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2009-104 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. P20090104 Date Issued: Friday, April 17, 2009 This is to certify that work requested to be done as shown by Permit Number P20090104 has been completed. Tax Map Number. 523400-309-010-0002-007-000-0000 Location: 28 LUZERNE Rd Owner. SUSAN L CRATON Applicant: SUSAN L CRATON 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 Direc r-of1ftu@1ditie& rcement Planning Board or Zoning Board of Appeals. TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development- Building&Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20090104 Application Number. A20090104 Tax Map No: 523400-309-010-0002-007-000-0000 Permission is hereby granted to: SUSAN L CRATON i For property located at: 28 LUZERNE Rd 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 QueensburyZoning Ordinance. Tyne of Construction Value Owner Address: SUSAN L CRATON 28 LUZERNE Rd Septic Alteration Residential QUEENSBURY, NY 12804 Total value Contractor or Builders Name/Address Electrical Inspection Agency Plans &Specifications 2009-104 septic alteration residential $25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Thursday, April 08, 2010 (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 T9wn4 Queembury, e nesday,April 08, 2009 SIGNED BY for the Town of Queensbury. Director of Building Code nforcement -------------- ?, r/v��_ 7 OFFICE USE ONLY ""_____________ ► ► 0 , ► ► TAX MAP N0. '-�- _� / , P RMIT N0. PERMIT f ' ► ; � APPROVALS: ZONING 0 ► TOWN CLERK , --------------- , , , --- -. APPLICATION FOR SEPTIC DISPOSAL SYSTEMP III /I-I .. A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJECT TO REVIEW PEluylll PERMIT. EW BEFORE ISSUANCE OF A VALID OWNER: INSTALLER: ADDRESS: v ADDRESS: PHONE NOS, PHONE NOS. LOCATION OF INSTALLATION: �tiC YEAR BUILT NO.OF BE OOMS X COMPUTATION= = TOTAL DA RESIDENCE INFORMATION: ILY FLOW 1980 or older X 150 gallon per bedroom _ GARBAGE GRIN E 1981 1991 X 130 gallon per bedroom INSTALLED? 1992-present X 110 gallon per bedroom - SPA OR HOT TUBi1 / INSTALLED? PARCEL INFORMATION: ✓ TOPOGRAPHY: Flat rolling Steepslo o pe /oSlope ✓ SOIL NATURE: Sand Loam Clay Other ✓ GROUNDWATER: At what depth?'Z46� ✓ BEDROCK/IMPERVIOUS MATERIAL: At w t depth 7� ✓ DOMESTIC WATER SUPLY: Municipal Well (If well: Water supply from any septic ✓ system absorption is�_ft.) PERCOLATION TEST: Rate is /--/— Per minute per inch. (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 subd' ' TANK SIZE / Ivlslon). _GALLON (MIN. SIZE IS 1,000 GAL.)Add 250 gallons to the siz each garbage grinder, spa or whirlpool tub. a of the septic tank for SYST TYPE: ABSORPTION FIELD (WITH NO. 2 STONE) Total length —/ ❑ SEEPAGE PIT(S) (WITH NO. Bed or g ft. Each trench�X 3 STONE) How many? ❑ ALTERNATIVE SYSTEM Size? other type? ❑ 17 HOLDING TANK SYSTEM Total required capacity? Tank size? Number of tanks? TM :........ ::..:.NOTE: ALARM SYS ASSOCIATED :...::................ ELECTRICAL WORK MUST BE INSPECTED BY A TOWN APPROVED ELECTRICAL INSPECTION AGENCY. PLEASE REVIEW LIST .....:.............•. ST PROVIDED. ..::.: . ....::.: .. For your protection, please note that pursuant to Section 136- 9 of the Code of the Town of Queensbury, an permit or approval granted which is based upon or is granted 2 reliance upon an matey' y' y failure to make a material fact or circumstance known by or on be half of an applicant, shall be voidresentation or I have read the regulations with respect to this application and aQuueagree to abide by these and all requirements of the Town of QUESTIONS? CALL 761-8256 OR EMAIL ensburyary Sewage Disposal Ordinance. code GALL71-82VISIT OUR WEBSITE FOR MORE INFORMATION son Re wr© � w�nn►gueensbury net ponslble Date Town of Queensbury .Community Development Office ffi 742 Bay Road, Queensbury, NY 12804 Septic Inspection Report Office No. (518) 761-8256 Date Ins 1p Queensbury Building &Code Enforcement Arrive: : a 742 Bay Rd., Queensbury, NY 12804 Inspectors Initia NAME: >LOCATION: : RECHECK: Comments and/or diagram Soil Ty oam/ Cla Type of Wate • ici' ell Water terlin ration distance ft. Well separation distance ft. Other wells: ft. Well Casing Length 50' + / - Y N_N/A Absorption Field: Total length t2 ft. Length of each trench Depth of trenches ft. Size of Stone JA Seepage Pits: Number Size: x Stone Size: Piping Size Type Building to tank ol Tank to Distribution Box a 1 Distribution Box to Field Pit ' k N (, � Opening Sealed: N End Ca N Inlet/Outlet Pipes &Baffles Y N Location Separations Foundation to tank ft. Cj Foundation to absorption ft. Separation of Pits ft. Conforms as per PI Ian' N Engineer Report and,As-Bu" Y N Location of System on Property: Front Re Left Side Right Side Middle Front Middle Rear m t Approved Partial Approved and needs to be re-inspected, please call the Building &Codes Office Disapproved Last revised 06/18/07 U\Building&Codes Forms-01-1)\Building&Codes\Inspection Forms\Septic Inspection Report.doc I f V tV s� dls a � s l v , . '00"'K 0 J (v'14 40 � 0 i.. v 0 IIJ �� 3