2010-522 ..41" TOWN OFQ UEENSBURY
Foyo742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development- Building &Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number. P20100522 Date Issued: Tuesday, November 02, 2010
This is to certify that work requested to be done as shown by Permit Number P20100522
has been completed.
Tax Map Number: 523400-289-009-0001-062-000-0000
Location: 345 GLEN LAKE Rd
Owner: TAVIS & ASHLEY LEOMBRUNO
Applicant TAVIS & ASHLEY LEOMBRUNO
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
3. 4I "" 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20100522 Application Number. A20100522
Tax Map No: 523400-289-009-0001-062-000-0000
Permission is hereby granted to: TAVIS &ASHLEY LEOMBRUNO
For property located at: 345 GLEN LAKE 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: TAVIS &ASHLEY LEOMBRUNO
345 GLEN LAKE Rd Septic Alteration Residential
QUEENSBURY,NY 12804-0000 Total Value
Contractor or Builder's Name/Address Electrical Inspection Agency
QUEENSBURY SEWER
JAY SWEET
Plana &Specifications
2010-522
septic alteration
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Saturday, October 29,2011
(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 To f Quee ury 'r',,l a I ctober 29,2010
SIGNED BY 1 4 for the Town of Queensbury.
Director of Building&Code Enforcement
`>' ?-- / -6L___'
J. _ j OFFICE USE ONLY ----• -----••--•.--
TAX MAP NO. t� /�—___ _�—��ER p
LS �^ C��[1 V IS
PERMIT NO. „ ,
MIT FEE c___.c -i
APPROVALS: ZONfNG —'—"—
TOWN CLERK nu 2 8 1010
SEPTICD- •--__-_.-.•______________ _ ,�8 �� X•
APPLICATION FOR
A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS.AI SPOSAL SYSTEM P ;. -.UIL°1NG &c�DEs
PERMIT. —� PPLICATION IS SUBJECT TO REVIEW BEFORE ISSUANCE OF
A VALID
:�i
OWNER: �'�l US'/ ,.
rf ,-.•, ei
INSTALLER: e, . /
ADDRESS: '3 G!E v( A
�,-(ADDRESS: Ab y
PHONE NOS. ��4 d / G
PHONE NOS.
LOCATION OF INSTALLATION:
YEAR BUILT NO.OF
BEDROOMS X COMPUTATION= = TOTAL DAILY FLOW RESIDENCE INFORMATION:
1980 or older X 150 gallon per bedroom
1981 •1991 = `7�. GARBAGEAGRINDE
X 130 gallon per bedroom INSTALLED?�_
1992-present =
X 110 gallon per bedroom = SPA OR HOT TU
PARCEL INFORMATION: INSTALLED?
✓ TOPOGRAPHY:
Flat rolling Steep slope o
✓ SOIL NATURE: /,Slope_
Sand_ Loam__
,f GROUNDWATER: Clay Other
At what depth?
✓ BEDROCK/IMPERVIOUS MATERIAL:
At what depth?,_______
✓ DOMESTIC WATER SUPLY:
Municipal Well
(If,well: Water supply from any septic
✓ PERCOLATION TEST: Rate is system absorption is--__ft.)
r
per minute per inch.
(Test to be completed by a licensed professional engineer or architect.
PROPOSED SYSTEM FOR NEW CONSTRUCTION: All individual sewage disposal )
9 systems must be designed by
a licensed professional engineer or architect(unless installed in a Plannin Board
TAN_K SIZE: ES r. 9 approved subdivision).
— 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 2P ft. Each trench_ X it
❑ SEEPAGE PIT(S) (WITH NO. 3 STONE)
How many?
❑ ALTERNATIVE SYSTEM BSize?
Bed or other type?
❑ HOLDING TANK SYSTEM Total required capacity?
Tank size? Number of tanks?_ _________
" NOTE: ALARMSYSTEM
AND ASSOCIATED
APPROVED ELECTRICAL INSPECTION AGENCY.ELECTRICAL WORK MUST BE INSPECTED BY A T
.. .......:...... .......... .::.:.......::..:....:..:.. PLEASE REVIEW LIST PROVIDED. OWN
For your protection, lease
p notethat pursuant Section 136-29 of the Code of the Town of Quear,eni.,„
permit or approval granted which is basededupon
or is rirnn+es,i :. __,._
failure to Malec, .......__._, .
R.
Septic Inspection Report
Office No. (518) 761-8256 Date Inspection request received:
Queensbury Building&Code Enforcement Arrive: am/pm Depart:0 i a) am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: e"
NAME: tikg),Aqb PERMIT NO.: .r 10 �2 2
LOCA ION:. 21 ( 2" / INSPECT ON: to/ --t/j
RESoil Type: Comments and/or diagram
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 �� f i
Absorption Field: Total length ft.
Length of each trench ft.
Depth of trenches ft. -1-31/4)1 h./
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
Location/ 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
Location of System on Property:
Front Rear Left Side Right Side Middle Front Middle Rear
System Useus:
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
s V0 //. • i 1 4
Or 7l U• \------p---_
SI' 4i 3
\\.,/\&'� 'i T"%, 24_1 ' t N �, t vt�- if `J%i7.2' " 2.4, ti �7 ��
J LV )
'Ito ' /': ''' '' . 'T-LI-I.-131,\L*, I
t., w
a'
.4�: I , + o z
40 i
7 i ' i ` KFC \�,� r ^ ,tb
•
41/
_44*
•
%�`�.�o '.� -q--�',-:-'-:w'7, N� lam`.
461 F'� t*: a ".7 ,i
�o
t - .,,4
// . , : ,�C(�' O�' (-0
' �� `c�= �-t ' Iv. �t-0Rc c� LGA ` .
LS/I'OSU6/O 1Fi - i��"L Ii �n t!�°�•e.,1 k;,.,p �/�` # {W�� �'7�\
ALL RIGHTS RESERVED. COPY OR REPRO- DETAIL OF LOT FOR
ABL SURVEYING, I'LLC DUCTION OF THIS PLAN OR ANY PORTION TAVIS LEOMBRUNO
E. MONTENA, SURVEYOR THEREOF IS PROHIBITED WITHOUT THE
P.O. BOX 391 WRITTEN PERMISSION OF THE SURVEYOR. AND ASHLEY LEOMBRUNO
UNAUTHORIZED ALTERATION OR ADDITION TO A
5023 LAKE SHORE DRIVE SURVEY MAP BEARING A LICENSED SURVEYORS SEPTEMBER 14, 2010 SCALE 1" =20'
BOLTON LANDING NY 12814 SEAL IS A VIOLATION OF SECTION 7209,
SUBDIVISION 2 OF THE NEW YORK STATE TOWN OF QUEENSBURY, WARREN COUNTY,
518-644-3910 EDUCATION LAW. NEW YORK
11 : 3Cja
Septic Inspection Report
Office No. (518)761-8256 Date Inspection request received: 16 Ja-7/ ib
Queensbury Building&Code Enforcement Arrive: am/pm Depart: am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials:C
NAME: ' Sw 'f 2 Leon/or-1,0\0PERMIT NO.• " �ezill ! r ,"0 "-s
LOCATION: 3-{-5 6 L&Lac INSPECT ON: L01 .): i v
RECHECK:
�� Comments and/or diagram
Soil Type* i•�' oa. a
Type of Water: Municipal/ Kfl",, • .-
Waterline separation distance ft. '( 1
Well separation distance (c2 4 ft.
Other wells: ft. 3(4 _ T��
Well Casing Length 50' +/- Y N N/A
[150'to well required if NO]
Absorption Field: Total length ft. ,Q
Length of each trench ft. - Z�' 45
Depth of trenches '2 t- ft.
Size of Stone .
Seepage Pits: Number pfer___
Size:
Stone Size:
Piping Size Type
•
Building to tank 1 ` ZreAk i.—)C� —
Tank to Distribution Box VI - -3
Distribution Box to Field/ Pit `` 1
Opening Sealed: _N
End Cap N 704
Inlet/Outlet Pipes&BafflesIL-
4 <F0
Manholes 12"or less below grade N
[provide extension collar if Yes] N
Location/ Separations V
Foundation to tank ft. _
Foundation to absorption ft.
Separation of Pits
Conforms as per P •. •� � =� \
Engineer Report an, Y N (.
ETU Maintenance Contract _Y—N `-' \---
provided
Location of System on Property:
meront Rear Left Side Right Side Middle Front Middle Rear
-m _ i. S .t •
Approved
V Partial Approved and needs to be re-inspected, please call the Building&Codes Office
Disapproved
L:\Pam Whiting\2010\Building Codes Forms\Tnspectlon Focros\Septic Inspection Report_03 29 10.doc
Septic Inspection Repo.
Office No. (518) 761-8256 Date Inspection •''.151' -�• :
Queensbury Building &Code Enforcement Arrive: : /part: am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's iffy= -. _
NAME: l.—EOM ROIJp P.' NO.: \\Rai AOC _ � '�
LOCATION: I •ECT ON: ci
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 YTN
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.
Conforms as per Plot Plan _Y_N
Engineer Report and As-Built Y N \ 17
ETU Maintenance Contract _Y_ N
provided
Location of System o, Property: v �C
Front ear Left Side Right Side Middle Front Middle Rear
stem se S , us:
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 Report03 29 10.doc