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2011-595 TOWN OFQ UEENSBURY s� so742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development - Building & Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE Permit Number: P20110595 Date Issued: Tuesday, December 13, 2011 This is to certify that work requested to be done as shown by Permit Number P20110595 has been completed. Tax Map Number: 523400-315-006-0002-038-000-0000 Location: 5 MOCKINGBIRD Ln Owner: MARGARET C. QUINTAL Applicant: MARGARET C. QUINTAL 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 "a „ ` 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 0" ciwo 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development-Building&Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20110595 Application Number: A20110595 Tax Map No: 523400-315-006-0002-038-000-0000 Permission is hereby granted to: MARGARET C. QUINTAL For property located at: 5 MOCKINGBIRD 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: MARGARET C. QUINTAL 5 MOCKINGBIRD Ln Septic Alteration Residential QUEENSBURY,NY 12804 Total Value Contractor or Builder's Name/Address Electrical Inspection Agency Plans&Specifications 2011-595 septic alteration residential $40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Sunday,December 09,2012 (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 tee„ `r' , ecember 09,2011 71/.' SIGNED BY for the Town of Queensbury. Director of Building&Code Enforcement gECEOVE SICommunity Development Office DEC n 8 2011 — Town of Queensbury • 742 Bay Road • Queensbury, New York •12 04 TOWN OF QUEENSBURY BUILDING & CODES Office Use Onl TAX M P -Z .. 5-"cb O'?��N�_- PERMIT NO. PERMIT FEE_ ___ APPROVALS: ZONING __ TOWN CLERK APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT: A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS. APPLICATION IS SUBJECT TO REVIEW EFORE ISSUANCI OF A d VALIDLPERMIT. OWNER:I ^e G(/-f /LJ'i 4-6.- INSTALLER: lb/I 1.‘Arty V .tL V-�_ 12-t.,4 a� ADDRESS: 5 rt 0 C'C.kip bl _L _ ADDRESS: e ® 30 12-'1 6 PHONE NOS.7 lJ Q 2-- '5 / PHONE NOS. 7 7 4 - Q -ro LOCATION OF INSTALLATION: j ("r ®C(G Lir 4//L RESIDENCE INFORMATION: YEAR BUILT NO.OF X COMPUTATION = TOTAL DAILY FLOW BEDROOMS (Gallons per bedroom) GARBAGE GRINDER 1980 or older X 150 = INSTALLED? 1V 0 1981 -1991 X 130 = SPA OR HOT TUB 1992-present 3 X 110 = 3 0 INSTALLED?___ _ PARCEL INFORMATION: ✓ TOPOGRAPHY: FLAT ROLLING STEEP SLOPE %SLOPE____ ✓ SOIL NATURE: SAND ✓ LOAM CLAY OTHER I GROUNDWATER: AT WHAT DEPTH? I BEDROCK/IMPERVIOUS MATERIAL: AT WHAT TH?_ I DOMESTIC WATER SUPLY: MUNICIPAL__ _ WELL (If well:water supply from any septic system absorption is: ft) I PERCOLATION TEST: RATE IS__ PER MIINUTE PER INCH[mpi] (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�a I d approved subdivision). Fxis; TANK SIZE: ©a 9 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: ❑ABSORPTION FIELD (WITH NO. 2 STONE) Total length ___ft. Each trench X ❑ SEEPAGE PIT(S)(WITH NO. 3 STONE) How many? Size? ,ALTERNATIVE SYSTEM Bed ,r other type? Lam"'' #X 2.-- 0 HOLDING TANK SYSTEM Total required capacity? Tank 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. 1 e r •ulati,ns with r s ect to this application and agree to ab' a 7ties�-'' - require sof the Town of Queensbury QUESTIONS? CALL 761-8256 OR EMAIL n' ry Sewa �'1 osal Ori nce. codesaaueensburv.net -- - 1/t VISIT OUR WEBSITE FOR MORE INFORMATION ignature of Person -esponsible Dae wwrw.queensburY.net Of jj � , : f x % -{ r = \ * Septic Inspection Report 6" Office No. (518)761-8256 Date Inspection request received: Queensbury Building&Code Enforcement Arrive: am/pm Depart: ft':,)25f 742 Bay Rd., Queensbury, NY 1804 { Inspector's Initials: ` •--,, °t NAME: 6 _ /ji 14'' PERMIT N .. // \) J LOCATION: i(z• 4/ PERMIT / f:!(,� INSPECT ON: /2 --4--7 -77 RECHECK: i Comments and/or diagram Soil Type: .nd oam/Clay Type of Water: Mu «..1/Well Water Waterline separation distance . 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 C c.___ft. Length of each trench -03. ft. --7---1-.. c3-1V—M Depth of trenches ft. ,r Size of Stone__ . \/ ' Seepage Pits: Number •! �'�`� Size: / • i Stone Size: ` Y Piping Size Type ., ` Building to tank . `sKt 1 1 �')i);,...; ,,,,s4 Tank to Distribution Box 42 -�et-k A. Distribution Box to Field/ Pit rz "'3 C Opening Sealed: VY•_,__N End Cap N Inlet/Outlet Pipes&Baffles Y . Manholes 12"or less below grade Y I._ [provide extension collar if Yes] Yr Location/ Separations Foundation to tank ft. Foundation to absorption1 - ft. Separation of Pits ft. Conforms as per Plot Plan N N Engineer Report and As-Built / Y—N ETU Maintenance Contract _Y_N provided Location of System n Property: Front Rear Left Side Right Side Middle Front Middle Rear System Use Stat • 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\Sepdc Inspection Report_03 2910.doc CENTER PROJECT SERVICES 73 Sheridan Street, Glens Falls, NY 12801 Phone-518-796-2515 December 6, 2011 BE ON Project# 150 Dan Drellos '' O'•' SITE AT Sanitary Sewer Services ALL ';FI` S FOR Luzern Road a`E. OUR. TM OF Queensbury,NY 12804 1. : _" Re: Proposed Replacement Septic Quintal Residence—5 Mockingbird Lane, Queensbury,NY Dear Dan: At your request we have reviewed your proposed replacement septic system design at the site of the existing 3 bedroom house of at 5 Mockingbird Lane in Queensbury. As per our conversation the residence has an existing failed septic system. We have reviewed the proposed replacement septic system design and we agree that a standard absorption bed is acceptable. Based upon a design flow rate of 330 GPD and a percolation rate of 1 to 5 minutes, you will need 347 square feet of absorptive area. We recommend using a 20 ft wide by 20 ft long absorption bed with 4 — 15 foot long laterals, which will provide 400 sf of absorptive area. The absorption bed can be constructed with the existing 1,000 gallon septic tank, new distribution box, and 4 inch diameter perforated pipe and stone. Please feel free to contact me at 796-2515 if you have any questions and that you for your assistance with this request. Sincerely, Thomas R. Center Jr, P.E. TOWN OF OU • BUILD Reviewed B, : �� `'' Date: