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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 Show all existing and proposed structures. Indicate the setbacks of all structures and buildings from all property lines. SIDE PROPERTY LINE • _ . s _ - 111111111OWE _ �_- (2)CZ i; pN3 :\,e_ 0 . IP•T\ '----* ii i .� --I—:. r . • __.ir- — _ _ _ - _ 1'7��� ERE. _ zi zi W o z - .. .--- ___ - - --- r -- — -- . --- - J • � 4 � -0 zl O I � i 7.7 a. 't my O N cn _ m WI �' `'GZ � I I , a. ______i_ 7 Q m ,- _ m w rn 5.r 00 -0 t D: rn O __�. t!r• I I .1 l := cr r;A m I— ' rn z — TOWN Q. � _ �r o��o`m•P p , . IN, t:_, e� t ,rii c)ii, f NOV , 2012 �' i I. l_ [ -4- 1 I , __,____, SIDE PROPERTY LINE , en' 1 1-11C7—