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2008-337 TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201 4z Community Development- Building &Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE Permit Number. P20080337 Date Issued: Thursday, July 24, 2008 This is to certify that work requested to be done as shown by Permit Number P20080337 has been completed. Tax Map Number. 523400-309-009-0003-083-000-0000 Location: 27 MAINE Ave Owner. DONNA MAILLE Applicant: BEATRICE A MANDIGO This structure maybe occupies -akltY MALLIE 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 Director of Building&&de IMorcernent 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: P20080337 Application Number. A20080337 Tax Map No: 523400-309-009-0003-083-000-0000 Permission is hereby granted to: GARY MALLIE BEATRICE A MANDIGO For property located at: 27 MAINE 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. Tyne of Construction Value Owner Address: BEATRICE A MANDIGO S 175 LUZERNE Rd Septic Alteration Residential QUEENSBURY, NY 12804 Total value Contractor or Builder's Name/Address Electrical Inspection Agency Plans &Specifications 2008-337 septic alteration residential $25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Friday,June 26, 2009 (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 Tov rt o er , , Pur ` ,";June 26,2008 SIGNED BY i� for the Town of Queensbury. Director of Building&Code Enforcement ...........r...r.....r rr.r...................................rr«.. + rir. +ii',Yii r.r�r«rrrrrrs(. OFFICE USE ONLY + TAX MAP NO. PERMIT N0. j MIT FE 0 +; APPROVALS: ZONING TOWN CLERK01 t/ I*' .......... APPLICATION FOR SEPTIC DISPOSAL SYSTEM PE.RMITi A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJECT TO REVIEW BEFORE ISSUANCE OF A VALID PERMIT. OWNER: (6C INSTALLER: �� r ADDRESS: . #'� 7/ ' `C/�t'c A C-C ADDRESS: r!' '� "�✓ram' PHONE NOS. PHO19E NOS._ d ��/ LOCATION OF INSTALLATION: .,2 7 v� . ..NO.OF- i.» :.....................„,........,1 RESIDENCE INFORMATION: YEAR BUILT BEDROOMS X COMPUTATION= = 1 TOTAL DAILY FLOW i .»... »....•.......r......................................». ». .... .I GARBAGE GRINDER 1880 or older 2 X 150 gallon per bedroom = 3® w j INSTALLED? (.XN ..-.130 gallon per bedroom ..'..s- .................».....................................,..... SPA OR HOT TUB 1...1092-present.�...............r........,...-.r.-..,....1._X..�».....110 gallon per bedroorri ..... ...»...-................................................•............j INSTALLED? t PARCEL INFORMATION: ✓ TOPOGRAPHY: FLAT ROLLING STEEP SLOPE %SLOPE ✓ S`OIL NATURE: SAND LOAM CLAY OTHER ✓ GRQUNDWATER: AT WHAT DEPTH?/ BEDROCK/IMPERVIOUS MATERIAL: AT WHAT DEPTH? ✓ DOMESTIC WATER SUPLY: MUNICIPA& WELL (IF WELL:WATER SUPPLY FROM ANY SEPTIC-SYSTEM ABSORPTION IS FT. 1 ✓ PERCOLATION TEST: RATE IS /— PER MIINUTE 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 subdivision). Add 250 gallons to the size of the septic tank and leach field for each garbage grinder, spa or whirlpool tub.; ✓ SEPTIC TANK: GALLON (MIN. SIZE IS 1,000 GAL.) TILE FIELD: EACH TRENCH-, FT. ✓ TOTAL SYSTEM LENGTH: SEEPAGE P1T(S): HOW MANY? Tom"" ✓ SIZE OF EACH FT. X FT. ✓ SIZE OF STONE TO BE USED: # I DEPTH OR THICKNESS FT ✓ BED SYSTEM SIZE: X ✓ ALTERNATIVE SYSTEM: LENGTH ANDIOR SIZE _ ✓ HOLDING TANK SYSTEM:(If required) NO. OF TANKS: I SIZE OF EACH ✓ GALLONS.(TOTAL CAPACITY:_._, GAL,. NN14rl4.NN{.NY.W NN1N•1•W.NNI•I........•NNNNI•.•i•.•.•..1•NI.1•NN..•..•...........•.•N.•NNNNNNNNin.I ....................... ..................•..N.•.•.•NN....V.....•..•....•.......•...•..NNN...•N.�NNNI...1.1..•1.1•...•.•..1•.•.•.•.•.•..N....N...•N.•1..•.N•.....".I.N.............•.....»"'.....•NNN..NNN.. NOTE: ALARM SYSTEM AND ASSOCIATED ELECTRICAL WORK MUST BE INSPECTED BY A TOWN 3 APPROVED ELECTRICAL INSPECTION AGENCY. PLEASE REVIEW LIST PROVIDED. 1.1•.•..N..NiV..•1.1N4y.......N1.1.NNN.•Ni•,•.•VI•:•N.•N.•1•V.N...1•1•.•NNNNNi•.•....N..:•I.:.......N..l•.•..1..•.•N.•N1.i.i,1•N3.:N•l.1,:•N:.1.....1•.•.....•..:.1•1....•.4•N....34N•N.•N.•N.•NNN.n.tVY`NI•Nl•NN:4•N........;......•.•NN1..........W.............•.•.•.•VNNMl,1.N3.NNNNN.•N1•>V.i' 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, 1 have read the regulations with respect to this application and OuESTIONS? CALL 761-8256 OR EMAIL agree to abide by these and all requirements'of the Town of codeseaueensburv.net Queensbury nitary Sewage Disposal Ordinance. VISIT OUR WEBSITE FOR MORE INFORMATION wwvd.queertbury.net Sliiia7iure of Person Responsi a Date Town of Queensbury R Community Development Office • 742 Bay Road, Queensbury, NY 12804 o-337 i w t "IN (jjt i CON �...1 its �../ , , 3 Septic Inspection Repoli Office No. (518) 761-8256 Date Inspection request received: Queensbury Building &Code Enforcement Arrive: am/pm Depart: [ am/pm 742 Bay Rd., Queensbury, NYA12804 Inspectors Initials: Z l t i NAME: /" K I j'e - PERMIT NO.: '73—� LOCATION: Z`1, M�-� /�iNC`- INSPECT ON: RECHECK: Comments and/or diagram Soil Type: Sand Loam/ Clay Tpe of Water: Municipal Well Water Waterline separation 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 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 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 Location of System on Prope Front Rear Left Side Right Side Middle Front Middle Rear System s: Approved Partial Approved and needs to be re-inspected, please call the Building &Codes Office Disapproved Last revised 06/18/07 L:\Building&Codes Forms-OLD\Building&Codes\Inspection Forms\Septic Inspection Report.doc Gr,r Z 7 j�e, •tiv Ll eft �O FtS /obo �7 I a r� L5 IKO"O-Y / 172 Foundation Inspection Report Office No.(518)761-8256 Date Insjecti west received: Queensbury Building&Code Enforcement Arrive: T-_�= -'iu,/P /� Depart: am/pm 742 Bay Rd.,Queensbury,NY 12804 Inspector's Initials: UQC - NAME: /e- PERMIT#: LOCATION: �^ ' INSPECT ON: —© TYPE OF STRUCTURE: Comments, Y N N/A Footings Piers Monolithic Slab Reinforcement in Place The contractor is responsible for providing protection from freezing for 48 hours following the placement of the concrete. Materials for this purpose on site. Foundation/Wallpour Reinforcement in Place Footing Dowels or Keyway in place Foundation Dampproofmg Foundation Waterproofing Footing Drain Daylight or Sump Footing Drain Stone: 12 inch width 6 inches above footing 6 mil poly for wet areas under slab Backfill Approval Plumbing Under Slab PVC/Cast/Copper Foundation Insulation Interior/Exterior R- Rough Grade 6 inch drop within 10 ft. L:\Building&Codes Forms\Building&Codes\Inspection Forms\Foundation Inspection Report.doc Last printed 12/20/2005 9:24:00 AM 1w. _71 J - 3 �-- 1 Septic Inspection Report /-7 Office No. (518) 761-8256 Date Inspection request received: Queensbury Building &Code Enforcement Arrive: am/pm Depart: ' am/pm 742 Bay Rd., Queensbury, NY 12 04 Inspector's Initials: I.k-k NAME: PERMIT NO.: 9'33 LOCATION: INSPECT ON: WIVE RECHECK: `u Comments and/or diagram Soil T Loam J Clay Type of Water: Municipal Well Water Waterline separation distance Well separation distance ft. Other wells: ft. Well Casing Length 50' + / - Y N N/A Absorption Field: Total length ft. Length of each trench Depth of trenches Size of Stone Seepage Pits: Number Size: Stone Size: Piping Size T Building to tank Tank to Distribution Box `5eAk Distribution Box to Field Pit Opening Sealed: N End Ca N Inlet/Outlet Pipes &Baffles Y N Location Separations Foundation to tank ft. Foundation to absorption ••� ft. Separation of Pitsj, ft. Conforms as per Plot Plan I VA, N Engineer Report and As-Built Y N Location of System on Pr7Left Front Rear de Right Side Mid le ron Middle Rear !;7?Alp �rovred pproved and needs to be re-inspected, please call the Building &Codes Office ved Last revised 06/18/07 L:\Building&Codes Forms-OLD\Building&Codes\Inspection Forms\Septic Inspection Report.doc