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2013-558 fefila TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201 Community Development - Building & Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE Permit Number: P20130558 Date Issued: Monday, December 09, 2013 This is to certify that work requested to be done as shown by Permit Number P20130558 has been completed. Tax Map Number: 523400-302-017-0001-036-000-0000 Location: 31 WINTERGREEN Rd Owner: JOHN & ANN DALEY Applicant: JOHN & ANN DALEY 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, 41 Variance, or other issues and conditions as a result of approvals by the Director of Building& ode E1rcement Planning Board or Zoning Board of Appeals. Oek• TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 f Community Development-Building& Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20130558 Application Number: A20130558 Tax Map No: 523400-302-017-0001-036-000-0000 Permission is hereby granted to: JOHN & ANN DALEY For property located at: 31 WINTERGREEN 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. Type of Construction Value Owner Address: JOHN &ANN DALEY Septic Alteration Residential 31 WINTERGREEN Rd Total Value QUEENSBURY,NY 12804 Contractor or Builder's Name/Address Electrical Inspection Agency SANITARY SEWER GEORGE DRELLOS 792-7257 PO BOX 224 GLENS FALLS NY Plans&Specifications 2013-558 Res. Septic Alteration $40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday,December 06,2014 (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 Town Quee sbury // Fri 1 •, ,%ecember 06,2013 r F t( SIGNED BY `�'v �,` for the Town of Queensbury. Director of Building&Code Enforcement ruN Community Development Office 6E^ 0 5 2g13 Town of Queensbury • 742 Bay Road • Queensbury, New York •12804 `' Office Use Only �� TAX MAP NO. 3 O I [ ! -1'�(e PERMIT NO. / 3- 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. OWNER: ?Dl/) P/97e INSTALLER: ,ql/..� Lt} . �X'- -e r �C'/(/� e / ADDRESS: 3/ G� ''y/ am e� re ADDRESS: ! l/_ !✓D X� ZZ�( e /�"-s (r / PHONE NOS./` 6:732f/C; PHONE NOS. (cF -72f7 LOCATION OF INSTALLATION: dienCh RESIDENCE INFORMATION: YEAR BUILT NO.OF X COMPUTATION = TOTAL DAILY FLOW BEDROOMS (Gallons per bedroom) GARBAGE GRINDER II 1980 or older X 150 = INSTALLED? -' 1981-1991 X 130 = SPA OR HOT TUB 1992-present 3 X 110 = go INSTALLED? ') PARCEL INFORMATION: ✓ TOPOGRAPHY: FLAT ROLLING STEEP SLOPE %SLOPE ✓ SOIL NATURE: SAND X LOAM CLAY OTHER ✓ GROUNDWATER: AT WHAT DEPTH? I BEDROCK/IMPERVIOUS MATERIAL: AT WHAT DEPTH? ✓ 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: Z) 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: ABSORPTION FIELD(WITH NO.2 STONE) Total lengt07 ft. Each trench -me) X (7 ❑SEEPAGE PIT(S)(WITH NO.3 STONE) How many? /1— Size? o ALTERNATIVE SYSTEM Bed or other type? /L ❑HOLDING TANK SYSTEM Total required capacity? AV/42- 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 t nd all requirements of the Town of Queensbury QUESTIONS? CALL 761-8256 OR EMAIL Sanity ag . r e. / codesCaqueensbury.net ignature of Person Responsible Date VISIT OUR WEBSITE FOR MORE INFORMATION www.queensbury.net Town of Queensbury Building & Code Enforcement I /ohm Office No. (518) 761-8256 Septic Inspection Report Inspection request received: Name: S t\n DA og Inspected on: icA � Location: `� I 11� (',\'4-t_°f'C re n Arrive: ��,_ p.m. Permit No.: /r3-5 Sc Inspector's Initials: I' , Ce ments and/or dia.ram Soil Type Sam .... ,. lay Type of Wate Munici al ell Water Waterline separation.istance 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 .7.,1:57) ft. Length of each trench ft. Depth of trenches Z 2.10. Size of Stone Seepage Pits: Number Size: x Stone Size: Piping Size Type Building to tank . )) T1 x6 j-I'f 6J1 uC� Tank to Distribution Box )._f It Distribution Box to Field/Pit i f)01-9).'7 445 0��J—� Opening Sealed: �/Y//_N End Cap 1/Y__ Inlet/Outlet Pipes&Baffles V Y N Manholes 12"or less below grade N [provide extension collar if Yes] Y N Location/Separations Foundation to tank 10 ft. Foundation to absorption 2-tB ft. Separation of Pits ft. Conforms as per Plot Plan Vic 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 fiddle System Use Stat : Approved Partial Approved and needs to be re-inspected, please call the Building&Codes Office Disapproved Septic Inspection Report ..------__ i J -0 AA/ 011e / ._ . .. _. ..____ _....... . . .. .... ..... ... . . .......... _. _ . , 11 ,o .... -9 1.)l ,...„....0.. . , 0 . 9 , .....- 1 : 1 . -... Ni 4S)t- .-- l 4..... ( I I ._ 1- e._N c•e,- 2_ a N r -MINN OF QUEF ,,_,! Reviewed By . Ail ' . Date: 1_. 61 ....,.. _ -- 3/ W,, cv-Tetell\ eery SEPTIC PLOT PLAN I HAVE SEEN OR OBSERVED ALL OBJECTS ---------- - - - . .______... -SUCH AS HOUSES;IAELLS,_TRE.ES, FENCES, ETC ___ SHOWN IS DOCUMENT.I HAVE PERSONALLY MEASU"; HE DISLAT-F-GaTit0..,,,,,,,N .*dr.GRAM. .-2--, SIGNAT *4 DATE