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2006-616 40111111K, 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: P20060616 Date Issued: Wednesday, January 16, 2008 This is to certify that work requested to be done as shown by Permit Number P20060616 has been completed. Tax Map Number: 523400-289-009-0001-068-000-0000 Location: 354 GLEN LAKE Rd Owner: JANE MADEY Applicant: JANE MADEY 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, 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 ET 1 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development- Building&Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20060616 Application Number. A20060616 Tax Map No: 523400-289-009-0001-068-000-0000 Permission is hereby granted to: JANE MADEY For property located at: 354 GLEN LAKE 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: JANE MADEY 590 POST Ln Septic Alteration Residential SOMERSET, NJ 08873-0000 Total Value Contractor or Builder's Name/ Address Electrical Inspection Agency QUEENSBURY SEWER JAY SWEET Plans &Specifications 2006-616 septic alteration $25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Wednesday, September 05, 2007 (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 ex irztion date.) Dated at the To o- nsb ;4 / , ptember 05, 2006 d SIGNED BY \ for the Town of Queensbury. Director of Building&Code Enforcement 06- OFFICE USE ONLY TAX MAP NO. PERMIT NO. PERMIT FEE , APPROVALS: ZONING TOWN CLERK AUG j 2006 APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT; A PERMIT MUST BE^"T4INED BEFORE WORK BEGINS.APPLICATION IS SUBJECT TO REVIEW BEFORE ISSUANCE OF A VALID PERMIT. MacteOWNER: I • INSTALLER: G 1 x ? . l\�1 tC ADDRESS: � L/ '" C I y fJ h..UP r ADDRESS: a-. kJ AL. PHONE NOS. PHONE NOS. (r, / `-r / 5- 3 LOCATION OF INSTALLATION: ,..?-5.-17/ C-42-1-"- �,�f YEAR BUILT NO.OF X COMPUTATION= = I I RESIDENCE INFORMATION: BEDROOMS TOTAL DAILY FLOW 1980 or older1 1 G STALL E QRI 9ER X 150 gallon per bedroom I = /7.aI INSTALLED? 1981 -1991 X 130 gallon per bedroom 1 = 1 ........_.........,.....w........,..._.... I SPA P X 110 gallon OR HOUB , T T 1992- resent ' A—' per bedroom _ ' INSTALLED? PARCEL INFORMATION: ✓ TOPOGRAPHY: FLAT ROLLING V STEEP SLOPE %SLOPE ✓ SOIL NATURE: SAND }C LOAM CLAY OTHER ✓ GROUNDWATER: AT WHAT DEPTH? BEDROCK/IMPERVIOUS MATERIAL: AT WHAT DEPTH? ✓ DOMESTIC WATER SUPLY: MUNICIPAL WELL Y (IF WELL:WATER SUPPLY FROM ANY SEPTIC-SYSTEM ABSORPTION IS FT. ) ✓ PERCOLATION TEST: RATE IS 13 J S i '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). Add 250 gallons to the size of the septic tank and leach field for each garbage grinder, spa or whirlpool tub. ✓ SEPTIC TANK/u r GALLON (MIN. SIZE IS 1,000 GAL.) TILE FIELD: EACH TRENCH FT. ✓ TOTAL SYSTEM LENGTH: FT. SEEPAGE PIT(S): HOW MANY? ✓ SIZE OF EACH FT. X FT. ✓ SIZE OF STONE TO BE USED: # /DEPTH OR THICKNESS FT. ✓ BED SYSTEM SIZE: X V 0 ✓ ALTERNATIVE SYSTEM: e Al SI(.S.IR� LENGTH AND/OR SIZE ✓ HOLDING TANK SYSTEM:(If required) NO. OF TANKS: /SIZE OF EACH ✓ GALLONS./TOTAL CAPACITY: GAL. 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 these and all requirements of the Town of QUESTIONS? CALL 7614256 OR EMAIL Queensbury Sanitary Sewage Disposal Ordinance. oodesOaueeneburv.net VISIT OUR WEBSITE FOR MORE INFORMATION 6., www.queenaburv.net Signature P4son Responsible Date Town of Queensbury • Community Development Office • 742 Bay Road, Queensbury, NY 12804 RESOLUTION APPROVING JANE MADEY'S APPLICATION FOR SANITARY SEWAGE DISPOSAL VARIANCES RESOLUTION NO.: BOH 15,2006 INTRODUCED BY: Mr.John Strough WHO MOVED ITS ADOPTION SECONDED BY: Mr.Tim Brewer WHEREAS, Jane Madey filed an application for variances from provisions of the Town of Queensbury On-Site Sewage Disposal Ordinance, Chapter 136 to install a replacement absorption system: 1. one foot (1') from the west property line instead of the required ten feet (10') setback; and 2. fifty feet(50')from the well instead of the required one-hundred feet(100')setback; on property located at 354 Glen Lake Road in the Town of Queensbury, and WHEREAS,the Town Clerk's Office published the Notice of Public Hearing in the Town's official newspaper and the Local Board of Health conducted public hearings concerning the variance requests on April 17th and June 19th,2006, and WHEREAS, the Town Clerk's Office has advised that it duly notified all property owners within 500 feet of the subject property, NOW, THEREFORE, BE IT RESOLVED, that 1. due to the nature of the variances, the Local Board of Health determines that the variances would not be materially detrimental to the purposes and objectives of this Ordinance or other adjoining properties nor otherwise conflict with the purpose and objectives of any Town plan or policy; and 2. the Local Board of Health finds that the granting of the variances is necessary for the reasonable use of the land and is the minimum variances which would alleviate the specific unnecessary hardship found by the Local Board of Health to affect the applicant; and BE IT FURTHER, RESOLVED, that the Local Board of Health hereby approves the application of Jane Madey for variances from the Sewage Disposal Ordinance to install a replacement absorption system: 1. one foot (1') from the west property line instead of the required ten feet (10)' setback; and 2. fifty feet(50')from the well instead of the required one hundred feet(100') setback; contingent upon the following conditions: 1. that the residence continue to be a seasonal residence only; 2. that the current footprint of the structure not be expanded; 3. that the applicant agrees to appear before the Town Board to obtain approval of any future structural expansion before the applicant applies to the Zoning Board of Appeals for any needed ZBA approvals of any proposed expansion; and 4. that the applicant agrees to provide a deed restriction in form acceptable to Town Counsel in favor of the Town of Queensbury which deed restriction could not be amended without the Town Board's approval as the benefited party. Such deed restriction is to keep the size of the footprint where it currently is until the property owner returns to obtain Town Board approval, in its discretion, with any release or modification of such deed restriction; on property located at 354 Glen Lake Road in the Town of Queensbury, and bearing Tax Map No.: 289.9-1-68. Duly adopted this 19th day of June, 2006,by the following vote: AYES : Mr. Strough,Mr. Brewer,Mr. Stec,Mr. Boor, Mr. Sanford NOES: None ABSENT: None Septic Inspection Report Office No. (518) 761-8256 Date Inspection request received: Queensbury Building &Code Enforcement Arrive: am/ part: am/pm 742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: NAME: ` / PERMIT NO.: . .I LOCATION: :?.i �/�i--• C.a-l�W.INSPECT ON: Mr RECHECK: Comments and/or diagram Soil Type: Sand/ Loam/ Clay Type of Water: Munidpal / Well Water Waterline separation distance _ft. ���� Q Well separation distance ft. Other wells: _ft. 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/ Partial End Cap 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 Y N Engineer Report and As-Built Y___..N Location of System on Property: Front Rear Left Side Right Side Middle Fron Middle Rear -m U - ta!gs: Approved Partial Approved and needs to be re-inspected, please call the Building &Codes Office Disapproved Last revised 021006 Last revised 1/6/05 TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development- Building&Codes (518) 761-8256 Inspections per Permit Pernik n P20060616 Inspection Date Inspection Type Approved/Denied Comments Permit Type Person Responsible 9/7/2006 12:00:00AM Septic Septic Alteration Residential JOHN O'BRIEN Denied 2006-616 ENGINEER'S APPROVAL LETTER OK TO BACKFILL ENGINEER HAS INSPECTED MATER TREATMENT — ULTRAVIOLET TREATMENT UNIT TO BE ADDED TO WELL WATER SUPPLY LINE DUE TO LACK OF SEPERATION BETWEEN WELL AND ELJEN SYSTEM. MAP REFERENCE I MAP OF PART OF THE LANDS OF JOHN H. SULLIVAN & OTHERS BY: LESLIE W. COULTER _ --- DATED: MAY 23, 1947 100' WELL SETBACK TELL LOCATED ~ \� RETAER THAN 100'7 \ LANDS N/F OFF TOWN OF QUEENSBUR\ (VACANT LOT) 1 "'... .moo. BRF 10 19/95 / / DISTRIBUTION LANDS N/F OF LANDS N/F OF, \ BOX HAYES P. C. SULLIVAN ` (VACANT LOT) PF 12/20/0 ( 1.000 GAL. \ CN•.., SEPTIC T �R "'�► b ° EXISTING SEPTIC SYSTEM L14 '`�. ��_\ 4, 300 GAL. STEEL TANK &�FONE / SEEPAGE/CESSPOOL TO B QLF OF ELJEN IN Ut�ITa �cjp — DISCONNECTED&INFlLLED. j 420 I i 1aL LIMITS OF ODSater\ ` ` ato 1 I aoo/ 1 1 1 STORY WOOD FRAMED O [p HOUSE Vp ASPHALT DRIVE coPAT10 F t � t t t Jtoto I � tC +r EXISTING BASEMENT SEPTIC SYSTEM J !lJJJ t Y APPROXIMATE LOCATION TO BE r3 r\ §LATE .f��ggl�t sc�. t.t j DISCONNECTED &INFlLLED WITH N68 s•O PA710 / Q/ Ogre ( j / �BA�ENTTIINLLET PIPE ! �. LANDS N/F OF 420 R.J. SULLIVAN / 410 1 t NO WELL OBSERVED t / ` IN THIS AREA 5'± 1 PROPERTY SUPPLIED 400 If / L 100' ~ BY LAKE WATER WELL SETBACK LEGEND BRFO= BATHEY ROD FOUND ~ �. IPFO= IRON PIPE FOUND \�` 90.,= UTILITY POLE PLAN CJ= REFERENCED MAP L07 NUMBERS DATUM = U.S.G.S. 'OUR INTERVAL = 2 FOOT Scale: 1"=20' l 3 ThURA1 . ?- 7 -06 Septic Inspection Report Office No. (518) 761-8256 Date Ins.- ion u- 'i -I I. -"--- _ � Queensbury Building &Code Enforcement Arrive: "All am • 10 -part: • a . Ini .Is• 742 Bay Rd., Queensbury, NY 12804 Inspector's NAME: I, I' ) IT NO.: 04 . 2/6 LOCATION: :_,5( f , IN 'ECT ON: (?— 7 -O RECHECK: Comments and/or diagram Soil Ty Loam / CIa Type of Water: Municip Well Water Waterline separation distance _ ft• Well separation distance <TC ft. ►6 ?E - ik\i �Jv) V Other wells: -ft. Absorption Field: Total length I-0 ft. Length of each trench J C`'-' ) ft. Depth of trenches 2-- ft. Size of Stone t - 1L• A A Seepage Pits: Number Size: x Stone Size: ---- Piping Size Type Building to tank ' i' N Tank to Distribution Box .f' Distribution Box to . ilud/ Pit 1-1" , Te GLS k5-.\-. )\ t Opening Seale I.N Partial / End Cap ‘��/ I Inlet/Outlet Pipes&Baffles i _.1 L _.._,_N Location/ Separations Foundation to tank I Z— ft. 'B (--'3P� EP.._ t r= \-; vF_ Foundation to absorption _ .Z ft. Separation of Pits ft. rms as per Plot Plan Y I`r Engineer Repor-tThid As-Built _ _____Y eN Location of System on Property: E 3` ` tE _ �� _ ______ Fro a eft Side Right Side t.,- _ iddle Fro. Middle Rear System Use Status: •• .ved All ��al Approved and needs to be re-inspected, please call the Building &Codes Office 1 • ,s sapproved th Last revised 021006 \t7 C_ a Last revised 1/6/05 -06` TOWN OF QUEENSBURY F 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 ' Community Development- Building &Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20060616 Application Number. A20060616 Tax Map No: 523400-289-009-0001-068-000-0000 Permission is hereby granted to: JANE MADEY For property located at: 354 GLEN LAKE Rd in the Town of Queens bury,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: JANE MADEY 590 POST Ln Septic Alteration Residential SOMERSET, NJ 08873-0000 Tota Value Contractor or Builder's Name/ Address Electrical Inspection Agency QUEENSBURY SEWER JAY SWEET Plans &Specifications 2006-616 septic alteration $25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Wednesday, September 05, 2007 (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 bu4ITu; a / ember 05, 2006 SIGNED BY for the Town of Queensbury. Director of Building&Code Enforcement �, �.�._ W� .,__ �. :� „�,� e _ ._. �. �,�