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2011-527 .0 '` TOWN OFQ UEENSBURY tivo 742 BayQueensbury,Road,Q eens bury,NY 12804-5902 (518)761-8201 Community Development - Building & Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE Permit Number: P20110527 Date Issued: Friday, October 21, 2011 This is to certify that work requested to be done as shown by Permit Number P20110527 has been completed. Tax Map Number: 523400-295-014-0002-014-000-0000 Location: 39 MT. VIEW Ln Owner: HARRY & CLARA LA PANN Applicant: HARRY & CLARA LA PANN • 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 '� `I .fl property owner of the responsibility for compliance with Site Plan, ; ,>;� F +r` ' 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. � ;4 TOWN OF QUEENSBURY OW 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development-Building&Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20110527 Application Number: A20110527 Tax Map No: 523400-295-014-0002-014-000-0000 Permission is hereby granted to: HARRY&CLARA LA PANN For property located at: 39 MT. VIEW 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. Type of Construction Value Owner Address: HARRY&CLARA LA PANN 39 MT. VIEW Ln Septic Alteration Residential QUEENSBURY,NY 12804 Total value Contractor or Builder's Name /Address Electrical Inspection Agency MORNING STAR SEPTIC 793-2290 744-8139 107 JEWELL Rd GANSEVOORT NY 12831-0000 Plans&Specifications 2011-527 septic alteration residential $40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Thursday, October 18,2012 (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 Town of Queensbury; Tuesday,October 18,2011 SIGNED BY Er.= � for the Town of Queensbury. Director of Building&Code En orcement Revised 41/4/2410 OFFiC�USt 0 � 1/'l � �1�E ;--- T t�9AP NO. 17j 2 / J PERMIT NOO. PERMIT FEE 1. A� APPROVALS: ZONING TOWN CLERK i-- 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: _ g, �I�..-_ INSTALLER: r. ADDRESS: 3/ /f�7t ��c ADDRESS: /0`7 .. / PHONE NOS. 1/ 0 LII S PHONE NOS. LOCATION OF INSTALLATION: 3' l/'Nt RESIDENCE INFORMATION: YEAR BUILT NO.OF X COMPUTATION = TOTAL DAILY FLOW BEDROOMS (Gallons per bedroom) GARBAGE GRINDER 1980 or older ^� X 150 = y V INSTALLED? ///O 1981-1991 X 130 = SPA OR HOT TUB 1992-present X 110 = INSTALLED? SIJ 6 PARCEL INFORMATION: ✓ TOPOGRAPHY: go.OLUNG STEEP SLOPE %SLOPE ✓ SOIL NATURE: SAND )( LOAM CLAY OTHER ✓ GROUNDWATER: AT WHAT DEPTH? 6 .14- ✓ BEDROCK/IMPERVIOUS MATERIAL: AT WHAT DEPTH? ✓ DOMESTIC WATER SUPLY: MUNICIPAL WELL (If well:water supply from any septic system absorption is: ft) ✓ PERCOLATION TEST: RATE IS PER MIINUTE PER INCH[mpg (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: /tet© 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 /VI' ft. Each trench 60 X 2 4 2. /-� ❑SEEPAGE PIT(S)(WITH NO.3 STONE) How many? Size? 0 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 requi --• ents of the Town of Queensbury QUESTIONS? CALL 761.8256 OR EMAIL Sanitary Sewage Disposals di.nce. codesaqueensburv.net = /( VISIT OUR WEBSITE FOR MORE INFORMATION t__tet i Signature of Per i Responsible Date www.queensburvnet Town of Queensbury* Community Development Office*742 Bay Road, Queensbury NY 12804 /1 LC,/ r • Septic Inspection Report Office No. (518)761-8256 Date Inspection request received: Queensbury Building&Code Enforcement Arrive: am/pm DDDeepart: / i �.. am/pm 742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: �C I NAME: ZZ-1, Pt��(11 j PERMIT NO.: //- 2 LOCATION: 3 RECHECK: � 7� j r�' a t`1- INSPECT ON: 0-1 7// Comments and/or diagram Soil Type: t:., • Loam/Clay Type of Water: Cnid Well Water Waterline separation distance ft. -- Well separation distance Other wells: ft. Well Casing Length 50' +/- Y N N/A [150'to well required if NO] 11 Absorption Field: Total length le, ft. Length of each trench e 0 ft. Depth of trenches '2 '-Ir- ft. `2.62 5 Iv Size of Stone Seepage Pits: Number Size: x Stone Size: Piping Size Type Building to tank tt Tank to Distribution Box Distribution Box to Field I Pit , 'L` _ h Opening Sealed: ._N End Cap _ye_N Inlet/Outlet Pipes&Baffles _ZY — Manholes 12"or less below grade Y [provide extension collar if Yes] Y Location/ Separations Foundation to tank ft. Foundation to absorption a k ft. Separation of Pits tetk- Conforms as per Plot Plan Engineer Report and As-Built Y_N ETU Maintenance Contract _Y_ N provided Location of System • Property: Front Rear Left Side Right Side Middle Front Middle Rear m t r: Approved Partial Approved and needs to be re-inspected, please call the Building&Codes Office Disapproved L:\Pam Whiting\2010\Building Codes Fomis\Inspectlon Forms\Sept c Inion Report.03 29 10.doc (.1 c;i • • 6 01 711 'T g CI co co 2 1 .1•E M >.- II .......--...0.—- al q til - ----" 14 ? 0 ••••1 •--, (Z., o E — r-- a 01 E co 00 D • Lh cv f- -... 0 05 c0 ..,sak c I. Q 0 z ,..9 .e a 8 -• — I A Iii > o (1) •.* 0 > 4'. \ _frt. is co 0 D w c733 ‘41 ..c• % 0-- ti•g 1-- al C6 o 3 111 iii IS _ a a „it , a EE ..s <- •-.0...-k- W ----- I . 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