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2007-549 TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201 Community Development - Building & Codes (518) 761-8256 CERTIFICATE OF OCCUPANCY Permit Number: P20070549 Date Issued: Tuesday, May 01, 2012 This is to certify that work requested to be done as shown by Permit Number P20070549 has been completed. Location: 323 CLEVERDALE Rd Tax Map Number: 523400-226-012-0001-036-000-0000 Owner: MARY BETH DOPP Applicant: MARY BETH DOPP This structure may be occupied as a: Septic Alteration Residential By Order of Town Board TOWN OF QUEENSBURY Issuance of this Certificate of Occupancy 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 Planning Board Director of Building&Code Enforcement 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: P20070549 Application Number. A20070549 Tax Map No: 523400-226-012-0001-036-000-0000 Permission is hereby granted to: MARY BETH DOPP For property located at: 323 CLEVERDALE 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: MARY BETH DOPP Septic Alteration Residential ROBERT SAMMLER Total value 16 SOMERSET Ln SCOTIA,NY 12302 Contractor or Builder's Name/Address Electrical Inspection Agency Plans &Specifications 2007-549 septic alteration residential $25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Thursday,August 28,2008 (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 To o eens a ay,August 28, 2007 7W— SIGNED BY gt� for the Town of Queensbury. Director-of Building&Code Enforcement OFFICE USE ONLY 10 ; TAX MAP NO. PERMIT NO. PERMIT FEE + ; ' 0 , APPROVALS: ZONING TOWN CLERK ' ; , 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: k4 'g /2 <'a r/F'I �C�l� INSTALLER: V7, (v �' <YZ ADDRESS: 4) • ADDRESS: &81 PHONE NOS. -77 L(- f g L PHONE NO-S. LOCATION OF INSTALLATION: NO.OF RESIDENCE INFORMATION: BEDROOMS YEAR BUILT X COMPUTATION= = TOTAL DAILY FLOW 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: 0_Flat oiling Steep slope %Slope ✓ SOIL NATURE: Sand/ Loam Clay Other ✓ GROUNDWATER: At what depth? 7 ✓ BEDROCK/IMPERVIOUS 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 com eted 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). TANK SIZE: 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: ❑ ABSORPTION FIELD (WITH N0. 2 STONE) Total gt ft. Each trench X ❑ SEEPAGE PIT(S) (WITH NO. 3 STONE) Ho ? Size? ❑ ALTERNATIVE SYSTEM Bed or other ty e? HOLDING TANK SYSTEM Total required capacity? Tank size? &umber of tanks? EI 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 Sanitary Se age Disposal Ordinance. codes@ciueensbury.net VISIT OUR WEBSITE FOR MORE INFORMATION X2- D a 7 www.gueensbury.net Signature of Person Responsible Date -,1% Town of Queensbury • Community Development Office - 742 Bay Road, Queensbury, NY 12804 B 5-LGL 6/06 Septic Inspection po Office No. (518)761-8256 Date Ins ion ived: Queensbury Building&Code Enforcement Arrive: m Depart: am/pm 742 Bay Rd., Queensbury, NY 12804 Inspector's In' ' l NAME: M tA ER P R IT NO.: Q1 1 LOCATION: Z''� C_���1EQ �� I S ECT ON: 4—ZO—1 Z RECHECK: Comments and/or diagram Soil Type: Sand/ Loam/ Clay Type of Water: Municipal Well Water Waterline separation distance ft. Well separation distance ft. Other wells: ft. Well Casing Length 50'+/ - Y N N/A 150'to well required if NO 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 Building to tank Tank to Distribution Box Distribution Box to Field/ Pit Opening Sealed: Y N End Cap Y N InletjOutlet Pipes&Baffles Y N Manholes 12"or less below grade Y—N [provide extension collar if Yes _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 ETU Maintenance Contract Y_ N provided Location of System on Property: Front /Rr Left Side Right Side Middle Front Middle Rear st m Use S s: Approved EAC—IF—k Partial Approved and needs to be re-Inspected, please call the Building &Codes Office Disapproved L:\Pam Whiting\2010\&wilding Codes Forms\inspecdon Forms\Septic Inspection Report-03 29 10.doc COMMONWEALTH ELECTRICAL INSPECTION SERVICE,INC. Main Office 176 Doe Run Road-Moobeim,PA 17545 MUNICIPAL CERTIFICATE .- ELECTRICAL APPROVAIL Permit No........................................Cert. N 2 20288 Cut-in Card No ...._............................... Owner...................13.tU..b............ .,.................................................................................... Location...................3.2..a.... .. .........................�. g et. .. s.� ................................ Installation Consisting of..........-& TL.t x...... ' ........................................................................................................................... ..........................-......... i i .............................................................................................................................:.........I........--,........... I Installed By /. - J. r The conditions following governed the issuance of this ccri ficatc,and any certificate previously issued is cancelled:- This certificate only covers the electrical equipment and installation conditions as of date. Upon the introduction of additional equipment of alterations,application shall be promptly spade for inspection. Inspectors of this Company shall have the privilege of making inspections at any time, and if its i rules are violated,the Company shall have the right to revoke this certificate. Date...,,,.. .�,e2.7. ��............. tIVSPECfOR.._.L-+�.. �� .. I Metabtr N.f P.A.,I.A.Ejf. L0 3Jed O-lgWnw Noll 085Z86L bb:60 Zt0Z/08/b0 r Septic Inspection R Office No. (518)761-8256 Date Inspection r ived: Queensbury Building&Code Enforcement Arrive: a Depart: am/pm 742 Bay Rd., QueenLLsbury, NY 12804 Inspector's In Is• NAME: J IT NO.: e)7—\� LOCATION: 3 (Z( FEE R�_ P,0 I ECT ON: — -- Z RECHECK: Comments and/or diagram Soil Type: Sand/ Loam Clay Type of Water: Municipal Well Water Waterline separation distance ft. Well separation distance ft. Other wells: ft. Well Casing Length 50' +/- Y N N/A \ 150'to well required If NO 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 Ca Y N In outlet Pipes&Baffles Y N Manholes 12"or less below grade _Y_N [provide extension cellar if Yes Y N Location Separations Foundation to tank ft. Foundation to absorption ft. Separation of Pits ft. Conforms as per Plot Plan N Engineer Report and As-Built Y ETU Maintenance Contract Y N provided � r Location of System on Property: Front Rear Left Side Right Side E Middle Rear System t S t Approved Partial Approved and n to be re- all the Building &Codes Office Disapproved L:\Pam Whiting\2010\Bu1ld1ng Codes FormsVnspectlon Forms\Septic lrgxxUorr ReporL03 2910.doc Dennis L. Dickinson, L5/PE X asso inres S�#4 Telephone: Devin T. Dickinson (5 18)GG8-4G7G 7 Ir0 uois Street Lake George, N wYork 12845 a Facsimile: P.O. Box 388 (5 18)GG8-4G74 Lake George, New York 12845 8 February 2012 Mr. John O'Brien Town of Queensbury Building Department 742 Bay Road Queensbury,New York 12804 RE: Sammler QU: 226.12-1-36 Dear Mr. O'Brien: I have inspected the holding tank system for the above referenced property on 8 November 2007 and have determined that the system has been installed according to approved plans and in a workmanlike manner. If you have any questions, please contact my office. Since ly, Dennis L. Dicki n, PE dtd nF0 F. TOWN OFrQUEENSBURY BUILDING & CODES Septic Inspection Re Office No. (518) 761-8256 Date Ins io ue ed: U Queensbury Building &Code Enforcement Arrive: ` p art: a pm 742 Bay Rd., Queensbury, NY 12804 Inspector's Ini is NAME: P IT NO.: ��- •��� LOCATION: _ I PECT ON: RECHE K: Comments and/or diagram Soil T : Sand Loam/ Clay T of Water: Municipal Well Water ` � Waterline separation distance ft. Well separation distance ft. Other wells: ft. Q �_A i2 I,A� 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 Conforms as Mr Plot Plan Y En ineer Report and A ui Location of System on Property: Front Rear Le a Right Side Middle Front Middle Rear System Use roved rtial Approved a , Disapproved Last revised 06/18/07 L:\Building&Codes Forms-OLD\Building&Codes\Inspection Forms\Septic Inspection Report.doc CCT Septic Inspection Report �- Office No. (518) 761-8256 Date Inspe�ctigx-feq st r � e Queensbury Building &Code Enforcement Arrive: see m/pm 742 Bay Rd., Quee bury;;,??NA�Y 12804 Inspector's Initial NAME: o 4�� C i�Y1 m C'e P IT NO.: LOCATION: I PECTON: in / !o / ,a RECHECK: Comments and/or diagram Soil Type: Sand Loam Clay Tvpe of Water: Municipal/ Well Water Waterline separation distance ft. Well separation distance ft. Other wells: ft. Well Casing Length 50' + / - I 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: kv , Piping Size lype Building to tank Tank to " Dis it Mto Y N PiFoundation Y N is Foundation to absorption ft. Separation of Pits ft. Conforms as per Plot Plan I Y N En ineer Report and As-Built Y N Location of System on Property: Front Rear Left Side Right Side Middle Front CM=iddleRear System-U77kPaprtilal proved 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 7; l Septic Inspection Rep rt Office No. (518) 761-8256 Date Ins ction r est ec ' 1 Queensbury Building &Code Enforcement Arrive: m part: u-Flo -�� 742 Bay Rd., Queensbury, NY 12904 spector's Initi Z-e�©�— ¢' NAME: P MIT NO.: LOCATION: 6 SPECT ON: RECHECK: a �, mm nts and or diaciram Soil Type: Sand Loam/ Clay Type of Water: Municipal Well Water Waterline separation distance ft. Well separation distance ft. Other wells: ft. , 1 1C�tJ1E1� OF \-},p�-VI OG Well Casing Length 50' +/ - Y N N A Absorption Field: Total length ft. Length of each trench ft. t Depth of trenches ft. Size of Stone Seepage Pits: Number Size: x Stone Size: a- Fbu�lLlRiio�J Piping Size Type Building to tank lsi� Tank to Distribution Box G Distribution Box to Field/ Pit 0 ning 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 Property: Front Rear eft Side Right Side Middle Front Middle Rear tem 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-01.1)\Building&Codes\Inspection Forms\Septic Inspection Report.doc