2012-540 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: P20120540 Date Issued: Wednesday, December 19, 2012
This is to certify that work requested to be done as shown by Permit Number P20120540
has been completed.
Tax Map Number: 523400-296-014-0001-007-000-0000
Location: 78 MONTRAY Rd
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 Compliance DOES NOT relieve the �� n
property owner of the responsibility for compliance with Site Plan, Cat/
Variance, or other issues and conditions as a result of approvals by the Director of Building&Codes nfor ent
Planning Board or Zoning Board of Appeals.
TOWN OF QUEENSBURY
742 Bay Road,Quem4nit-Y,NY 12804-5902 (�18) 761-8201
Community Development-Building& Codes (518)761-8256
BUILDING PERMIT
Permit Number: P20120540 Application Number: A20120540
`Yax Nlap No: 523400-296-014-0001-007-000-( 000
["crmissiot-iislict-ebygr,tntcdt:(:): GRAYSON PROPERTIESLI.,C
N,)r property hxated at: 78 ON RAY Rd
in thCTONVII Of Qn)LIcesbuConstructor ry, to Place
at: the above location in accordance with application together with plot plans and other information hereto filed
an(] approvcdand in comptiaricc with the NYS Uniform Building,(:odes and the Queensbury Zoning
Ordinance. iyvc of Construction Value
0WIM-Ad(h-C',s: GRAYSON PROPERTIES LLC Septic,Alteration Residential
1004 CHESTNUT St Total Value
MECHANICVILLE, NY 12118
Contractor or Builder's Name / Address I-1carical Inspection Agency
DOUG SIMMONS
669-4588
241 SUGAR HILL. Rd
REXFORD NY
Nalls&Spccificafions,
2012-540 Lot 8, 78 Montray Rd,
Res. Septic alteration
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Thursday, November 14, 2013
(If as long"period is required,an application for an extension nuist be suade to the code Enforcement Officer
of the Town of Queensbury before the expiration date.)
Dated at the Town of Queensbury; Wednesday, November 14, 2012
SK;NFD BY for the'['own of Queensbury.
Director of Building& ('ode 1anforcenient
Revised 4/14/2010
OFFICE USE ONLY
TAX MAP NO,,c • ill !-17 PERMIT NO. / —5Z ERMIT FEEk e3_— i� e
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: � rr y G•^,o/'sa^/ INSTALLER: /7 041 c� Ili 141 J ,rp 1
ADDRESS: /D D c/ CA e s 71 N rti > S�. f P G I ' ADDRESS: (/� � /�l H i f i l i d xC X f o,r U
PHONE NOS. 3--) - (9..a 9 a 7 e / PHONE NOS. c/
LOCATION OF INSTALLATION: Lc+K
4
4 RESIDENCE INFORMATION:
YEAR BUILT
NO. X COMPUTATION = TOTAL DAILY FLOW
BEDROOMS (Gallons per bedroom) GARBAGE GRINDER
1980 or older X ' 150 = j d INSTALLED? N 0
1981 -1991 X 130 = SPA OR HOT TUB
1992-present X 110 = INSTALLED? N O
PARCEL INFORMATION:
I TOPOGRAPHY: FLAT ROLLING Y\ STEEP SLOPE • %SLOPE
✓ SOIL NATURE: SAND X LOAM CLAY OTHER
I GROUNDWATER: AT WHAT DEPTH?-
✓ BEDROCK/IMPERVIOUS MATERIAL: AT WHAT DEPTH?
I DOMESTIC WATER SUPLY: MUNICIPAL X 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: 1 Q 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:
0 ABSORPTION FIELD(WITH NO.2 STONE) Total length ft Each trench X
jt ] SEEPAGE PIT(S)(WITH NO.3 STONE) How many? Size?
`,Q(-e 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
Sanita. Sewage Disposal Ordinance. codesCa otreensburv.net
r , VISIT OUR WEBSITE FOR MORE INFORMATION
Signature of Person Responsible Date www.nueensburv.net
Town of Queensbury* Community Development Office *742 Bay Road, Queensbury NY 12804
Septic Inspection Report
Office No. (518) 761-8256 Date Inspection r u-, rs cei -•:
Queensbury Building &Code Enforcement Arrive: -=�;L" -/I..-'.rt: 3:ZD a pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: Per
NAME: `-�� �CN Ff-D����\� PE' 1T NO.: 1 Z"51-10
LOCATION: l,tl ZS �\c & c R#t� I -PECT ON:
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. _
Depth of trenches _ ft.
Size of Stone
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type
Building to tank H ' g£_i 140
Tank to Distribution Box K 'f e/(— 4 a
Distribution Box to Field/ Pit
Opening Sealed: _Y—N
End Cap _Y
Inlet/Outlet Pipes& Baffles _ N
Manholes 12"or less below grade 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 _Y_ N
Engineer Report and As-Built —Y— N
ETU Maintenance Contract _Y_ N T
provided U p
Location of System on Property:
Front ar Left Side Right Side Middle Front Middle Rear
S stem Use S us:
Approved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
L:\Pam Whiling\2010\Building Codes Forms\Inspection Forms\Septic Inspection Report 03 29 10.doc
Septic Inspection Report
Office No. (518) 761-8256 Date Ins' ion r:.• - re ed:
Queensbury Building &Code Enforcement Arrive: - ► I. /Depart: C1-1-1L)am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Ini. ""
NAME: GR64 'rJ PTE ) P:' . IT NO.: I 7--5(-1-0LOCATION: 1-c '� 1-A O��^C RA`s 1-a��-L}wj I •'ECT ON: 11– 3 -I ?
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.
Depth of trenches ft.
Size of Stone
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
End Cap _Y_ N
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. v
Foundation to absorption ft. `3J
Separation of Pits ft.
Conforms as per Plot Plan —Y^ N
Engineer Report and As-Built —Y
ETU Maintenance Contract _Y N
provided
Location of System on Property:
Front Rear eft Side Right Side Middle Front Middle Rear
System Use ' -t .
pproved
P.rtial Approved and needs to be re-inspected, please call the Building &Codes Office
w isapproved
L:\Pam Whiting 2010\Building Codes Forms\Inspection Forms\Septic Inspection Report 03 29 10.doc
Septic Inspection Report
Office No. (518) 761-8256 Date In ion r=: ,. - ived•
Queensbury Building &Code Enforcement Arrive: - 1�%• /'--=rt: Vs am =
742 Bay Rd., Queensbury, NY 12804 Inspector's Initi• . j
- 1
NAME: ��`�,'�D� �� it lt'E L, P RI NO.: 1 ?
LOCATION: �:^ —1(�H� ' PECT ON: 11—Z9—f Z_
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.
Depth of trenches ft.
Size of Stone
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type
Building to tank
Tank to Distribution Box �-- i V
Distribution Box to Field/ Pit
Opening Sealed: Y N
End Cap _Y_ N
Inlet/Outlet Pipes&Baffles _—Y •
Manholes 12"or less below grade _Y l�
[provide extension collar if Yes] _Y ✓N
kA3 \
Location/ Separations _E
Foundation totank ft.
Foundation to absorption ft.
Separation of Pits ft.
Conforms as per Plot Plan _Y N C-C
Engineer Report and As-Built _Y N _
ETU Maintenance Contract _Y_ N — � — V\-V e_ V\ ti
provided `C
Location of System on Property:
Front Rear Left Side Right Side Middle Front Middle Rear
System Use Status:
pproved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
L:\Pam Whiting\2010\Building Codes Forms\inspection Forms\Septic Inspection Report03 29 10.doc
ino-netek.cA q-ii
Septic Inspection Report
Office No. (518) 761-8256 Date In ••- on r;,•10 ��
Queensbury Building &Code Enforcement Arrive: - P-•: : 40 arr
742 Bay Rd., Queensbury, NY 12804 Inspecto s Initi. . -.'
NAME: C...5-1-A r) "MIT�O NO.: /,;)--.5".1 O
LOCATION: 1-,2•+-t" M 0 r)--1-r6L u INSPECT ON: 1/ -J 9
RECHECK:
Comments and/or diagram
Soil Type: Sand / Loam/ Clay
Type of Water: Municipal/ Well Water x
Waterline separation distance _ _ .ft.
Well separation distance ft.
Other wells: ft. "" C c 7 -1- 2.)
Well Casing Length 50' + / - Y N N/A
[150'to well required if NO] _ a
Absorption Field: Total length _._ ft.
Length of each trench ft. \-1---_. T St �*
Depth of trenches ft. r ti
Size of Stone rj�
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type � � �� .3 n
Building to tank i 5c,� -
Tank to Distribution Box V
Distribution Box to Field/ Pit
Opening Sealed: Y—N
End Cap _
Inlet/Outlet Pipes&Baffles Y
Manholes 12"or less below grade _Y_ N
[provide extension collar if Yes] _Y_ N
Location / Separations
C) �C:3 5 L_
Foundation to tank `7,L-4 ft.
Foundation to absorption ft. Th----K t`J
Separation of Pits ft. ��
Conforms as per Plot Plan _Y_N
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
System Use Status:
Approved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
L:\Pam Whiting\2010\Building Codes Forms\Inspection Forms\Septic Inspection Report_03 29 10.doc
(448 Ap (y\
Septic Inspection Report
Office No. (518) 761-8256 Date Inspection req ,,;� -eiv• •:
\�
Queensbury Building &Code Enforcement Arrive: -'7b a •� rt: Z � p�
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: �"
i
NAME: Q r ' .RMIT NO.: /
LOCATION: /1 I `1 �C1-.rcq ra NSPECT ON: ii /to-/
RECHECK: v
Comments and/or diagram
Soil Ty• -;0011%-,- Loam/ Clay
Type of Water. 'unici ' Well Water
Wate ' eparation distance ft.
Well separation distance ft.
Other wells: ft.
Well Casing Length 50' +/ - Y N N/A
[150'to well required if NO]
��•� ssliVCADV -\ v
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
Tank to Distribution Box
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
[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 _Y N
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
System Use Status.
Approved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
L:\Pam Whiting\2010\Building Codes Forms\Inspection Forms\Septic Inspection Report 03 29 10.doc
:` = Community Development Office
'';`� Town of Queensbury • 742 Bay Rd.
Queensbury, New York •72804 PLOT PLAN
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