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2012-505 .41M4. TOWN OF QUEENSBURY 742 BayRoad,Queensbury,NY 12804-5902 (518) 761-8201 Q n', Community Development - Building & Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE Permit Number: P20120505 Date Issued: Tuesday, November 20, 2012 This is to certify that work requested to be done as shown by Permit Number P20120505 has been completed. Tax Map Number: 523400-309-009-0002-017-000-0000 Location: 12 MAINE Ave Owner: DAVID & APRIL DICKINSON Applicant: DAVID & APRIL DICKINSON 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 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 742 13',I.V R03d,QUCCI)sbury,NY 12804-i9O2 (518) 761-8201 Commurifty Development-Building& Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20120505 Application Number: A20][20505 Tax Nlap No: 525400-3)09-009-0002-01.7-000-(y000 DAVID & APRIL DICKINSON 1^or property located au 12 MAINE Ave in OICTONVII Of(Queensbury,to constrLICt or place al the above location it) accordance with application together with Plot plan",'and other information hereto filcd and approved and in compliance with the NYS Uniform Building Codes sand the Quccnsbur� Zoning Ordlofflice. Tyle of Cotistructiog Value Owner Address: DAVID & APRIL DICKINSON Septic Mteration Residential 589TWIN CHANNELS Rd Total Value QUEENSBURY, NY 12804 Cootractor or Builder's Name / Address E'lectrical frispectionAgency Plans&Specifications 2012-505 Res. Septic Alteration $40.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Thursday, November 14, 2013 (If it longer period is required,an application for an extension must be ma&to floe code Enforccinent Officer of the Town of Queensbury before the expiration date,) Dated at the Towri of Queensbury; Wednesday, November 14, 2012 S I G N I'M BY for the Town of Quccrisbury. Director of Building&Code I snforcement Community Development Office N' 'v 2012 - Town of Queensbury • 742 Bay Road • Queensbury, New York •12804 Office Use Only /, � TAX MAP NO.c ,b(�} 1 /, / ` ! PERMIT NO. Ia�Jb PERMIT FEE 40` rt)ONING TOWN CLERK 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. . �J ,�,, OWNER: p�A�l.k�� t'AKNL.Iti1�lC3` INSTALLER: ADDRESS: U �i a { ,_.[y o k1<d, rc1.CijJ1�Ql ADDRESS: PHONE NOS. ,3' ba.4.1.. PHONE NOS. LOCATION OF INSTALLATION: I ! 1 1 a,U&JL4 V RESIDENCE INFORMATION: YEAR BUILT NO.OF X COMPUTATION = TOTAL DAILY FLOW BEDROOMS (Gallons per bedroom) GARBAGE GRINDER 1980 or older X 150 = Lf 1 fl INSTALLED? 1981 -1991 X 130 = SPA OR HOT TUB 1992-present X 110 = INSTALLED? PARCEL INFORMATION: / I ✓ TOPOGRAPHY: FLAT ROL NG L STEEP SLOPE_W\ %SLOPE1A— N ✓ SOIL NATURE: SAND I LOAM IV }\ CLAY V I.\ OTHER ✓ GROUNDWATER: AT WHAT DEPTH? 1\1 ✓ BEDROCK/IMPERVIOUS MATERIAL: AT WI'DEPTH? ✓ DOMESTIC WATER SUPLY: MUNICIPAL ((/ WELL \(If well:water supply from any septic system absorption is: ft) ✓ 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 Board approved subdivision). TANK SIZE: r)C)(, 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: �1 /; 1 ❑ABSORPTION FIELD(WITH NO.2 STONE) Total length 2 t) C ft. Each trench 4 x )( ❑ SEEPAGE PIT(S)(WITH NO. 3 STONE) How many? Size? 0 ALTERNATIVE SYSTEM Bed or other type? ❑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 the •ulations with respect to this application and agree to abide by the 1d al.requirements of the Town of Queensbury QUESTIONS? CALL 761-8256 OR EMAIL Sanitary S1 1 Di�..salOrdinance. I ( codes(aqueensburv.net . '° VISIT OUR WEBSITE FOR MORE INFORMATION Signatur- o P•rso' 'esponsible Date www.queensburv.net • Community Development Office OCT 2 4 2012 Town of Queensbury • 742 Bay Road • Queensbury, New York •12804 Office Use Only C�• !� TAX MAP NO.30 9 ' r - `J /Jfir PERMIT NO. I e V 5 PERMIT FEE / T) 67° APPROVALS: ZONING TOWN CLERK 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: �ii\(4 4-'t- Dr I i v t urm r1.Se),,, INSTALLER: �l ADDRESS: / D '� LJf v1 1C- (A ( (10 S ADDRESS: % PHONE NOS. g3-/ ;?",-/3 PHONE NOS. LOCATION OF INSTALLATION: /A (\131 ( /�F e RESIDENCE INFORMATION: NO.OF COMPUTATION YEAR BUILT X = TOTAL DAILY FLOW BEDROOMS (Gallons per bedroom) GARBAGE GRINDER, 1980 or older X 150 = INSTALLED? CJ 1981 -1991 X 130 = SPA OR HOT TUX 1992-present X 110 = INSTALLED? (� PARCEL INFORMATION: / ✓ TOPOGRAPHY: FLAT ROLLING z------ STEEP SLOPE %SLOPE ✓ SOIL NATURE: SAND LOAM CLAY OTHER ✓ GROUNDWATER: AT WHAT DEPTH? ✓ 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 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: //'>6ALLON(MIN. SIZE IS 1,000 GAL.)Add 250 gallons to the size of the septic tank for each garbage grinder, spa or whirlpool tub. ` 1�i l SYSTEM TYPE: li�lF t 1r"C��Z� UNILV- i i /A]ABSORPTION FIELD(WITH NO.2 STONE) Total lengt �.7 ft. Each trench OD X J l� ❑SEEPAGE PIT(S)(WITH NO. 3 STONE) How many? Size? 0 ALTERNATIVE SYSTEM Bed or other type? ❑ 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 the regulations with respect to this application and agree to abide by these and all requirements of the Town of Queensbury QUESTIONS? CALL 761-8256 OR EMAIL San' ry Sewage i al Ordinance. codes(aqueensbury.net CM ✓/.e, ^z /D- .4`l— U.'2— Signature of Person Responsible Date VISIT OUR WEBSITE FOR MORE INFORMATION www.queensburv.net PRO PeRTY Lme 0 kvE'9 ' LlSZ st_ Cie CZL :a Q _ d a J L a ¢wao a oJ:' ai�r�7 3 cl 6 v rAkAA,3 /J ( A- A Septic Inspection Report Office No. (518) 761-8256 Date Ins loon r-• :+-• •- .-iv-: • /0 / N Col RCO v ,,, M 'V `•mss " .a a , ,p ,. raw e p k ..... , . \•\\ , • .____ _..... , cy , 0, '—„0" . i'v1:11 \ \ 11fl � '�"� E-7--- � 7!1d0S ) ) m � l PLOT PLAN _.< ITN I HAVE SEEN OR OBSERVED ALL OBJECTS lu m TREES, FENCES, ETC l J n Up cD SHCH AS HOUSES,WELLS, m -o SHOWN ON THIS DOCUMENT.I HAVE PERSONALLY ML 5 T ISTANCE SET FORTH ON�F IS D`PC M v o n `► L Q D� 51GN?�TU C a P 1110- D-ef, eW IQOfl D o�o nC Z u' C) M —i ITY� u --- DP m O ., 5D C Q m C _ r ti ° kQ 2 ft Il /1�(4 ` ' r ; A � mo0 r\C kri a ) . J. a IN% c.-, FP W ti) T i 1110 • i D O m 1- Z. 7 rz 9 --G I PA Ci ‘i t'Ve. Ave,