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2012-233 TOWN OF QUEENSBURY 742 Bay Road, Qucensbuty,NY 12804-5902 (518) 761-8201 Community Development - Building & Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE Permit Number: P20120233 Date Issued: Thursday, November 14, 2013 This is to certify that work requested to be done as shown by Permit Number P20120233 has been completed. Tax Map Number: 523400-295-019-0003-022-000-0000 Location: 17 OWEN Ave Owner: PAUL & RAMONA LEONARD Applicant: PAUL & RAMONA LEONARD 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 f" owner of the responsibilityP for com compliance with Site Plan f P � j/- property � Variance, or other issues and conditions as a result of approvals by the Director of Building& Code Enfo♦« ment Planning Board or Zoning Board of Appeals. TOWN OF QUEENSBURY LT 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development-Building&Codes (518)761-8256 BUILDING PERMIT Permit Number: P20120233 Application Number: A20120233 Tax Map No: 523400-295-019-0003-022-000-0000 Permission is hereby granted to: PAUL&RAMONA LEONARD For property located at: 17 OWEN Ave 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: PAUL& RAMONA LEONARD Septic Alteration Residential 17 OWEN Ave Total Value QUEENSBURY,NY 12804-0000 Contractor or Builder's Name/Address Electrical Inspection Agency Plans&Specifications 2012- Residential Septic Alteration $40.00 PERMIT FEE PMD-THIS PERMIT EXPIRES: Saturday, May 11, 2013 (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 Town uee sbury• ri t , i ay 11, 2012 SIGNED BY f for the Town of Queensbury. Director of Building& Code Enforcement ,. j MAY 1 U 2012 w Community Development Office ...,.0._,-...:..,, Town of Queensbury - 742 Bay Road - Queensbury, New York -12804--„:SBURY CODES Office Use Only a` c� �j TAX MAP NO. 0)9 .19 - 3-.:A.3, PERMIT NO. 1 A - vi 33 PERMIT FEE v' O APPROVALS: ZONING -OWN CLERK APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT: A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJECT TO REVIEWW BEFORE �IS�SUANCEnOF A VALID PERMIT. OWNER' U) Ce�Nctr t INSTALLER: T-lyaci'1 L(c,/” t/�6 ADDRESS: 1'7 GDIPG Ai Al ✓L ADDRESS: ( ! �TQ�L e" A ✓e PHONE NOS. 7613 6j ` S ` PHONE NOS. ` 3 9 5 1 LOCATION OF INSTALLATION: 1-7 owe it" 11%le Q e e etis- b tJ �,/ ,�' I 1-o -1 ( RESIDENCE INFORMATION: YEAR BUILT NO.OF X COMPUTATION = TOTAL DAILY FLOW BEDROOMS per bedroom) GARBAGE GRINDER (Gallons 1980 or older 3 X 150 = Lis© INSTALLED? N 1981 -1991 X 130 = SPA OR HOT TUB, / 1992-present X 110 = INSTALLED? tv PARCEL INFORMATION: ✓ TOPOGRAPHY: FLAT ROLLING ^ X STEEP '-OPE %SLOPE ✓ SOIL NATURE: SAND /(' LOAM CLAY OTHER ✓ GROUNDWATER: AT WHAT DEPTH? ✓ BEDROCK/IMPERVIOUS MATERIAL: AT WHAT DEPTH? ✓ DOMESTIC WATER SUPLY: MUNICIPAL )( WELL (If well:water supply from any septic system absorption is: AICA ft) ✓ PERCOLATION TEST: RATE IS_ I A S PER MIINUTE PER INCH[mpij (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: DSO 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 ❑ SEEPAGE PIT(S)(WITH NO. 3 STONE) How many? Size? 1 ALTERNATIVE SYSTEM Bed or other tvr-' ( U 'c & Li 14 ccs h 0yi;c4 ' 3&' `l )1 410., to' ❑ 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 wi espect to this application and agree to abij- b, these and all req ents of the Town of Queensbury QUESTIONS? CALL 761-8256 OR EMAIL S. '�S ag .all dinance- ) codes(a queensburv.net A� `a VISIT OUR WEBSITE FOR MORE INFORMATION Signature of rson Responsible Date www.queensburv.net Septic Inspection Report Office No. (518) 761-8256 Date Ins•- log...m.9 • : -i ed: Queensbury Building &Code Enforcement .Arrive: 40,•I Depart: - a m 742 Bay Rd., Queensbury, NY 12804 Inspector's Initia s. . � NAME: LOrJAR) , NO.: 1 2.__-2.7-)..3 LOCATION: 1 -1 CCt3E-K1 i \1C= 'ECT ON: I 1 -12-13 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 — ‘13-6-1-A LL G V\C'tRCL)RL F� Tank to Distribution Box ��� , l Distribution Box to Field/ Pit `c � Opening Sealed: _Y N ���J 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 / BULi ... Foundation to tank f1! e Foundation to absorption :`eft. ' Separation of Pits / ft. Conforms as per Plot P -n ..7"_N Engineer Report an,' As-Built N ETU Maintenance ontract _Y N provided Location of System on property: Froni ar Left Side Right Side Middle Front Middle Rear SY ►n T)( ____ pproved 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 Inspecction Report_03 29 10.doc V 5.4 -),0-1- 0 telOVIN.,1Wirtla, y` ?� 1 .r- A-1 unft Xis . L i I , Disox i , 6o' � t2,ec \e3 II viv)Q .... of Li , AS BA! ! LT t, . . c\Qc*cA" .1 . 4 ki( io 0 -' \'' . -- 1.1,_. itit___4. _ C"l< \ ,\'c\t AR`),g#4C 0 ovue.,,i A v e_ Q L 1 1 '173 - 1. c-LS c't EQul,zer 1i 1 I }o r Qu cid/311 f4 i5 h cciPtc41 i _ ______________ vUcci e r Loc.c. 33.or) Ooock Septic Inspection Report Office No. (518) 761-8256 Date Ins.- ion r e ed. Queensbury Building &Code Enforcement Arrive: O am • /`•:,•rt:—32- /p 742 Bay Rd., Queensbury, NY 12804 Inspector's Ini =Is* NAME: 1">' \ �--E * A C) 949-H27-. . . IT NO.: LOCATION: PECT ON: 31 RECHECK: Comments and/or diagram Soil Ty•,=.�..�;Mt►..m / Clay Type of Wat- : - ater Water me separation distance Well separation distance ft. a__Lk kt Other wells: ft. Well Casing Length 50' +/ - Y N N/A [150'to well required if NO] Absorption Field: Total length \Z"D ft. Length of each trench ft. Depth of trenches z' — '-1 ft. Size of Stone *3 Seepage Pits: Number k Size: Stone Size: ��A�\— Lj V Sit_\ tJ E Piping Size Type Building to tank Tank to Distribution Box L["Distribution Box to Field/ Pitjvf-t ��JOpening Sealed: End Cap Inlet/Outlet Pipes& Baffles , N Manholes 12"or less below grade _ N [provide extension collar if Yes] _Y_ N Location/ Separations Foundation to tank _ft. ..1C--‘4->T. Y70 Foundation to absorption ��ft. Separation of Pits ft. A Conforms as per Plo ' .n Y ► �� ` _ ` Engineer Report a►: As-Buil ' N ETU Maintena ce Co . _Y N „'v provided Location of System on Property: IXO(---N Front Rear -- Side Right Side Middle Fro Middle Rear S stem Use Status. 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\Sepuc Inspection Report_03 29 10.doc I 4-1 eb/__e_ cR6-„Ljeld ni TIl .s2.)er 61,4-ecc.5 . 3.7.-----, 11 E COPY 3 1---- 4..) .) I 7 Id a' -:":-,-.5': — 3' 21 761 - i >D 3. Cs. pear D-B,v __ .......--- . i •`-r-•-•"" 1 ,_ ,___.... I/0/ ir • - 4 .-,-?.sit 1 _If 1 o 1 - re-R-IC\r‘ TOWN OF QU- gpsify I i I -•- i £ BUILDING .4. CORA:Ifs FA, . .i- P)5 14\ 1‘j I A o 1 leoluckf 0 Reviewed :: • . Date: Alffirit ) 7 oweo A\ie or- 0 by 73 --- 6,9‘cci ---0 ,... "I have sen or ooservec, or •elieve I sav77TftderiUeThr--- • -- -- - ---- . --- D • 1........ cc, .2 fl '\// 1;4 Ri ail obects .:;,,fth .1 r.%:,(,;es, wOir.... ii‘-,-, , i . ..",','5., etc., sl , ,,,ri I '..J 'L:i...'.. ;_t 1 (22`2C.' f., it..r. n9 2012 DJ p. rw ,j+ .,111 Jil the diagram. ' Lj TOW:14 u; uu•ci-04:-.,f3-URY Ls) k ____11;,,, 5- 9- Q BUILDING & CODES _ • DATE */ wc,-Tec 1. 'e