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2004-913 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: P20040913 Date Issued: Friday, November 19, 2004 This'is to certify that work requested to be-done as shown by Permit Number ? P20040913 has been completed. Tax Map Number: 523400=308-018-0001-058-000-0000 Location: 52 NORTH CHURCH Ln Owner: MALCOLM & GLORIA O'HARA Applicant: MALCOLM & GLORIA O'HARA 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 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: P20040913 Application Number: A20040913 Tax Map No: 523400-308-018-0001-058-000-0000 Permission is hereby granted to: MAT,('OLM& GLORTA 014ARA For property located at: 52 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 die NYS Uniform Building Codes and the Queensbury Zoning Ordinance. I Type of Construction Value Owner Address: MALCOLM& GLORIA O'HARA 52 NORTH CHURCH Ln Septic Alteration Residential Total Value QUEENSBURY, NY 12804 Contractor or Builder's Name /Address Electrical Inspection Agency Plans&Specifications 2004-913 SEPTIC ALTERATION $25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday,November 18, 2005 (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.) i Dated at the wn o uee h sday, November 18, 2004 SIGNED BY for the Town of ueensbu Q rY. Director of Building&Code Enforcement Application for Permit-'Septic Disposal System Town of Queensbury 742 Bay Road Queensbury,NY 12804 (518) 761-8256 1. OWNER INFORMATION: :.......................................................................... ............................ �� Office Use Location of installation: �� tjo�-( (a, eF Permit No. Tax Map No. Nq Fee 4'X Owners Name: �� r�V Address: OFQU 04 D��'�ND NSBDRY C� 2. INSTALLER'S NAME : . ' 7V✓' � ° PH OD O• � /2 —17` f�7` 3. RESIDENCE INFORMATION: (circle year of dwelling, indicate#bedroom(s) and multiply#of bedrooms with applicable gallons per bedroom to equal-total daily flow) Year of House: No of Bedrooms x Computation = Total Daily Flow 1980 or.older x 150 gal/bdrm = 1980— 1991 .2 x 130 gal/bdrm = 1991 —present x 110 gal/bdrm = Garbage Grinder Installed yes` i no 30SIi Spa or Hot Tub Installed yes_ / no 4: PARCEL INFORMATION: (circle applicable information&indicate measurements) Tmoara-ohv Soil Nature Ground Water Bedrock or Im ervious Material Domestic Water Su ply sand at what depth at what depth unici Rolling o feet feet well Steep slope clay if well; water supply _%slope other from any septic-system depth: absorption is . ft. other Percolation Test: (To be completed by licensed professional engineer or architect) Rate: minute per inch 5. 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). Add 250 gallons to the size of the septic tank and leach field for each Garbage Grinder, Spa or Whirlpool Tub. CVir >,-J4- Septic Tank: I bow' gallon (min. size 1,000 gal.) Tile Field: each trench ft. Total System Length: ft. Seepage Pit(s): number of size of each: ft. by ft. Size of Stone to be used: # 1 depth or thickness feet i Bed.System Size: o x Alternative System: length and/or size 6. HOLDING TANK SYSTEM: (if required) Number of tanks: / Size of each: gallons /TOTAL Capacity: gallons Note: Alarm System and associated electrical work must be inspected by a Town approved electrical inspection agency. 7. SIGNATURE &INFORMATION FOR RESPONSIBLE PERSON(please read) 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 o ewbury Sanitary Sewage Disposal Ordinance. ig ature of responsible person Date Towhl Of (1114--elvAbu'ry �rwca•s :111c1 �iCW;IJ;C Dispo.:a1 (.11:1plet. A-11-801011-1'10N 11'11AA.) ' �I:PniLA'1'1C)lN Ii:1�tZl,�ilti�h]I�.N'1';i ' POND OND 4'1E:LL. iN 11¢TF'iZ• .r �` � fit tt'r4.1 . ' 'tll�rltT CJ�S�►If; ram... ,�'••- • •�j IbusE t� IE •'Zr��" Ilt:�u�sz:. G . E .. Sc f't Ic. ' I/�,1.+ 1�.,.., 1 Ut'►iStrl„t 111rt( 1 � r �fif�+r�Rt'txn a 7. SICTN,ATURE &INFORMATION FoF,Usilt1"JoLz r rr%z%-#v, W1.904-0•wu�,f '` '''•, r r.- NACE ENGINEERING, P.C. 169 Haviland Road, Queensbury,NY 12804 Phone-518-745-4400 Fax -518-792-8511 November 18, 2004 Project#49152 Mr. Jay Sweet Queensbury Septic Tpyy ® NOV PO Box 4283 A&1 �N Q�r �Op� loWNOF 1 2004 Bay Road GC�eU Lake George,NY 12845 0®��, pCOo�Rr Re: Percolation Test O'Hara Residence - 52 North Church Lane, Queensbury,NY Dear Jay: At your request, on November 17, 2004, I performed a percolation test at the O'Hara residence located at 52 North Church Lane in Queensbury. The test was performed to.the front (southeast) of the existing residence in the location where construction of a replacement leach field is proposed. The results of the testing are as follows: Percolation Test Stabilization percolation rate- 1" in 1 minute, 02 seconds The test was run in the native sand at a depth of 24 inches in a 30 inch deep hole. The hole was presoaked and the test was run 12 times until it stabilized with three consecutive runs of 1:00, 1:00 and 1:02 respectively. The design flow for this 3 bedroom residence at 110 gallons per bedroom requires an absorption area of 411 sf. The replacement bed for the should of consist of an absorption bed with 480 sf of absorption area. p Please call me if you have any questions. 7 Sincerely, Thomas R. Center Jr., EI V 1 2004 TOWN 8U OIL ANEIVSBURY D COpE R.cc,, a 1 11> a � m13 n a � C vu U c., ^ 6 i UILDING & DeZPT o kEVIEWEp 8Y DATE "I have seen or observed, or believe I saw evidence of, all objects such as houses, w;eils, trees, fences, etc., showr; on this document. I also represent that I have personally m asu,ed th_, distances set forth on the diagram." SIGNATURE DATE Septic Inspection Report Office No. (518)761-8256 Date Inspection request received: Queensbury Building&Code Enforcement Arrive: am/ in Depart: am/pm 742 Bay Rd.,Queensbury,NY 12804 Inspector's Initials: NAME: —Q PERMIT NO.: l LOCATION: /N• C�c JV—e— � tj INSPECT ON: vl d RECHECK: Comments and/or diagram Soil TYP4. Sand&76 ,lav Type of unicipa /Well Water Waterline separat ance ft. Well separation distance ft. Other wells: ft. Absorption Field: Total length ft. Length of each trench ft. Depth of trenches 4k ft. Size of Stone Z Seepage Pits: Number Size: x Stone Size: Piping Size Type Building to tank t ST's 62 Tank to Distribution Box Distribution Box to Field/Pit tt Opening Sealed: Y/N/Partial Location/Separations Foundation to tank ft. Foundation to absorption ft. Separation of Pits ft. Conforms as per Plot Plan Y N Location of System on Property: Front Rear Left Side Right Side Middle Front Middle Rear System Use Status: —.Approved Partial Approved and needs to be re-inspected,please call the Building&Codes Office Disapproved L:\SueHemingway\Building.Codes.Inspection.FORMS\Septic Inspection Report.doc January 28,2003 Septic Inspection Report Office No. (518) 761-8256 Date Inspection request received: Queensbury Building&Code Enforcement Arrive: am/ epart: pm 742 Bay Rd., Queensbury,NY 12804 Inspector's Initials: ` 1 NAME: / v PERMIT NO.: l 1 r l LOCATION: `7 J r INSPECT ON: v RECHECK: Comments and/or diagram Soil Type: an lay Type of Wate ic' Well Water Waterline separation distance ft. Well separation distance ft. Other wells: ft. Absorption Field: Total len h ft. CC)5 �� / �17 G S Length of each trench Depth of trenches ft. Size of Stone Seepage Pits: Number Size: x Stone Size: Piping Size Type Building to tank Tank to Distribution Box �� 7 Distribution BoytoFfield/Pit SD 2 enin Seale : Y Ift Partial Location/Separations Foundation to tank ft. Foundation to absorption ft. Separation of Pits ft. Conforms as per Plot Plan VY N Locati f System on Property: Fro Rear Left Side Right Side Middle Front Middle Rear System Us S s: Approved Partial Approved and needs to be re-inspected,please call the Building&Codes Office .Disapproved