANCE OF A VALID PERMIT. !OWNER: t I�/4�- c / INSTALLER: -5 I U-� , ►^'L ADDRESS: Nv' 1(it l �2 n !'Qlr�- ADDRESS: y���/7 Sy �.4Qq Fy����� PHONE NOS. ( PHONE NOS. LOCATION OF INSTALLATION: elk) j CA Q(12tJYS NO.OF RESIDENCE INFORMATION: YEAR BUILT BEDROOMS X COMPUTATION= = TOTAL DAILY FLOW 1980 or older X 150 gallon per bedroom = INSTALLED?RINDF�R 1981 -1991 X 130 gallon per bedroom = SPA OR HOT TUB 1992-present X 110 gallon per bedroom = INSTALLED? PARCEL INFORMATION: ✓ TOPOGRAPHY: Flat rolling Steep slope %Slope ✓ SOIL NATURE: Sand^z Loam Clay Other ✓ GROUNDWATER: At what depth? ' ✓ BEDROCK/IMPERVIOUS MATERIAL: At what depth? ✓ DOMESTIC WATER SUPLY: Municipal 4� Well (If well: Water supply from any septic system absorption is ft.) ✓ PERCOLATION TEST: Rate is ( S-D se z minutes 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: %`��° 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 TYPE: i ABSORPTION FIELD (WITH NO. 2 STONE) Total length ft. Each trench X S� ❑ SEEPAGE PIT(S)(WITH NO. 3 STONE) How many? Size? ❑ ALTERNATIVE SYSTEM Bed or other type? ❑ HOLDING TANK SYSTEM Total required capacity? Tank size? Number of tanks? 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 requirements of the Town of QUESTIONS? CALL 761-8256 OR EMAIL Queensbury Sanitary Sewage Disposal Ordinance. coaesCc�4ueensburv.net r VISIT OUR WEBSITE FOR MORE INFORMATION i Z� gueensburv.net 6� www. Signat re of Perso Resp6nsible Date Tozvn of Queensbury - Community Development Office - 742 Bay Road, Qiteensbury, NY 12804 B 5-LGL 6/06 Septic Inspection Report Office No. (518) 761-8256 Date Inspectiones: : Queensbury Building &Code Enforcement Arrive: rt: am/pm 742 Bay Rd., Queensbury, NY 12804 Inspector's InitiNAME: E1'1C�E LOCATION: 1 t-spe:Vyx Coin" 1.ta F 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 Absorption Field: Total length ft. Length of each trench ft. Depth of trenches ft. Size of Stone Seepage Pits: Number Size: x Stone Size: Piping Size Type Building to tank Tank to Distribution Box Distribution Box to Field Pit Opening Sealed: Y N End Ca Y N Inlet/Outlet Pipes &Baffles Y N Location Separations Foundation to tank ft. Foundation to absorption ft. Separation of Pits ft. Conforms as per Plot Plan N Engineer Report and As-Built Y N Location of System on Property: Front Re Left Side Right Side Middle Front Middle Rear S U S s: Approved Partial Approved and needs to be re-inspected, please call the Building &Codes Office Disapproved Last revised 06/18/07 U\Building&Codes Forms-OLD\Building&Codes\Inspection Forms\Septic Inspection Report.doc G. Peter Jensen 17 West Road South Glens Falls New York 12803 (518)798—3859 December 04, 2008 To Whom It May Concern: I have designed(plan 07-0502)and observed the installation of the septic system for Bill&Kelle Engel at 18 North Church Lane,Town of Queensbury, Warren County New York. It would appear that the installation is within the intent of the design documents. To the best of my knowledge and belief, no field conditions were encountered that would require a re-design of the septic system. Hancor graveless chambers have been substituted for the specified stone and pipe,this substitution is acceptable. To the best of my knowledge and belief all of the distance separation requirements have been met. Sincerely, G. Peter nsen P E D ARC ER JF,y y�j Q C9' sF.y a A 4 w �l9 0?6020 + tF of N9*-40K r Septic Inspection Report Office No. (518) 761-8256 Date InmInitia5ls. uest e' ed: Queensbury Building &Code Enforcement Arrive: rt: WC� 742 Bay Rd., Queensbury, NY 1 804 Inspecto NAME: ` OPECTO IT NO.: _0S LOCATION: o �,� N: - RECHECK: Comments and/or diagram Soil Ty am/Cla Type of Water: unici Water Wate ration distance ft. F 2.&1 A Well separation distance ft. Other wells: ft. Well Casing Length 50' + - Y N N/A Absorption Field: Total length Z O ft. Length of each trench ft. �Rac�� t+SFrt_Ti2ol'_J Depth of trenches Size of Stone A- Seepage Pits: Number Size: x Stone Size: Piping Size Type Building to tank 14 '` & Tank to Distribution Box C- Distribution Box to Field Pit P\3Crot-�►�o�C�� t�l irl t +�11�2� Opening Sealed: N �� End Cap N Inlet/Outlet Pipes &Baffles N Location Separations Foundation to tank ft. Foundation to absorption ft. Separation of Pits Conforms as per Plot Plan N � - PLOT �l J Engineer Report and As-Built Y_ N V-C)?— v'7E Location of System on Property: O (� i t3 cILL Front Rear ft Sid Ri ide Middle Fronta Middle Rea Systern Use tus: Approved Partial Appro ed and needs to be re-inspected, please call the Building &Codes Office Disapproved Last revised 06/18/07 L:\Building&Codes Forms-OLD\Building&Codes\Inspection Forms\Septic Inspection Report.doc 1 } o T E MANHOi..C`_ �:DVErR f�MANHO> ,E COVER /. 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INS L�.TAAT t QN tvf US"` L3O ! N5 P6cGE'D T ' E 1_ -- ,I � �\ PR t®►� '''v G,�V Etar:�-tom- 3Y 'TN,�' StJI LDrN4: i ------- N - � , -, i - 1 - 1N---.?PL''GTZ'R OG THE `>•AWN fXvE- rSF3CJRy I L-Li a Oc-;TLE rS I I S F EDRDOt`1 E } ! EbAFFLE , l RE51DENCE I WITH POST 149t FtxTURES ; T_ w :z I CONTRACTOR BEWARE : 5EP"•� TANK I� >.�T'S AND DRY WELUS) ExrsT- LOCATt4t�1 N SEED APff-A AFTER IN57ALLA iC)N _____- FtiACKFILL l UNKNOWN- EMPTY, FILL WITH SAND ©1 7 RtEJTION PIPE AND ABANDON Of? REMoV E A- ! (' - ----- "— -- 51APE �• t PER FOOT 3`z-i4 R E O Ll I R E(,, �-; - UNTRE_ATEO 13U1 LOIN(, PAPER /�._ I , 4*0 SEWER PIPE PITai ;�!. /Z F'ER FOb7 -.._ f N / aG ; WASHtsD GRAVEL GR P .�:�HE,.J jTONE .-.__.- ... . , .-•.. ., .-_ - I - �� - AGGREGATE 1 (4 ii) e>o-rr m OF' TF2EN:.N MINIMUM 2-O 2',A8,0VE SEASONAL H IGr ! NO \NA T ER , TPENC'HES 4'-0 D,G. W!`!-I MINIMUM LE`JE i_ TF�IJ`lGN I TiDN! 4'-U UNDIS'ORBE.G SOIL RE�Cii4�tEL A s E, U 1 LT OE_60� I M f\ 1`1 T_s It K a Violation of the Law for any Per , A&C Unless Acting Under the C)trection of Licensed Arc'wtect, to Aker any Portion of This - ---- \ , QQt,^,lyrtl�n. in any ww t any Portion of this �ID -I A Document iti i0 Apn A )r+ 1,e 4!1?rirg Architect Shall Affix to the r'ortI(-I: Alteicd his Seal and the Notation 'Alterco r.y" Followed by his y 'I T l ��e^�o ' Signature and Ine Uat . of Stich A11e►ation, and ec '9T {CP a 8pttaac Descr"ton of the Alteration. � 8 5EPT1G TANK OUTLET 2.3-0 I 3�_t., _� l Bt L.LjO KELL..E ENGIEL- pISTRIP.SUT10N SOX 31, 6 i 44-b F' L O -T F'1_,0,N ! $f�GI N Nt NG THE NC H�1 31-O 4 5-O �'�r S,NSEN DRAW 11SE;G.1NNlN C+ TRENCH S 54-o I 63-O SOUTH GLEN$FALLS PLAIN I .DATE SCALD i S CA L E I c 2h i . . NEW YORK 12803 BY END TRENCH 1 i 69-O 97-� I END TRENCH'S � 83'3 ) d,o' 9 c r-©502! �nwV ,08 A5 Nd"tEl♦