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2009-289 TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201 4z Community Development- Building &Codes (518) 761-8256 CERTIFICATE OF COMPLI_ANCE Permit Number. P20090289 Date Issued: Tuesday, July 07, 2009 This is to certify mat work requested to be done as shown by Permit Number P20090289 has been completed. Tax Map Number 523400-308-019-0001-011-000-0000 Location: 116 SHERMAN ISLAND Rd Owner. GEORGE & DEBORAH CARPENTER Applicant: GEORGE & DEBORAH CARPENTER 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 / f property owner of the responsibility for compliance with Site Plan, rG 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. TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development- Building&Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20090289 Application Number. A20090289 Tax Map No: 523400-308-019-0001-011-000-0000 Permission is hereby granted to: GEORGE &DEBORAH CARPENTER For property located at: 116 SHERMAN ISLAND 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 Queensbury Zoning Ordinance. Type of Construction Value Owner Address: GEORGE &DEBORAH CARPENT 116 SHERMAN ISLAND Rd Septic Alteration Residential QUEENSBURY,NY 12804 Total value Contractor or Builders Name/Address Electrical Inspection Agency IBS SEPTIC &DRAIN ATTN: IVAN BELL 2 LOWER WARREN St QUEENSBURY,NY 12804 Plans &Specifications 2009-289 septic alteration residential $25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Wednesday,June 30,2010 (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 wn Quee ;uX ,June 30, 2009 SIGNED BY for the Town of Queensbury. Director of Building&Code Enforcement --_..............---.. ._.._.,.._.._...__.._.........._ 0 .. . ll�_ VIF._ OFFICE USE ONLY D TAX MAP NO. PERMIT NO. PERMIT FEE % + I► 3 U ��9 t , APPROVALS: ZONING TOWN CLERK ' 0 N O U—�SgURY + T B IICD ........................... . ... MG.&eppE ------ APPLICATION FOR SEPTIC DISPOSAL SYSTEM IT: A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJECT TO REVIEW BEFORE ISSUANCE OF A VALID PERMIT. G p OWNER: ` 0( n 'P/ INSTALLER: 1—ADDRESS: J ADDRESS: IL6 W Pr Wov r PHONE NOS. PHONE NOS. LOCATION OF INSTALLATION: RESIDENCE INFORMATION: YEAR BUILT NO.OF X COMPUTATION= = TOTAL DAILY FLOW B OOMS GARBAGE GRINDER 1980 or older X 150 gallon per bedroom = INSTALLED. 1981 -1991 X 130 gallon per bedroom = SPA OR HOT TUB 1992-present X 110 gallon per bedroom = INSTALLED? PARCEL INFORMATION: ✓ TOPOGRAPHY: Flat rolling Steep slope %Slope ✓ SOIL NATURE: Sand Loam Clay Other ✓ GROUNDWATER: At what depth? ✓ BEDROCKAMPERVIOUS MATERIAL: At what depth? ✓ 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 ecngineer or architect (unless installed in a Planning Board approved subdivision). TANK SIZE: el�Jjv 1 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: nn ABSORPTION FIELD (WITH NO. 2 STONE) Total length ) tt. Each trench X � ❑ 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 I IRT POn'"ncn Septic Inspection Report Office No. (518) 761-8256 Date Inspection r a Queensbury Building &Code Enforcement Arrive: r 742 Bay Rd., Queensbury, NY 128 4 Inspector's Initials: NAME: IT NO.: LOCATION: NSPECT ON: RECHECK: Comments and/or diagram Soil Ty oam Clay Type of Wate . Mu ' ' ll Water Wat aration distance ft. Well separation distance ft. Other wells: ft. Well Casing Length 50' + / - Y N N/A Absorption Field: Total length ft. Length of each trench ft. Depth of trenches ft. Size of Stone -J�c- Seepage Pits: Number Size: x Stone Size: Piping Size Type Building to tank Tank to Distribution Box Distribution Box to Field / Pit Opening Sealed: N End Cap N Inlet/Outlet Pipes&Baffles Y N Location Separations Foundation to tank3�2- Foundation to absorption Separation of _its Z ft. Conforms as per 916t Plan N Engineer Report ao As-Bu' Y N Location of System on Property: Front Rear Left Side Right Side Middle Fron Middle SystemUse 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 414 'j, r q110 3jU01 iA�- r V C J _ v U s� 1 o�