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2010-485 f i 106` TOWN OFQ UEENSBURY 742 Bay y R oad,Queensbury,NY 12804-5902 (518) 761-8201 Community Development- Building &Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE Pe 't Number: ,P20100485 Date Issued: Monday, October 18, 2010 This i to certif3'that work requested to be done as shown by Permit Number P20100485 has b en completed. Tax Map Number. 1 523400-301-017-0001-041-000-0000 Location: 528 WEST MT. Rd Owner. DONALD & JOYCE LATTERELL Applicant DONALD & JOYCE LATTERELL 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 thek"--- 1 Jroperty owner of the ilesponsibility 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 br Zoning Board of Appeals. ��` TOWN OF QUEENSBURY s 1E7 1 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development- Building&Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20100485 Application Number. A20100485 Tax Map No: 523400-301-017-0001-041-000-0000 Permission is hereby granted to: DONALD &JOYCE LATTERELL For property located at: 528 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: DONALD &JOYCE LATTERELL 528 WEST MT. Rd Septic Alteration Residential QUEENSBURY, NY 12804 Total Value Contractor or Builder's Name/Address Electrical Inspection Agency Plans &Specifications 2010-485 septic alteration residential PERMIT FEE PAID- THIS PERMIT EXPIRES: $25.00 Thursday, October 06, 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 Toeensb ii sda , October 06,2010 SIGNED BY 14 for the Town of Queensbury Director of Building& •de E orcement y �I ECEQWEO Community Development Office _ 1 1("T 0 4 2U10 Town of Queensbury • 742 Bay Road • Queensbury, New Yo'k • gq,.�,,, WN OF QUEENSBURY BUILDING& CODES Office Use Only �j (TAX MAP NO. ^��` 0 7PERMIT NO. L' ,;}- PERMIT FEEis APPROVALS: ZONING __ ___ TOWN CLER APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT: A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJECT TO REVIEW FORE ISSUANCE FA VALI PERMIT. r OWNER: , IL/X ) &a it C-jLt_tL- INSTALLER: 1 ADDRESS: 2. _ 7 J Al22Sa—Irr-0 l� /i�J ADDRESS: t0 J X34- 1` - T / PHONE NOS.742— l / PHONE NOS.-_[C�r C)F-��__ LOCATION OF INSTALLATION: J 2 1 W. F J/CS/i PIA-) j RESIDENCE INFORMATION: NO.OF COMPUTATION YEAR BUILT X = TOTAL DAILY FLOW BE/DOOMS (Gallons per bedroom) GARBAGE GRINDER_ 1980 or older X 150 = 600 INSTALLED?___ 1981 -1991 X 130 = SPA OR HOT TUB l� 1992-present X 110 = INSTALLED? PARCEL INFORMATION: ✓ TOPOGRAPHY: FLAT ROLLING STEEP SLOPE %SLOPE ✓ SOIL NATURE: SAND_! LOAM_____ CLAY OTHER I GROUNDWATER: AT WHAT DEPTH? ✓ BEDROCK/IMPERVIOUS MATERIAL: AT WHAT DEPTH? ✓ DOMESTIC WATER SUPLY: MUNICIPALELL_ _(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:1_00° 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 1 SEEPAGE PIT(S) (WITH NO. 3 STONE) How many? 2- Size?I c_ t- r-�_ ❑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 by these --• -II requir-ments of the Town of Queensbury QUESTIONS? CALL 761-8256 OR EMAIL an'ary Sewa,e Ni-.osal r, Hance. codes(alqueensbury.net /80/3 gnature of Pers n Responsible Date VISIT OUR WEBSITE FOR MORE INFORMATION www.queensbury.net Septic Inspection Report Office No. (518) 761-8256 Date Inspection req -� - -d: Queensbury Building &Code Enforcement Arrive: \ 5h a- I�uj 'depart: 7,_!, tl% amiJ 742 Bay Rd., Queensbury, NY 12804 Inspector's Initials. NAME: ‘- �-Tgat 1_ PERMIT MIT NO.: i G —1--I R� LOCATION: 57 9 v.jT CAC t RC) INSPECT ON: 1(>-- l W HL RECHECK: _,/ Comments and/or diagram Soil Ty. : Sa.■.A oam/ Clay Type of Water: Ilauti6l1PWell Water ,t,.,.�� Water) .e _.-• : ion distance Fa 1;T' 1' fm. 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 Seepage Pits: Number z-_ Size: ? x 10 Stone Size: -' Piping Size Type Building to tank LI 'i '1C,i-\ '-{G Tank to Distribution Lia ' ` . _, Distribution Box to Field it l t) `) 312, Opening Seale : End Cap Y N Inlet/Outlet Pipes&Baffles „N Location/ Separations Foundation to tank Ce . Foundation to absorption U . Separation of Pits ft. Conforms as per Plot Plan Y_-__N Engineer Report and As-Built _Y_ N Location of System on Property: Front Rea, Left Sid Right Sid Middle Front Middle Rear Ss - - ., . 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 I() 74' Lrf 6.-07 Septic Inspection R- • •rt Office No. (518) 761-8256 Date In pection - •u- , r- -' ed: /a/I 3V��g Queensbury Building &Code Enforcement Arrive: •% am/p •.-•.It: \ arum 742 Bay Rd,Q�Q'ueensbury, NY 12804 r Inspector's I 6. -• N ivs „Lai- `y v ER IT NO.: Ci/D- i f 85.5 LOCATION: W-UL,1 °L"/14 l/ INS•ECT ON: 76,4 lc }lye,0 RECHECK: Comments and/or diagram Soil T •-• ,,u,: .. +.m/Clay Type of W. -r: Munic% , ell Water Water me separation distance c?--c,;€ '1,,,\E7ft. 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. AV Size of Stone Seepage Pits: Number Size: x !�% t � Stone Size: _7 qecA\e-c- 2-' /`" Piping Size Type Building to tank 4�' y i Tank to Distribution -- '1 R-n� 77 A` h "N � Cl" Distribution Box to Field Pt t.'' bc) e. � � Opening Y_ _N End Cap _N Inlet/Outlet Pipes&Baffles _1(„),____N Manholes 12"or less below grade Y_N [pro e e ] -__..-Y—.N Location/ Separations I� Foundation to tank x.11, `ft. Foundation to absorption ) ft. -- ' VT 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 Si Middle Front Middle Rear System Use Statu . 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\Septic Inspection Report_03 29 10.doc I tit t • . t 1 2,..... 1 :2' ._ :I1/4\. ........ .9.. ......."-'! ''' f , 1 t TOWN OF QUEENSBURY BUILDING DEPARTMENT Based on our limited examination,compliance with our comments shall not be construed as indicating the plans and specifications are in • ;',.? ..( / full compliance with the Building Codes of New York State. .•2 ,'}' . , . ,., \ I , . , THIS PLAN TO BE ON PROJECT SITE AT ALL TIMES FOR THE DURATION OF ;-.i ..,..,-. N.' r'+' CD ...Cl. ' "1 i CONSTPUCT!ON / ,/i---.: 1 —. ' ',.- '"a•;,../I. .. --t l< t C, s 0 CD . , .r- fr, , I! i , .,.,.....-,--,„..„----,........,...,..,... 1 1 -T----- 12, i i/ ly.\W) kc-A ([,Tye t I 21 TOWN OF QUEENSBURY/ r BUILDING DEPARTMENT , 23 Based on,our limited examination,'compliance with aur comments shall not tie construed as 2*0 1 -;:i--T-.7i indicating,the plans and specifications are in full compliance with the Building Codes of -i :�s a, New York State. ' 1 _j : I ct, G � y , , r 1 ' a i C.a,,.',Ch y, r n CC • �1 1 t 11 C r,r) il ,\ r <4 t4 V `1 Q�pT.ic�a_,j Cf' r' "•, • r" 14N ii r. I Fi + _ ' _ J. /7