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2008-414 i TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201 4::) --.A Community Development- Building &Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE Permit Number. P20080414 Date Issued: Thursday, October 02, 2008 This is to certify that work requested to be done as shown by Permit Number P20080414 has been completed. Tax Map Number. 523400-301-013-0001-006-000-0000 Location: 605 WEST MT. Rd Owner. ROBERT & JOAN MACEY Applicant: ROBERT & JOAN MACEY This structure maybe 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 D, ctoro uil i g forrement 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: P20080414 Application Number. A20080414 Tax Map No: 523400-301-013-0001-006-000-0000 Permission is hereby granted to: ROBERT&JOAN MACEY For property located at: 605 WEST MT. 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: ROBERT&JOAN MACEY Septic Alteration Residential 605 WEST MT. Rd Total value QUEENSBURY, NY 12804 Contractor or Builder's Name/Address Electrical Inspection Agency Plans &Specifications 2008-414 septic alteration residential $25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Friday,August 07, 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 f Que bu y,August 07, 2008 SIGNED BY for the Town of Queens bury. ury• Director of Building&Code Enforcement +r r r r I r r r r r r r r r r r r r r r r r r r r r r r r r r rrrr.r_r _.rrr.r_rr.___rr.. _err .......... Y j OFFICE USE ONLYI .......... � '" � � TAX MAP NO. `G ' 1 PERMIT NO, O - PERMIT FEE»,�� , ' APPROVALS: ZONING TOWN CLERK ' ' � ; _________________r.___-_.._......... ------ ___..... ............... 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, r 'l OWNER: INSTALLER: �3 -- ADDRESS: 1'i_� S,• �� r� � ADDRESS: PHONE NOS.�./.`rg `>t `►✓ � PHONE NOS. 1 {p LOCATION OF INSTALLATION:_� ,-C// »».....W.OI`».....». ....................»»..» ..»........»...».»...»..... ...» .......»...»...................:.........................»......I RESIDENCE INFORMATION: wYEAR BUILTw BEDROOMS Xm » COMP »TOTAL DAILY FLOW UTATION= Ip (� X » . 0 .............r............................»». »..»... �.. ....»..»............. »... C3ARBAQE QR��;`-�— _ 150 gallon per bedroom r..._ rO » INSTALLED? 1.981 -1991 » »». .X.. ».130 gallon per»bedroom... 1 .. ,....,.. 1992 r ff SPA OR HOT TUB »»»�present »....................................».......X.........»110.gallon per bedroom .....'`......................................»..............»................... INSTALLED? PARCEL INFORMATION: ✓ TOPOGRAPHY: FLAT ROLLING STEEP SLOPE %SLOPE ✓ SOIL NATURE: SAND ✓� LOAM CLAY OTHER ✓ GR UNQWATER AT WHAT DEPTH? BEDROCKAMPERVIOUS MATERIAL: AT WHAT DEPTH? ✓ DOMESTIC WATER SUPLY: MUNICIPAL kL WELL :::�f (IF WELL:WATER SUPPLY FROM ANY SEPTIC-SYSTEM ABSORPTION IS FT. ) ✓ 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 1k1,000 GAL. TILE FIELD: EACH TRENCH FT, ✓ TOTAL SYSTEM LENGTH:"ZL FT. SEEPAGE PIT(S): HOW MANY? ✓ SIZE OF EACH FT. X FT. ✓ .SIZE OF STONE TO BE USED: #�_/DEPTH OR THICKNESS 2 FT. ✓ BED SYSTEM SIZE: X ✓ ALTERNATIVE SYSTEM: LENGTH ANDIOR SIZE ✓ HOLDING TANK SYSTEM:(If required) NO. OF TANKS: /SIZE OF EACH ✓ GALLONS./TOTAL CAPACITY. GAL. N NOTE: ALARM SYSTEM ANDIASSOCIATED ELECTRICAL WORK MUST BE INSPECTED BY A TOWN '� APPROVED ELECTRICAL{NSPECTION AGENCY. PLEASE REVIEW LIST PROVIDED. I1N1.1•I.Y:YY4.{•{.1•1Y•i•14•1.1•1.1•{.1•VNNN{•NNN:YVY•Nf•N{4444.14•i•Ni•i•1•:•{•;•YN;.P:•{Y.irl.l•1•NNN1.14444.{.NIY.H:•14.i•N:.i•NN{•IV4.1•1.{•i•N144rNN14•{•14.1•{4.i•.•:4•.•!•{•1•Irl•{.:•{•{•1........•1...1444•i•NI.{WNI.1YY444Y.p{•{•i•Ni•{•1.1.1.1.1.1•VI.NN...... NI.1•NN� 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" l have read the regulations with respect to this application and agree to abide by these and all requirements of the Town of QUESTIONS? CALL 7614256 OR EMAIL Queensbury Sanitary Sewage Disposal Ordinance. codes*gueensburv.net VISIT OUR WEBSITE FOR MORE INFORMATION w=,qj 1�*btSry,nat Signature of Person Re ponstbie l; Alke Town of Queensbury • Community Development Office • 742 Bay Road, Queensbury, NY 22804 Septic Inspection Report Office No. (518) 761-8256 Date Inspection request received: Queensbury Building &Code Enforcement Arrive: am/pm Depart: am/pm 742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: NAME: PERMIT NO.: (A- LOCATION: L��& INSPECT ON: RECHECK: Soil Type: Sand/ Loam/ Clay Comments and/or diagram Type of Water: Municipal/ Well Water Waterline separation distance ft. Well separation distance ft. Other wells: ft. Well-(Ss-ing 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 �T 'not 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 E As-Built Y N Location of System on Property: Front ar Left Side Right Side Middle Front Middle Rear Ss m s S 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-OLD\Building&Codes\Inspection Forms\Septic Inspection Report.doc t t�J b c Septic Inspection Report Office No. (518) 761-8256 Date Inspection request received: b Cl Queensbury Building &Code Enforcement Arrive: am/ m Depart: am/pm 742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: NAME: _ - lQ�°� PERMIT NO.: LOCATION: I��P�d`^mod ' INSPECT ON: RECHECK: Comments and/or diagram Soil T n oam/Clay lype of Water: &AbP&yWell Water Waterline—separation distance ft. Well separation is nce ft. Oth we ft. Well Casing Length 0'+ / - Y N N/A Absorption Field: Total length . ft Length of each trenc -?-(jgq- ftAV Depth of trenches ft. Size of Stone Val) Seepage Pits: Number Size: f v l) <� Stone Size:- Piping Size T Building to tank Tank to Distribution Box '4 x--, k" Distribution Box to Field/ Pit 0 nin Sealed: N End Ca 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 Engineer Report and As-Built Location of System on Property: Front Rear Left Side Right Side Middle Front Middle Rear System Use S u , 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-OLD\Building&Codes\Inspection Forms\Septic Inspection Report.doc t B 1 7{� 4 } f a � t � �, h a }t t V � r CD © r @C 4tCGGS, �noe of, o k�orb esa $�G. "jpv'd' , > t ti4 a 'o�'s sesG��ll� �.��t that l ha�t� Est.t also Pray d gTa F �7 {GCl1 GCt.h i\v nM wo w , J 7` rC CJO j x IL IN OW i is sully k } STREAM PROPERTY LINE PROPERTY LINE a c f W POND TIGW WELL IN CASING WATER 15, 8a Q' CASING MIN. 0 W z J W �J J ?J HOUS E 2 `NAM GARAGE a HOUSE o W VO �O GARAGE 1 O z }J 0- a, Z ii �� SEPTIC Q CSEPTIC a TANK n. cV TANK � O j a DISTRIBUTION BOX 0 ABSORPTION FIELD PROPERTY LINE ROAD SEWAGE SYSTEMS: SEPARATION REQUIREMENTS -- ABSORPTION FIELD Please refer to Queensbu�Town Code, Sewers and Sewage Disposal, Appendix A, 136:A1 and Appendix B, 136:A3, for more detailed information on SEPARATION REQUIREMENTS. SEWAGE SYSTEMS: SEPARATION REQUIREMENTS - SEEPAGE PIT POND PROPER-��1N� WELL IN Please refer to Queensbury Town WATER �-15'MIN TIGHT Code, Sewers and Sewage Disposal, CASINi Appendix A, 136:A1 and Appendix B, 136:A3, for more detailed information o on SEPARATION REQUIREMENTS. NSEEPAGE PIT ZD N10 HOUSE z SEPTI TANK GARAGE ISTRIBUTION BOX PA Z Off` PROPERTY LINE f 'r ROAD r, r