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2008-617 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. P20080617 Date Issued: Monday, December 01, 2008 This is to certify that work requested to be done as shown by Permit Number P20080617 has been completed. Tax Map Number. 523400-309-009-0003-046-000-0000 Location: 161 LUZERNE Rd Owner. ELIZABETH MOFFRE Applicant: ELIZABETH MOFFRE 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 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: P20080617 Application Number. A20080617 Tax Map No: 523400-309-009-0003-046-000-0000 Permission is hereby granted to: ELIZABETH MOFFRE For property located at: 161 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 Queensbury Zoning Ordinance. Type of Construction Value Owner Address: ELIZABETH MOFFRE 161 LUZERNE 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 2008-617 SEPTIC ALTERATION RESIDENTIAL $25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Friday, November 20, 2009 (If a longerperiod is required,an application foran extension must be made to the code Enforcement Officer of the Town of Queensbury before the expiration date.) Dated at the tPwm/Qree ury� h rsday,November 20, 2008 SIGNED BY for the Town of Queensbury. Director of Building&Co e Enforcement �_____________--_,__.___._.____OFFICE USE ONLY_....._, . ...�,, _ % Lol TAX MAP NO. PERMIT NO. CJ1 I �FE); APPROVALS: ZONING TOWN CLERK Nit` 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: 2 ! — ' ! INSTALLER: �' / < � (� �L P/4/(�� r� ADDRESS: Yf C!' �e ADDRESS: 0 v/)� �r �-S PHONE NOS. PHONE NOS.? �°' � � LOCATION OF INSTALLATION: (Z Z A-c'11j RESIDENCE INFORMATION: OF YEAR BUILT NO. X COMPUTATION= = TOTAL DAILY FLOW BEDROOMS GARBAGE GRIND E 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? & ` ✓ BEDROCK/IMPERVIOUS MATERIAL: At w at depth? ✓ DOMESTIC WATER SUPLY: Municipal Well (If well: Water supply from any septic system absorption is ft.) ✓ PERCOLATION TEST: Rate is ZMA minutes 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 engine r or,architect(unless installed in a Planning Board approved subdivision). TANK SIZE: GALLON (M . 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: { 1 ABSORPTION FIELD (WITH NO. 2 STONE) Total lengtoW ft. Each trench 40 X ❑ SEEPAGE PIT(S)(WITH NO. 3 STONE) How many? Size? ❑ ALTERNATIVE SYSTEM Bed or other type? /f 1 ❑ 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 QUESTIONS? CALL 761-8256 OR EMAIL Queensbury Sa ' ry Sewage Disposal Ordinance. codes(Mmueensburv.net VISIT OUR WEBSITE FOR MORE INFORMATION www.aueensbury.net Sig re of Person Re le Date _n Town of Queensbury • Community Development Office 742 Bay Road, Queensbury, NY 12804 B 5-LGL 6/06 Septic Inspection Report r 16 s r ° 9r Office No. (518) 761-8256 Date Inspection request received: /Z-V/` 9 Queensbury Building&Code Enforcement Arrive: am/Dm Depart am/pm 742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: �r NAME: �. L PERMIT NO.: l LOCATION: - INSPECT ON: RECHECK: Commen and/or diagram Soil T Sa Loam Clayn Type of Water- a Well Water Waterline se ration distance ft. Well separation distance ft. Other wells: ft. Absorption Field: Total length ft. Length of each trench ft. Depth of trenches ft. Size of Stone See Pits: Number Size: x - Stone Size: Piping Siz Type V/ Building_to tank l ,► Tank to Distribution Box `k W1 iUti- r Distribution Box to-fAeld Pit L� J O ni Sealed: N Partial End Ca Inlet/Outlet Pipes&Baffles Y Location Se rations Foundation to tank ft. Foundation to absorption ft. Separation of Pits ft. Conforms as per Plot Plan Y Y N E ineer Rep2rt and As-Built Y I�— Location of System on Property: Front � Left Side Right S' Middle Front Middle Rear m Approved Partial Approved and needs to be re-inspected, please call the Building &Codes Office Disapproved Last revised 021006 Last revised 1/6/05 t� © rr e, (vc,