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2013-217 TOWN OF QUEENSBURY pow742 Bay Road,Queensbury,NY} Q ry, 12804-5902 (518) 761-8201 Community Development - Building & Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE Permit Number: P20130217 Date Issued: Friday, January 08, 2016 This is to certify that work requested to be done as shown by Permit Number P20130217 has been completed. Tax Map Number: 523400-309-007-0002-029-000-0000 Location: 30 MALLORY Ave Owner: DANIELLE DEVORE Applicant: DANIELLE DEVORE 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 (— aviP 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. 004 TOWN OF QUEENSBURY s 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development- Building& Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20130217 Application Number: A20130217 Tax Map No: 523400-309-007-0002-029-000-0000 Permission is hereby granted to: DANIELLE DEVORE For property located at: 30 MALLORY Ave 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: DANIELLE DEVORE Septic Alteration Residential BARRY PETERS Total Value PO BOX 1317 SEBASTOPOL, CA 95473-0000 Contractor or Builder's Name/Address Electrical Inspection Agency IBS SEPTIC & DRAIN ATTN: IVAN BELL 2 LOWER WARREN St OUEENSBURY,NY 12804 Plans&Specifications 2013-217 Res. Septic Alteration $40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Tuesday,May 20,2014 (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 of Queensbu Mo. ;a/ May 20,2013 SIGNED BY ` for the Town of Queensbury. Director of Building&Code Enforcement -- _• Community Development Office Town of Queensbury • 742 Bay Road • Queensbury, New York •12804 M<,' Y 2013 Office Use Only J Lib/� TAX MAP NO.3 0 9 . -�' .kci PERMIT NO./ 3—a/ 9 PERMIT FEE S L 1.° s15 0 APPROVALS: ZONING TOWN CLERK APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT: A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS.APPLICATIONpIS SUBJECT TO REVIEW BEFORE ISSUANCE` OF A VALID PERMIT. OWNER: Arc-1 P I lr N INSTALLER: "�I..3 J �e��tf L ADDRESS: �) Mu `\Dr V ADDRESS: ! (v+ P T "� P C+4 PHONE NOS. �fl PHONE NOS. J —7T6 D 11 LOCATION OF INSTALLATION: .Y) v1 Vi\Jr- NV t. RESIDENCE INFORMATION: YEAR BUILT NO.OF X COMPUTATION = TOTAL DAILY FLOW BEDROOMS (Gallons per bedroom) GARBAGE GRINDER 1980 or older X 150 = Lisc INSTALLED? 1981-1991 X 130 = SPA OR HOT TUB 1992-present X 110 = INSTALLED? PARCEL INFORMATION: ) } ✓ TOPOGRAPHY: FLAT RO ING STEEP SLOPE IV %SLOPE N ✓ SOIL NATURE: SAND LOAA31/4\f k CLAY N 1\ OTHER (Y ✓ GROUNDWATER: AT WHAT DEPTH? ►Y ✓ BEDROCK/IMPERVIOUS MATERIAL: AT WH T DEPTH?__ _ ✓ DOMESTIC WATER SUPLY: MUNICIPAL WELL \(If well:water supply from any septic system absorption is: ft) ✓ PERCOLATION TEST: RATE IS `V PER MIINUTE PER INCH(mpg (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 MO in a Planning Board approved subdivision). TANK SIZE: LNa GALLON (MIN. SIZE IS 1,000 GAL.)Add 250 gallons to the size of the septic tank for each garbage grinder, spa or whirl I tub. SYSTEM PE: '[. ABSORPTION FIELD(WITH NO. 2 STONE) Total length2- C) - C) ft. Each trench 5- X -)C ❑SEEPAGE PIT(S)(WITH NO.3 STONE) How many? IV Size? N r ❑ALTERNATIVE SYSTEM Bed or other type? \\tt o HOLDING TANK SYSTEM Total required capacity? \ Tank size? \v �1\ 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 w isposalOrdinance. codes(aiqueensburv.net �� VISIT OUR WEBSITE FOR MORE INFORMATION Sign e erson Responsible Date www.oueensburv.net -__STPT_ u_ S Septic Inspection Ref. Office No. (518) 761-8256 Date Ins.- ion r-a i-st . -' ed: Queensbury Building &Code Enforcement Arrive: =C-)r ' !epart: am/pm 742 Bay Rd., Queensbury,. NY 12804 Inspector's Initia 1 NAME: OLIV_h.1_SPE'�/IT NO.: 3� &i LOCATION: 3 is ca i E-''L3 Awe IN"ECT ON: 1 —(a—I (o 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. Foundation to absorption ft. � ��` �._.�_.�� Separation of Pits ft. vC16\-T tC Conforms as per Plot Plan Y N 1 Engineer Report and As-Built Y— N ETU Maintenance Contract _Y_ N provided Location of System on Property: Front Re Left Side Right Side Middle Front Middle Rear System Us tat 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 - 1a alkAse Septic Inspection Report Office No. (518) 761-8256 Date Ins.- ion r:-. - - -•. Queensbury Building &Code Enforcement Arrive: = .. a ..rt: aml�fn/ 742 Bay Rd., Queensbury, NY 12804 Inspector's Ini . 1. NAME: f Q Jtrh IT NO.: (3 c ( / LOCATION: .3 p MCMOJ t�-tr, PECT ON: �'�1i-1 3 RECHECK: J Comments and/or diagram Soil Type r / •. • Clay Type of Water: unic':.• Well Water Waterline separation distance t'2 ft. FRS• c AiN2-3:7 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 cbft. Depth of trenches Z. ft. Size of Stone 7.- - Seepage Pits: Number Size: x _ Stone Size: Piping Size Type Building to tank +-1`1 �v5j + *J Tank to Distribution Box '-t" ►ip(2 ' 5 Q v Distribution Box to Field/ Pit Li " Km/13_1 -v-,k 4t VRW Opening Sealed: .�y_N End Cap _ N Inlet/Outlet Pipes &Baffles ✓Y/ N Manholes 12"or less below grade vY— [provide extension collar if Yes] _Y Location/ Separations Foundation to tank V./ ft. Foundation to absorption Ic i ft. Separation of Pits Conforms as per Plo an Y_ N Engineer Report an s-Bt �Y Qac) €Q.- ETU Maintenanc act Y N provided Location of System on Property: Front Rear Left Side ight Side u'•e le Fron Middl 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 � 1 w ) ) 3 0 % 1 ' � 10 ry ' cr.; cf— • MP 2,02013 G 5� o r 20t,r 1W _ SEPTIC PLOT PLAN or r ' (i f s I HAVE SEEN OR OBSERVED ALL OBJECTS SO ;HOUE 0 \D 'nr� 1\v SUCH DOCUMENT.I HAVE PERSONALLY MEA R ANCE SET FORTH ON TMSES ii DI RAM. SIGN Iv' a DATE 3 73-7-11-7 -INI 0 f; v7 �U1 i 1 v- ? A :^e TOWN OF QUE - ;,U.. BUILDING & 7r D, ;_ -- Reviewed B . /1, r1, b' 4 Date: mink I \\