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2005-784 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: P20050784 Date Issued: Thursday, September 29, 2005 This is to certify that work requested to be done as shown by Permit Number P20050784 has been completed. Tax Map Number: 523400-309-013-0002-021-000-0000 Location: 479 BIG BAY Rd Owner: TRUMAN & JULIANNE K GLEASON Applicant: TRUMAN & JULIANNE K GLEASON 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 r: 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: P20050784 Application Number: A20050784 Tax Map No: 523400-309-013-0002-021-000-0000 Permission is hereby granted to: TRI JN4AN& JI JI,IANNF K ('TI,F.ASON For property located at: 479 BIG BAY 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: TRUMAN& JULIANNE K GLEAS 243 TOWN LINE Rd Septic Alteration Residential Total Value FORT EDWARD, NY 12828 Contractor or Builder's Name /Address Electrical Inspection Agency I.B.S_ SEPTIC 2 LOWER WARREN STREET OITEENSBITRY_ NY Plans&Specifications 2005-784 SEPTIC ALTERATION $25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday, September 29, 2006 (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 Town of Queensbury; Thursday, September 29, 2005 SIGNED Y for the Town of Queensbury. ctor f B ode Enforcement i Application for Permit-Septic Disposal System Town of Queensbury 742 Bay Road Queensbury,NY 12804';(518) 761-8256 1. OWNER INFORMATION: .........................'.......................................................................................................... ; "� l — ) Office Use Location of installation: / 9 1 3 1 �u n -'J I File Permit No.05 / E� Tax Map No. Fee Paid C), _ Owner's Name: TL ,i--•ct , f u✓ Address TT (.t/`�V t 14— �/!�AlO r- ..................... ��-..... .5� Pf 2. INSTALLER'S NAME : , //C, PHONE NO. 41f, 3. RESIDENCE INFORMATION: (circle year of dwelling,indicate#bedroom(s) and multiply#of bedrooms with applicable gallons per bedroom to equal total daily flow) Year of House: No. of Bedrooms x Computation = Total Dail 1980 or older x 150 gal/bdrm = 1980—1991 x 130 gal/bdrm = i 1991 —present x 110 gal/bdrm = �/� SEA' � 200 " Garbage Grinder Installed yes_ / no/. Spa or Hot Tub Installed yes_ / no 4. PARCEL INFORMATION: (circle applicable information&indicate measurements) (ringg a h oil tore Ground Water Bedrock or impervious Material ter Supply nd at hat pth atA4et th municipal 1 Steep slope clay if well;water supply _%slope other from any septic-system depth: absorption is ft. other Percolation Test: (To be completed by licensed professional engineer or architect) Rate: minute per inch 5. PROPOSED SYSTEM: For New Construction: All individual sewage disposal systems must be designed by a liceinsed 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 Tull. /-6­42 Septic Tank: _a gallon (min.size 1,000 gal.) l ; Tile Field: each trench ft. Total System Length: l fJ ft• Seepage Pit(s): number of size of each: ft. by ft. Size of Stone to be used: # / depth or thickness feet Bed System Size: x Alternative System: length and/or size 6. HOLDING TANK SYSTEM: (if required) Number of tanks: / Size of each: gallons /TOTAL Capacity: gallons Note: Alarm System and associated electrical work must be inspected by a Town approved electrical inspection agency. 7. SIGNATURE &INFORMATION FOR RESPONSIBLE PERSON(please read) 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 T of Queensbury Sanitary Sewage Disposal Ordinance. � o Signature of respolfisible person Date ,I oW,ll "af (111C011 alnsi•y 5r,.wta�c �su1 �c;wsil;e I)i,�i>c�s:al (aurssit•:• I • - t • A11,40RII'' ION. IPII,i.0I.) . 'ISI:I'�1itIS,'1'It,�PJ IZI�tZ�,JIItI�hlI��(�t'I';i • CaN I 1f POND WELL. lH 1�¢fR i�• � •. 'tv}%tr cASr.Ir; rt u•fwa 100, ly, I l .� 1 .�' Scr•t1� "M SICTNATURE INFMt \ ��•�~ ! , t111yttr�`rlltlf�l( f I� IvIA'I ON PQR I YtJI�I�`f 4sbt•. tv vt� �,so,�..,.......�:: j i Septic Inspection Report Office No.(518)761-8256 Date Inspection request received: R ` Queensbury Building&Code Enforcement Arrive: am/UtPP rt: �m 742 Bay Rd.,Queensbury,NY 1,2804 Inspector's Initials: NAME: PERMIT NO.: J 7 LOCATION: Gta is 4 INSPECT ON: Z 0 RECHECK: Comments and/or diagram Soil Type: Sand/Loam/Clay Type of Water: Municipal/Well Water Waterline separation distance ft. O �� Well separation distance ft. Other wells: ft. Absorption Field: Total length ft. Length of each trench ft• Depth of trenches ft• Size of Stone Seepage Pits: Number �< ( Size: x D Stone Size- Piping Size Typex Building to tank C(J Tank to Distribution Box Distribution Box to Field/Pit Opening Sealed: Y/N/Partial Location/Separations Foundation to tank ft. Foundation to absorption ft. Separation of Pits ft. Conforms as per Plot Plan I Y N Location of System on Property: Front Rear Left Side Right Side Middle Fro Middle Rear S stem Use St s• Approved Partial Approved and needs to be re-inspected,please call the Building&Codes Office Disapproved LiwSueHemingway\Building.Codes.Inspection.FORMS\Septic Inspection Report.doc January 28,2003 i C;) Septic Inspection Report t Office No.(518)761-8256 Date Inspection request received: cJ 5 Queensbury Building&Code Enforcement Arrive: am/ Depart: am/pm 742 Bay Rd.,Queensbury,NY 12804 Inspector's Initials:2 NAME: �ru-_. G _r� PERMIT NO.: Vand/oriazram LOCATION: INSPECT ON: RECHECK: Comm Soil Type Sand Clay Type of VVaTerMunicipo/Well Water Waterline separa ' stance 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 Seepage Pits: Number Size: x Stone Size: Piping size Type_ Building to tank ,1 Tank to Distribution Box " 5 cP- Distribution Box to Field!Pit Opening Sealed: Y/N/Partial End C Location/Separations Foundation to tank Foundation to absorption ft. Separation of Pits ft. Conforms as per Plot Plan Y N Engineer Report and As-Built Y N Location of SykjtFT on Property: Front Rear Left Side Right Side Middle Front Middle Rear System Use Status• Approved Partial Approved and needs to be re-inspected,please call the Building& Codes Office Disapproved Last revised 1/6/05 t b A �DacaI 7� 42, +► y .. 4distances set forth on th diagram.' SI ATUR DATA u� � � � 0 yp TOWN OF-' UEE BU BUILD (] . O T. 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