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2012-581 TOWN OF QUEENSBURY F 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development - Building & Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE Permit Number: P20120581 Date Issued: Tuesday, December 18, 2012 This is to certify that work requested to be done as shown by Permit Number P20120581 has been completed. Tax Map Number: 523400-303-020-0002-010-000-0000 Location: 15 BELLE Ave Owner: GEORGE & GENEVA GALUSHA Applicant: GEORGE & GENEVA GALUSHA 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 (---- avP 11 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& 'ode En•rcement Planning Board or Zoning Board of Appeals. TOWN OF QUEENSBURY 7-12 Bay pored,t,uuco,lburti N)' 12804 5902 (518)76 -8201 Community IDearelopnraent-Building& Codes (5111) 761-5256 BUILDING PERMIT Permit Number: 1'20120581 Application Mamber: A20120581 Ta, iwlap No: 523400-303-02.0-0002-01 O}-000-0000 Peruaissiora is here.l>1'granted to: GEORGE & GENEVA GAQ,USHA For property located;at: 15 BELLE Avco in theTown of Queensbury„ to construct or place at the above location in accordance with application together Nvith plot plans and other infortnaation hereto filed and approved and ill compliance with the NYS l_'uiform Buildital;Codes and the Quecnsbury Zoning Orditaatace. Type..of Construction 'Va'lue (lavaaer.lddress: GEORGE cit. GENEVA GALUS11A 1 Septic A.dtettati.ota lt..es[elelltital 15 LLLT Ave. Total Valtte QU Efi*SBURY,NY 12804 t ontractor or Builder's Name: / .\ddre.ss Flectrical Inspection Agee cy STONE INSTAL L,AT[(.7NS 2'32-6707 4305 STA-1'E ROUTE 50 SARATOGA NY 12866-0000 1 Luis ck Specifications 2012-581 Res. Septic Alte ratioti 540.00 PERNnT FEE PAID -'ITIS PER MIT EXPIRES: Saturday, December 14, 201: (if.a longer period is required,an application for art extension rnust be made to tite code Enforcement Officer of tlae't o)nt of Queensbury before the expiration date.) Dated at the Town of Quteenslattty, Friday, December 14,2012 SIGNED BY for the'l ov,n of d.2aaecnsbii,ry. 17irectc>r of BUildiaaT & Code 1:,':nforccraacnt !t}___- Community Development Office DEC 1 4 2012 — Town of Queensbury • 742 Bay Road • Queensbury, New York •12804 Office Use Only4e c ✓ TAX MAP NO. 3o 3 .�?— 0 PERMIT NO. 1 ?V V 8 ) PERMIT FEE 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. ) 1 l L 1 OWNER: 6 C 1? e hh Cc,/ ii S n c.. INSTALLER: 6tn Y�e s'-ice,5 7-ct iSe. k/7 C%,s S ADDRESS: /`) J5G I Jre/�rnyz, ADDRESS: `f 3() Rte L , Co ;J[ (.4.i-or, I ZS 6 PHONE NOS. _7 ),- ! li 7 / . PHONE NOS. d' 3 — -7C 7 LOCATION OF INSTALLATION: / 1,41/C i'C, ©IJ r"e<,$6 i.,• n y ,, 1 Z B - 4/ RESIDENCE INFORMATION: YEAR BUILT NO.OF X COMPUTATION = TOTAL DAILY FLOW BEDROOMS (Gallons per bedroom) GARBAGE GRINDER 1980 or older X 150 = INSTALLED? A/C 1981 -1991 3 X 130 = .3q0 SPA OR HOT TUB 1992-present X 110 = INSTALLED? A/0 PARCEL INFORMATION: ✓ TOPOGRAPHY: FLAT ROLLING ,C STEEP SLOPE %SLOPE ✓ SOIL NATURE: SAND X LOAM CLAY OTHER 1 GROUNDWATER: AT WHAT DEPTH? AloI1 C P."1.5 c..if 7LO7,2 / t� if ✓ BEDROCK/IMPERVIOUS MATERIAL: AT WHAT DEPTH? ��9C PteSC eef 7� ✓ DOMESTIC WATER SUPLY: MUNICIPAL X WELL (If well:water supply from any septic system absorption is: ft) ✓ PERCOLATION TEST: RATE IS / PER MIINUTE PER INCH[mpi] (Test to be completed by a licensed professional engineer or architect) PROPOSED SYSTEM FOR NEW CONSTRUCTION: All individual sewage disposal systems must be designed by a licensed professional engineer or architect(unless installed in a Planning Board approved subdivision). TANK SIZE: j1 Gt0 GALLON(MIN.SIZE IS 1,000 GAL.)Add 250 gallons to the size of the septic tank for each garbage grinder, spa or whirlpool tub. r-/,$}-,n y SYSTEM TYPE: . [r X ABSORPTION FIELD(WITH NO.2 STONE) Total length /-`f(ft. Each trench 3 x vs f-- / j7 RFC2/ o 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 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 SanitSewage Dis sal Ordina ce. _ codes(a.dueensburv.net ` VISIT OUR WEBSITE FOR MORE INFORMATION Sig tune of Pe n Responsible Date www,queensbury.net Septic Inspection Report Office No. (518) 761-8256Date Inspection requ- r=•9ived: 7 ..-' ,--"' Queensbury Building &Code Enforcement Arrive: 7 '7-3C-2-'am I / -epart: •A Itn am/pn).7 742 Bay Rd., Queensbury,� ._ r '" NY 12804 Inspector's Initials: ._� -- "- NAME: &al ICS ha jERMIT NO.: /c•-)---5- 1 LOCATION: /S 8e_116.1 74-L >v INSPECT ON: / , -- / )'-i RECHECK: 1 Comments and/or diagram Soil Type: San Loa / Clay Type of Waters unic �// ell Water Wat- line sepal-- on distanceft. - -•.ration distance ft. Other wells: _ ft. Well Casing Length 50' + / - Y N N/A [150'to well required if NO] Absorption Field: Total lengthft. Length of each trench .27 L ft. Depth of trenches - y ft. CL.L- Size of Stone t-.-'11-i' Seepage Pits: Number r-Ar0J7 I V\ CN , ,_ Size: x Stone Size:,, v- -i v Piping Size Type Building to tank \-7 (—.-Tank to Distribution Box LL i` J-x.. ;.-t_ T� � Distribution Box to Field/ Pit ' ' 1-70(2.-7i i --c, c e -Z-k-k Opening Sealed: N End Cap ` N - L � �t �'[ Ii 5�� Inlet/Outlet Pipes&Baffles _7,,, T�' Fi ��A� � Manholes 12"or less below grade ;L N ` [provide extension collar if Yes] Y N 'F tc-A ` Location / Separations t Foundation to tank ru, ft. h S B kJ 1 IT Foundation to absorption _ ?T ft. . Separation of Pits eft: Conforms as per PIot'Plan I Y/ N Engineer Report and -Bui Y N ETU Maintenance Con ct _Y_ N provided "1-: NtiSL- Location of System on Property: Front Rear Left Side Right Side Middle Front Middle Rear System Use Sta us: V 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 f '/-----1-741 Ca.,I ilif-thl / gi a.t-- /9 tf--, ) , 9 P - /7 -i 2. .. D F' - ,,i/- 'iv?" .. .,.. -- 89' 5 4 1- 87/5-" ...... , , gi4c15 /1 L x rsl 1toot)5,.;/ ../O M 15 ti - / 13-." ile eL.,H,/1 /t//. \.. 7,6 << p.orx i,,),./-45c.,,,d G•evc/ril / 3?--(i .51 - . \4 -__ _ 4 rC/1"15 i'l .5. 0- . . \.„, P-4. ,) 1 3ELIi n/� LOT PLAN �,�w4 ha: r1 SEPTIC ALL 013J CTS �� v ` �` I HAVE SEEN OR OBSERVED FENCES, ETC = 1 Uv JELLS,TREES, P•F ... 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