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2010-429 gamiiTOWN OFQ UEENSBURY Bay Road, 742 Queensbury,NY 12804-5902 (518) 761-8201 Community Development- Building &Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE Permit Number. P20100429 Date Issued: Monday, August 30, 2010 This is to certify that work requested to be done as shown by Permit Number P20100429 has been completed. Tax Map Number. 523400-309-005-0001-022-000-0000 Location: 11 WINTERGREEN Rd Owner. MATTHEW LAFARR Applicant: MATTHEW LAFARR 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. la ti TOWN OF QUEENSBURY coro 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development- Building&Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20100429 Application Number: A20100429 Tax Map No: 523400-309-005-0001-022-000-0000 Permission is hereby granted to: MATTHEW LAFARR For property located at: 11 WINTERGREEN Rd in the Town of Queens bury,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: MATTHEW LAFARR 11 WINTERGREEN Rd Septic Alteration Residential QUEENSBURY,NY 12804-0000 Total Value Contractor or Builder's Name/Address Electrical Inspection Agency STONE INSTALLATIONS 4305 ROUTE 50 SARATOGA SPRINGS,NY 12866-0000 Plans &Specifications 2010-429 septic alteration residential $25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Friday,August 26,2011 (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 T9wi of ween 'b-uxy;t ', X I , August 26, 2010 SIGNED BY ' `" •.. ', for the Town of Queensbury. Director of Building&Code Enforcement % I ' • OFFICE USE ONLY �5 4 TAX MAP NO. PERMIT NO. /�' PERMIT FEX1) APPROVALS: ZONING TOWN CLERK 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: MA/ ll q INSTALLER: 5 4 e" TA., iai IIq ADDRESS: I I kit/in 4cr i(cc(� K O ADDRESS: "-JO 5 i f 5-o 5J 4-14101-i- / 1410 -t J r Z , PHONE NOS. PHONE NOS. a .Z op LOCATION OF INSTALLATION: I) Win 3-e( ieo NO.OF 7 RESIDENCE INFORMATION: YEAR BUILT BEDROOMS X COMPUTATION= = TOTAL DAILY FLOW GARBAGE GRINDER 1980 or older X 150 gallon per bedroom = INSTALLED? .Ale 1981 -1991 X 130 gallon per bedroom = , SPA OR HOT TUB 1992-present 3 X 110 gallon per bedroom = '� -3 o j .pQ INSTALLED? A42 PARCEL INFORMATION: ✓ TOPOGRAPHY: Flat rolling __ Steep slope %Slope ✓ SOIL NATURE: Sand N) Loam Clay Other ✓ GROUNDWATER: At what depth? ✓ BEDROCK/IMPERVIOUS MATERIAL: At what depth? ✓ DOMESTIC WATER SUPLY: Municipal X Well (If well: Water supply from any septic system absorption is ft.) ✓ PERCOLATION TEST: Rate is .S minutes 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. SYST TYPE: g_- ABSORPTION FIELD (WITH NO. 2 STONE) Total length I IC) ft. Each trench X ❑, SEEPAGE PIT(S)(WITH NO. 3 STONE) How many? Size? th 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. �►- la3 , _ rit_ Septic Inspection Report Office No. (518) 761-8256 Date Inspection request received: >/2 7 f 0 Queensbury Building &Code Enforcement Arrive: am/pm Depart:it am pm 742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: A / NAME: --t PERMIT NO.: _ I 12_61 LOCATION: IL W I nt- r f c-<c f-CI , INSPECT ON: NSI RECHECK: / Comments and/or diagram Soil Type: -:=i, Loam/ Clay Type of Water: ni is- / Well Water Waterline .-ration distance ft. Well separation distance V, ! ' ft. Other wells: ft. Well Casing Length 50' + / - Y N N/A Absorption Field: Total length ft. /4 C44- 1— 5 Z�. Length of each trench -ft. Depth of trenches .d k-'`2j ft. 2 A - -N)5 Size of Stone Seepage Pits: Number — A. , -1-) — Size: Stone Size: Piping i Type Building to tank Tank to Distribution Box Distribution Box to Field/ Pit P;y Opening Sealed: - End Cap V Y N Inlet/Outlet Pipes&Baffles Y—N �Zr ��y� j�l i�!-�• `� Location/Separations • Foundation to tank /o ft. Foundation to absorption r ft. Separation of Pits ► k Conforms as per Plot Plan _' _ N Engineer Report and As-Built Y N Location of System on Property: Front ear Left Side Right Side Middle Front Middle Rear System Use StGs: 1�/ 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 BUILDING PEPAKI MGN I Based on our limited examination,compliance with our comments shall not be construeOs /0— indicating the plans and s cifiications ark In 4tZ full compliance with the Building Codes of l New York State. _ _ _ gait 1_4.--Ft, r e''A I ..... ---, _ iilf /l t11/tei-/-r/7 ecco re). 1 .tp j L Qe4byV. 11I K / 1 �,z©y �` 1 •-t, I /�to�`�r O�rl /". f " r n. , 7 8_ 5 7/ �� 77`x-• �v "c; d mac)5. $% �>"t 1.J�'f",c:� /.�.8&:0.1-- - � 1 L E copy a I iJ,5 I Yt C )"�'G»L Cs t PIRG Ail-;/-1 P.5 C�!l � 7� O 5V?�� F � �� ��cit4 � G.(,tJ.1/Gi c•L S.S C Cw'„'"�� v-....5 , e ,.. ��� v \o 3 d,roo.� S, .✓j' L.-1- C r-z' 4)-(05 ... )4.ix.,,.;41. ...c.............................., ) + - 4,k-v, D f nt.e it./{ft/'S -Flovv rca.4--=.. -- 5 h., 1 (,fie„le- )011'' / `Kfcii/rel i +1 e t l tia. U i- — /D,3 — ; � a � 1 ?o/c1,1 i 1 i—cd,rc,-hoYt L9 ,;44 /4 ,5 14 A' 516 I 1 C '91 — j:."S4j—c' „..„c; ) V7- I f , ( ' ttt7 LL✓f I I Fiveili TOWN FL 'ti6••Y dr r/' !°'i �l',.,/,, =�',,.°.n ���; observed, or believe I saw evidence of, Reviewe if Pit :{ ',Iss, wells trees, en! eF ;&�;;t �a •► eIstr sf etc ,��,rt t/,,:tit: .7 , ,,,, ,r, di...¢.S^.E�'eF, \•`.l F..Ioil i.ne d.6!C�grain , r / '.J `,. I ANT RE DATE _ _._ r�+�t� P �` pa. n • I t I a-- cc c6 U 4t r N ',.- ': -.%,..i C KCi a -4 4 ! p.,f3vx H TA r,k0 1444.4--- i4 ! _T�1k o44ltJ - 171 .� p- (3ox lo. 12. cox - I7" • 8 TAnk_ 1,1'44' f..1- — 1-VG '' IA)(e41. -WO • 1 I(3 TA/1 e 4 a, — 11,'s., -IA) ie4. ). .j' F 4, • EA/Owl- - G� 0060-1 -- 61' • P o r c Civ . ,. .2 - (7 ' riv0(A ,- 6? ' • " 1 i • h.:x(14-ec J A, ten • i40 kg; •