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2008-241 TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development- Building &Codes (518) 761-8256 CERTIFICATE 'C"NIFE7 COMPLIANCE Permit Number. P20080241 Date Issued: Tuesday, June 10, 2008 This is to certify that work requested to be done as shown by Permit Number P20080241 has been completed. Tax Map Number. 523400-295-014-0002-057-000-0000 Location: 11 JOHN CLENDON Rd Owner. WILLIAM & BONNIE THOMAS Applicant: WILLIAM & BONNIE THOMAS This structure maybe 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, Variance, or other issues and conditions as a result of approvals by the Director of Building&Code Enfoitement 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: P20080241 Application Number. A20080241 Tax Map No: 523400-295-014-0002-057-000-0000 Permission is hereby granted to: WILLIAM &BONNIE THOMAS For property located at: 11 JOHN CLENDON 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: WILLIAM&BONNIE THOMAS 11 JOHN CLENDON Rd Septic Alteration Residential QUEENSBURY, NY 12804 Total value Contractor or Builder's Name/ Address Electrical Inspection Agency STONE INSTALLATIONS 4305 ROUTE 50 SARATOGA SPRINGS,NY 12866-0000 Plans &Specifications 2008-241 Septic System- residential $25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Wednesday, May 27, 2009 (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 T o eens ry, Tdte ay,May 27, 2008 SIGNED BY for the Town of Queensbuuy. Director of Building&Code Enforcement For an EPA homeowner's guide: htt : www.e a. ov n des ubs ho eown -------------------------------------------------------- OFFICE USE ONLY r` a�i �- TAX MAP NO.__-_________ PE MIT NO.______"_____PERFIE ___ APPROVALS: ZONING_____ ________TOWN CLERK------________ { -------------------------------------------------------------- L3 U i'__--1�..„......�. '�4I� ai..i Y� _terms APPLICATION FOR SEPTIC DISPOSAL SYSTEN -� .a A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJECT TO REVIEW BEFORE ISSUANCE OF A VALID PERMIT. OWNER: Bonnie&William Thomas INSTALLER: Stone Industries ADDRESS: 11 John Clendon Rd ADDRESS: 4305 Route 50, Saratoga Spqs, NY 12866 PHONE NOS. 798-5984, (w)793-5556 PHONE NOS. 800-446-6331 cell 232-6707 LOCATION OF INSTALLATION: East-side-of dwelling _ RESIDENCE YEAR BUILT NO.OF BEDROOMS X COMPUTATION= = TOTAL DAILY FLOW INFORMATION: 1980 or older X 150 gallon per bedroom = 0 GARBAGE GRINL INSTALLED? C 1981-1991 © X 130 gallon per bedroom = 390 1992-present X 110 gallon per bedroom = 0 SPA OR HOT TUBS/ INSTALLED? PARCEL INFORMATION: ✓ TOPOGRAPHY: FLAT ROLLING ✓ STEEP SLOPE SLOPE % ✓ SOIL NATURE: SAND_!�__ LOAM CLAY OTHER ✓ GROUNDWATER: AT WHAT DEPTH? None BEDROCK/IMPERVIOUS MATERIAL: AT WHAT DEPTH? None ✓ DOMESTIC WATER SUPLY: MUNICIPAL ✓ WELL_,(If well:water supply from any septic system absorption is:( ft) ✓ PERCOLATION TEST: RATE IS 1.5min/inch PER MIINUTE 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: _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: q , , ❑ABSORPTION FIELD(WITH NO.2 STONE) Total length�0 ft. Each trench � X ❑SEEPAGE PIT(S)(WITH NO. 3 STONE) How many? Size? _ [:]ALTERNATIVE SYSTEM Bed or other type?_—� El HOLDING TANK SYSTEM Total required capacity?___—__ 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 QUESTIONS? CALL 761-8256 OR EMAIL to abi y these and all requirements of the Town of Queensbury codesCa)gueensbury.net Sanit Sewage Dispos rdinance. VISIT OUR WEBSITE FOR MORE INFORMATION ILA?— 57�1;z-6 1 www.nueensbury.net Si ature f P o Responsible Date ��,- Toznn of Queensbury• Community Development Office • 742 Bay Road, Queensbury, NY 12804 Septic Inspection Report Office No. (518)761-8256 Date In aio est received: Queensbury Building &Code Enforcement Arrive: am/p ep am/pm 742 Bay Rd., Queensbury, NY 12804 Inspect s Initials: NAME: 0 M PERMIT NO.: LOCATION: INSPECT ON: 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' + 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 Location Separations Foundation to tank ft. Foundation to absorption ft. Separation of Pits ft.Conforms as as r Plot Plan N i AM11 Engineer Report and As-Built Y N Location of System on Property: Front Rea Left Side Right Side Middle Front Middle Rear System Use S Approved Partial Approved and needs to be re-inspected, please call the Building &Codes Office Disapproved Last revised 06/18/07 L:\Building&Codes Forms-OLD\Building&Codes\Inspection Forntis\Septic Inspection Reportdoc (-3 Oo) a,s+ Septic Inspection Report Office No. (518) 761-8256 Date InspecticN request received: Queensbury Building &Code Enforcement Arrive: .am/ ep rt: am/pm 742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: I NAME: , 1�— .` / . _ ,�/� PERMIT NO.: LOCATION: - r L ` w 'u (/ INSPECT ON: r RECHECK: Comments and/or diagram Soil Ty f Loam / Clay Type of Water: Vunlcip4l / Well Water Waterli ration distance ft. Well separation distance ft. Other wells: Well Casing Length 50' + / - Y N N/A Absorption Field: Total length Length of each trench ft. Depth of trenches ft. ' Size of Stone "r� Seepage Pits: Number Size: x Stone Size- Piping sizo, Type Building to tank -f-, Tank to Distribution Box Distribution Box to Field Pit V. " Opening Sealed: Y End Ca Inlet/Outlet Pipes&Baffles Y N Location Separations Foundation to tank ft. Foundation to absorption ft. Separation of Pits ft. Conforms as per Plot Plan V Y N Engineer Report and As-Built Y N Location of System on Pro Front Rear a Sid 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 Last revised 06/18/07 L:\Building&Codes Forms-OLD\Building&Codes\Inspection Forms\Septic Inspection Report.doc Septic Inspection Report Office No. (518) 761-8256 Date Ins= T("- request received: Queensbury Building&Code Enforcement Arrive: am Depart: am/pm 742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: NAME: `i o ,5 PERMIT NO.: 'Z " LOCATION: s ",&A"Oy INSPECT ON: c� RECHECK: Comments and/or diagram Soil Type: Sand Loam/Clay TylLe of Water: Municipal/ Well Waterfi� Waterline separation distance ft. l Well separation distance ft. Other wells: ft. Absorption Field: Total length ft. Length of each trench ft. I /. L 0 F Depth of trenches ft. Size of Stone Seepage Pits: Number Size: x Stone Size: Piping Size Type Buildina to tank Tank to Distribution Box Distribution Box to Field Pit Opening Sealed: Y Z NJ Partial End Ca Inlet/Outiet Pipes&Baffles Y N Location/ Se rations 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 Location of System on Property: Front Rear Left Side Right Side Middle,/Frot Middle Rear 5y-4=Use pproved Partial Approved and needs to be re-inspected, please call the Building&Codes Office Disapproved Last revised 021006 Last revised 1/6/05 v RECORD PLAN DRAWING SUBMISSION FOR REPLACEMENT SEPTIC SYSTEM Date: June 9,2008 To: Town of Queensbury Building Department / 742 Bay Road Queensbury,NY 12804 Re: Thomas Residence I 1 John Clendon Road Queensbury,NY 12804 To Whom It May Concern: Find enclosed an 11 x 17 record drawing depicting the replacement septic system as it was constructed at the above noted address. If you have any questions please call. Ryan K. Riper, P.E. 225 Ruggles Rd. Saratoga Springs,NY 12866 Ph. 518-817-0099 Encl.