2012-108 01" TOWN OF QUEENSBURY
Fors742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF OCCUPANCY
Permit Number: P20120108 Date Issued: Tuesday, April 03, 2012
This is to certify that work requested to be done as shown by Permit Number P20120108
has been completed.
Location: 78 MONTRAY Rd
Tax Map Number: 523400-296-014-0001-007-000-0000
Owner: GRAYSON PROPERTIES LLC
Applicant: GRAYSON PROPERTIES LLC
This structure may be occupied as a:
Septic Alteration Residential By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Occupancy DOES NOT relieve the property
owner of the responsibility for compliance with Site Plan, Variance, or
other issues and conditions as a result of approvals by the Planning Board Director of Building&Code En'•rcema t
or Zoning Board of Appeals.
TOWN OF QUEENSBURY
.04 .
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: P20120108 Application Number: A20120108
Tax Map No: 523400-296-014-0001-007-000-0000
Permission is hereby granted to: GRAYSON PROPERTIES LLC
For property located at: 78 MONTRAY 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: GRAYSON PROPERTIES LLC Septic Alteration Residential
1004 CHESTNUT St Total Value
MECHANICVILLE,NY 12118
Contractor or Builder's Name/Address Electrical Inspection Agency
DOUG SIMMONS
669-4588
241 SUGAR HILL Rd
REXFORD NY
Plans& Specifications
2012-108
Lot 9. 78 Montray Rd - Replace Existing Tank
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Thursday, March 21,2013
(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 Town Quee bury Wei s tis y, March 21, 2012
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
F I OFFICE USE ONLY C C 0
11
TAX MAP NO. 61(e) J —I PERMIT NO. /6)7 D PERMIT FEE R Uv
APPROVALS: ZONING TOWN CLERK 'I , ���' i ���
IWN OF Q{}EE.NSB4JRY._.. .,.
APPLICATION FOR SEPTIC DISPOSAL SYSTE IR
& c2oDEs
A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJECT TO REVIEW BEFORE ISSUANCE OF A VALID
PERMIT. /
OWNER: Lg(-(L y 62c 2 1-3-°"'"/ INSTALLER: bc1 Sin,-+4.o�
/00y ' e y 4- S YvteekA,J,cv i C_ N y
ADDRESS: I �a J , . ' r G I ADDRESS: ‘2?Y/ Jkf-'1-c 1-H I rZ Re1c J Ay
PHONE NOS. .J71— Z2 y - -27(32/ PHONE NOS. s7 1(f% ‘‘fi — /v'�t2
LOCATION OF INSTALLATION: 78 /7744lice c /Lc. 14 g
I YEAR BUILT NO.OF RESIDENCE INFORMATION:
BEDROOMS X COMPUTATION= = TOTAL DAILY FLOW
GARBAGE GRINDER
1980 or older
X 150 gallon per bedroom = INSTALLED? 7VO
1981 -1991 X 130 gallon per bedroom = 2 ‘a
SPA OR HOT TUB
1992-present X 110 gallon per bedroom = INSTALLED? //v
PARCEL INFORMATION:
/ TOPOGRAPHY: Flat rolling Steep slope %Slope
✓ SOIL NATURE: Sand / Loam Clay Other
✓ GROUNDWATER: At what depth?
✓ BEDROCK/IMPERVIOUS MATERIAL: At what depth?
/ DOMESTIC WATER SUPLY: Municipal 0 Well (If well: Water supply from any septic
system absorption is ft.)
/ PERCOLATION TEST: Rate is minutes 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: /6100 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?
❑ HOLDING TANK SYSTEM Total required capacity?
Aef ilf e t?‘-5 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 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. codesOciueensburv.net
3S1/J z VISIT OUR WEBSITE FOR MORE INFORMATION
__P e,_/..„ -_,_,„_i
www.queensbury.net
Signatr of Person Responsible Date
.17
Town of Queensbury • Community Development office • 742 Bay Road, Queensbury, NY 12804
B 5-LGL 6106
. fraA/A -- /C)
Septic Inspection Report
Office No. (518) 761-8256 Date Ins.-cti9n r-! ,de" 'v- : r/A
Queensbury Building &Code Enforcement Arrive: ," 1-) . J•,�i ,r, -p.•-. ,2Dp
a m
742 Bay Rd., Queensbury, NY 12804 Inspectors Init- - wow--
NAME: (-r ec Q n ..MIT NO.: ( /l]X
LOCATION: `7 g l Ind-r�� Ra ,NSPECT ON: .-_30--/`�
RECHECK: `
-, Comments and/or diagram
Soil Type gd L.eam / Clay
Type of Water: unniic:pALAsiell-Water
Waterline separation distance ft.
Well separation distance ft.
Other wells: ft. _
Well Casing Length 50' + / - Y N N/A
Absorption Field: Total length 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 i,( ,k 5 CA4- '{Z
Tank to Distribution Box L) U -Vb ib •
4116
Distribution Box to Field / Pit /
Opening Sealed: ✓Y 1
End Cap �Y�N
Inlet/Outlet Pipes &Baffles — N
Location/ Separations
• Foundation to tank k 1. ft.
Foundation to absorption ft.
Separation of Pits ft.
Conforms as per Plot Plan —Y N
Engineer Report and As-Built Y N
Location of System on Property:
Front ar Left Side Right Side MiddTe-Front Middle Rear
S st s •
Approved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
Last revised 06/18/07 L:\Building&Codes Forms-OLD\Building&Codes\Inspection Forms\Septic Inspection Report.doc
Community Development.Office
4 Town of Queensbury • 742 Bay Rd.
Queensbury, New York •12804 PLOT PLAN
Show all existing and proposed structures. Indicate the setbacks of all structures and buildings from all property lines. •
SIDE PROPERTY LINE
■■1111■ ■■■■■■■■11 ■ _!�■■ 1111■■■■■■1111■ ■ I
■11 ■■■■■1 ■■■■■1111■ ■111 1111■■n.
IIIiIIIiIiIIIIiiflhIIIII.1iIiiIiflIIIIIfl
i■ fl i_,_
■ ■■aR .i ... ,11..i.
1111111111 11�i■■11■►� i■i ■
. , _,,•__ ,„_..IfthIIIIIiI!iiiiiii1 # iIiiIUIIIII73'. 1 - 111M11111111 I1I1i!IIIIIIIIIIIIlIIII5tII+IIIIIIIIi - i
LFJ 1114—a-1U.HIIIIIIIIflhIIII!iiIIiIIIIIiIIIiIIU
CCLCi. Ilj. �► I ,IIII
Cii
� -� 111111 , � rQ
W i -- ■■■■■1111■■■11■1r...� ■a■■■■■■■■ 1 - .. $m
In=11 ■1111■■■■■■■■ 1111■■ ,s_'� I ■Li■� _ _,_.
_7
I . _ 1 ■■■■111111111111■■■■■■N ■ .. .. . ml,,,
■E ■ ■■ ■■■■■1111■■■ ■11■■■ ' ■ : „Lidioninvehi,_ ,
!I, '-i'.=1111■:S ■ ■ ■ ■ ■1111 ■ 'Isigim ' � 1111 ■ -�Rgve ' ,rtest '-- � :
, r�■■■■ 11■■■111111 1111 ±-.1°'.!
.:�D
_ oo �,
■ ■N■■■■■■■■■■ 1111iiiiiirdir-- + i_ --
2 01
SIDE PROPERTY LINE 1 ens i A 7- --