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2010-375 TOWN OF QUEENSBURY f.4,0! 742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201 Community Development - Building & Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE Permit Number: P20100375 Date Issued: Tuesday, March 19, 2013 This is to certify that work requested to be done as shown by Permit Number P20100375 has been completed. Tax Map Number: 523400-239-012-0002-063-000-0000 Location: 6 HOLLY Ln Owner: FLORENCE E CONNOR LIVING TRUST Applicant: FLORENCE CONNOR TRUST This structure may be occupied as a: Septic Alteration Residential Test Pit/Perc Test Review 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, 0.4 Variance, or other issues and conditions as a result of approvals by the Director of Building&Co`► nf:'4 of:' ement 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: P20100375 Application Number: A20100375 Tax Map No: 523400-239-012-0002-063-000-0000 Permission is hereby granted to: FLORENCE CONNOR TRUST For property located at: 4 HOLLY Ln 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: FLORENCE CONNOR TRUST BRIAN&FLORENCE TRUSTEES Septic Alteration Residential 6 HOLLY Ln Test Pit/Pere Test Review LAKE GEORGE,NY 12845-0000 Total Value Contractor or Builder's Name/Address Electrical Inspection Agency Plans &Specifications 2010-375 deep hole- perc test $225.00 PERMIT FEE PMD- THIS PERMIT EXPIRES: Friday, September 09, 2011 (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 T Quee u ;l . : , September 09,2010 SIGNED BY c_1_,) \ for the Town of Queensbury. Director of Building&Code Enforcement /6--.57Ls Town of Queensbury■ Building&Codes Enforcement Office■742 Bay Road■ Queensbury,NY 12804 DEEP HOLE/PERC TEST Request for Town Engineer Review Property Owner: Ftt..a'r.E.P4C - 2t Cc',-.P IO. Phone: ,375/- 65-6. 31(0'0 Property Owner's Address: ('0 HoL.L'Y LANE LAKE EO 12C L NY 12b 4G Location of Test: I() 14 SLY LA14 E Tax ID#: �?�q. ,� cam-CO3 *Applicant's Engineer: 2),„ E14.1-4.1 I'j MFi-"_c- - Phone: 7(442 I-C::517 Applicant's Agent -MAC.2 Phone: '742 c:::)- 1-7 Additional Notes: 1. Reason for Request? New Septic System 51?1,Replacement Septic System Failed Septic System Subdivision Site Plan Review 2.Are Wetlands present? YES IX NO UNKNOWN *Note: Applicant is required to engage an engineer for design and testing of the system. The Town Engineer's responsibility is to witness system testing only. PLOT PLAN: Plot plan, to scale, to be submitted with application FEE SCHE p_ -. $200 Flat Fee Date Paid: -2-7-10 Check No.: b. OR Fee to be determined during To Be Determined: Site Plan/Subdivision review process SIGNATURE: In carrying out the provisions of Article IV, the Local Board of Health or the enforcement officer may engage the services of a qualified professional consultant for expert review and recommendation arising from the carrying out of the provisions of Art. IV, including but not limited to the review of plans, specifications and reports, attendance at inspections, dye tests, deep hole test pits, septic related deep hole and percolation tests, system installations, and any other aspect of any matter contained in this Art. IV, and any costs incurred in such review shall be paid to the Town by the owner of the property before any approval can be granted under this Art. IV shall become effective within 30 days of presentment of an invoice for same, whichever is sooner. Such costs shall not exceed $1,500 without prior written notice to the party to be charged with same. My signature below indicates I have thoroughly read and understand the instructions, agree to the submission requirements and have completed the application. I also fully understand that additional engineering fees may be necessary per Town of Queensbury Local Law 136-14D. SIGNATURE OF APPLICANT: ''' /. Caw...* . Date: 07/2.31/0 SIGNATURE OF AGENT: , � ._„_ -74N,. Date: 7-Z1- t Q Original (B&C File) Canary (Planning) Pink(Applicant) Gold (Town Clerk) „7-31. 12-2 -6 FFICE USE ONLY TAX MAP NO. PERMIT NO. PERMIT FEE ,I , ; , APPROVALS: ZONING , : , TOWN CLERK A ' 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: FL-c�iZ-E 'r 4115R.t NO PISTALLER: CIZAK�AL� `E(G,.dr\IA T 4 ADDRESS: (C '�E�I,.I��( �/�� C J �'�v�C-t+LAr-G ki-u-L.�-Q � ADDRESS: LAKE GLEpQ,Cs-V-I r"”( 1ZfEr"}�J LAKE. *Eb2C.E t TY,'"( 12 434 S PHONE NOS. Cid---56t7—�j 1 CpO PHONE NOS. 'PM -c -'t-, LOCATION OF INSTALLATION: 4-7 t+ U_!( L A-1AE, YEAR BUILT NO.OF X COMPUTATION= = TOTAL DAILY FLOW RESIDENCE INFORMATION: BEDROOMS 1980 or older 1,5X 150 gallon per bedroom = GARBAGE GRINDER /... c) INSTALLED? 11�d 1981 -1991 X 130 gallon per bedroom = 1992-present X 110 gallon per bedroom = SPA OR HOT TUB INSTALLED? 11,0 PARCEL INFORMATION: ✓ TOPOGRAPHY: Flat rolling ✓ Steep slope %SloP a t ✓ /SOIL NATURE: Sand �/ Loam I/ Clay Other ✓ GROUNDWATER: At what depth? > Col / BEDROCK/IMPERVIOUS MATERIAL: At what depth? >'�� ✓ DOMESTIC WATER SUPLY: Municipal Well ✓ (If well: Water supply from any septic system absorption is ft.) ✓ PERCOLATION TEST: Rate is IS vat minute 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). TANK SIZE: tZ''O 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 or other type? Et....)SN- GAF tvi-T ,vc-N 3 t_"-M C�rtr�GutT�„!�i tn4 0 HOLDING TANK SYSTEM Total required capacity? `� _ � � -57.- LF Tank size? Number of tanks? I. NOTE: ALARM SYSTEM AND ASSOCIATED EL:.:. ..:................................................ .. . ... . ............................... I. ECTRICAL 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. IL---- -- . .. - TOWN OF QUEENSBURY 011.144 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development-Building& Codes (518) 761-8256 40. Inspections per Permit Permit# P20100375 Inspection Date Inspection Type Approved/Denied Comments Permit Type Person Responsible 07/28/2010 Miscellaneous Test Pit/Perc Test Review JENNIFER HENDERSON Staff Misc 2010-375 permit entered 09/08/2010 Miscellaneous Test Pit/Perc Test Review JENNIFER HENDERSON Staff Misc 2010-375 SEPTIC PERMIT ADDED TO PERC TEST PERMIT 09/09/2010 Miscellaneous Test Pit/Perc Test Review JENNIFER HENDERSON Staff Misc 2010-375 permit issued 08/23/2011 Septic Test Pit/Perc Test Review CHARLES DYER Staff Partial 2010-375 partial only-for 1/2 of field-will need to verify pump&fmal electric 08/24/2011 Septic Test Pit/Perc Test Review CHARLES DYER Staff Partial 2010-375 verified tanks&field 08/26/2011 Septic Test Pit/Perc Test Review CHARLES DYER Staff Partial 2010-375 verified pump&panel-provide engineer report as-built 08/30/2011 Final Electric Test Pit/Perc Test Review COMMONWEALTH ELECTRICAL Approved 2010-375 TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development-Building&Codes (518) 761-8256 Inspections per Permit Permit# P20100375 Inspection Date Inspection Type Approved/Denied Comments Permit Type Person Responsible 11/08/2011 Test Pit/Perc Test Review CHARLES DYER Staff Misc RECEIVED AS-BUILT ENGINEERING REPORT 03/19/2013 Miscellaneous Test Pit/Perc Test Review STAFF Misc 2010-375 septic approved in August 2010-permit never closed out CC issued to file Septic Inspection Report Office No. (518)761-8256 Date Inspection request received: Queensbury Building&Code Enforcement Arrive: am/pm Depart: et\t c am/pm 742 Bay Rd., Queensbury, NY 12804 Inspector's Initials:6i4,44.9 l NAME: PERMIT NO.: cS —17 LOCATION: (e t Z.-.),,\I LA- INSPECT ON: .4 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. Well Casing Length 50'+/- Y N N/A [150'to well required If NO] Absorption Field: Total length ft. Length of each trench ft. L Depth of trenches ft. 6..., Size of Stone .� Seepage Pits: Number Size: x Stone Size: - y Piping Size Typeli Building to tank Tank to Distribution Box Distribution Box to Field/ Pit Opening Sealed: Y—N p\I tin (if3-°(-1' End Cap Y N t Inlet/Outlet Pipes&Baffles Y_N Manholes 12"or less below grade Y N [provide extension collar if Yes] Y N Location/ Separations Foundation to tank ft. Foundation to absorption ft. Separation of Pits ft. Conforms as per Plot Plan si'r N Engineer Report and As-Built N ETU Maintenance Contract N provided Location of System on Property: Front Rear Left Side Right Side Middle Front Middle Rear stem S .t r• -,------'' ArApprov-. •a 4. Approved and needs to be re-inspected, please call the Building&Codes Office Disapproved L:\Pam Whiting\2010\Building Codes Forms\Inspecdon Forms\Septic Inspection Report_03 29 10.doc „,„„„„„ ,,,,,, ,„„„„, ENVIRONMENTAL DESIGN PARTNERSHIP,LLP November 4,2011 Town of Queensbury Community Development Department 742 Bay Road Queensbury,NY 12804 Attn: Dave Hatin, Director of Buildings&Codes 1vd "m? Fiy Re: Connor Residence 6 Holly Lane Dear Dave: In compliance with application approvals granted by the Town of Queensbury I offer the following regarding the referenced project. The design plan reviewed and approved by the Town as associated with the wastewater system application is as follows: Proposed Replacement Wastewater System for the Connor Residence 6 Holly Lane Owners: Florence and Brian Connor Town of Queensbury • Sheet 1: Site Plan with Proposed Wastewater System Sept 3,2818 • Sheet 2: Design Details& Notes Sept 3,2818 During the course of construction I was on the job site to observe key components of the system installation. The orientation of the proposed tank placement(septic and pump tanks)has been modified from the design plan. In addition the location of the d-box has also been revised. These revisions are now reflected in the attached `as-built' drawing, Sheet AB-1. All other aspects of the work were constructed as designed and using the materials as specified. Based on my inspection of the system installation it is my opinion that the wastewater system is in compliance with the intent of the approved design plan and is ready for operation. Please contact me should you require any further information. Sincerely, Dennis MacElroy, PE Cc: Florence and Brian Connor 900 Route 146,Clifton Park,New York 12065 phone(516)371-7621 -fax(518)371-9540 SITE LOCATION MAP SCALE: 1" = 2,000' MAP REFERS l i) MAP ENTITLED: "MAP OF A SURVEY MADE FOR FLORENCE E. CONNOR, BRIAN K. CONNOR, S-1 ", DATED NOVEMBER 6, 2007 AS PREPARED BY Van DUSEN & STEVES LAND SURVEYORS. ►.rxrIXOTI•A DENOTES DIRECTION OF SLOPE I.P.F. DENOTES IRON PIPE FOUND I.R.F. DENOTES IRON ROD FOUND N/F DENOTES NOW OR FORMERLY U. P. DENOTES UTILITY POLE SOIL DA TA: SOILS INVESTIGATION CONDUCTED JULY 2, 2010 BY DENNIS MACELROY, PE - ENVIRONMENTAL DESIGN PARTNERSHIP CLARK WILKENSON, PE - TOWN OF QUEENSBURY ENGINEER DEEP TEST HOLES T. P. #1 - NORTH SIDE O - 4" ORGANIC MATERIAL 4 - 24" SILTY .SAND WITH ROOTS - LIGHT BROWN 24 - 40" SILTY SAND- LIGHT BROWN 40 - 72" SANDY SILT - FIRMER WITH DEPTH NO OBSER VA TION OR INDICATIONS OF GROUND WATER T P. #2 - SOUTH SIDE O - 4" ORGANIC MATERIAL 4 - 20" SILTY SAND WITH ROOTS 20 - 42" SILTY SAND - LIGHT BROWN 42 - 72" SANDY SILT BROWN FIRMER WITH DEPTH NO OBSERVATION OR INDICATIONS OF GROUND WATER PERCOLATION TESTS PERC HOLES DUG DOWN INTO ORIGINAL NATIVE SOILS, 24"f DOWN P. T.,# 1 - STABILIZED RATE OF 14 MINUTES PER INCH P. T. j 2 - STABILIZED RATE OF 11 MINUTES PER INCH DESIGN RATE TO BE USED : 11 - 15 MINUTES PER INCH NO TE.- THE E:THE PROPOSED ABSORPTION FIELD SHALL CONSIST OF THREE 32 LF ELJEN GSF UNIT RUNS FOR A TOTAL OF 96 LF MINIMUM. DUE TO THE SLIGHT SLOPE OF THE SITE THE TRENCHES SHALL 'STEP' DOWN THE SLOPE. THE FIELD SHALL BE SIZED A MINIMUM OF 20' X 34'. © 2010 BY ENVIRONMENTAL DESIGN PARTNERSHIP, LLP, ALL RIGHTS RESERVED UNAUTHORIZED ALTERATION OR ADDIT70N TO THIS MAP IS A VIOLA77ON OF SECTION 7209 SUBDIVISION 2 OF THE NEW YORK STATE EDUCATION LAW. COPIES FROM THE ORIGINAL OF THIS SURVEY MAP NOT MARKED WITH THE LAND SURVEYORS EMBOSSED SEAL SHALL NOT BE CONSIDERED A VALID TRUE COPY. ml Mw S86'46'19 "W A.L.O. ABSORPTION FIELD W/ ELJEN GSF MODULES (3) LATERALS — 32 LF EACH 96 LF TOTAL LANDS N/F OF WILLIAM & PAMELA ROBERTS 162.88' TIE LINE N36'41 '19 "W 34.82' LANDS N/F OF SUSAN J. O'HANLON ,i" P-narrP, KAAIKI erRncc wni i v LANDS N/F OF WILLIAM & PAMELA ROBERTS L /4 K c; 1�oF� C;E- w x 0� H co o zw . w z> H � 0 �' N Z W` V1 zn� / V� H � U) to Z � w W� J W Ztoo E♦ F- N W 02 Z z iQ. z ar W zW HQwU z�� z,� ��u W Z NQW co W (L W ZW Uw Q D a Z �.., C J Q � L- V N a w �� Qjo W U Y) 0 H1 Z Z coZ w W C UJ (o J q0� 0 �D Z o w aw ZwZ ISI ::� � O W a00 w za >O�z 19 z �:oo �O�ZoZ w�CO 0 �� wC2W m W w w< o o J11 1 w x 0� H co o zw . w z> H � 0 �' N Z W` V1 zn� / V� H � U) to Z � w W� J W Ztoo E♦ F- N W 02 Z z iQ. z ar W zW HQwU z�� z,� ��u W Z NQW co W (L W ZW Uw Q D a Z �.., C J Q � L- V N a w �� Qjo W U Y) 0 H1 Z Z coZ w W C UJ (o J q0� 0 �D Z o w aw ZwZ ISI ::� � O W a00 w za >O�z 19 z �:oo �O�ZoZ w�CO 0 �� wC2W m W w w< o o 4 0 � 0 I— w '-' W H� Q 3 co Z W ���0 0 0 _ U o o L w �- m m � Mwoo o/ O p J N Z I Q fII W U W W /l ( /T �_ V ) COMMONWEALTH ELECTRICAL INSPECTION SERVICE,INC. Main Office 176 Doe Run Road-Manheim,PA 17545 MUNICIPAL CERTIFICATE - ELECTRICAL APPROVAL Permit No./0-376—Cert. NS" 218 9 Cut-in Card No. Owner 6 co NA./e Location .<TIO GG K -4" Q U4 Installation Consisting of.....2 e Zc./c=A- f ted—CO A/772o C5 frP '11) Installed By 4-1—' C14/2/2--- Lic.No. The conditions following governed the issuance of this certificate,and any certificate previously issued is cancelled:- This certificate only covers the electrical equipment and installation conditions as of datc. Upon the introduction of additional equipment or alterations,application shall be •romptly made for inspection. Inspectors of this Company shall have the privilege of making spe.ions at any time, and if its rules are violated,the Company shall have the right to r this c ' if : e. Date "1 INSPECTOR 1... Member N.F.P.A.,I.A.E.I. Septic Inspection Report Office No. (518)761-8256 Date Inspection request received: Queensbury Building&Code Enforcement Arrive: am/pmipart:.;1Q am/pm 742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: 1 ' NAME: PERMIT NO.: 2 c5l U — c RECHECK:• -- INSPECT ON: race, l t I Comments and/or diagram Soil Type. rd /Clay Type of Water: Mun I/Well Water t%Alheffele. 0::17-a314:4) Waterline separation distance ft. Well separation distance ft. ?it-72-6- 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 12. ft. 9 tJ A Depth of trenches ft. i�. `Tt T ` ��'"'"l Size of Stone t' Seepage Pits: Number -1\)�, _ Size: x Stone Size: Piping ire Type Building to tank `iNCI s ,- Tank to Distribution Box _ Distribution Box to Field/ Pit 1 u- -k� Opening Sealed: N End Cap _.__.N Inlet/Outlet Pipes&Baffles �7' __ N Manholes 12"or less below grade V Y_.N [provide extension collar if Yes] Y N (02.0A/t1itio Location/ Separations ; „ � Foundation to tank ft. 4J(7 .. Foundation to absorption R. �,e� � ����,�-� � � � 3 .., Separation of Pits ./E.° . tom, Conforms as per Plot Plan 7 N Engineer Report and As-Built N ETU Maintenance Contract provided Location of System on Pro Front Rear ft Side Right Side Middle Front Middle Rear emU - S,t •. Approved V Partial Approved and needs to be re-inspected, please call the Building & Office Disapproved L:\Pam Whiting\2010\Building Codes Forms\Inspectlon Forms\SeptIc Inspection Report_Q3 29 10.doc ci - LQ 6 c a Septic Inspection Report Office No. (518)761-8256 Date Inspection request received: Queensbury Building&Code Enforcement Arrive: am/i r 0-part/'bo -am/pm 742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: .1., NAME: f.`.. PERMIT NO.: int© ---nc- LOCATION: INSPECT ON: t5tl t\ RECHECK: 1 Comments and/or diagram Soil Type: nd od Clay . Type of Water: Municipal/Well Water Waterline separation distance ft. Well separation distance ft. Other wells: ft. Well Casing Length 50' +/- Y N N/A [150'to well required if NOl Absorption Field: Total length ft. Length of each trench 'Z ft. '2.,e \ Wa-.`ti's, Depth of trenches ft. Size of Stone tKITIV 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 VC:r1-1.1.= End Cap Y—N "t) -.1-7 Inlet/Outlet Pipes&Baffles Y N Manholes 12"or less below grade Y_N •k t t -1 )) — [provide extension collar if Yes] Y N Location/Separations Foundation to tank Ort Foundation to absorption ft. - . _-- Separation of Pits ft. - Conforms as per Plot Plan Y_ _ Engineer Report and As-Built Y K N ETU Maintenance Contract _Y_N provided Location of Syste roperty: Front Rear Left Side Right Side Middle Front Middle Rear 1stem - .tom: Approved Partial Approved and needs to be re-inspected, please call the Building &Codes Office Disapproved L:\Pam Whiting\2010\Building Codes Forms\Inspectfon Fomes\Septicc Inspection Report_03 29 10.doc %i-f Septic Inspection Report Office No. (518)761-8256 Date Inspection request received: Queensbury Building&Code Enforcement Arrive: am,/Qfn Depart: 4..A0 am/pm 742 Bay Rd., Queensbury, Y 12804 Inspector's Initials:/ r6-41) NAME: `�t-llA/iP" PERMIT NO.: LOCATION: 110 t-'. INSPECT ON: -fir/-2' i it 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. Well Casing Length 50' +/- Y N N/A [150'to well required if NOl ` Si H Absorption Field: Total length ft. Length of each trench ft. I t(2_ d e f Depth of trenches _ft. `- Size of Stone Seepage Pits: Number Size: Stone Size: Piping Size Type R/C)-t Building to tank Tank to Distribution Box 91-‘A-14 -S Distribution Box to Field/ Pit Opening Sealed: Y N End Cap Y N Inlet/Outlet Pipes&Baffles Y—N Manholes 12"or less below grade Y—N J [provide extension collar if Yes] Y N �� �- 4- t�" • Location/ Separations Foundation to tank ft. Foundation to absorption ft. Separation of Pits ft. Conforms as per Plot Plan _Y 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 .t r. 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 Report_03 29 10.doc