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2012-438 TOWN OF QUEENSBURY Fors742 Bay Road,Q ueensbury,NY 12804-5902 (518)761-8201 Community Development - Building & Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE Permit Number: P20120438 Date Issued: Wednesday, September 12, 2012 This is to certify that work requested to be done as shown by Permit Number P20120438 has been completed. Tax Map Number: 523400-308-015-0001-052-000-0000 Location: 19 DIVISION Rd Owner: JAMES C JENKS Applicant: JAMES C JENKS 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, ebv2P Variance, or other issues and conditions as a result of approvals by the �` Director of Building&Code 'nforce ent Planning Board or Zoning Board of Appeals. TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development-Building&Codes (518)761-8256 BUILDING PERMIT Permit Number: P20120438 Application Number: A20120438 Tax Map No: 523400-308-015-0001-052-000-0000 Permission is hereby granted to: JAMES C JENKS For property located at: 19 DIVISION 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. Twe of Construction Value Owner Address: JAMES C JENKS Septic Alteration Residential 19 DIVISION Rd QUEENSBURY NY 12804-0000 Total value Contractor or Builder's Name/Address Electrical Inspection Agency SANITARY SEWER GEORGE DRELLOS 792-7257 PO BOX 224 GLENS FALLS NY Plans&Specifications 2012-438 Residential Septic Alteration $40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Tuesday,September 10,2013 (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 Queensbury; Monday,September 10,2012 SIGNED BY for the Town of Queensbury. Director of Building&Code Enforcement 'r- Community Development Office SEP 0 7 2012 , - Town of Queensbury • 742 Bay Road • Queensbury, New York •12804 Office Use Only C� Q TAX MAP NO. 3 b g . 15-1-5e-A. PERMIT NO. LA` ! 3 " PERMIT FEE A VO. 00 APPROVALS: ZONING TOWN CLERK — APPLICATION FOR SEPTIC DISPOSAL SYSTEM ' RMIT: A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS. APPLICATION IS SUBJECT TO REVIEW FORE ISSUANCE 0 'A VALID PERMIT. OWNER: IT f nf _ Q 6 INSTALLER: • ! d�c_ , _ ADDRESS: I 9 �_L efsif icri ifZ4) ADDRESS: illireAraMir r ).. J PHONE NOS. !-�7ti ( ' I © ) PHONE NOS. 7 ? �? — u c s`3 LOCATION OF INSTALLATION: RESIDENCE INFORMATION: NO.OF COMPUTATION YEAR BUILT X = TOTAL DAILY FLOW BE OMS (Gallons per bedroom) GARBAGE GRIN I�E,R 1980 or older X 150 = �J INSTALLED?__ 0 1981 -1991 X 130 = SPA OR HOT TUB 1992-present X 110 = INSTALLED?___. PARCEL INFORMATION: ✓ TOPOGRAPHY: FLAT ROLLING_ STEEP SLOPE %SLOPE ✓ SOIL NATURE: SAND__ LOAM CLAY OTHER_ ✓ GROUNDWATER: AT WHAT DEPTH? ✓ BEDROCK/IMPERVIOUS MATERIAL: AT WHA EPTH? ✓ DOMESTIC WATER SUPLY: MUNICIPAL WELL (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 O( J 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: / ( , nBSORPTION FIELD(WITH NO.2 STONE) Total length ",,,0 ft. Each trench X__ 0 ❑SEEPAGE PIT(S) (WITH NO. 3 STONE) How many? Size? ❑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 d the :gu a i s - with respect to this application and agree to abi a by t ese an�:II es irem s of the Town of eensbury QUESTIONS? CALL 761-8256 OR EMAIL S itary ewage r •• AO•-I Or nce-- /} codes(a�queensburv.net S ature of Per-ot Responsible Date��/ Z' VISIT OUR WEBSITE FOR MORE INFORMATION P www.aueensbury.net uesdc% 1b ) (Q*J ) Septic Inspection Report Office No. (518) 761-8256 Date Inspection . re-ei -•: Queensbury Building &Code Enforcement Arrive: — nm 742 Bay Rd., Queensbury, NY 12804 Inspector's Initia . NAME: -fK S P-R NO.: 3 LOCATION: t q n Rci 'ECT ON: ©i— it RECHECK: Comments and/or diagram Soil Type* ••• •• •am / Clay Type of Water: •• II Water Water i - - •aration distance ft. Well separation distance ft. • Other wells: ft. Well Casing Length 50' + / - Y N N/A Absorption Field: Total length i, ft. Length of each trench _.-010 ft. Depth of trenches ft. Size of Stone Seepage Pits: Number Size: x Stone Size: Piping Size Type Building to tank E Tank to Distribution Box ( Distribution Box to Field / Pit 1 y 9 L) 6Dg_ Opening Sealed: N End Cap Inlet/Outlet Pipes&Baffles Y •N Location/ Separations • Foundation to tank f- ( I . 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 R::r Left Side Right Side Middle Fr —Middle Rear S U - . 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 ._ _ A) i Olsro g 74).., ..—__ . 1\0,, , 4.0 ii if �1 i p p , . • . LD CO `< o 7 o _ 0_ CD 0 C cn D 13 o c m z iy0 - > 0 _.. m o --- ---4,----------- .i ti - y N r Z c, ' e seer or observed, or beieve I saw evident, of m s dil ohi cf; such as Vic, wells, bees feices, etc., fSll(1 OR th:s dDc,u ent. I also rep esent that I lave 0• or'all° •• 3scre l the distances set fcr-h c '.e diagram." War SI.SNA T I RE , DPTE Y REAR PROPERTY LINE SEP • TOWN OF QUEENSBURY TOWN!OF OUEENSBURY BUILDING & CoDES DEPT. BUILDING DEPARTMENT Based on our limited examination,compliance d with our comments shall not be construed as Reviewed B ; indicating the plans ;nd specifications are in Date: c`_� full compliance with the Building Codes of New York Staie,