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2011-144 ..� _, 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: P20110144 Date Issued: Wednesday, December 19, 2012 This is to certify that work requested to be done as shown by Permit Number P20110144 has been completed. Tax Map Number: 523400-301-005-0001-005-000-0000 Location: 777 WEST MT. Rd Owner: ROBERT& PATRICIA DI STEFANO Applicant: ROBERT& PATRICIA DI STEFANO 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 Lidding& ode orc nt Planning Board or Zoning Board of Appeals. TOWN OF QUEENSBURY .41111 742 Bay Road,Qucensbury,NY 12804-5902 (518)761-8201 VTIO Community Development-Building&Codes (518)761-8256 BUILDING PERMIT Permit Number: P20110144 Application Number: A20110144 Tax Map No: 523400-301-005-0001-005-000-0000 Permission is hereby granted to: ROBERT&PATRICIA DI STEFANO For property located at 777 WEST MT. 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: ROBERT&PATRICIA DI STEFAN( Septic Alteration Residential 777 WEST MOUNTAIN Rd Total Value QUEENSBURY,NY 12804-8123 Contractor or Builder's Name/Address Electrical Inspection Agency MORNING STAR SEPTIC Plans&Specifications 2011-144 septic alteration $40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Wednesday,April 25,2012 (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.) a 1 . Dated at the Town of Q ensb .44/Alida ,, a j' 25,2011 SIGNED BY Vel for the Town of Queensbury. Director of Building&Code Enforcement Revised 4/14/2010 OFFIC S ONLY .<_30‘,TAX MAP N 75----PERMIT NO. //'— / 4ERMIT 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 VALID PERMIT. OWNER: 0 ,(1 cl INSTALLER: /2yy, Slc-►_ 5�..L4-- ADDRESS: 7 7 Z C:+.%. 4?- Zw ADDRESS: /6'7 /4 b PHONE NOS. 74'' 2. 2.C., PHONE NOS. *)?3 2-.-2-C‘.0 LOCATION OF INSTALLATION: 744— is 7 RESIDENCE INFORMATION: YEAR BUILT NO.OF X COMPUTATION = TOTAL DAILY FLOW BEDROOMS (Gallons per bedroom) GARBAGE GRINDER 1980 or older X 150 = INSTALLED? _,-.--- 1981 -1991 X 130 = SPA OR HOT TUB 1992-present 3 X 110 = .73c INSTALLED? .f-- PARCEL INFORMATION: ✓ TOPOGRAPHY: FLAT ROLLING STEEP SLOPE i %SLOPE /dam}--10 i S ✓ SOIL NATURE: SAND 4 LOAM CLAY OTHER I GROUNDWATER: AT WHAT DEPTH? .5'11L ✓ BEDROCK/IMPERVIOUS MATERIAL: AT WHAT DEPTH? ' I DOMESTIC WATER SUPLY: MUNICIPAL 7L WELL (If well:water supply from any septic system absorption is: ft) ✓ PERCOLATION TEST: RATE IS 2';c,' PER MIINUTE PER INCH(mpij (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). /L TANK SIZE: - 1 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: kf/i'' '----/) 1/f.---)L i34/ o A SORPTION FIELD(WITH NO.2 STONE) Total length -ft. Each trench-�S*'' X—+- SEEPAGE PIT(S)(WITH NO.3 STONE) How many? 2— Size? (c) X e ❑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 requ ements of the Town of Queensbury QUESTIONS? CALL 761-8256 OR EMAIL Sanitary Sewage Disposal rdi ance. codesPqueensburv.net inti w lJC-- +n VISIT OUR WEBSITE FOR MORE INFORMATION Signature of Perso Responsible Date www.queensburv.net Town of Queensbury* Community Development Office * 742 Bay Road, Queensbury NY 12804 ) --2_, __ ( /7,4_,.. Septic Inspection Report / / Office No. (518) 761-8256 Date Inspectio request received: L1/ 21 Queensbury Building & Code Enforcement Arrive: I:,,' J am/p• Depart: am/pm 742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: . Cf NAME: b e Cts ('SAN 0 PERMIT NO.::_� ` L 1 L 1 LOCATION: -77 -1 t-1(_sT M 7-, la-0 . INSPECT ON: iF 7 RECHECK: Comments and/or diagram Soil Types- ---. oam / Clay Type of Water:A/Municipal ell Water Wate .- .:-•;`ation distance /1.--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 - i- Seepage Pits: Number Size: c,. x Stone Size: ; /� Piping . Size Type Building to tank Tank to Distribution Box Distribution Box to Field/ Pit `' 47K'- -' Opening Sealed: Y N End Cap , N Inlet/Outlet Pipes &Baffles N/ Y N Location/ Separations • Foundation to tank ft. Foundation to absorption ft. Separation of Pits ft. Conforms as perP _i N Engineer Report an As-Built \ "Y N Locati• . • tern on Property: Front Rear Left Side Right Side Middle Front Middle Rear S -„ . s: Approved Partial Approved 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 q.v./L.4eptic Inspection Report Office No. (518) 761-8256 Date Inspectio request received: I Queensbury Building &Code Enforcement Arrive: 2.Vo am/pmI ppepart: am/pm 742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: cJf NAME: b D PERMIT NO.: dol 1-'1 . LOCATION: 1 )7 041-A-6/4-1,/ INSPECT ON: ' __ • l am' RECHECK: 0 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 [150'to well required if NO] 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 Cap _Y_N Inlet/Outlet Pipes &Baffles _Y N Manholes 12"or less below grade __Y_ N [provide extension collar if Yes] TY..T N Location/ Separations Foundation to tank ____ ft. Foundation to absorption ft. Separation of Pits ft. Conforms as per Plot Plan T Y N Engineer Report and As-Built _Y_ N ETU Maintenance Contract Y_ N dor provided Location of System on Property: Front Rear Left Side Right Side Middle Front Middle Rear System Use Status: proved Partial Approved and needs to be re-inspected, please call the Building &Codes Office Disapproved L:\Pam Whiting\2010\Building Codes Forms\Inspection Forms\Septic Inspection Report 03 29 10.doc , . /1— /I/4' 518-793-2290 ,,-------- , • Fax#518-793-2115 . Nr2 367 ' : ' ' . --- E-mail:morningstarseptic@ hotrnail.corn , , _.....,„....,—,,• ' • www.momingstarseptic.corn ingt10 41.146 ti•Eig V:I CU • . Date: - :mr ."4". 107 Jewel Road,Gansevoort,NY 12831 TO: • . - M A P THIS PLAN TO BE ON . Rivii. z-D 4'5- 601 /Jr /6n- o17 c-- PROJECT SITE AT. ALL TIMES FOR THE DURATION OF CONSTRUCTION 1 if 1 1 • \.2,77_7", 1,007 ...- • ) 1 ... . , . *C• I_________ -- . ,.., . . . n ECEEINE . ..0114' t.i ——-•----- i . va--, - 6 X 8 • .:1 APR 27 2011 / TOWN OF QUE'ENSBURY . 47- / BUILDING& CODES % • . . - , 4 . , ^ . • . . • . , ,... •S ..,‘ . ----- . \ i 0. " /f — / 41 518-793-2290 _ � l 367 --;=41101111101111.1101. Fax ax#518-793-2115 18-793-2115 E-mail: septic@ hotmail.com ww .morningstorsaptic.corn =VIE PT C iiIRV1C11 VA*. vig4 Date: 107 Jewel Road,Gansevoort, NY 12831 TO: •s a M A P THIS PLAN TO BE ON -����-� - 6oltr �(..--60n C— ALLSITE AT � ALL TIMES FOR THE DURATION OF CONSTRUCTION 30- / ; - Jr 1 r f,X c8 • • er • A fi I 4/1 518-793-2290 Fax#518-793-2115 V6'] + { • &mail: Fax www.morningstarseptic.com := PTIC i111RY10E Date: 107 Jewel Road,Gansevoort, NY 12831 TO: ,4 W.Ar. - "1'1'7- M A P 6___- .,'ee' vii.. -_---p PL ,IA) r 3 l -----, 1 i Yr �--� 4`,a+,.3.4, � {II Jas' 1. V \ 6-0 PL 101 v • J4----:- ILL !' . TOWN OF CIUNSBURY BUILDING DEP RTMENtoPdliea:ceof Based on our lishah hot be construed as with our comments ands specifications ar �iin�, dip. ._ — —_-- ndicating the plans �uilding A OW(V�F`CV — compGance- with t --___I BUILDING & CO FIE, It F cOP ew York State. Reviewed ,1 ',„. Date: _liiiI' .�_ ,