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2013-548 TOWN OF QUEENSBURY ?Fs742 Bay Road,Qucensbury,NY 12804-5902 (518)761-8201 Community Development - Building & Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE Permit Number: P20130548 Date Issued: Tuesday, December 03, 2013 This is to certify that work requested to be done as shown by Permit Number P20130548 has been completed. Tax Map Number: 523400-308-016-0001-004-000-0000 Location: 1 STEPHANIE Ln Owner: RICHARD R. SEELEY Applicant: RICHARD R. SEELEY This structure may be occupied as a: Septic Alteration Residential By Order of Town Board TOWN OF OF QUEENSBURY Issuance of this Certificate of Compliance DOES NOT relieve the � / _ t/ 41,52t- property owner of the responsibility for compliance with Site Plan, �/ tGY 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,Queensbury,NY 12804-5902 (518)761-8201 Community Development-Building& Codes (518)761-8256 BUILDING PERMIT Permit Number: P20130548 Application Number: A20130548 Tax Map No: 523400-308-016-0001-004-000-0000 Permission is hereby granted to: RICHARD R. SEELEY For property located at: 1 STEPHANIE Ln 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: RICHARD R. SEELEY 1 STEPHANIE Ln Septic Alteration Residential QUEENSBURY,NY 12804 Total Value Contractor or Builder's Name /Address Electrical Inspection Agency IBS SEPTIC & DRAIN ATTN: IVAN BELL 2 LOWER WARREN St OUEENSBURY.NY 12804 Plans&Specifications 2013-548 Res. Septic Alteration $40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Tuesday,December 02,2014 (If a longer period is required,an application for an extension must be made to the code Enforcement Officer of the Town of Queensbury before the expiration date.) Dated at the To f Qu sbu M n a December 02,2013 SIGNED BY for the Town of Queensbury. Director of Building&Code Enforcement wince use umv Town of Queensbury Building & Codes Received: SEPTIC DISPOSAL PERMIT Tax Map ID: 1e$.i10-/ `f • Permit No.: /3-5</ 8 A permit must be obtained before beginning construction Permit Fee: $ 416, uv Approvals: l � fr Applicant: �i . 11 • Se, D� l ( InstallerlBuildere—r i?_5. (r %7V 04 Address: J ( (4.,, r 6( 1) Address ) moon vli aL Phone: - 9 q -fl p (// ( Phone 3 ( - ©g 6 / Owner: / i c(n-[0 r rll 5c c Location of Installation .c727610:4--( (, rU Address: ( $ ' nAt 4-7G ( v l GGGGGG��r��r (2 f� 1 Phone 7 / 7 / n Contact Person for Building&Code Compliance: ).---(-4-4"._ Day Phone: Ji( "O Y ri Residence Information: Year Built #of Bedrooms Gallons per bedroom =Tota l Flow 1980 or olderGarbage Grinder installed? 1981 -1991 /`\/ x 150 x 130 = Ya) .///4ASpa or Hot Tub Installed? /1/1 1992-Present x 110 = Parcel Information: Topography lat Rolling _Steep Slope %Slope Soil Nature Sand ILo,arm ay / Other A/ t Groundwater At hat depth? l BedrockllmperviousMaterial A tdepth? /v Domestic Water Supply \Municipal Well(if well,water supply from any septic system absorption is ft.) Percolation Test Rate- 41/er minute per inch(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 / bn0 gallon(minimum size 1,000 gallons),add 250 gallons to size of septic tank for each garbage grinder,spa or whirlpool tub System Type: !!!Absorption Field(with#2 stone) Total leng i p v C7 ft. Each tre ch X_ So Seepage Pit(S)(with#3 stone) How many? 1fl Siizej'? Alternative System Bed or other type? / ., / 1 Holding Tank System Total required capacity? /(41-Tank size?,/" #of tanks?, NOTE: 1)Alarm system and associated electrical work must be inspected by a Town approved electrical inspection agency-see Certified Electrical form on Town website; 2) Effective as of March 23, 2006 Septic System-As Built Plot Plan: The Building Department will no longer allow systems to be covered until such time as an As-Built Plot Plan is received and approved by the Building Inspector. The installed system must match the septic system layout on file. There will be no exceptions. 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. ✓l have read the regulations with respect to this application and agree to abide by these and all requirements of the Town of Queensbury Sanitary Sewage Disposal Ordinance. Print Name: —L ( GI G f Date: 4 4. /O 2 Signature: / / ' Date: - I /v 3 Town of Queensbury Building&Codes Septic Disposal Permit 518-761-8256 ' /'Y on Queensbury Building & Code Enforcement f Office No. (518) 761-8256bt er prv\ J l Septic Inspection Report Inspection request received: / ��! f 3 Name: ,L✓O- L-( Inspected on: f aI a l / � Location: / S+cphan t ro 1-11 ne Arrive: Z= �/Pr—.m.I OP Permit No.: 13 - Sy I( Inspector's Initials: r Air to P. ents and/or dia.ram Soil Type •am I Clay Type of Water�I Water Waterline separation distance I 0 ft Well separation distance ft. �� ��� Other wells. _ ft. AS Well Casing Length 50'+/- Y N N/A [150'to well required if NO] Absorption Field Total length Z 00 ft Length of each trench HP-4q)ft. Depth of trenches 7L-ft. c- L -c, \E4 \%Aki„�� Size of Stone -• !F Z Seepage Pits Number Size: x Stone Size: Piping Size Type Building to tank Elk-` 411 hc\ 1-kfl Tank to Distribution Box Litt f nV a5- c Distribution Box to Field/Pit / \t \-111,513-36- f �t A09-a5 �o Pee Opening Sealed: _Y/ N End Cap ✓Y/ N . a. ao L©>J � vS' a uk t y`� Inlet/Outlet Pipes&Bathes %/1' Nt Manholes 12"or less below grade Y N [provide extension collar if Yes] Y N Location/Separations Foundation to tank \tD ft. Foundation to absorption in ft. 1— Separation of Pits /�/�ft. Conformsineeres per Plot -B / ✓'Y N Engineer Report an As-Bu Y_N ETU Maintenance Con am]provided Y N Location of System on Property: Front Re r Left Side Right Side Middle Front Middle Rear S stem Use Sta : Approved Partial Approved and needs to be re-inspected, please call the Building&Codes Office Disapproved Septic Inspection Report i Li ori/ f e d ?kct ) 1 '0 +/, 1 4" 15Ti n ' Tni/X /0' i f1wNA tice±t.m 2 / zz i • !T -7-4e9 � not e to 3 vlG To i7' 1 1Y ,2404 , hk47. ,47 C L:.:Its j. • Q m.itaelf A ' ?. crb I Ir ,41 :ii_____ _I ,TH ' t S 1 ME 1111.11 NV ! • - Er M• II 1 ' t 6 r - I did& tali i 11 111 -0411 .. - of' '1'74.--- ----Ti 1 • sErio, :;,, lag ... to ./i ti , _ .,,4 eAkvhsH,,Et,,Ns_Er:LEssEmNR:gin • Willi all 1H - li Avtu „ m„ . Ism In li _ , • • Ill N° e I - mat - -ii44-/ - - 1 1 - -&crs Imi i - - - L inn P6 fp ai - - 110111 1611 rpm a; . .-d-rd eH1 - a - .111. mml..1111