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2013-422 isre ` TOWN OF QUEENSBURY i 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development - Building & Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE Permit Number: P20130422 Date Issued: Friday, September 13, 2013 This is to certify that work requested to be done as shown by Permit Number P20130422 has been completed. Tax Map Number: 523400-278-020-0001-020-000-0000 Location: 11 SUNNYSIDE RD. NORTI I Owner: MICHELLE & JEFFREY KAIN Applicant: MICHELLE & JEFFREY KAIN 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 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 F 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 oar Community Development-Building& Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20130422 Application Number: A20130422 Tax Map No: 523400-278-020-0001-020-000-0000 Permission is hereby granted to: MICHELLE&JEFFREY KAIN For property located at: 11 SUNNYSIDE RD. NORTH 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: MICHELLE&JEFFREY KAIN 11 SUNNYSIDE NO. Septic Alteration Residential QUEENSBURY,NY 12804 Total Value Contractor or Builder's Name/Address Electrical Inspection Agency SANITARY SEWER DAN DRELLOS PO BOX 224 GLENS FALLS NY Plans&Specifications 2013-422 Res. Septic Alteration $40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday, September 05,2014 (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 own o uee utf' 7h. . ., , September 05,2013 SIGNED BY for the Town of Queensbury. Director of Building&Code Enforcement 'sY�< Community Development Office Town of Queensbury • 742 Bay Road • Queensbury, New York •12804 Office Use Only 2 �C/ TAX MAP NO. h ,aO - I -AV PERMIT NO. 1,3 <j PERMIT FEE 1 D tv 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: ✓ C/LlCrty A-CL 1/10 INSTALLER: Al 7-ra/ J P wP� �N`iv e c ADDRESS: /7 Su,(/✓NGl Sae ✓1/Drlf-'4 ADDRESS: f&. A"-A- 22 (-;1"-e- / j21-41/ PHONE NOS. // PHONE NOS. S7 77.=%2--72 f 2 LOCATION OF INSTALLATION:rre''ti Si o�L RESIDENCE INFORMATION: NO.OF COMPUTATION YEAR BUILT X = TOTAL DAILY FLOW BEDROOMS (Gallons per bedroom) GARBAGE GRINDER 1980 or older X 150 = INSTALLED? Ts-- - 1981 -1991 X 130 = SPA OR HOT TUBL�+ 1992-present r X 110 = VYp INSTALLED? PARCEL INFORMATION: ✓ TOPOGRAPHY: FLAT ROLLING STEEP SLOPE %SLOPE I SOIL NATURE: SAND LOAM Jc CLAY OTHER ✓ GROUNDWATER: AT WHAT DEPTH? N A- /-1/ 1 - ✓ BEDROCK/IMPERVIOUS MATERIAL: AT WHAT DEPTH? 14-- ✓ DOMESTIC WATER SUPLY: MUNICIPAL WELL 1. (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: /0771 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 SO ft. Each trench S D / X 6 ❑SEEPAGE PIT(S)(WITH NO.3 STONE) How many? Size? ❑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 Sanit ewe,j2isposa O finance. codes(aqueensburv.net Signa ure of Person Responsible Date VISIT OUR WEBSITE FOR MORE INFORMATION www.queensbury.net at t. .j C _ 3 � Septic Inspection Report Office No. (518) 761-8256 Date Inspaction reque 1: --• Queensbury Building &Code Enforcement Arrive: '?= I 0 a itar P-part: -3;/.)h am m 742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: / NAME: 567i4 c K •- 'MIT NO.: / ' 161,),. LOCATION: l l o /IA 9S-.1 ct€ 1 • 6 INSPECT ON: -1 3 RECHECK: Comments and/or diagram Soil Type: (anima / Clay Type of Water: Municipal/Well Water Waterline separation distanceft. Well separation distance N3 i-1-1113' ft. Other wells: 10 i- ft. Well Casing Length 50' + / - Y N N/A [150'to well required if NO] Absorption Field: Total length t,' ft. - Length of each trench c)..) ` . Depth of trenches I - 3 ft. ;`` V\JI OD ATF Size of Stone 4t 7 _ Seepage Pits: Number Size: x Stone Size: Piping Size Type Building to tank `. ii 6c)-k W D Tank to Distribution Box bnci:-5 Distribution Box to Field/ Pit /1--\‘'. Opening Sealed: vY_N End Cap •_ N Inlet/Outlet Pipes & Baffles N Manholes 12"or less below grade Y_. N [provide extension collar if Yes] Y— N Location / Separations Foundation to tank t l7 ft. Foundation to absorption t'�/ft. To 4=3_ ��� i, E 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 Re/ Left Side Right Side Middle Front Middle Rear System Use Sta s: 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 i . 7 e_Pr cl kfq- «‘) THIS PLAN TO BE ON PROJECT 1( /1/.6, S'L,L-A-)Alx'scje SITE AT ALL TIMES FOR THE • -e ..,-- DURATION OF CONSTRUCTION r\\\ TOWN OF QUE• 'cf.& \11 , , , ,. BUILDING & •D • P.- '4, // Reviewed B .',/. // , , \i'V • \,-) ( / / Zve —...I gf '. \ i \ li ! C I 04- ! I , -7--"0 c):,,,• -• \‘'7 '\ \ t7 1 1 N ! I 1 . , ! \ \ ' t %, : It V . , , to' k ! c: , N .• i v) . • \ : H II" . - --- , ----___L • , I ____ • .._... N , . i.