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2011-198 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: P20110198 Date Issued: Wednesday, December 19, 2012 This is to certify that work requested to be done as shown by Permit Number P20110198 has been completed. Tax Map Number: 523400-296-017-0001-013-000-0000 Location: 2 GREENWAY Dr Owner: SANDRA KIMBALL Applicant: SANDRA KIMBALL 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 En rcement 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: P20110198 Application Number: A20110198 Tax Map No: 523400-296-017-0001-013-000-0000 Permission is hereby granted to: SANDRA KIMBALL For property located at: 2 GREENWAY Dr 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: SANDRA KIMBALL Septic Alteration Residential 2 GREENWAY Dr QUEENSBURY,NY 12804-0000 Total Value Contractor or Builder's Name/Address Electrical Inspection Agency Plans&Specifications 2011-198 septic alteration residential $40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Sunday,May 13,2012 (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.) Dated at the Tow�i'o ueens ry rtd�ay May 13,2011 � SIGNED BY / �� ° S— for the Town of Queensbury. Director of Building&Code Enforcement p EC E9WE :._ Community Development Office MAY 1 0 2011 Town of Queensbury • 742 Bay Road - Queensbury, N w UEENSBURY Office Use Onl BUILDING&CODES y TAX MAP NO �b ` r PERMIT NO. PERMIT FEE APPROVALS: ZONING TOWN CLER APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT: A PERMIT MUST BE OBTAINED BEFORE VYORK BEGINS. APPLICATION IS SUBJECT TO REVIEW - FORE ISSUANCE OF A V�LID PERMIT. OWNER: v r I �l 17��} Ile//Lt (/� INSTALLER: 8 / A-x `�/CC1l< •�_ ADDRESS: `o e Q N p ��CJ� ADDRESS:P ) �}DV 2�Y C� PHONE NOS. / 9 7-_ !y�/ PHONE NOS. 1 / ® F`rD _ LOCATION OF INSTALLATION: 0 Q¢-IJu—A�7 YEAR BUILT NO.OF X COMPUTATION - TOTAL DAILY FLOW RESIDENCE INFORMATION: BEDROOMS Gallons per bedroom GARBAGE GRIND�y&O 1980 or older 3 X 150 = � INSTALLED? f"" 1981 -1991 X 130 = SPA OR HOT TUB 1992-present X 110 = INSTALLED PARCEL INFORMATION: ✓ TOPOGRAPHY: FLAT ROLL! _ STEEP SLOPE %SLOPE ✓ SOIL NATURE: SAND LOAM^_ CLAY OTHER ✓ GROUNDWATER: AT WHAT DEPTH? ✓ BEDROCK/IMPERVIOUS MATERIAL: AT WHAT DEPTH? ✓ DOMESTIC WATER SUPLY: MUNICIPAL,E WELL (If well:water supply from any'septic system absorption is: ft) ✓ PERCOLATION TEST: RATE IS ---PER MIINUTE 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: ❑ABSORPTION FIELD (WITH NO. 2 STONE) Total length---_---ft. Each trench_ X ❑ SEEPAGE PIT(S) (WITH NO. 3 STONE) How many?______ Size? - __ EkALTERNATIVE SYSTEM ed Ir 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. e read the regulations with respect to this application and agree to ?'-�)=Idd-eby these fid I requir nts of the Town of Queensbury CQUESTIONS? CALL 761-8256 OR EMAIL rySewe. - posalfinance , desCa�Queensburv.netture of Person Responsible Date BSITE FOR MORE INFORMATIONww.gueensburV.net ,L ` r Septic Inspection Report Office No. (518)761-8256 Date Inspection uest received: Queensbury Building&Code Enforcement Arrive am/pr�,A Depart: am/pm 742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: "I�i NAME: PERMIr NO.: Z/ LOCATION: INSPECT ON: 5l i RECHECK: Comments and/or diagram Soil T Loam/Clay Type of Water: rnci al Well Water Water) a semdation distance ft. Well separation distance ft. Other wells: ft. Well Casing Length 50'+/- Y N NjA 150'to well r wired 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 Si e Type Building to tank Tank to Distribution Box Distribution Box to Field/ Pit w �` Opening Sealed: N End Cap _ A II-.00f cD Inlet/Outlet Pipes&BafflesZY Manholes 12"or less below grade _Y._ [provide extension collar if Yes 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 `jZ�r 746 /A UlL� ETU Maintenance Contract Y_N provided Location of System operty: Front Rear Left Side Right Side Middle Front Middle Rear stem Use Status Approved Partial Approved and needs to be re-Inspected, please call the Building&Codes Office Disapproved L:\Pam Whiting\2010\Building Codes Forms\Inspectlon Forms\Septic Inspecdon ReporL03 2910.doc i - II :c d ELL fj i A B - G SID ItAr A ,-T I Septic Inspection Report Office No. (518) 761-8256 Date Inspection uest received: Queensbury Building&Code Enforcement Arrive _ /pm �epart: am pm 742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: _ NAME: IIft, ? PERMTf NO.: LOCATION: GreeiNio INSPECT ON: RECHECK: Comments and/or diagram Soil TYPWSS Loam/Clay Type of Water: i Well Water Wate line se tion distance ft. aration 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 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 ETU Maintenance Contract Y_N provided Location of System on Property: ` Front Rear Left Side Right Side Middle Front Middle Rear System Use Status: roved artial Approved and needs to be re-inspected, please call the Building &Codes Office Disapproved L:\Pam Whiting\2010\Bu11d1ng Codes Foams\Inspection Forms\septic Inspecction ReporL-03 2910.doc 1 SERVICESCENTER PROJECT 73 Sheridan Street, Glens Falls,NY 12801 Phone-518-796-2515 May 9, 2011 Project# 141 Dan Drellos Sanitary Sewer Services Luzerne Road Queensbury,NY 12804 Re: Proposed Replacement Septic -Kimball Residence—2 Greenway Drive, Queensbury,NY Dear Dan: At your request we have reviewed your proposed replacement septic system design at the site of the existing 3 bedroom house of at 2 Greenway Drive in Queensbury. As per our conversation the residence has an existing failed septic system. We have reviewed the proposed replacement septic system design and we agree that a standard absorption bed is acceptable. Based upon a design flow rate of 450 GPD and a percolation rate of 1 to 5 minutes, you will need 473 square feet of absorptive-area. We recommend using a 20 ft wide by 25 ft long absorption bed with 4 — 20 foot long laterals, which will provide 500 sf of absorptive area. The absorption bed should be constructed with the existing 1,000 gallon septic tank,new distribution box,4 inch diameter perforated pipe and stone. Please feel free to contact me at 796-2515 if you have any questions and that you for your assistance with this request. Sincerely, Thomas R. Center Jr, P.E. i S FT I'th rJe leee f- bse�rve , Grtbeh ve I-sa�v-evIidencete 0 jP S.I r S._ us s w-I.IS rrcesre crr e I L,r do .u�r,eni ! a! o r pr seer that I i av e 0 �P, ,a! v n-L�. ,r,d the pis anc,s set 7c th n t! e d agr m. — SIGNd\ Uft I DA P Qla �- IM - - - 4