2010-548 TOWN OFQ UEENSBURY
742 BayRoad,Queensbury,NY 12804-5902 (518) 761-8201
Q r3',
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20100548 Date Issued: Wednesday, December 15, 2010
This is to certify that work requested to be done as shown by Permit Number P20100548
has been completed.
Tax Map Number: 523400-252-000-0001-075-001-0000
Location: 2999 DUNHAMS BAY
Owner: CAPITAL REGION PROPERTIES, LLC
Applicant: CAPITAL REGION PROPERTIES, LLC
This structure may be occupied as a:
Septic Alteration Commercial
By Order of Town Board
TOWN OF QUEENSBURYf
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
eak,
ION 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20100548 Application Number: A20100548
Tax Map No: 523400-252-000-0001-075-001-0000
Permission is hereby granted to: CAPITAL REGION PROPERTIES, LLC
For property located at: 2999 DUNHAMS BAY
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: CAPITAL REGION PROPERTIES, LI
1754 CENTERAL Ave Septic Alteration Commercial
ALBANY,NY 12205-0000 Total Value
Contractor or Builder's Name /Address Electrical Inspection Agency
Plans&Specifications
2010-548
SEPTIC ALTERATION COMMERCIAL
$35.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday,November 18,2011
(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 own o Queetl butt', :"/Thursday,November 18,2010
f r' s
SIGNED BY ... ",� for the Town of Queensbury.
Director of Building&Code Enforcement
For an EPA homeowner's guide: httD://www.ena.gov/npdes/nubs homeowner •uido c ___t� ize.•df
OFFICE USE ONLY I L. � "ft' `i, .
•
TAX MAP NO. / PERMIT NO. /C. -5-4/YPERMIT FEE ,mo
j q t1�1�;. _
TOWN CLERK
APPROVALS: ZONING � Vis. rr L
T.UWI1111: Iv;BURY
BtJILQI�iC
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PE
A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJECT TO REVIEW BEFORE ISSUANCE OF A VALID
PERMIT.
OWNER: Capital Region Properties, LLC INSTALLER: IBS Septic & Drain Service
ADDRESS: 1754 Central Avenue. Albany, NY ADDRESS: 2 Lower Warren, Queensbury, NY
PHONE NOS. 785-4156 PHONE NOS. 798-8194
LOCATION OF INSTALLATION: 2999 State Route 9L
RESIDENCE
YEAR BUILT NO.OF X COMPUTATION= = TOTAL DAILY FLOW INFORMATION:
BEDROOMS
1980 or older II X 150 gallon per bedroom = 0 GARBAGE GRINDER
INSTALLED?
1981 -1991 II X 130 gallon per bedroom = 0
1992-present J X 110 gallon per bedroom = 0 SPA OR HOT TUB
INSTALLED?
PARCEL INFORMATION:
✓ TOPOGRAPHY: FLAT ROLLING STEEP SLOPE SLOPE<7° %
✓ SOIL NATURE: SAND X LOAM CLAY OTHER /
✓ GROUNDWATER: AT WHAT DEPTH? 2'LI BEDROCK/IMPERVIOUS MATERIAL: AT WHAT DEPTH?
✓ DOMESTIC WATER SUPLY:/ >1 a
MUNICIPAL WELL (If well:water supply from any septic system absorptionis:( ft)
✓ PERCOLATION TEST: RATE IS 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).
TANK SIZE: 261-1) 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: /?7�� r,( SF
El ABSORPTION FIEtS (WITH NO. 2 STONE) Total length '`I��' Each trench X
o 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.
I have read the regulations with respect to this application and agree QUESTIONS? CALL 761-8256 OR EMAIL
to abid- . these -•d all requirements of the Town of Queensbury codeS( queensburv.net
Sanita k Sewage Dis,osal Ordinance.
VISIT OUR WEBSITE FOR MORE INFORMATION
Ar /A 11 t 7 10 www.aueensburv.net
ature of -ers• Responsible Date
Town of Que nsbury• Community Development Office • 742 Bay Road, Queensbury, NY 12804
•
STATE OF NEW YORK
DEPARTMENT OF HEALTH
110:111COP -
Glens Falls District Office
77 Mohican Street Glens Falls,New York 12801 (518)793-3893 Fax(518)793-0427
• Richard F. Daines,M.D. James W.Clyne,Jr.
Commissioner Executive Deputy Commissioner
10/14/10
Thomas Jarrett, P.E.
Jarrett Engineer, PLLC
12 East Washington Street
Glens Falls, NY 12801
Re: Letter of Approval •
Dunhams Bay Lodge, DOH Facility No. 56-6810
Town of Queensbury, Warren County
Dear Mr. Jarrett,
We have, this day, approved the plans for a replacement commerical septic system at the D
Dunhams Bay Lodge in the Town of Queensbury. The approved design is described on plans
designed by your office, titled Dunhams Bay Resort, North Lodge System, and most recently
revised October 4, 2010. This approval is conditioned on the following:
• Construction is completed according to the approved plans.
• Construction is inspected by a design professional. When complete, construction is certified by
a design professional that the project was built according to the approved plans. This
certification shall be provided to the Department of Health and the local code enforcement
office.
• Construction shall be completed within two years of this.approval date. After that time, any time
extension for construction must be approved by-the Department of Health.
The responsibility for the design of the sanitary system lies solely with the design professional
and the proper operation of the sanitary system lies solely with the owner. The purpose of the
Department of Health review is for compliance with the New York State Sanitary Code and in no
way guarantees proper system operation.
Enclosed you will find three sets of the approved plans. Please forward copies of the approved
plans to the owner/applicant, Town of Queensbury Department of Buildings and Codes. One
set of the plans will remain on file in the Glens Falls District Office. Please contact me if you
have any questions.
Respectfully,
•
itawS6r
Mike Shaw,
Public Health Engineer II
c: Owner/Applicant
Town of Queensbury Code Enforcement
DEC Region 5, Warrensburg
Anita Gabalski, DOH
Gregg Reynolds
•
Septic Inspection Report
Office No. (518) 761-8256 Date Inspection request received:
Queensbury Building&Code Enforcement Arrive: am/ iti–Depart: am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: `4)
fi w / ,) - s
NAME: k. �iv\ >� , ��!' PERMIT NO.: I:e,.�!
LOCATION: %j .594 cA:Tie. tL INSPECT ON: - L
RECHECK:
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'+/- 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. ` �` n� ' –"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 S us:
71 Approved
Partial Approved and needs to be re-inspected, please call the Building&Codes Office
Disapproved
L:\Pam Whiting\2010\Building Codes Forms\Inspection Forms\Sept c Inspection Report_03 29 10.doc
•
JARRETTEngineers, PLLC Civil&Environmental Engineering
December 15,2010
Mike Shaw,Public Health Engineer II
New York State Department of Health
Glens Falls District Office
77 Mohican St.
Glens Falls NY 12801
Re: Dunham's Bay Resort—North Lodge Wastewater System
NYSDOH Facility#56-6810
JE 06-100.06
Dear Mike,
This letter is to certify that representatives from this office visited the site numerous times
during construction of the wastewater system. Based on our observations, we believe
that the system was constructed substantially in conformance with plans prepared by this
office and approved by the NYS Department of Health.
If you have any questions,please do not hesitate to contact us at 792-2907.
Sincerely,
JARRETT Engineers, PLLC
ftti,
H. Thomas arrett,P.E.
Principal
C o.':-. Michael Dauphinais,NYSDEC Warrensburg
Dave Hatin, Town of Queensbury Building&Codes
Alan Goldstein,Dunham's Bay Resort
Bill Sherman, Dunham's Bay Resort
F:IDataFile12006 Projects12006 Commercia1106-100 Dunhams Bay106-100.06 Lodge WWITechnicall Work Docs106100.06101208
Lodge WWCertification.doc
12 Fast Washington Street 518-792-2907
Glens Falls, NY 12801 Fax 798-1864
514(
Septic Inspection Report
Office No. (518)761-8256 Date Ins request received:
Queensbury Building&Code Enforcement Arrive ic am/,u Depart: am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: 1
5___4 -
NAME: � �' 1 _ _ ;Zs PERMIT NO.:
LOCATION: -� 7 `7' !` /r�,-� r� INSPECT ON: /" . - — "Cir
RECHECK:
Comments and/or diagram
Soil Type: Sand/ Loam/Clay
Type of Water: Municipal/Weil 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] Y N
Location/ Separations
Foundation to tank ft.
Foundation to absorption ft.
Separation of Pits ft. ,� �' r / f � --�
Conforms as per Plot Plan _Y N / .�/ ' /�� �r`` ''�
Engineer Report and As-Built _Y—N r f
ETU Maintenance Contract Y N /Ae j l iA4 c5 J t if Tra
provided /L
"i 1YRT
Location of System on Property:
Front Rear Left Side Right Side Middle Front Middle Rear
System Use Status:
Approved
/
I Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
L:\Pam Whiting\2010\Building Codes Forms\Tnspectlon Forrns\Septic Inspection Report_03 2910.doc
Septic Inspection Report
Office No. (518)761-8256 Date Inspection request received:
Queensbury Building&Code Enforcement Arrive: am/ n Depart: am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: ��
NAME: J)i.'t\/\ j�� 5 / � PERMIT NO.: -
LOCATION: -2.?? /� _ ye,)
% `� f�fz 1 f;.�f-�, `�� INSPECT ON:
RECHECK:
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 NOl
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 0
Building to tank E c it o�t i/ 6 '
Tank to Distribution Box
Distribution Box to Field/ Pit 46,ih,e f•- /�►' e j,,t.f'
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 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 ,n j ,,L9r..- . O,,l7
L:\Pam Whiting\2010\Building Codes Forms\Inspection Forms\Sepdc Inspection Repoit_03 29 10.doc
JARRETT Engineers, PLLC
Civil&Environmental Engineering
Report Of Construction Observation
Project: Dunhams Bay Date: 11/08/10
Client: Project#JE 06-100.06
Location: Route 9L Queensbury
Contractor: IBS Septic
Subcontractor: Utopia Precast
Weather Conditions: Temp.:
Labor and Equipment(on-site working):
Work performance(location, nature of work,work in progress/work completed):
Reviewed the recently poured Siphon chamber. The 3" holes were formed in the ends of
the structure. A 6" hole was formed in the side of the structure. The elevation of the 6"
hole was near the top of the sidewall, which may require the tee to be modified when
installed in the tank.
Three access ports were formed into the cover.
Photo's were taken and are in the file.
_Report continued on Back
Report Prepared by: Peter L. Beecher 11/08/10
(name/position) (date)
Copies to:
12 East Washington Street-Glens Falls, NY 12801
518-792-2907/518-798-1864 Fax
JARRETT Engineers, PLLC
Civil& Environmental Engineering
Report Of Construction Observation
Project: Dunhams Bay WW Date: 11/15/10
Client: Project#JE 06-100.06
Location: Route 9L Queensbury
Contractor: IBS Septic
Subcontractor:
Weather Conditions:
Labor and Equipment(on-site working):
Work performance (location, nature of work, work in progress/work completed):
Met with Butch Bell, IBS septic to review system layout, and locations for the silt fence
and proposed stormwater diversion swale.
Stripping and storing of the topsoil was to be performed after the installation of the silt
fence.
Butch was going after silt fence when I left the site (approx. 11:30 am).
Report continued on Back
Report Prepared by: Peter L. Beecher 11/15/10
(name/position) (date)
Copies to:
12 East Washington Street-Glens Falls, NY 12801
518-792-2907/518-798-1864 Fax
Dunham's Bay Resort 11/16/10
JE 06-100.06
Notes from a site visit drive by of the Dunham's Bay Lodge wastewater construction
project on Tuesday morning the 16th of November at 7:15 am. Site fence had been
installed yesterday by IBS and it looks effective, however we haven't had any rain yet.
No construction on the system has started.
F:1DainFile'2006 Projecls12O06 Commercial'06-100 Diun/uams 13ar'.06-/0206 Lodge WireorrespISeni lienrs06100.06 101116 Drive
By Noles.doc
JARRETT Engineers, PLLC
Civil&Environmental Engineering
Report Of Construction Observation
Project: Dunhams Bay Date: 11/22/10
Client: Project#JE 06-100.OQ
Location: Route 9L,Queensbury
Contractor: IBS Seotic
Subcontractor:
Weather Conditions: Temp.:
Light rain
Labor and Equipment(on-site working):
Foreman
1 Laborer
mini excavator
Dump truck hauling sand
Work performance(location. nature of work,work In progress/work completed
Review installed septic tank, siphon chamber,"D"box,and related piping.
Placing granular fill beneath the proposed leach beds.
_Report continued on Back
Report Prepared by: Peter L. Beecher 11/22/10
(name/position) (date)
Copies to:
12 East Washington Street-Glens Falls,NY 12801
518-792-2907/518-798-1864 Fax
•
Dunham's Bay Resort 11/24/10
JE 06-100.06
Notes from a site visit to the Dunham's Bay Lodge wastewater construction on
Wednesday,November 24th,2010 at 7:15. No one was working yet but 9 of the 10
laterals and the two beds had been laid out. No back fill has been placed yet and they are
nearly flat as directed yesterday to Butch. In other words,they are not stepped down the
slope as much as we had originally planned for because the upper two laterals were
slightly deeper than we originally planned for due to the deepness of the gravity sewer
coming out of the building. Each lateral is 12 chambers long (Quick 4)and everything
seems to be in good shape, the property sand appears to be placed underneath the
chambers.
F:WalaFile120061'rojec1s12006 Conunercial"06-100I)unh mis Bny 106-!00 06 Lodge H'WCorresp'Seni liemsi06100.06 101124 Sue
F9si!iVoles.doc
Jarrett Engineers, PLLC
Report Of Construction Observation
h
-1)/!.7-;., Ft [. a A
Date:
Project: D nha 's Bay Resort— North Lodge Wastewater System
Client: Dunham's Bay Resort—Alan Goldstein Project# 06-100.06
Location: North Lodge WW System —West Lawn
Contractor: IBS Septic
Subcontractor:
Weather Conditions: Temp.:
J`'vtsfh/Y v/Iii[ V ;2 j -
Labor and Equipment(on-site working):
MI ai t(Av'4/we -/- 6P&
Work performance (location, nature of work, work in progress/work completed):
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(k( por'.;r a t`I') /NS Ne r'Uf-e) 6 " •/tu <:'f' 0 .5-6Y
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- -?5' AlTATifdt-V)
Report continued on Back
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Report Prepared by: `° � I
(n me/position) (date)
Email Copies to: Alan Goldsteiji;
Jarrett Engineers,PLLC
Tt\\ V--N
Report Of Construction Observation
Date: 1t J►S Jro 9'O 01-1 3 ;30 Qn
Project: Dunham's Bay Resort-North Lodge Wastewater System
Client: Dunham's Bay Resort-Alan Goldstein Project#06-100.06
Location: North Lodge WW System-West Lawn
Contractor: IBS Septic
Subcontractor: --
Weather Conditions: 3014rf,is „d< <( 6::,1 rr ()j?, 1..1,r,r#,' Temp.:
Labor and Equipment(on-site working):
e t i t twA-V014. -t t CA-00w
fi
Work performance (location, nature of work,work in progress/work completed):
t�nc Tr4i,( S T r)fV
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_Report continued on Back
_
Report Prepared by: /( - xitie 41,
(name/position) (date)
Email Copies to: Alan oldstein; ill Sherman; Dave Hatin, Tn of Qsby
Mail Copies to: Dave Hatin,.Tr of Qsby
12 East Washington Street 518-792-2907
Glens Falls,N. Y. 12801 Fax 518-798-1864
Jarrett Engineers, PLLC
Report Of Construction Observation iva3 /0
Date: 1 i/l`� 1 U Ar°.-} I, ,/ '-'1.7 /,2f ' . /k . C'6 l p �t<
Project: Dunha 's Bay Resort—North Lodge Wastewater System
Client: Dunham's Bay Resort—Alan Goldstein Project# 06-100.06
Location: North Lodge WW System —West Lawn
Contractor: IBS Septic
Subcontractor:
Weather Conditions: Temp.:ak/ArY go
6r-
Labor and Equipment(on-site working
/\-'11/,). t /., !{ 1 ; , V✓� 4_ (-e ( 6:3 r'(() ! i if / ,,/ '( !, /. -', }
likil r /i',". 4 c !<.(7 1 ) i , . :'<< ,
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,
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Gt t.t\t•W`t WI Ht1S 6(r '``=
Report continued on Back
Report Prepared by: 1411! v�A,A/t i ii``('iit.. ; l,3. 11 7 f 0
(name/position) (date)
Email Copies to: Alan Goldstein; Bill Sherman; Dave Hatin, Tn of Qsby
Mail Copies to: Dave Hatin, Tn of Qsby
12 East Washington Street 518-792-2907
Glens Falls,N. Y. 12801 Fax 518-798-1864
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Jarrett Engineers, PLLC
Report Of Construction Observation (f/�3//�
Date: 11 �% /to e 1 1 '��.c-� A t Vi
()F, %o .c Iv
Project: Du ha 's Bay Resort— North Lodge Wastewater System
Client: Dunham's Bay Resort—Alan Goldstein Project#06-100.06
Location: North Lodge WW System —West Lawn
Contractor: IBS Septic
Subcontractor: _""'_•
Weather Conditions:
f 1aL`fG >' cil,OEjoY 7i7 0°rrJ fzi r Tem .:
Labor and Equipment(on-site working):
Por(J( `K C( \fAltae. vi10 , wt.Iry
-1-- (_,n' n(1 c (2,
Work performance(location, nature of work, work in progress/work completed):
U()Ar,.; U.(',(-(i tom:0 f t) bo/- Ii i'o e t,vs f'5 r►i(4(...0 J i. {t '(L
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Report continued on Back "'DUE 'r' (',, avor DU( 7' G(Ipv,�Dwitri)t_ J
P41,Atrfj ( �) J
Report Prepared by: -- i -
--y' ' // 2S /0
' -" ( ame/position) (date)
Email Copies to Alan Goldstei , Bill Sherman; Dave Hatin, Tn of Qsby
Mail Copies to: Dave Hatin n of Qsby
12 East Washington Street 518-792-2907
Glens Falls,N. Y. 12801 Fax 518-798-1864
(ll -56) -
Septic Inspection Report
Office No. (518)761-8256 Date Inspection request received:
Queensbury Building&Code Enforcement Arrive: am/pm De art: L1\h'am/pm
742 Bay Rd., Qu sbury, NY 12804 Inspector's Initials: Cl -
1 C�`�
NAME: L j1 ' i ti � �i C-�C�G PERMIT NO.: (�� -
LOCATION: 2727 51 i`1^ INSPECT ON: / - ///L7
RECHECK: '
Comments and/or diagram
Soil Type: /Clay
Type of Water: Muniapal/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 v ft. 2—iAi it 5-
Depth of trenches ft.
Size of Stone
Seepage Pits: Number
Size: )44—
Stone
.
Stone Size:
Piping Size Type
Building to tank
Tank to Distribution Box (-I
Distribution Box to Field/ Pit N)2
Opening Sealed: • __ N
End Cap Y N
Inlet/Outlet Pipes&Baffles �_N
Manholes 12"or less below grade Y N
[provide extension collar if Yes] _ f N
Location/ Separations
Foundation to tank ft. 77-1
Foundation to absorption ft.
Separation of Pits ft. � Z
Conforms as per Plot Plan _Y N 1j'6 7
Engineer Report and As-Built Y_N 'RC "`"'
ETU Maintenance Contract _Y N
provided
Location of System on Property:
Front Rear Left Side Right Side Middle Front Middle Rear
em U .i..
a: pproved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
W Disapproved
L:\Pam Whiting\2010\Building Codes Forms\Inspection Forms\Septic Inspection Report_03 29 10.doc
C (6, S � +c/ ("IV"(
f �
Septic Inspection Report
Office No. (518) 761-8256 Date Inspection request received: ( / / i ( 0
Queensbury Building &Code Enforcement Arrive: am/pm D part: I l \ a /pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: kik
NAME: Cf1Pk 1 42C( - L'o , heS PERMIT NO.: 0 \,
LOCATION: 5Tgit Nvi 9L INSPECT ON: IV!Wf
RECHECK:
Comments and/or diagram
Soil Type: Sand/ Loam/ Clay
Type of Water: Municipal/ Well Water
Waterline .• • 'on distance ft.
We separati• distance ft.
• ,er wells: ft. '-'"�
Well Ca ng Length .0'+/ - Y N N/A "\tt .c 1C1.2;71
Absorption Field: Total - gth ft.
Length of each k :nch ft. I
Depth of tre hes ft.
Size of • one r \-71/%--tik _d --
Seepage Pits: N .-r
Si e: x
Sto - Si -: ���Z-- �U ��-�-•� �`�
Pipi g Size Type
wilding to • k
Tank to 'istribution •x
Distribution : 'x to Field Pit
-ping - led: _ _N
En, Cap _ _N �
Inlet/Outlet • •:. & •ffles Y N
Location/ -•:rations
• Foundation to tank .
Foundation to absorption
Separation of Pits ft.
Conforms as per Plot Plan T Y— N
Engineer Report and As-Built —Y N
Location of System on Property:
Front Rear Left Side Right Side Middle Front Middle Rear
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
Septic Inspection Report
Office No. (518) 761-8256 Date Inspection request received:
Queensbury Building&Code Enforcement Arrive: am/ Depart: am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials:
NAME: j)Li\ I — > PERMIT NO.: /('` 54Y
LOCATION: Z et17 c1 7<._ INSPECT ON:
RECHECK:
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 ,9
Inlet/Outlet Pipes&Baffles Y N kJ/ fir t- , s t2 cid "c�/
Manholes 12"or less below grade Y—N
[provide extension collar if Yes] Y N • ate//
Location/ Separations
Foundation to tank ft.
Foundation to absorption ft.
Separation of Pits ft.
Conforms as per Plot Plan w 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
stem se S t s:
Approved
Partial Approved and needs to be re-inspected, please call the Building&Codes Office
Disapproved
L:\Pam Whiting\2010\Building Codes Forms\Inspection Forrns\Sedc Inspection Repat_03 29 10.doc
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