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2006-671 .11" TOWN OF QUEENSBURY 742 BayRoad,Queensbury,NY 12804-5902 (518) 761-8201 �►�� Qu �Y� Community Development- Building &Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE - Permit Number. P20060671 Date Issued: Friday, January 18, 2008 This is to certify that work requested to be done as shown by Permit Number P20060671 has been completed. Tax Map Number: 523400-289-006-0001-033-000-0000 Location: 28 NACY Rd Owner. DAVID & MARY LOU DUTRA Applicant: DAVID & MARY LOU DUTRA 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 ci),„„7.9 45t--- 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 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development- Building &Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20060671 Application Number. a20060671 Tax Map No: 523400-289-006-0001-033-000-0000 Permission is hereby granted to: DAVID &MARY LOU DUTRA For property located at: 28 NACY 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: DAVID &MARY LOU DUTRA ERCV Septic Alteration Residential 2500 US 27 Total Value CLERMONT, FL 34714-0000 Contractor or Builder's Name/Address Electrical Inspection Agency Plans &Specifications 2006-671 septic alteration residential septic variance recieved 9/26/06 $25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Thursday, September 27,2007 (If a longer period is required,an application for an extension must be made to the code Enforcement Officer of the Town of Queensbury before the expiration date.) Dated at the To nsb /, Wyttheia ay September 27,2006 SIGNED BY t 4' `.' , `"7 "I, for the Town of Queensbury. Director of Building&Code Enforcement Za / 6 -- / —33 OFFICE USE ONLY TAX MAP NO. PERMIT NO. - 7/PERMIT FEE � ,� ) P c� „ TOWN CLERK APPROVALS: ZONING S� r APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT: A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJECT TO REVIEW BEFORE ISSUANCE OF A VALID PERMIT. /� / OWNER: .%Ci i1:(/ D a TiQ. INSTALLER: F t. t ADDRESS: Nl< c Url ADDRESS: 1 l")302__ Z-i- 11--VA PHONE NOS. 3/ 6 7 y$ `/y TZ p PHONE NOS. —771 — 9 Z T LOCATION OF INSTALLATION: .2 le /04 G, /"i d CELL35 7 7 � -- 7062 (0 Pf\,,) (Z p� NO.OF RESIDENCE INFORMATION: �� Fit YEAR BUILT BEDROOMS X COMPUTATION= = TOTAL DAILY FLOW I GARBAGE GRINDER 1980 or older ° X I 150 gallon per bedroom 1 = a O 0 INSTALLED? 1981 -1991 X 130 gallon per bedroom = SPA OR HOT TUB 1992-present X ! 110 gallon per bedroom I = INSTALLED? .'moo PARCEL INFORMATION: YY ✓ TOPOGRAPHY: FL T ROLLING `1 STEEP SLOPE %SLOPE ✓ SOIL NATURE: SAND LOAM CLAY OTHER ✓ GROUNDWATER: AT WHAT DEPTH? BEDROCK/IMPERVIOUS MATERIAL: AT WHAT DEPTH? ✓ DOMESTIC WATER SUPLY: MUNICIPAL WELL ^7b TO flb al 13t -F-A4 K, (IF WELL:WATER SUPPLY FROMuEtbH To «ok-Vr I.% j AIJ ANY SEPTIC-SYSTEM ABSORPTIO I FT. ) ✓ PERCOLATION TEST: RATE IS 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: 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 ✓ ALTERNATIVE SYSTEM: LENGTH AW/OR SIZE '15 (A, S z- _-- 1,76-co COAL Cts,c✓ HOLDING TANK SYSTEM:(If required) NO. OF TANKS: /SIZE OF EACH 1!(, __ rn��..a� . 3oQtG__ ✓ GALLONS./TOTAL CAPACITY: 3G61 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 761-8256 OR EMAIL Queensbury Sanitary Sewage Disposal Ordinance. coxes®Queensburv.net VISIT OUR WEBSITE FOR MORE INFORMATION iaJ &i 5 02 l , 0 G www.queensburv.net Signature of Person Responsible Date ,. :>> Town of Queensbury •• Community Development Office •• 742 Bay Road, Queensbury, NY 12804 z. I�c o [ 41r A ��.•, RESOLUTION SETTING PUBLIC HEARING ON SEWAGE DISPOSAL VARIANCE APPLICATION OF DAVID DUTRA RESOLUTION NO.: BOH 19,2006 INTRODUCED BY: Mr. John Strough WHO MOVED ITS ADOPTION SECONDED BY: Mr. Tim Brewer WHEREAS, the Queensbury Town Board serves as the Town's Local Board of Health and is authorized by Town Code Chapter 136 to issue variances from the Town's On-Site Sewage Disposal Ordinance, and WHEREAS, David Dutra has applied to the Local Board of Health for a variance from Chapter 136, §136-11, which requires an applicant to obtain a variance for a holding tank and the applicant has requested a new,Code-compliant holding tank to replace the existing septic system on property located at 28 Nacy Road in the Town of Queensbury, NOW,THEREFORE, BE IT RESOLVED, that the Town of Queensbury Local Board of Health will hold a public hearing on Monday, September 25''', 2006 at 7:00 p.m. at the Queensbury Activities Center, 742 Bay Road, Queensbury, to consider David Dutra's sewage disposal variance application concerning property located 4.28 Nacy Road in the Town of Queensbury and bearing Tax Map No.: 289.6-1- 33 and at that time all interested persons will be heard, and BE IT FURTHER, RESOLVED, that the Local Board of Health authorizes and directs the Queensbury Town Clerk to publish the Notice of Public Hearing presented at this meeting and send a copy of the Notice to neighbors located within 500 feet of the property as required by law. Duly adopted this 11`h day of September,2006,by the following vote: AYES : Mr. Sanford, Mr. Strough, Mr. Brewer, Mr. Stec, Mr. Boor NOES : None ABSENT: None -GO e_, / Septic Inspection Report S Office No. (518) 761-8256 Date In pectiororequest received: Queensbury Building &Code Enforcement Arrive: am/ m Depart: am/pm 742 Bay Rd., Queensbury, NY 12804 Inspector`s Initials: 'C�L------ NAME: NAME: MPERMIT NO.: /!-vLOCATION: 2. -Ted, INSPECT ON: -il('l07 RECHECK: / Comments and/or diagram Soil Type: Sand/ Loam/ Clay Type of Water: Municipal/Well Water .....-'/' i -� , Waterline separation distance ft. w Well separation distance ft. F&OP6e Other wells: ft. L Pe-&AR.D 1p 111)0/Q_ Absorption Field: Total length ft. or. I c Length of each trench ft. Depth of trenches ft. 463t rl c- �Ce I M( i . � M1.1 g-"`T Size of Stone ,-c Seepage Pits: Number I--\ 136-6-ii..) A' /lea r (L(55&b -OU r Size: x Stone Size: >4N D i i y S% 14 4-5 Na r Frry Piping Size Type /')mil°W69 Building to tank Tank to Distribution Box ...----- 44/0k �� Distribution Box to Field / Pit tj Opening Sealed: Y/ N/ Partial ,./v 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 Y N Engineer Report and As-Built _Y N Location of System on Property: Front Rear Left Side Right Side Middle Front Middle Rear System Use Status: proved artial Approved and needs to be re-inspected, please call the Building &Codes Office Disapproved Last revised 021006 Last revised 1/6/05 Septic Inspection Report Office No. (518) 761-8256 Date Inspecti Qq request received: Queensbury Building &Code Enforcement Arrive: '6 . rO am/ppm ,Depart: am/pm 742 Bay Rd., Queensbury, NY 12804 Inspector's I itials: ��(" art: NAME: 1>kfiRte4 PERMIT NO.: LOCATION: 74/4"C'y /?-0 INSPECT ON: MEM 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. Absorption Field: Total lenuth 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 int- (� 1 d Engineer Report and As-Built Y N Location of System on Property: C1, Front Rear Left Side Right Side Middle Front Middle Rear system Use tatu : Approved Partial Approved and needs to be re-inspected, please call the Building &Codes Office Disapproved Last revised 021006 Last revised 1/6/05 /0 .-fz_ r•Ri ‘b Ay --xsta-.% 4-.7i6 Septic Inspection Report 1 Office No. (518) 761-8256 Date Inspectio uest received: 0 Queensbury Building &Code Enforcement Arrive: !/) lam/p rt: am/pm 742 Bay Rd., Queensbury, NY 12804 Inspectdi�s It itials: ..) NAME: Pt��/D�- - PERMIT NO.: _pc,r"' . c7,7 J LOCATION: Lel Ac y YN, / , INSPECT ON: RECHECK: / Comments and/or diagram Soil Type: Sand/ Loam/ Clay 5 . Type of Water: Municipal/ Well Water a( (AD v Waterline separation distance ft. - Well separation distance ft. Other wells: _ _ft. l /� �k s Absorption Field: Total length ft. Length of each trenchft• Depth of trenches ___ft. Size of Stone Seepage Pits: Number Size: x Stone Size: AL /4w• LI-Lk-le-7-1k- SkU( " Piping Size Type O Ft- — Ol / Building to tank °� Tank to Distribution Box _Distribution Box to Field/ Pit Opening Sealed: Y/ N/ Partial End Cap Inlet/Outlet Pipes &Baffles I ____Y N I 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 Al - > 1/41.4c.—. CC--C - Location of System on Property: Front Rear Left Side Right 'de LA- 4 ip--- Middle Front Middle Rear System Use Status: /Approved ✓ Partial Approved and needs to be re-inspected, please call the Building &Codes Office Disapproved Last revised 021006 Last revised 1/6/05 Septic Inspection Report Office No. (518) 761-8256 Date Inspon,request received: Queensbury Building &Code Enforcement Arrive: !3 r'�' am/pm part: am/pm 742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: \� NAME: T"i►'Z PERMIT NO.: 00✓ Co 1 LOCATION: /VA /4 INSPECT ON: /!®D�• RECHECK: Comments and/or diagram Soil Type: Sand/ Loam/ Clay Type of Water: Municipal/ Well Water .. 54/4 - Waterline separation distance ft. 1 Gb/� Well separation distance ft. Other wells: �D 6/4-c_- /,4 N Absorption Field: Total len•th ft. > • Length of each trench ft. Depth of trenches ft. /5 i Size of Stone r,410 t< — a L�b CcJFK, Seepage Pits: Number Size: -�-�--x----- - Stone Size: Piping Siz ti Type Building to tank 9 lb 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 3` Foundation to absorption _ ft. Separation of Pits -7 ft. Conforms as per Plot Plan Y N Engineer Report and As-builtT..,Y Y. N Location of System on Property: Front Rear Left Side Right Side 1-41Le ‘710&" Middle Front Middle Rear System Use Status: Acaproved Partial Approved and needs to be re-inspected, please call the Building &Codes Office Disapproved Last revised 021006 Last revised 1/6/05 NOTES: 1) THIS SURVEY WAS PREPARED WITHOUT THE BENEFIT OF AN ABSTRACT OF TITLE AND IS THEREFORE SUBJECT TO ANY EASEMENTS, COVENANTS OR RESTRICTIONS OF RECORD ANY STATEMENT OF FACTS SUCH DOCUMENT WOULD DISCLOSE. 2) UNAUTHORIZED ALTERATION OR ADDITION TO A SURVEY MAP BEARING A LICENSED LAND SURVEYORS SEAL IS A VIOLATION OF SECTION 7209, SUB -DIVISION 2, OF THE NEW YORK STATE EDUCATION LAW. 3) ONLY COPIES FROM THE ORIGINAL OF THIS SURVEY MARKED WITH AN ORIGINAL OF THE LAND SURVEYORS SEAL SHALL BE CONSIDERED TO BE VALID TRUE COPIES. DEED REFERENCE.- Mary Lou & David E. Dutra, Sr. to Eth a/ Du tra Dated October 8, 1999 Liber 1136 Page 230 LEGEND o I.R.F. IRON ROD FOUND o I P.F. IRON PIPE FOUND o I R.S. IRON ROD SET UTILITY POLE oc�c� STONE WALL BARBED WIRE FENCE o POINT W.F.F. WOOD FENCE POST —ohw— OVERHEAD WIRES n/f NOW OR FORMERLY