2006-616 40111111K, 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: P20060616 Date Issued: Wednesday, January 16, 2008
This is to certify that work requested to be done as shown by Permit Number P20060616
has been completed.
Tax Map Number: 523400-289-009-0001-068-000-0000
Location: 354 GLEN LAKE Rd
Owner: JANE MADEY
Applicant: JANE MADEY
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
ET 1 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20060616 Application Number. A20060616
Tax Map No: 523400-289-009-0001-068-000-0000
Permission is hereby granted to: JANE MADEY
For property located at: 354 GLEN LAKE 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 Value
Owner Address: JANE MADEY
590 POST Ln Septic Alteration Residential
SOMERSET, NJ 08873-0000 Total Value
Contractor or Builder's Name/ Address Electrical Inspection Agency
QUEENSBURY SEWER
JAY SWEET
Plans &Specifications
2006-616
septic alteration
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Wednesday, September 05, 2007
(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 ex irztion date.)
Dated at the To o- nsb ;4 / , ptember 05, 2006
d
SIGNED BY \ for the Town of Queensbury.
Director of Building&Code Enforcement
06-
OFFICE USE ONLY
TAX MAP NO. PERMIT NO. PERMIT FEE ,
APPROVALS: ZONING TOWN CLERK AUG j 2006
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT;
A PERMIT MUST BE^"T4INED BEFORE WORK BEGINS.APPLICATION IS SUBJECT TO REVIEW BEFORE ISSUANCE OF A VALID
PERMIT.
MacteOWNER: I
• INSTALLER: G 1 x ? . l\�1 tC
ADDRESS: � L/ '" C I y fJ h..UP r ADDRESS: a-. kJ AL.
PHONE NOS. PHONE NOS. (r, / `-r / 5- 3
LOCATION OF INSTALLATION: ,..?-5.-17/ C-42-1-"- �,�f
YEAR BUILT NO.OF X COMPUTATION= = I I RESIDENCE INFORMATION:
BEDROOMS TOTAL DAILY FLOW
1980 or older1 1 G STALL E QRI 9ER
X 150 gallon per bedroom I = /7.aI INSTALLED?
1981 -1991 X 130 gallon per bedroom 1 = 1
........_.........,.....w........,..._.... I SPA P X 110 gallon OR HOUB
,
T T
1992- resent ' A—'
per bedroom _ ' INSTALLED?
PARCEL INFORMATION:
✓ TOPOGRAPHY: FLAT ROLLING V STEEP SLOPE %SLOPE
✓ SOIL NATURE: SAND }C LOAM CLAY OTHER
✓ GROUNDWATER: AT WHAT DEPTH? BEDROCK/IMPERVIOUS MATERIAL: AT
WHAT DEPTH?
✓ DOMESTIC WATER SUPLY: MUNICIPAL WELL Y
(IF WELL:WATER SUPPLY FROM ANY SEPTIC-SYSTEM ABSORPTION IS FT. )
✓ PERCOLATION TEST: RATE IS 13 J S i 'PER MIINUTE PER INCH (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). Add 250
gallons to the size of the septic tank and leach field for each garbage grinder, spa or whirlpool tub.
✓ SEPTIC TANK/u r GALLON (MIN. SIZE IS 1,000 GAL.) TILE FIELD: EACH TRENCH FT.
✓ TOTAL SYSTEM LENGTH: FT. SEEPAGE PIT(S): HOW MANY?
✓ SIZE OF EACH FT. X FT.
✓ SIZE OF STONE TO BE USED: # /DEPTH OR THICKNESS FT.
✓ BED SYSTEM SIZE: X V 0
✓ ALTERNATIVE SYSTEM: e Al SI(.S.IR� LENGTH AND/OR SIZE
✓ HOLDING TANK SYSTEM:(If required) NO. OF TANKS: /SIZE OF EACH
✓ GALLONS./TOTAL CAPACITY: GAL.
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 7614256 OR EMAIL
Queensbury Sanitary Sewage Disposal Ordinance. oodesOaueeneburv.net
VISIT OUR WEBSITE FOR MORE INFORMATION
6., www.queenaburv.net
Signature P4son Responsible Date
Town of Queensbury • Community Development Office • 742 Bay Road, Queensbury, NY 12804
RESOLUTION APPROVING JANE MADEY'S APPLICATION FOR
SANITARY SEWAGE DISPOSAL VARIANCES
RESOLUTION NO.: BOH 15,2006
INTRODUCED BY: Mr.John Strough
WHO MOVED ITS ADOPTION
SECONDED BY: Mr.Tim Brewer
WHEREAS, Jane Madey filed an application for variances from provisions of the Town of
Queensbury On-Site Sewage Disposal Ordinance, Chapter 136 to install a replacement absorption
system:
1. one foot (1') from the west property line instead of the required ten feet (10')
setback; and
2. fifty feet(50')from the well instead of the required one-hundred feet(100')setback;
on property located at 354 Glen Lake Road in the Town of Queensbury, and
WHEREAS,the Town Clerk's Office published the Notice of Public Hearing in the Town's
official newspaper and the Local Board of Health conducted public hearings concerning the
variance requests on April 17th and June 19th,2006, and
WHEREAS, the Town Clerk's Office has advised that it duly notified all property owners
within 500 feet of the subject property,
NOW, THEREFORE, BE IT
RESOLVED, that
1. due to the nature of the variances, the Local Board of Health determines that the
variances would not be materially detrimental to the purposes and objectives of this
Ordinance or other adjoining properties nor otherwise conflict with the purpose and
objectives of any Town plan or policy; and
2. the Local Board of Health finds that the granting of the variances is necessary for the
reasonable use of the land and is the minimum variances which would alleviate the
specific unnecessary hardship found by the Local Board of Health to affect the
applicant; and
BE IT FURTHER,
RESOLVED, that the Local Board of Health hereby approves the application of Jane
Madey for variances from the Sewage Disposal Ordinance to install a replacement absorption
system:
1. one foot (1') from the west property line instead of the required ten feet (10)' setback;
and
2. fifty feet(50')from the well instead of the required one hundred feet(100') setback;
contingent upon the following conditions:
1. that the residence continue to be a seasonal residence only;
2. that the current footprint of the structure not be expanded;
3. that the applicant agrees to appear before the Town Board to obtain approval of any
future structural expansion before the applicant applies to the Zoning Board of
Appeals for any needed ZBA approvals of any proposed expansion; and
4. that the applicant agrees to provide a deed restriction in form acceptable to Town
Counsel in favor of the Town of Queensbury which deed restriction could not be
amended without the Town Board's approval as the benefited party. Such deed
restriction is to keep the size of the footprint where it currently is until the property
owner returns to obtain Town Board approval, in its discretion, with any release or
modification of such deed restriction;
on property located at 354 Glen Lake Road in the Town of Queensbury, and bearing Tax Map No.:
289.9-1-68.
Duly adopted this 19th day of June, 2006,by the following vote:
AYES : Mr. Strough,Mr. Brewer,Mr. Stec,Mr. Boor, Mr. Sanford
NOES: None
ABSENT: None
Septic Inspection Report
Office No. (518) 761-8256 Date Inspection request received:
Queensbury Building &Code Enforcement Arrive: am/ part: am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials:
NAME: ` / PERMIT NO.: . .I
LOCATION: :?.i �/�i--• C.a-l�W.INSPECT ON: Mr
RECHECK:
Comments and/or diagram
Soil Type: Sand/ Loam/ Clay
Type of Water: Munidpal / Well Water
Waterline separation distance _ft. ���� Q
Well separation distance ft.
Other wells: _ft.
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/ Partial
End Cap
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 Y N
Engineer Report and As-Built Y___..N
Location of System on Property:
Front Rear Left Side Right Side
Middle Fron Middle Rear
-m U - ta!gs:
Approved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
Last revised 021006
Last revised 1/6/05
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building&Codes (518) 761-8256
Inspections per Permit
Pernik n P20060616
Inspection Date Inspection Type
Approved/Denied Comments Permit Type Person Responsible
9/7/2006 12:00:00AM Septic Septic Alteration Residential JOHN O'BRIEN
Denied 2006-616
ENGINEER'S APPROVAL LETTER
OK TO BACKFILL ENGINEER HAS INSPECTED
MATER TREATMENT — ULTRAVIOLET TREATMENT UNIT TO BE ADDED TO
WELL WATER SUPPLY LINE DUE TO LACK OF SEPERATION BETWEEN
WELL AND ELJEN SYSTEM.
MAP REFERENCE I
MAP OF PART OF
THE LANDS OF
JOHN H. SULLIVAN & OTHERS
BY: LESLIE W. COULTER _ ---
DATED: MAY 23, 1947
100'
WELL SETBACK
TELL LOCATED ~ \�
RETAER THAN
100'7
\
LANDS N/F OFF
TOWN OF QUEENSBUR\
(VACANT LOT) 1
"'... .moo.
BRF 10 19/95 / / DISTRIBUTION LANDS N/F OF
LANDS N/F OF, \ BOX HAYES
P. C. SULLIVAN ` (VACANT LOT)
PF 12/20/0 ( 1.000 GAL.
\ CN•.., SEPTIC T
�R "'�► b ° EXISTING SEPTIC SYSTEM
L14 '`�. ��_\ 4, 300 GAL. STEEL TANK &�FONE /
SEEPAGE/CESSPOOL TO B
QLF OF ELJEN IN Ut�ITa �cjp — DISCONNECTED&INFlLLED. j
420 I
i
1aL
LIMITS OF ODSater\ ` ` ato 1 I aoo/ 1
1
1 STORY
WOOD FRAMED
O [p HOUSE
Vp ASPHALT
DRIVE
coPAT10
F
t
� t t t Jtoto I �
tC +r
EXISTING BASEMENT SEPTIC SYSTEM J !lJJJ t
Y APPROXIMATE LOCATION TO BE r3 r\ §LATE .f��ggl�t sc�. t.t j
DISCONNECTED &INFlLLED WITH N68 s•O PA710 / Q/ Ogre ( j
/ �BA�ENTTIINLLET PIPE
!
�. LANDS N/F OF 420
R.J. SULLIVAN / 410 1 t
NO WELL OBSERVED t / `
IN THIS AREA
5'±
1 PROPERTY SUPPLIED 400 If
/ L 100' ~ BY LAKE WATER
WELL SETBACK
LEGEND
BRFO= BATHEY ROD FOUND ~ �.
IPFO= IRON PIPE FOUND \�`
90.,= UTILITY POLE PLAN CJ= REFERENCED MAP L07 NUMBERS
DATUM = U.S.G.S.
'OUR INTERVAL = 2 FOOT Scale: 1"=20'
l 3
ThURA1 . ?- 7 -06
Septic Inspection Report
Office No. (518) 761-8256 Date Ins.- ion u- 'i -I I. -"--- _ �
Queensbury Building &Code Enforcement Arrive: "All am • 10 -part: • a .
Ini .Is•
742 Bay Rd., Queensbury, NY 12804 Inspector's
NAME: I, I' ) IT NO.: 04 . 2/6
LOCATION: :_,5( f , IN 'ECT ON: (?— 7 -O
RECHECK:
Comments and/or diagram
Soil Ty Loam / CIa
Type of Water: Municip Well Water
Waterline separation distance _ ft•
Well separation distance <TC ft. ►6 ?E - ik\i �Jv) V
Other wells: -ft.
Absorption Field: Total length I-0 ft.
Length of each trench J C`'-' ) ft.
Depth of trenches 2-- ft.
Size of Stone t - 1L• A A
Seepage Pits: Number
Size: x
Stone Size: ----
Piping Size Type
Building to tank ' i' N
Tank to Distribution Box .f'
Distribution Box to . ilud/ Pit 1-1" , Te GLS k5-.\-. )\
t
Opening Seale I.N Partial /
End Cap ‘��/
I Inlet/Outlet Pipes&Baffles i _.1 L _.._,_N
Location/ Separations
Foundation to tank I Z— ft. 'B (--'3P� EP.._ t r= \-; vF_
Foundation to absorption _ .Z ft.
Separation of Pits ft.
rms as per Plot Plan Y I`r
Engineer Repor-tThid As-Built _ _____Y eN
Location of System on Property: E 3` ` tE _ �� _ ______
Fro a eft Side Right Side t.,- _
iddle Fro. Middle Rear
System Use Status:
•• .ved
All
��al Approved and needs to be re-inspected, please call the Building &Codes Office
1 •
,s sapproved
th
Last revised 021006 \t7 C_ a
Last revised 1/6/05
-06` TOWN OF QUEENSBURY
F 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
' Community Development- Building &Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20060616 Application Number. A20060616
Tax Map No: 523400-289-009-0001-068-000-0000
Permission is hereby granted to: JANE MADEY
For property located at: 354 GLEN LAKE Rd
in the Town of Queens bury,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: JANE MADEY
590 POST Ln Septic Alteration Residential
SOMERSET, NJ 08873-0000 Tota Value
Contractor or Builder's Name/ Address Electrical Inspection Agency
QUEENSBURY SEWER
JAY SWEET
Plans &Specifications
2006-616
septic alteration
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Wednesday, September 05, 2007
(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 f Que bu4ITu; a / ember 05, 2006
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
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