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2013-497 TOWN OF QUEENSBURY 742 Bay RoadQueensbury,NY 12804-5902 (518) 761-8201 Community Development - Building & Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE Permit Number: P20130497 Date Issued: Tuesday, October 29, 2013 This is to certify that work requested to be done as shown by Permit Number P20130497 has been completed. Tax Map Number: 523400-301-009-0001-022-000-0000 Location: 46 BRONK Dr Owner: ANTHONY GARCIA Applicant: ANTHONY GARCIA This structure may be occupied as a: Septic Alteration Residential By Order of Town Board TOWN OF QUEENSBURY /A--- Issuance of this Certificate of Compliance DOES NOT relieve the (r 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 s 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 f� igy Community Development- Building&Codes (518)761-8256 BUILDING PERMIT Permit Number: P20130497 Application Number: A20130497 Tax Map No: 523400-301-009-0001-022-000-0000 Permission is hereby granted to: ANTHONY GARCIA For property located at: 46 BRONK Dr 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: ANTHONY GARCIA Septic Alteration Residential FRIEDA JANE GARCIA Total Value 46 BRONK Dr QUEENSBURY NY 12804-0000 Contractor or Builder's Name/Address Electrical Inspection Agency IBS SEPTIC &DRAIN ATTN: IVAN BELL 2 LOWER WARREN St OUEENSBURY,NY 12804 Plans&Specifications 2013-497 Res. Septic Alteration $40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Wednesday, October 22,2014 (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 To of eensb , 0 ► •s f:y, October 22, 2013 SIGNED BY Air for the Town of Queensbury. Director of Building&Code Enforcement Community Development Office Town of Queensbury • 742 Bay Road • Queensbury, New York -12804 Office Use Only 2 _ TAX MAP NO. 3 0 I R -I-a c PERMIT NO. I J -!\'11(/ /�j/� 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_BI FOCRECISSUANCE OF A VALID PERMIT. OWNER: 10 r•13(... U r ( INSTALLER: —1— .J J 1 �- ADDRESS: 1+-6 n I'l ' ADDRESS: L Q \!v P r "v UI f(Q N J 04.e,r- r 9 �( L� PHONE NOS. 3--�� (�r PHONE NOS. f U' ! LOCATION OF INSTALLATION: -1 b 6(0 y\ IC f f RESIDENCE INFORMATION: YEAR BUILT NO.OF X COMPUTATION = TOTAL DAILY FLOW BEDROOMS (Gallons per bedroom) GARBAGE GRINDER 1980 or older X 150 = 4 5`) INSTALLED? 1981-1991 X 130 = SPA OR HOT TUB 1992-present X 110 = INSTALLED? PARCEL INFORMATION: / ✓ TOPOGRAPHY: FLAT ROLyI \1 NG STEEP SLOPE `v1-NS %SLOPE N N l I ✓ SOIL NATURE: SAND ‘/ LOAM CLAY OTHER IV II t ✓ GROUNDWATER: AT WHAT DEPTH? W ..- ✓ BEDROCK/IMPERVIOUS MATERIAL: AT WH T DEPTH?�1 ✓ DOMESTIC WATER SUPLY: MUNICIPAL J WELL\V h (If well:water supply from any septic system absorption is: ft) ✓ PERCOLATION TEST: RATE IS 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: 1 Don 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. rel l(Jt L,e -\r,,,, Q rN . SYSTEM TYPE: I\ ❑ABSORPTION FIELD(WITH NO.2 STONE) Total length \\IPV ft. Each trenchAl N tc x IVf ❑SEEPAGE PIT(S)(WITH NO. 3 STONE) How many? NP Size? IV f o ALTERNATIVE SYSTEM Bed or other type? \\11--\,_ `` ❑ HOLDING TANK SYSTEM Total required capacity? _ N 1 \ Tank size? I V 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 an. all irements of the Town of Queensbury QUESTIONS? CALL 761-8256 OR EMAIL :::: ry•- Ordinance. j /� w`re Pe onsible Jl� IVISIT OUR WEBSITE FOR MORE INFORMATION i P www.queensburv.net Town of Queensbury Building & Code Enforcement (1/Iik �'_l() Office.No. (518) 761-8256 GG Septic Inspection Report Inspection request received: ivld.S2-o/2) Name: (1G^el‘CA_- Inspected on: /ii O .2• 3-6/3 Location: "f(G_„Fro%-/ l)v1v-(-- Arrive: -/2 4 _ •.,� t.m. Permit No.: 13-LO? Inspector's Initials: Coma and/or diagram Soil TypeS'."-aa rl Clay V Type of Wate Munici !]Q�i>Water Waterline separation distance 1'Pi. 7- 661g c___,4-tt- Well separation distance ft. 64-C1-e'2 ' ` "' 6) 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 A" h�q_ ,1. Tank to Distribution Box Lk'' c Distribution Box to Field/Pit ` Opening Sealed: s/Y N �(, tl�__ End Cap _Y_N �0 ` Inlet/Outlet Pipes&Baffles N D V--- Manholes 12"or less below grade Y_N [provide extension collar if Yes] __Y_N Location/Separations Foundation to tank 'l 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 provided _Y_N Location of System on Property: --- Front Rear Left Side Right Side Middle Front 'fie R System Use Stat : Approved Partial Approved and needs to be re-inspected, please call the Building &Codes Office Disapproved Septic Inspection Report 1 A^\/1 nn //P`\ Ca M) Septic Inspection Report Office No. (518) 761-8256 Date Inspection request received: Queensbury Building &Code Enforcement Arrive: ;?'1,i am/pm Depart: am/pm 742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: /1- NAME: Glaf'(116) PERMIT NO.: / 3-y1-/ LOCATION: 4-/ to A rn n INSPECT ON: / 3 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. (,� 11 e- / "ti4 t a ` i /l�J ' Depth of trenches ft. Size of Stone Seepage Pits: Number Size: x Stone Size: Piping Size Type Building to tank Tank to Distribution Box Distribution Box to Field/ Pit 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 on Property: Front Rear Left Side Right Side Middle Front Middle Rear System Use Status: 'proved 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 's W.' IA •4J z . fr:1 L'I -9 elo ,-.--- ---- z::-. .4, ) ..).-2.-r-V-1 r- r...-_,. iii ., I? `) t I ' ty) ''-'3 fj;1. . ^GO cc SEPTIC P g� OfiS -3 u 0 co OBSERVED ALL 9"0-m -,=s i I HAVE SEEN ORWELLS,TREES,FENCES,ETC R, - ..q,f \NP a-°C7OOejj [ O �J SUCH AS HOUSES, I HAVE PERSONALLY _ � 4, 0 HIS DOCUMENT. I.DI G"M, " "- SHO ' �� , : ANGE SET FORM ON m r.' ,r�m DAT '--, %_, SIe1RreirdliURi I i ;� :2:. -1-< � ons _ � 8.c'' ',I...2 • 2.5'U) D I M I ) ) 1J �J1 �.i ) I n Mt c\ nn 4 �{i` a .„,. i 6 ri-j- le n) = . • A 1/4. t at(....\( ,r ri()4.%I . - •R` r3').::3-1 5 0 t 1 1. O ry —J Z7-1,--- -., 5•:'-'..c.73 F 6J s; c SEP-___L-1C BSERVED ALL OBJ ETC I -6_ cL HAVE SEEN g TREES,FEN , , � r 0 r\` HOUSES,WELL i,--.a G) a�.-. =1_ V�- SUCH ASH m � 17.1 T (f .,M. � L, g : . SHOD�' THIS DOCUMENT.�HAVE PERSONAL ;� ��z o FORTH la r C . 2 z0 S ,, p T ,�;,�ANGE SET �,� e--) C =; "m \f� M / ticc. ^=fiirnc / DAT I �° v, 3 �-'n ��. Ft I� I i"! e,- Sl U r z E :E---..33 C n.4? 3 CD 4: C1:i to ,. 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