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2012-308 TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development - Building & Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE Permit Number: P20120308 Date Issued: Monday, October 21, 2013 This is to certify that work requested to be done as shown by Permit Number P20120308 has been completed. Tax Map Number: 523400-300-016-0001-009-001-0000 Location: 232 FULLER Rd Owner: THOMAS & HEATHER LAPHAM Applicant: THOMAS & HEAI'I-IER LAPHAM 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, 4 d Variance, or other issues and conditions as a result of approvals by the Director of Building&` ode ,forcement Planning Board or Zoning Board of Appeals. TOWN OF QUEENSBURY ` 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 ON Community Development-Building&Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20120308 Application Number: A20120308 Tax Map No: 523400-300-016-0001-009-001-0000 Permission is hereby granted to: THOMAS & HEATHER LAPHAM For property located at: 232 FULLER 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: THOMAS & HEATHER LAPHAM 232 FULLER Rd Septic Alteration Residential QUEENSBURY,NY 12804 Total value Contractor or Builder's Name /Address Electrical Inspection Agency IBS SEPTIC IVAN BELL 2 LOWER WARREN STREET OUEENSBURY.NEW YORK Plans&Specifications 2012 Septic System alteration $40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday,June 28, 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 of ueen ury; ur • y�' une 28, 2012 Z SIGNED BY for the Town of Queensbury. Director of Building&Code Enforcement Revised 4/14/2010 OFFICE USE ONLY ��� TAX MAP NO. 30O,f(i%-( "44,1PERMIT NO. 1 '3 O�PERMIT FEE I 7 2012 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. _I C 1 OWNER: ©M\ LfitPk r`-. � INSTALLER: ^Lid J ADDRESS: ')i)._ FC41\ r �"ql' ADDRESS: :+2_ L-D\0\mer vy A� orre'- r. PHONE NOS. —191- -.)..,0% PHONE NOS. 1 p- 1 4 LOCATION OF INSTALLATION: RESIDENCE INFORMATION: NO.OF COMPUTATION YEAR BUILT X = TOTAL DAILY FLOW • BEDROOMS (Gallons per bedroom) GARBAGE GRINDER 1980 or older X 150 = INSTALLED? 1981-1991 3 X 130 = 39 Q SPA OR HOT TUB 1992-present X 110 = INSTALLED? N l\ PARCEL INFORMATION: a r ✓ TOPOGRAPHY: FLAT ROL G J STEEP SLOPE 1V %SLOPE`' \V R, t ✓ SOIL NATURE: SAND LOAM CLAY IV k OTHER \ ti` ✓ GROUNDWATER: AT WHAT DEPTH? IV 1 A r ✓ BEDROCK/IMPERVIOUS MATERIAL: AT Wit- HATDEPTH?\h ✓ DOMESTIC WATER SUPLY: MUNICIPAL ' WELL V If well:water supply from any septic system absorption is: ft) ✓ PERCOLATION TEST: RATE IS NN N 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: \ 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 E: ii ,, ABSORPTION FIELD(WITH NO.2 STONE) Total length tor) I` ft. Each trench 5 X TD ❑SEEPAGE PIT(S)(WITH NO.3 STONE) How many? N I� Size? IV h- ❑ALTERNATIVE SYSTEM Bed or other type? \\I it o HOLDING TANK SYSTEM Total required capacity? W l C Tank size? ►r fr Number of tanks? ik 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 abide by these and all requirements of the Town of Queensbury QUESTIONS? CALL 761-8256 OR EMAIL Sanitary Se . s isposal 0 i nce. codes{a7queensburV.net �,z--> V � VISIT OUR WEBSITE FOR MORE INFORMATION Signature of •e n Res onsible Date www.queensburv-net Town of Queensbury* Community Development Office*742 Bay Road, Queensbury NY 12804 t ca) Septic Inspection Report Office No. (518) 761-8256 Date Inspection request received: Queensbury Building &Code Enforcement Arrive: am/pm Depart: t p am/pm 742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: / NAME: e I1cc.� m PERMIT N .: It '- 3o LOCATION: c',-3 Pa (ler Roi INSPECT ON: RECHECK: 90:7Comments and/or diagram Soil Type: Sa /r / Clay Type of Water: Municipal/ Well Water ej\tCoL C.±—SB J Waterline separation distance ft. Well separation distance ft. Other wells: ft. Well Casing Length 50' + / - Y N N/A Absorption Field: Total length 2-. • ft. Length of each trench ft. Depth of trenches /woo`` -ft= Size of Stone - Z� Seepage Pits: Number r J Size: Stone Size: Piping Size Type Building to tank '2_ K` LS7Z-PV Tank to Distribution Box 1`6) �'`2 Distribution Box to Field/ Pit `� j-Lv�-j 't (?_031 `� Opening Sealed: N End Cap VS,- N Inlet/Outlet Pipes&Baffles N Location/ Separations • Foundation to tank _ ft. Z-,'eGkt5 a--4; Foundation to absorption ft. Separation of Pits j•-•f' Conforms as per Plo • -• N Engineer Report an. As-Built Y N Location of System • • operty: Front (11f0- Left Side Right Side Middle Front Middle Rear • S -i Us- .1 .- AI Approv- •. ial 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 OSE. "-.?Q 1 a-3 - 20 ilAt-\ �' V 6eI� ;-.S --mac f„4t;-, loo° '` , +° " S c S 1,-6' . si 1 MI , r,; y) 4 ?..- (t hew rArr.p .D._ flo ‘i 1Yfy� 5�oi►or, 1a Vb v "I have seen or observed, or believe I saw evidence of, all objects such as houses, wells, trees, fences, etc., shown on this document. I also represent that I have personally €n.a'ore- the distances set tsrth on the diagram." 6-2:1—r "1ifi TIRE DATEs C: /o S !Q LE N a L . , .. . 2 .o �l � s �3-- TOWN OF QUEENSBUR BUILDING & Ce `a�r�i �T. Reviewed By: .4 -''.. Date: