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2012-580 TOWN OF QUEENSBURY EtT 742 Bay Road, ueensbury,NY 12804-5902 (518)761-8201 Community Development - Building & Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE Permit Number: P20120580 Date Issued: Monday, November 04, 2013 This is to certify that work requested to be done as shown by Permit Number P20120580 has been completed. Tax Map Number: 523400-295-020-0001-042-000-0000 Location: 160 FARR Ln Owner: GREGORY R BUCKINGHAM Applicant: GREGORY R BUCKINGHAM This structure may be occupied as a: Septic Alteration Residential By Order of Town Board TOWN OF QUEENSBURY Issuanceof this Certificate of Compliance DOES NOT relieve the (-- a„P /A-- 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 742 Bay Road,QucciiAmv.v,NY 12804 5902 (518)761-8201 Corninunity Development- Building& Codes (518) 761-8256 BUILDING PERMIT Perinit Nutuber: 1 20120580 Application Number: A201,20580 Tax Map No: 523400-295-020-0001-042-0004 -0000 Permission is hereby granted to: GREGORY R BUCKINGHAM P'or property located at: 160 I,ARR Ln in the Town of QueensburYT,to constrUCt or place at the abovc location Linaccordince with application together with plot plans and other information hereto filed and approved and in compliance with the NYS Uniform Building Codes :and the Queen sbury Zonling Ordinance. Typeof Construction valtic, Owner Address: GREGORY R BUCKINGHAM Soptic Alteration Resideritial ROBIN K TARANA Total Valtle 160 FARR Ln QUEENSBURY NY 12804-0000 Contractor or Builder',,Name / address 1,1carical hisixction.\gcnc% FRED SMITH 23 VERMONTAve OUEENSBURY, NY 12804-0000 Plans&, Specifications 20 12-5 80 Res. Septic Alteration S40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES- Saturday, Deceniber 14, 2013 (If:a longer period is required,an application fear ata extension must be slllde to the code Exiforcernent Officer 4 tire Town of Queensbury before the expiration date.) Dated at the Town of Queensbury; )ib ridgy, Deceniber 14,2012 SIGNED BY for ilie'l'own of Queetislitir.y. Director of Building& Code E'nforceincrit Community Development Office _ -, Town of Queensbury • 742 Bay Road • Queensbury, New York •1 28 04 DEC 14 2012 Office Use Only / TAX MAP NO. q,5,50—j_4'la PERMIT NO. l�- 5 '? PERMIT FEE 1 /(/I APPROVALS: ONING TOWN CLERK APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT: A PERMIT MUST BE OBTAINED BEFORE V�RK�EG,t1;VS. %�LI�� IS SUBJECT TO RE ER W� FO E UA�� OF A VALID PERMIT. OWNER: /v_(4 /�Yv,(�l(li /,1y�1(j ADDRESS: /41 /,t? C)I2E ADDRESS: /47--(/714'/ iF / rf f �f PHONE NOS. / / 0 p IC / PHONENOS. `�) C / LOCATION OF INSTALLATION: /6 (; M�-f 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 X 130 = SPA OR HOT TUB 1992-present J X 110 = 5 INSTALLED? PARCEL INFORMATION: / ✓ TOPOGRAPHY: FLAT ROLLING J STEEP SLOPE %SLOPE ✓ SOIL NATURE: SAND (-LILOAM CLAY OTHER I GROUNDWATER: AT WHAT DEPTH? I BEDROCK/IMPERVIOUS MATERIAL: AT WH T DEPTH? I DOMESTIC WATER SUPLY: MUNICIPAL [ WELL (If well:water supply from any septic system absorption is: ft) I 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: rr(fd 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. SYSTE TYPE: A �, ABSORPTION FIELD(WITH NO. 2 STONE) Total length 2'(1X) ft. Each trench .2 X J- ❑ SEEPAGE PIT(S)(WITH NO. 3 STONE) How many? Size? o ALTERNATIVE SYSTEM Bed or other type? o 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 hav-,ead 'fie regu tions with respect to this application and agree to ab',. by J e and I requirements of the Town of Queen bury QUESTIONS? CALL 761-8256 OR EMAIL `.>j*� �S� : i posal Ordinance. / / ��/ codes(o)queensburv.net �/ - Signat e o 'erson Responsible ate O ' VISIT OUR WEBSITE FOR MORE INFORMATION www.queensburv.net Septic Inspection Report Office No. (518) 761-8256 Date Inspection r-•uest received: Queensbury Building &Code Enforcement Arrive: = D . Depart: \\'•\vi •m 742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: _Depart: NAME: 8 LL !C‘h PERMIT NO.: /�' 5 5'0 LOCATION: I (DD P v .. L� INSPECT ON: t25w 1\—`\-\'7 RECHECK: Comments and/or diagram Soil Type: Sand/ Loam / Clay _ Type of Water: Municipal / Well Water p 1 o1�11 13 Waterline separation distance ft. 1 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 IA" .1C-1-\ Lib F1L� P�vM �(� C_b ►��D Tank to Distribution Box Distribution Box to Field/ Pit -To uJ � � \ Et\ • Opening Sealed: _Y N 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 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 ETU Maintenance Contract _Y_ N provided Location of System n Property: Front ear Left Side Right Side Middle Front Middle Rear S stem Use S tus: 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 Report 03 29 10.doc Mv `"3 n I Septic Inspection Report Office No. (518) 761-8256 Date Ins , iq rfeq - _ c Queensbury Building &Code Enforcement Arrive: 1 '" •, /%-part: � ''?(1 a • p•• 742 Bay Rd., Queensbury, NY 12804 Inspector's Initial.. /1_1' NAME: U ({C° i✓Y `1�/v\ P/IT NO.: / :� J LOCATION: f OF r SPECT ON: / d—/`) RECHECK: --� Comments and/or diagram Soil T •-, +:?5111.■_- • m/ Clay Type of Wate • Muni�ci sell Water Water i - • •. a ion 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 h Z ,ft. Length of each trench ZLoC) ft. Depth of trenches "Z ' _ft. Size of Stone Seepage Pits: Number Size: x Stone Size: Piping Size Type {� Building to tank j./ C t-t a06 6 - t-V0 1:),V- Tank to Distribution Box k h-V6 t `1 1,� 6 Distribution Box to Field Pit / c i Opening Sealed: ✓ _ N J \ lJ End Cap Inlet/Outlet Pipes&Baffles i N Manholes 12"or less below grade Y_N [provide extension collar if Yes] Y N Location/ Separations Foundation to tank t 2-- ft. Foundation to absorption 7Z ft. Separation of Pitsft. Conforms as per Plot Plan Y N Engineer Report and As-Built Y N ETU Maintenance Contract Y_ N provided Location of System on Property: Front Rear Left Side Right Side M'(die Front Middle Rear System Use Status. / Approved • Partial Approved and needs to be re-i spected, please call the Building &Codes Office Disapproved L:\Pam Whiting\2010\Building Codes Forms\Inspection Forms\Septic Inspection Report 03 29 10.doc Q›, SEPTIC PLOT PLAN ii-Alce I HAVE SEEN OR�•`gsERv n ALL O JECt5-- lc\ _ _ SUCH AS A).ES AWLS T,•.EES EN ES, ETC _ ._.-_ -- --_- SHOWN�� s N'.I HAVE PERSONALLY .� MEAS "'� •D iDolt, 1/s; ��'�'' NONTHIS DIAGRAM.<- A / - ` SIG ATURE 'DATE (L O n c 0 ?v cq ` F 1 �tr'�tt?� ) j - G7 -n i .. ..\A �,� ED n 0 m A? ` C r61'\ -. r. 0 - p -------- -__ v - '�-- O, Q . 7)-\ a LIN — -a... ^ _ l 0 Q CT �cc/ Ir- 6 V - ..7% oa _ i . cI N