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2002-319 TOWN OF QUEENSBURY 742 Ba Road ueensbu NY 12804-5902 518 761-8201 �� Y ,Q rY> � ) Community Development - Building & Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE Permit Number: P20020319 Date Issued: Monday, August 15, 2005 This is to certify that work requested to be done as shown by Permit Number P20020319 has been completed. Tax Map Number: 523400-289-013-0001-036-000-0000 Location: 20 BIRCH Rd Owner: BRIAN & M. LINDA SOLOSKI Applicant: BRIAN & M. LINDA SOLOSKI 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 (Thj / property owner of the responsibility for compliance with Site Plan, c..42 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 w_oero 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development- Building& Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20020319 Application Number: A20020319 Tax Map No: 523400-289-013-0001-036-000-0000 Permission is hereby granted to: BRIAN & M. LINDA SOLOSKI For property located at: 20 BIRCH 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: BRIAN & M. LINDA SOLOSKI Septic Alteration Residential 20 BIRCH Rd Total Value LAKE GEORGE,NY 12845 Contractor or Builder's Name/ Address Electrical Inspection Agency BATEASE, GLENN 46 DREAMLAKE RD OUEENSBURY,NEW YORK Plans &Specifications 2002-319 SEPTIC ALTERATION AS PER APPLICATION $25.00 PERMIT FEE PAID - THIS PERMIT EXPIRES: Wednesday,April 30,2003 (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 theth Town of ee4sbun ; Tuesday,April 30,2002 SIGNED t3,Y .,./ for the Town of Queensbury. Director of B 4 g N ode Enforcement Application for Permit—Septic Disposal System Town of Queensbury 742 Bay Road Queensbury,NY 12804 (518) 761-8256 1. OWNER INFORMATION: Office Use D Location of installation: o. J/f'C'h' /t,2 > 0 File Permit No. f -1 - `".. / Tax Map No. / / -,1:Fee Paid �-.,j, Owner's Name: $ L D,k ,�i l4Al .1- �1IL'�I� _....,_._._.......r_...._..........__-.._..........._.. Address: el D , '//, eh//1' ,Cfgi1le' ‘6�./. 2. INSTALLER'S NAME : GI E-ntN (i"?GA-{'C S.,.c PHONE NO. 3. RESIDENCE INFORMATION: (circle year of dwelling,indicate#bedroom(s)and multiply#of bedrooms with applicable gallons per bedroom to equal total daily flow) Year of House: I' I No.of Bedrooms, x Computation = Total Daily Flow 1980 or older _3 x 150 gal/bdrm = VCC) 1980—1991 x 130 gal/bdrm = 1991 —present x 110 gal/bdrm = Garbage Grinder Installed yes_ / no a#0// Spa or Whirlpool Installed yes_ / no '," 4. PARCEL INFORMATION: (circle applicable information&indicate measurements) Topography Soil Nature Ground Water Bedrock or Impervious Material Domestic Water Supply Flat sand L/ at what depth at what depth ipal Rolling loam feet feet e Steep slope clay r well;water supply _%slope other from any septic-system depth: absorption isles ft. other Percolation Test: (To be completed by licensed professional engineer or architect) Rate: minute per inch 5. 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). Add 250 gallons to the size of the septic tank and leach field for each Garbage Grinder,Spa or Whirlpool Tub. (Xi �n' 4 C- Pt \t i)131-012E- Septic Tank: /40Q gallon (min. size 1,000 gal) ,i4i 1 kADO . 7-0 Tile Field: each trench '` f� Total System Length: ft' IN, Seepage Pit(s): number of size of each: ft. by ft. TWO- t Size of Stone to be used: # / depth or thickness feet l i I iki 1;\ Bed System Size: x f Alternative System: length and/or size 6. HOLDING TANK SYSTEM: (if required) Number of tanks: / Size of each: gallons /TOTAL Capacity: gallons Note: Alarm System and associated electrical work must be inspected by a Town approved electrical inspection agency. 7. SIGNATURE &INFORMATION FOR RESPONSIBLE PERSON(please read) 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 these and all requirements of the Town of Queen Sanitary Se ge Disposal Ordinance. 0, .--, Signature of responsible person , Date/ ç \Q -\ `) Septic Inspection Report 9 ' / 1 Office No.(518)761-8256 Date Inspection request received: Queensbury Building&Code Enforcement Arrive: am/ m Depart:j �jm 742 Bay Rd., Queensbury,NY 12804 Inspector's Initials: 0 (T / � ,,] j l NAME: AA�, c�) PERMIT NO.: � � �`� � f LOCATION: .J V.z 0 INSPECT ON: RECHECK: ' "1-(, _ / 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. Absorption Field: Total length ft.Length of each trench ft. 111(tWes- Depth of trenches ft. �� Size of Stone . ' c 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/Partial End Caps Location/Separations 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 Fr nt Middle Rear S stem Use S tus• Approved Partial Approved and needs to be re-inspected, please call the Building& Codes Office Disapproved Last revised 1/6/05 TOWN OF QUEENSBURY c BUILDING & CODE ENFORCEMENT 742 Bay Road Queensbury NY I2804 (518) 761-8256 SEPTIC DISPOSAL SYSTEM INSPECTION i Name ay ; ; L_:X ) LocationC {_:, , �/, _- Date Permit # Q - SOIL TYPE: Sand-Loam-Clay- Results of Percolation Test- (if applicable) Rate-Minute/Inch TYPE OF SYSTEM: ABSORPTION FIELD: Total Le gth Length of each trench Depth of trenches Size of stone SEEPAGE PITS: Number- Size - ft. x , ft. Stone size _.— PIPING: ize Type Bldg. to Tank Tank to Dist. Box Dist. Box to Field/Pit Openings Sealed? Yes No Partial LOCATION/SEPARATIONS: Foundation to Tank feet Foundation to Absorption feet Separation of Pits feet Conforms as per Plot Plan Yes No LOCATION OF SYSTEM ON PRO'ERTY: (circle one) Front - Rear - Left Side Right Side Middle Front - Middle Rea COMMENTS: FiTE_P___ b 9-• t't F1 -E 3 E v 5 elt Gi k\V- . . 6 ___‘1 .\.kt 0 (co ..).N , ,,e_vtti., __. ,.iy.u%avtQ SYSTEM USt A PR VE6: YES NO Arrived' Depa ed: i ing In p c r TOWN OF QUEENSBURY BUILDING bCODE ENFORCEMENT 742 Bay Road Queensbury NY 12804 (518) 761-8256 SEPTIC DISPOSAL SYSTEM INSPECTION Name L i tDA ,:4A=s 6_Kt Location Zp ZR # RuR) Date 1 -07 Permit # ;Z-�,�}9 SOIL TYP'• and- oam-Clay- Results of Percolation Test- (if applicable) Rate-Minute/Inch TYPE OF SYSTEM: 6 ABSORPTION FIELD: Total L�e_�ngCtth 7"r �'T' Length of each trench 6,5 Depth of trenches r Size of stone I EV✓-( 6-`-14 SEEPAGE PITS: N u ber- Size - t. x ft. Stone size PIPING: Size Type . Bldg. to Tank ' Tank to Dist. Box ' Tl yt' Y�J t Dist. Box to Fie d/P' y --,Y �_\_6,� Openings Sealed? Y / " No Partial LOCATION/SEPARATI1 %. . Foundation to Tank c-spfo4 feet Foundation to Absorp ;on 2(-0'feet Separation of Pits -t Conforms as per Plot R`l .n �► , LOCATION OF SYSTEM ON/P' 'PER (c' fie) ront - Rear'1- Left Side Right Side k Middle Front - Middle Rea �,- e _S! cc\ ''' . -1A',Y-) e e01,) SYSTEM USE APPROVED: YES NO Arriv • ;I Dep ted J ` / ilipt, / uildin Insp ctor 1 ,/ • TOWN OF QUEENSBURY BUILDING b CODE ENFORCEMENT 742 Bay Road Queensbury NY 12804 (518) 761-8256 SEPTIC DISPOSAL SYSTEM INSPECTION Name } ' cc' )o LocationC Q)tr '\ Date th _ Permit #f e ,a-,3j/C) SOIL TYP • an am-Clay- Resul is of Percol a n Test- (if applicable) Ra to Minute/Inch TYPE OF SYSTEM: ABSORPTION FIELD: Total Length Length of each trench Depth of trenches Size of stone SEEPAGE PITS: Numb4r- /t Size - — ft. 1 / ft. Stone size f\' PIPING: Size Type Bldg. to Tank r1t f►.�(-� Tank to Dist. Box Dist. Box to Field/P t cc PJC, AT) Openings Sealed? %'o Partial LOCATION/SEPARATIt : Foundation to Tank &tli4fPet Foundation to Absorpt on 3c- 'feet Separation of Pits --'-feet Conforms as per Plot plan LOCATION OF SYSTEM ON PROPERT (circle one) ran Rear - Left Side - Right Side 1 e Front - Middle Rear COMMENTS: To 6 N o vz-v-E_O ,6 t t--1 T'0 1 ©t 17 uE • -Y© Et Cat 1cv_..'6 ► ram D �t �E � SYSTEM USE'APP • ► �o��.S? '��� Arrived- i� L- Dep• ed: 'f ''i 1 ' B ding Inspect r / i ? v o To -1 ! g` /Mr "j,�� Aa a AA3 ':6 7 . ), -gin do Nj 1 0s ()/' t e . , k , ,\. i, --- . ,,: ., ,,, s?)414/ ' , A D. ,c . P� - . ___ 0 k 1 ""'"----- )0 ---- o al\91.-* 0 , E (1,, � 1 (3 o 02' jf\ 1 T. � /77 ---y , .•,.. ) ."".. ... . ir ! 4a✓�F.:�, t_ .Thi\6;• 1w evidence t 11; S,, ° ceS,etc., 1 i i i z r Psent that I have ,, -ices se rt'i on the diagram." Z," '' ...vj e _.ram o c _ -) - -----------TS1 NAI1� y DATE �lti1'Si VJ��E , 091 , b4, Pam' 797avil L .= ti.y/?y • ti .t V-iie _ N in? A _.-4 7. d --'-)c - v - ci 0 3-4cd.1. i1 (73Qi d' 1a c ,):) 9 1 0-3-lam H;�cfcl\ - Y3 k Q 0.W �' • , ). Alb._ • 1 7,,,,\.� � '' ! Cj `mot o °' �V"7 U, ® o �- RE o - CD priiir - ; ficCall .Agy.!-ONI 18 z -.IN 0 1 �"� Jan. 'O .i N 4 r" , ::\ / • , . a � fA. � :� - CD <C 1 • - �/ <�c, n eD . .411!) ,c i \ ., • • �� of el . �--- o f . . , , \ . .k • • . q rix.j.ji",2e w r or - 6 / - • / wtLL :.ei, believe 1 _ 31d� F.:717 t fences,etc., � � _. �s;. ;ruses, w• s, r ---- - - -- 'resent-that I have—. --- . .rib-- :� .A8 03M31A31 1 ucumant. t al +rth on the diagram• �� 1 •. -.;; •a urea t� �-� d ` - d ., ,l II , lis oNlc �lne . 1 .4 NATURE DATE fs:.no .'1,, . x o J NAA01 . • • • L . Pam' t17a1. 2 — PI iF _038_ . •