2014-432 olSTOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20140432 Date Issued: Friday, September 19, 2014
This is to certify that work requested to be done as shown by Permit Number P20140432
has been completed.
Tax Map Number: 523400-301-014-0002-020-000-0000
Location: 79 MC ECHRON Ln
Owner: JAMES & PATRICIA STRYCHALSKI TRUST
Applicant: JAMES & PATRICIA STRYCHALSKI TRUST
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 G E/ /�
Alt—
property owner of the responsibility for compliance with Site Plan, wy� /� J
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
aON
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20140432 Application Number: A20140432
Tax Map No: 523400-301-014-0002-020-000-0000
Permission is hereby granted to: JAMES & PATRICIA STRYCHALSKI TRUST
For property located at: 79 MC ECHRON 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: JAMES & PATRICIA STRYCHALSK
JEFFREY STRYCHALSKI TRUSTEE Septic Alteration Residential
79 MCECHRON Ln Total Value
QUEENSBURY,NY 12804-0000
Contractor or Builder's Name /Address Electrical Inspection Agency
Plans&Specifications
2014432
Res. Septic Alterations
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Wednesday, September 16,2015
(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 expi 'on date.)
Dated at the Town o Quee s 71 ue: t% �/eptember 16,2014
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
v a
SEPTIC DISPOSAL PERMIT ~� ` n
Office Use Only
Y/� `U1
DATE r, ,ReC2Ned
It
Tex�Map ID. L Min -_ [j
TAX NAP ID ,�Q - a'a.0 Ptemiit Na�' _ K
Permittee OF rA E C:ncS _—
LOCATION OF INSTALLATION 7%- 4ie- £�A.0-.,_ i ApproyalsaG
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APPLICANT S7't-. S PHONE/E-MAIL 7F3 2 2 cre
ADDRESS Aa `7 Qa.:.Q.Q7 L/.� pvwxw
INSTALLER/BUILDER: r,.7 5ro_. Sg„ PHONE/E-MAIL 322et0
ADDRESS: �0 Ay,„..Ca2 An y,
OWNER OS s I V PHONE/E-MAIL
Address >o y7YLL 1r cAn
CONTACT PERSON'FOR BUILDING&CODES COMPLIANCE: PHONE ?k S 0 FF 5-9
RESIDENCE INFORMATION
Year Built #of bedrooms X Gallons per bedroom =Total Daily Flow
1980 or older Garbage grinder installed _Y _N
1981-1991 Spa or Hot Tub installed Y _N
1992-Present >bl.
PARCEL INFORMATION
Topography >c Flat rolling Steep slope %slope
Soil Nature Sand Loam Clay Other
Groundwater At what depth?
Bedrock I Impervious Material At what depth?
Domestic Water Supply .f Municipal Well(if well,water supply from any septic system absorption is ft.)
Percolation Test Rate: per minute per inch(test to be completed by licensed engineering I architect)
PROPOSED SYSTEM FOR NEW CONSTRUCTION
Tank Size /Aao gallons(minimum size 1,000 gallons,add 250 gallons to size for each garbage grinderor spa or hot tub)
System Type Absorption field with#2-stone K Total length SZ2D ft.;Each trench Ss— x 1/-
Seepage Pit with#3 stone How many: ;size
Alternative System Bed or other type?
Holding Tank System Total required capacity? Tank size #of tanks
Notes: 1)Alarm system&associated electrical work must be inspected by a Town approved electrical inspection agency;2)We will no longer
allow systems to be covered until such time as an As-Built plan is received &approved. The installed system must match the septic system
layout on file-no exceptions.
DECLARATION: My permit or approval wanted which is based upon or is granted in reliance upon any material representation or
failure to make a materiatfact or circumstance know by or on behalf of an applicant,shall be void. I have read the regulations and
agree to abide by these and all requirements of the Town of Queensbury Sanitary Sewage Disposal Ordinance.
Print Name: f RN/C ,f HALO Date: -l y
Signature: '- Date:
6
Town of Queensbury Building&Codes Principal Structure Application July 2014
a 30oo - 9:0o
Septic Inspection Report
Office No. (518) 761-8256 Date Insg<ection requ-- •=
Queensbury Building&Code Enforcement Arrive: 'ca55151a r /p ,/' part: 'Ea • pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initial ris
NAME: .4TR`� CNB\.v6i If
-1 IT NO.: 1' -H3Z
LOCATION: —79 MGF_Csl-Acl (SASE SPECT ON: 9 —Il— I4
RECHECK:
���� Comments and/or diagram
Soil Type.�::Tr1�r/ Loam/Clay
Type of Water: unidpa Well Water
Waterline separation distance -170 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 Zc'�
Length of each trench W@ .
Depth of trenches 2.-- ft.
Size of Stone Z_ i71-1;0e—
Seepage
tse—Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type
Building to tank C I 0[�
Tank to Distribution Box I hf7i�-3
Distribution Box to Field/ Pit ,ve a f )cj ,C -; YOCI3ea—
Opening Sealed: ✓Y N
End Cap
Inlet/Outlet Pipes&Baffles ( N
Manholes 12"or less below grade _ N
[provide extension collar if Yes] Y N
Location/ Separations
Foundation to tankft.
Foundation to absorption ft.
Separation of Pits ft.
Conforms as per Pia _N
Engineer Report a d As-Bpi / Y N
ETU Maintenan C —Y_ N
provided
Location of System on Prope
_
Front Re r ��'i Side iddle Front Middle Rear
:
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
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• • 518-793-2290
Fax#518-793-2115
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E-mail: momingstarseptic@hotmail.com
A www.morningstarseptic.com
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Jewel Road,Gansevoort,NY 12831
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BUILDING & C(IDLIj �'.
Reviewed'_By: 0
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SEPTIC_PLOT PLAN
I HAVE SEEN OR OBSERVED ALL OBJECTS
SUCH AS ELLS, TREES, FENCES. ETC
SHOWN ONO THIS DOUSES,VCUUMENT.I HAVE PERSONALLY
MEASURED 1HE DISTANCE SET ORTH ON THIS DIAGRAM.
SIGNATURE DATE