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2011-454 TOWN OFQ UEENSBURY 742 BayRoad,Queensbury,NY 12804-5902 (518) 761-8201 �� Q rY, Community Development - Building & Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE Permit Number: P20110454 Date Issued: Monday, December 05, 2011 This is to certify that work requested to be done as shown by Permit Number P20110454 has been completed. Tax Map Number: 523400-303-020-0002-042-000-0000 Location: 144 RIVER St Owner: 144 RIVER STREET, LLC Applicant: 144 RIVER STREET, LLC This structure may be occupied as a: Septic Alteration Commercial 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, dam ` 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 A.?" 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 vow Community Development-Building&Codes (518)761-8256 BUILDING PERMIT Permit Number: P20110454 Application Number: A20110454 Tax Map No: 523400-303-020-0002-042-000-0000 Permission is hereby granted to: 144 RIVER STREET, LLC For property located at: 144 RIVER St 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: 144 RIVER STREET, LLC C/O ROBINSON& SON, LLC Septic Alteration Commercial PO BOX 432 Total Value HUDSON FALLS,NY 12839-0000 Contractor or Builder's Name /Address Electrical Inspection Agency MCKENNA CONSTRUCTION 639-8683 /361-3527 562 WEST Rd FORT ANN NY 12827-0000 Plans&Specifications 2011-454 septic alteration residential $75.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday, September 14,2012 (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 Torn o j( ,eensiuk ; /jf 1W/e esda , September 14,2011 SIGNED BY -�`` '' v for the Town of Queensbury. Director of Building&Code Enforcement ..... { OFFICE USE ONLY � 1 � `'`" f' //54 77. T________„ ,„i TAX MAP NO. PERMIT NO. //. EMI T FEE + Li E1' 0 ? ?o1 Il ice.5 I • APPROVALS: ZONING TOWN CLERK APPLICATION FOR SEPTIC DISPOSAL SYSTEM PER ITT0wN O- QUEEt1SBU 2Y BUILDING & r A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS. APPLICATION IS SII • r ; ISSUANCE OF A VALID PERMIT. Al +c► ✓' OWNER: (<a6;0mivN I SJN L M LI INSTALLER: C� ( ',"0. OJt.-•st>0' ADDRESS: 11 44 1V& S -1' ADDRESS: �) - w4 -S"I .J?ij ! UA.' J /3 PHONE NOS. 5I t2)-- 1 4 0 -9 t 3o PHONE NOS. S.1 t7— (.73 5- 8 to g3 LOCATION OF INSTALLATION: t/'')4-g 4- ._t v- Q -C a g-g--:c..-e RESIDENCE INFORMATION: NO.OF COMPUTATION YEAR BUILT X = TOTAL DAILY FLOW BEDROOMS (Gallons per bedroom) GARBAGE GRIN E6 1980 or older X 150 = INSTALLED? (� V 1981-1991 X 130 = SPA OR HOT Tl.W 1992-present X 110 = INSTALLED? ,/ ('ems— Av ..12/15 ►—ci- v-E, ins_i P'v t,t`d-C a PARCEL INFORMATION: ✓ TOPOGRAPHY: FLAT ROLLING1 " \ STEEP SLOPE %SLOPE ✓ SOIL NATURE: SAND X LOAM CLAY OTHER ✓ GROUNDWATER: AT WHAT DEPTH? NOME ✓ BEDROCK/IMPERVIOUS MATERIAL: AT WHAT DEPTH? NON ✓ DOMESTIC WATER SUPLY: MUNICIPAL )< WELL (If well:water supply from any septic system absorption is: ft) ✓ PERCOLATION TEST: RATE IS 1-i 0 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 Board approved subdivision). TANK SIZE: `DUI 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: e �6 1,1(a , pvi.AP +0A-1( ❑ABSORPTION FIELD(WITH NO.2 STONE) Total length ft. Each trench X ❑SEEPAGE PIT(S)(WITH NO.3 STO How many? Size? ❑ALTERNATIVE SYSTEM Bed .\ether type? 775-Sy• F /5 'X 2-s" r ❑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. I have read e regulations with respect to this application and agree to abide by t e, and all requirements of the Town of Queensbury QUESTIONS? CALL 761-8256 OR EMAIL Sanitary Se :g: Disposal Ordinance. codesRaueensburv.net i 9 , 71 VISIT OUR WEBSITE FOR MORE INFORMATION Signatu of Person Responsible Date wwvr•aueensburY.net Town of Queensbury*Community Development Office*742 Bay Road, Queensbury NY 12804 Septic Inspection Report Office No. (518)761-8256 Date Inspection request received: Queensbury Building&Code Enforcement Arrive: am/pm Depart: z .0 ACC 742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: B. Air&VI NAME: 1 ZO" PERMIT NO.: I h ' LOCATION: 144- R'.01...2 C- INSPECT ON: 2-Ar RECHECK: Comments and/or diagram Soil Type: Sand ; •.m/Clay Type of Water: Municipal`/ ell Water Waterline separ tao distance ft. Well separation •istance I ft. Oth- wells: ft. `1✓ Well Casing Lencth 5#' +/- Y N N/A ` S BUILT [150'to welly required NO] ('fi Absorption REM: Total len. 1 ft. Length of each tre h / ft. depth of trench-• ft. I Size of Ston- Seepaie Pits: Number Size: x I Stone Size Piping Size Type Building to tank Tank to Distribution Box Distribution Box to Field/ Pit Opening Sealed. Y N End Y_N Inlet/Outlet Pipes&Ba Y_N Manholes 12"or less below gr:de Y N [provide extension collar if es] Y N Location/ ;•. ations Foundati• to tank ft. Foundation to absorption ft. Separation of Pits ft. Conforms as per Plot Plan N Engineer Report and As-Built N ETU Maintenance Contract _ N provided Location of System on Property: Fron Rear Left Side Right Side Middle Front Middle Rear st-mU - .ss r/Approved lorr Partial Approved and needs to be re-inspected, please call the Building&Codes Office Disapproved L:\Pam Whiting\2010\Building Codes Forms\Tnspectlon Fotms\Septic Inspection Report`03 29 10.doc /,4_ Septic Inspection Report Office No. (518) 761-8256 Date Inspection request received: /0/11/3-0/t Queensbury Building &Code Enforcement Arrive: am/pm Depart: �/ am/pm 742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: NAME: PE 474:20.: 4/.<‘ LOCATION: IZl " - INSPECT ON: /0//t/4_0,/ RECHECK: Comments and/or diagram Soil Type Clay Type of Water: Municipal/Well Water /-'1� �i, , Waterline separation distance ft. �G Well separation distance ft. 3 c,/ - 3 ).'7 Other wells: ft. Well Casing Length 50'+/- Y N N/A [150'to well required if NO] Absorption Field: Total length ft. Length of each trench 7-- ft. Depth of trenches 17— ft. Size of Stone bi—-27 Seepage Pits: Number Size: x Stone Size: Piping Size Building to tank 'T Tank to Distribution Box A Distribution Box to Field Pit A `L- Ad/ Opening Sealed: Y mieP End Cap N Inlet/Outlet Pipes&Baffles �N Manholes 12"or less below grade Y_.,_.N jZcV t''C �C� t [provide extension collar if Yes] Y N Location/ Separations Foundation to tank / 4— ft. Foundation to absorption ft. Separation of Pits ft. Conforms as per Plot Plan Engineer Report and As-Built Y N ETU Maintenance Contract Y N provided Location of System on Property: Front Rear Left Side Right Side Middle Front Middle Rear stem . : S . 1�: Approved Partial Approved and needs to be re-inspected, please call the Building &Codes Office Disapproved L:\Pam Whiting\2010\Building Codes Forms\Inspectlon Fomis\Septic Inspection Repd#_03 29 10.doc G. Peter Jensen 17 West Road South Glens Falls New York 12803 (518) 798—3859 October 13, 2011 To Whom It May Concern: I have designed(plan 11-0508) and observed the installation of the septic system for Robinson& Son, LLC at 144 River Street, Hudson Falls, Town of Queensbury, Warren County,New York. Ir would appear that the installation is within the intent of the design documents. To the best of my knowledge and belief, no field conditions were encountered that would require a re-design of the septic system. Sincerely, Bit, „ 1 C.� L z,,,oes7 ft/ G. Peter Jesen ,c0ED ARCy QeZER,IF,ys i� Q CY } Fy A t :04v:z1F6.4"'ll14:014. E`s y� m r OFFIGE d 1 J I j PIPE PITCf!H fit, PR I -"-o07- it / LI DEVERY r f 000 GAL 5E(0-r/G TANK P!=_ .._ . _...... __ L�_, 40/0 SOLIZ) P1 PE ��. ,1,154)0 CsAL LIFT STAri0W VVri