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2014-386 oi*.y�` 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: P20140386 Date Issued: Friday, October 03, 2014 This is to certify that work requested to be done as shown by Permit Number P20140386 has been completed. Tax Map Number: 523400-297-007-0001-018-000-0000 Location: 736 RIDGE Rd Owner: JEFFREY& JUDITH BENWAY Applicant: JEFFREY& JUDITH BENWAY This structure may be occupied as a: Septic Alteration Residential Test Pit/Perc Test Review By Order of Town Board TOWN OF QUEENSBURY Issuance of this Certificate of Compliance DOES NOT relieve the 41 5(--- property owner of the responsibility for compliance with Site Plan, ��wza�VJ 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: P20140386 Application Number: A20140386 Tax Map No: 523400-297-007-0001-018-000-0000 Permission is hereby granted to: JEFFREY& JUDITH BENWAY For property located at: 736 RIDGE Rd m 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: JEFFREY& JUDITH BENWAY 736 RIDGE Rd Septic Alteration Residential QUEENSBURY NY 12804-0000 Test Pit/Pere Test Review Total Value Contractor or Builder's Name /Address Electrical Inspection Agency Plans& Specifications 2014-386 Deep Hole/Perc Test Res. Septic Alteration $200.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Wednesday, September 02,2015 (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 f Que bury It •. i ay/ eptember 02, 2014 fVJ SIGNED BY for the Town of Queensbury. Director of Building&Code Enforcement Septic Inspection Report Office No. (518) 761-8256 Date Inspection request Queensbury Building&Code Enforcement Arrive: 2.2fL5a t 1.� e. : em 742 Bay Rd., Queensbury, NY 12804` Inspector's Initials: ea NAME: 1�+�t.\k\R�1NO.: [y—�2D LOCATION: —7 c3Co GZ1 OCE 2V SPECT ON: 1O-7:—P1 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. 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 _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 Use Sta : Approved Partial Approved and needs to be re-inspected, please call the Building &Codes Office Disapproved L:\Pam Whiting\2010\Building Codes Fonnaspe lon Foma\Septic Inspection Report_03 29 10.doc Town of Queensbury Building &Code Enforcement I burS 1C30 Office No. (518) 761-8256 Septic Inspection Report Inspection request received: Name: RPA c DS Inspected on: 9' `{ Location: 7 ,310 ktle Rd. Arrive: —3 g / Permit No.: Inspector's Initials: Co r • ents and/or dia•ram Soil Typ•. S. o..' ay Type of Wate ell Water Waterline separation distance tD ft. A- 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 75- ft. Length of each trench HC°? tS ft. Depth of trenches '2— ft. Size of Stone 3t Z Seepage Pits: Number Size: x Stone Size. Piping Size Type Building to tank 4" U1f) d Tank to Distnbution Box tk-u 50(1,935-- Distribution 35Distribution Box to Field/Pit M" 599.:35- to 4"6VE35 PE? Opening Sealed. t/Y / End Cap Y N F-13c) U0 VES Inlet/Outlet Pipes&Bathes vy( N Manholes 12"or less below grade �_ [provide extension collar if Yes] Y N Location/Separations Foundation to tank t2' ft.'" Foundation to absorption 7.2 ft. Separation of Pits ft. Conforms as per Plot Plan N Engineer Report and As-Built Y — ���� F�(„` Ealb �F ETU Maintenance Contract provided Y N Location of System on Property: Front Rear)—kett Side Side Middle Front iddle Rear System Use Status Approved Partial Approved and needs to be re-inspecte , please call the Building&Codes Office Disapproved Septic Inspection Report 1 1' i Office Use Only Town of Queensbury Building & Codes .� J \\J\,I,\ TaxSfviapi • r r` I ISI I SEPTIC DISPOSAL PERMIT ;l.a Nt3 �, 2Q14 t � 8k, P�md,No.: A permit must be obtained before beginning construction u " r t Pemtit Fee: $ ° > '7` Approvals:° t mno ..., __ J Applicant 7e 1":A:�j£Nµ Installer/BuilderS i 1v r i/+^'Sew e4 fer,�,i e Address: 73 Kid 9 e A' Address ft As_ 2 7 eild4/eerlfe"-1-- ff•-` 62/e,-j /7k/11 /i/'1 /2t'i Phone: t3 2- 3/Si Phone 7,2 - 71 r7 Owner. Location of Installation 736 #Cc 9e AC Address: Phone /� �q Contact Person for Building&Code Compliance: Geo tri C D real Day Phone: 77,17;16 Residence Information: �/ Year Built #of Bedrooms x Gallons per bedroom =Total Daily Flow 1960 or older x 150 = Garbage Grinder installed? /r/° 1981-1991 x 130 = Spa or Hot Tub Installed? /"d 1992-Present 1 x 110 = 330 Parcel Information: Topography Flat Rolling _Steep Slope _%Slope Soil Nature L Sand Loam _Clay _Other Groundwater At what depth? M714- Bedrodcllmpervious Material At what depth? gO p.-- Domestic Water Supply _Municipal Well(if well,water supply from any septic system absorption is ft.) Percolation Test Rate- I- 2?-1-3 per 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 /fv 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 length ft. Each trench X Seepage PIt(S)(with#3 stone) How many? AA Size? Alternative System or other type Z&`X Z a Holding Tank Sybtem Total required capacity?N a 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 farm 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.c9 Print Name: t� P b• �f Date: f- � a9"/ Signature: 1 ' Jay" Date: .P-29-, Town of Queensbury Max;&Codes Septic Disposal Remit 518-761-8256 I. cl Town of Queensbury• Building&Codes Enforcement Office•742 Bay Road• Queensbury,NY 12804 DEEP HOLE/PERC TEST Q 0 ) y J3 g(Q Request for Town Engineer Review J Property Owner. J-e-M- 'Elf VlWcy Phone: 83�-3 i 5? Property Owner's / Address: 73(0 Ici, ?4 a kx-e-c K.5171-7 .,may V p Location of Test 73 4 (!Z" ie fed Tax ID Si: 0R/7, 7- i -/fJ 'Applicant's Engineer. or 7� Phone: �l Applicant's Agent: G •FO 17,( ./re/�o 5 Phone: 77G\6` 3 7r! Additional Notes: 1.Reason for Request? Z( New Septic System I__I Replacement Septic System Failed Septic System Subdivision n Site Plan Review 2.Are Wetlands present? YES y NO UNKNOWN *Note: Applicant is required to engage an engineer for design and testing of the system. The Town Engineer's responsibility is to witness system testing only. PLOT PLAN: Plot plan, to scale, to be submitted with application FEE SCHEDULE: a. $ 200 Flat Fee Date Paid: y Check No.: b. OR Fee to be determined during To Be Determined: Site Plan/Subdivision review process SIGNATURE: In carrying out the provisions of Article IV, the Local Board of Health or the enforcement officer may engage the services of a qualified professional consultant for expert review and recommendation arising from the carrying out of the provisions of Art. IV, including but not limited to the review of plans, specifications and reports, attendance at inspections, dye tests, deep hole test pits, septic related deep hole and percolation tests, system installations, and any other aspect of any matter contained in this Art. IV, and any costs incurred in such review shall be paid to the Town by the owner of the property before any approval can be granted under this Art. IV shall become effective within 30 days of presentment of an invoice for same, whichever is sooner. Such costs shall not exceed $1,500 without prior written notice to the party to be charged with same. My signature below indicates I have thoroughly read and understand the instructions, agree to the submission requirements and have completed the application. I also fully understand that additional engineering fees may be necessary per Town of Queensbury Local Law 136-14D. SIGNATURE OF APPLICANT: Date: $N ('/4/ SIGNATURE OF AGENT: Date: Original (B&C File) Canary (Planning) Pink(Applicant) Gold (Town Clerk) r •. Town of Queensbury• Building&Codes Enforcement Office•742 Bay Road• Queensbury,NY 12804 DEEP HOLE/PERC TEST Request for Town Engineer Review Property Owner. .f e ' 7 dCn t-'4y Phone: Property Owner's / /J Address: 73 G /7 /I3 C Avid Location of Test: /trite q-P c / fr'z/ Tax ID#: A17-7-/�r 0 *Applicant's Engineer. /114-c-e k ovii7 e L/i 5 Phone: Applicant's Agent Phone: Additional Notes: to)-1— A / rot- ✓t j7/gtc{men r 517.1 PCs 1.Reason for Request? New Septic System 7•I l Replacement Septic System Failed Septic System Subdivision c Site Plan Review 2.Are Wetlands present? YES NO UNKNOWN *Note: Applicant is required to engage an engineer for design and testing of the system. The Town Engineer's responsibility is to witness system testing only. PLOT PLAN: Plot plan, to scale, to be submitted with application FEE SCHEDULE: a. $ 200 Flat Fee Date Paid: Check No.: b. OR Fee to be determined during To Be Determined: Site Plan /Subdivision review process SIGNATURE: In carrying out the provisions of Article IV, the Local Board of Health or the enforcement officer may engage the services of a qualified professional consultant for expert review and recommendation arising from the carrying out of the provisions of Art. IV, including but not limited to the review of plans, specifications and reports, attendance at inspections, dye tests, deep hole test pits, septic related deep hole and percolation tests, system installations, and any other aspect of any matter contained in this Art. IV, and any costs incurred in such review shall be paid to the Town by the owner of the property before any approval can be granted under this Art. IV shall become effective within 30 days of presentment of an invoice for same, whichever is sooner. Such costs shall not exceed $1,500 without prior written notice to the party to be charged with same. My signature below indicates I have thoroughly read and understand the instructions, agree to the submission requirements and have completed the application. I also fully understand that additional engineering fees may be necessary per Town of Queensbury Local Law 136-14D. SIGNATURE OF APPLICANT Date: �J��� SIGNATURE OF AGENT: Date: —7/1 T 7 Original (B&C File) Canary(Planning) Pink(Applicant) Gold (Town Clerk) Ete AP iy a g(o. Town of Queensbury• Building&Codes Enforcement Office•742 Bay Road• Queensbury,NY 12804 DEEP HOLE/PERC TEST ,J r ( Request for Town Engineer Review Property Owner. Q J-.� een wrl y Phone: Property Owner's /� Address: 7 3 6 /? ,. s05 e Location of Test "fit/ 7P/cf Tax ID a: 515 7. 7-/-fir *Applicant's Engineer: N/jf f k 17 t,n f l/; Phone: Applicant's Agent: J Phone: Additional Notes: .747�j f �G� �!D��L *rylaN r Sy J jese� 1. Reason for Request? New Septic System �VReplacement Septic System/ Failed Septic System Subdivision Site Plan Review 2.Are Wetlands present? YES NO UNKNOWN `Note: Applicant is required to engage an engineer for design and testing of the system. The Town Engineer's responsibility is to witness system testing only. PLOT PLAN: Plot plan, to scale, to be submitted with application FEE SCHEDULE: a. $200 Flat Fee Date Paid: Check No.: b. OR Fee to be determined during To Be Determined: Site Plan /Subdivision review process SIGNATURE: In carrying out the provisions of Article IV, the Local Board of Health or the enforcement officer may engage the services of a qualified professional consultant for expert review and recommendation arising from the carrying out of the provisionsrefa$rU )V, including but not limited to the review of plans, specifications and reports, attendance at &ions, dye tests, deep hole test pits, septic related deep hole and percolation tests, system installations, and any other aspect of any matter contained in this Art IV, and any costs incurred in such review shall be paid to the Town by the owner of the property before any approval can be granted under this Art. IV shall become effective within 30 days of presentment of an invoice for same, whichever is sooner. Such costs shall not exceed $1,500 without prior written notice to the party to be charged with same. My signature below indicates I have thoroughly read and understand the instructions, agree to the submission requirements and have completed the application. I also fully understand that additional engineering fees may be necessary per Town of Queensbury Local Law 136-14D. SIGNATURE OF APPLICANT: Date: � )) / c3 SIGNATURE OF AGENT: /ivz�� [ _� Date: a//T'27 Original (B&C File) Canary(Planning) Pink(Applicant) Gold (Town Clerk) CENTER PROJECT SERVICES 73 Sheridan Street, Glens Falls,NY 12801 Phone-518-796-2515 September 17, 2014 Project# 198 Dave Hatin Code Enforcement Officer Town of Queensbury 742 Bay Road Queensbury,NY 12804 Re: Benway—Replacement Septic System Dear Dave: This letter is to inform you that we inspected the completed replacement septic system for the Benway residence located at 736 Ridge Road in the Town of Queensbury on September 5, 2014. The replacement septic system as installed was for a 3 bedroom home and consisted of a new 1,500 gallon septic tank, new distribution box and a 20 ft wide by 25 ft long absorption bed with 4—20 ft long pipe and stone laterals. The system conforms to the requirements of the approved replacement septic system design. Please call me if you have any questions. Sincerely, t • 11 �e i Thomas R. Center, PE Q Z 2014 TOWN OF QUEENSBURY BUILDING&CODES AS BUILT N N£4 aAa rx+ 30 UZ 101 o (( .94,1. " I.19 gnu x aot � of ,�' Q•py ��, �� ,,+3K dz 55 s NIS DA 617 0-5 .*W z n VO o1 5 ti �5AV5;Z a-' al 9 Q38Q a a3a� �yi X15. -� ,nava z5Nn�s N ,aan 1d SOS x t f -to fto ai gyN •504 i g NtW yyaa -`C © os;% ii a i 0ilg3cl y1y2�•'��.ti\ fit.•- ,n* sax3 ia3xtio0 xi. lA� t 53'� U3x1µa0 a� v E N 'N\W 9 a„�y 15itSN Sita ly' N{. 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