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2011-344 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: P20110344 Date Issued: Tuesday, July 19, 2011 This is to certify that work requested to be done as shown by Permit Number P20110344 has been completed. Tax Map Number: 523400-316-014-0001-002-000-0000 Location: 338 BIG BOOM .Rd Owner: JOHN& SUE LANGDON Applicant: JOHN & SUE LANGDON 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: P20110344 Application Number: A20110344 Tax Map No: 523400-316-014-0001-002-000-0000 Permission is hereby granted to: JOHN & SUE LANGDON For property located at 338 BIG BOOM 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. T_we of Construction Value Owner Address: JOHN& SUE LANGDON Septic Alteration Residential 338 BIG BOOM Rd Total Value QUEENSBURY,NY 12804 Contractor or Builder's Name/Address Electrical Inspection Agency SANITARY SEWER DAN DRELLOS PO BOX 224 GLENS FALLS NY Plans&Specifications 2011-344 septic alteration residential $40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Wednesday,July 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 Tov day yJuly 18,2011 SIGNED BY c for the Town of Queensbury. Director of Building&Code Enforcement p E IE0 [ Community Development Office JUL 15 ZQ„ Town of Queensbury • 7.42 Bay Road • Queensbury, New Yor •1 OF QUEENS13URY BUILDING Office Use Only 6/ TAX MAP NO.3 PERMIT NO. PERMIT FEE APPROVALS: ZOMN0 TOWN CLERK APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT: A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJECT TO REVIEW FORE ISSUANCE OF A VALI -PERMIT. OWNER: Ty �VV, �9-s� INSTALLER: t r Z. �C�/LNLc ADDRESS: ADDRESS: P z,(� PHONE NOS. 9� S�- -7 .� b PHONE NOS. 7 96 LOCATION OF INSTALLATION: RESIDENCE INFORMATION: NO.OF COMPUTATION YEAR BUILT X = TOTAL DAILY FLOW BEDROOMS Gallons per bedroom GARBAGE GRINDER 1980 or older X 150 = INSTALLED?_ 1981-1991 X 130 = SPA OR HOT TUB L 1992-present i X 110 = To INSTALLED?. PARCEL INFORMATION:. ✓ TOPOGRAPHY: G FLAT ROLL STEEP SLOPE %SLOPE ✓ SOIL NATURE: SAND LOAM CLAY OTHER ✓ GROUNDWATER: AT WHAT DEPTH? S ✓ BEDROCKIIMPERVIOUS 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[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: 0c3 O 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: / o ABSORPTION FIELD(WITH NO.2 STONE) Total length ft. Each trench X ❑SEEPAGE PIT(S)(WITH NO.3 STONE) .How many? Size? ❑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. have read the regulations with respect to this application and agree to by thAes011 requir ents of the Town of ueensbury QUESTIONS? CALL 761-8256 OR EMAIL ary Sposal finance. codesCaD-gueensburv.net VISIT OUR WEBSITE FOR MORE INFORMATION fig ature of Pe on Responsible Date www.gueensbury.net � i Septic Inspection Rep Office No. (518)761-8256 Date Inspection v : Queensbury Building&Code Enforcement Arrive: epart: = r 742 Bay Rd., Queensbury, NY 12804 Inspector's In NAME: —L pta��1 PE NO.: LOCATION: ] (�,��,t`�r_�_�_ _ �C� IN Cr ON: V�l—1 RECHECK: Comments and/or diaciram Soil Ty m Clay Type of Wat uni ' II Water J. Waterfl—na-c-pparation 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 MOD ft. Length of each trench q0)A7)ft- Depth of trenches ` ft. Size of Stone Seepage Pits: Number Size: x Stone Size: Piping Size Type Building to tank N% Tank to Distribution Box Distribution Box to Field/ Pit t k Opening Sealed: N End Ca N Inle Outlet Pipes&'Baffies N Manholes 12"or less below grade _N [provide extension collar if Yesl Y N Location Separations Foundation to tank ft. Foundation to absorption 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 SystFonerty: Front Side Right Si addle Front Middle Rear stem se S Approved Partial Approved and needs to be re-inspected, please call the Building &Codes Office Disapproved L:\Pam Whiting\2010\13uilding Codes Forms\Inspec ion Fomis\Septic Inspection ReporL03 2910.doc SBCIOPV,JN : - - ha seen-�r bserved,_er believe ! saw euid . +. . f _ �. a 97 i is{! a{�3^�js siaci�iti ie!!ses, N�eNs; trees, fen es, ?:. " ✓ ( i� �i shovr''.' Cf This sir 4J ''l�i. { !) ��! �n S ,f ' ? gra l 7;pr�r ,?_f 1 I ;: �� u IINI ;tnijtr '9J `:.,. .:? 4C YY • � y r �;;-,s '�;F {;:,`ATE : < i JIL : , : : f G I i I : I ' : i : ! i I i --- <+ i , t 1 r I —) " ' 9 4 -- - - -1 • � 1 1 I i I i Septic Inspection Report Office No. (518)761-8256 Date Ins � > on req iv Queensbury Building&Code Enforcement Arrive: �� a p rt: am/pm 742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: -- NAME: IT NO.: _ l l LOCATION: 1 V) INSPECT ON: RECHECK: Comments and/or diagram Soil Type: Sand/ Loam/Clay Type of Water: Municipal Well Water t� �� LC) separation distance ft. Well separation distance ft. v \� `,� 6 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 Ca _Y_N Inle Outlet Pipes&BafFles Y N Manholes 12"or less below grade Y_ N [provide extension collar if Yes Y N Location I 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: Approved Partial Approved and needs to be re-inspected, please call the Building&Codes Office Disapproved L:\Pam Whiting\2010\13uilding Codes Forms\Inspection Fomis\Septic Inspection Report-03 2910.doc