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2015-198 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: P20150198 Date Issued: Thursday, May 28, 2015 This is to certify that work requested to be done as shown by Permit Number P20150198 has been completed. Tax Map Number: 523400-308-010-0001-068-000-0000 Location: 10 MABEL Ter Owner: LARRY& SUSAN BROWN Applicant: LARRY& SUSAN BROWN 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 (DJ 4 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 .41011h 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Fora Community Development-Building&Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20150198 Application Number: A20150198 Tax Map No: 523400-308-010-0001-068-000-0000 Permission is hereby granted to: LARRY& SUSAN BROWN For property located at: 10 MABEL Ter 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: LARRY& SUSAN BROWN Septic Alteration Residential 10 MABEL Ter Total Value QUEENSBURY,NY 12804-0000 Contractor or Builder's Name /Address Electrical Inspection Agency SANITARY SEWER GEORGE DRELLOS 792-7257 PO BOX 224 GLENS FALLS NY Plans&Specifications BP 2015-198 Residential Septic Alteration $40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Thursday, May 26,2016 (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 Tow of Q nsb ,I , • .y 26,2015 SIGNED BY for the Town of Queensbury. Director of Building&Code Enforcement SEPTIC DISPOSAL PERMIT Office Use Only DALE ; " Received Tax Map l TAX MAP ID O)"ro - 1'te' ia1 MAY Permit No. I) r -- / * . �� ✓ C /a c Permit`�ee c� r I'J�-G3�- LOCATION OF INSTALLATION A_--i - Approvals: OWN BLIILDI; APPLICANT ,5--;AS iR",,`1 �t--) tx) PHONE/E-MAIL ADDRESS /10 7176L 6e-x l'e/Y'et e e INSTALLER/BUILDER: ,S n' �� �'-G`C%� ,�'�6�%moi'' PHONE/E-MAIC >7'92 7 2r7 ADDRESS: pe. & 2z ?`/' 6/e,- 1-,q-/1 OWNER ---C /37g',O C•✓1`J PHONE/E--MAIL Address / ,}-6�C j e 1r Q c CONTACT PERSON FOR BUILDING&CODES COMPLIANCE: 6-CO „ C' b ' J PHONE 7f5,7/c RESIDENCE INFORMATION Year Built #of bedrooms X Gallons per bedroom =Total Daily Flow 1980 or older Garbage grinder installed _Y l,N 1981-1991 II�� iiiiff....- Spa or Hot Tub installed _Y c•-‹-N1992-Present 'td- / 6, PARCEL INFORMATION -�I 6-.W Topography Flat rolling Steep slope %slope Soil Nature )e-Sand Loam Clay Other Groundwater At what depth? J"4- Bedrock/Impervious Material At what depth? r N- Domestic Water Supply -Municipal Well(if well,water supply from any septic system absorption is ft.) Percolation Test Rate: _' S per minute per inch(test to be completed by licensed engineering/architect) PROPOSED SYSTEM FOR NEW CONSTRUCTION Tank Size /O7D gallons(minimum size 1,000 gallons,add 250 gallons to size for each garbage grinder or spa or hot tub) System Type Absorption field with#2 stone Total length T/ ft.;Each trench 5-c) ' x L/ Loot iJ �E Seepage Pit with#3 stone How many: ;size Alternative System Bed or other type? - Holding Tank System Total required capacity? Tank size #of tanks Notes: 1)Alarm system&associated electrical work must be inspected by a Town approved electrical inspection agency;2)We will no longer allow systems to be covered until such time as an As-Built plan is received&approved. The installed system must match the septic system layout on file-no exceptions_ .. DECLARATION: Any permit or approval granted which is based upon or is granted in reliance upon any material representation or failure to make a material fact or circumstance know by or on behalf of an applicant, shall be void. I have read the regulations and agree to abide by,these and all r uir is of the Town of Queensbury Sanitary Sewage Disposal Ordinance. ` ` Print Name: ( D � h L�� Date: j"'Z ' I Signature: ����L Date: S-- Z& -1.1 Town of Queensbury Building&Codes Septic Disposal Permit July 2014 Town of Queensbury Building & Code Enforcement T1u Office No. (518) 761-8256 2 1\ Septic Inspection Report Inspection request received: ��2101?-0t`� Name: ANY) Inspected on: FJ Location: (© r' 6 --avp Arrive: =4i1111'!m. Permit No.: 1 �' \J' Inspector's Initials: rte' OF ments and/or d[a•ram Soil Typ • oam/Clay Type o Water: .► %fe ►Tatem i'1/4C(C 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 2-7-0 ft. Length of each trench .LIeft. Depth of trenches ft. Size of Stone ?� Seepage Pits: Number Size: x Stone Size: Piping Size Type Building to tank Tank to Distribution Box yet Distribution Box to Field/Pit / y" 6V2-35 " br,9-35 `� C Opening Sealed: dN End Cap v� N Inlet/Outlet Pipes&Baffles 7._"1 N Manholes 12"or less below grade v N/ [provide extension collar if Yes] Y ✓N Location/Separations Foundation to tank AS Foundation to absorption ft. Separation of Pits ft. Conforms as per Plot Pla Engineer Report. • As-Built ETU Maintenance Contract provided Y N Location of System on Property: Front Rear Left Side Right Side Middle FrontMiddle Rear S stem Use Sta Approved Partial Approved and needs to be re-inspected, please call the Building&Codes Office Disapproved Septic Inspection Report /o1 vO / .„.- WI ,i0 , 4^- 5 c S a' ry _. 3° �- �;1 \'7 ttC b i Pow e g 3 /0 f)7 A g k Te era to