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2004-184 TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201 Community Development- Building & Codes (518) 761-8256 CERTIFICATE OF - COMP -A-NCE Permit Number: P20040184 Date Issued: 'Friday,Aoril 16, 2004 This'is to-certify that work requested to be done as shown by Permit Number P20040184 has been completed. Tax Map Number: 523400-295-019-0003-028-000-0000 Location: 8 SUNSET Dr Owner: THOMAS & LAURA LANE Applicant:- THOMAS.&LAURA LANE . This structure may be occupied as a: By Order-of Town Board Septic Alteration Residential - TOWN OF QUEENSBURY " Director of Building&Code Enforcement TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development-Building&Codes (518) 761=8256 BUILDING PERMIT Permit Number: P20040184 Application Number: A20040184 Tax Map No: 523400-295-019-0003-628-000-0000 Permission is hereby granted to: THOMAS &LATTRA LANE For property located at: 8 SUNSET Dr 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: THOMAS &LAURA LANE 8 SUNSET Dr Septic-Alteration Residential Total Value QUEENSBURY,NY 12804 Contractor or Builder's Name /Address Electrical Inspection Agency I.B:S. SEPTIC 2 LOWER WARREN STREET OTTEENSBTTRY_ NY Plans&Specifications 2004-184 SEPTIC ALTERATION $25.00 PERMIT FEE PAID-THIS PERMIT�EXPIRES:- Friday,April 15, 2005 (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 of Qu nsb VrS pril 15, 2004 SIGNED BY for the Town of Queensbury. Director of Building&Code Enforcement Application for Permit=Septic Disposal System Town of Queensbury 742 Bay Road Queensbury,NY 12804 (518) 761-8256 1. OWNER INFORMATION: :........................................................................................................................... ............: Office Use •• Location of installation: File Permit No. Tax Map No. Fee Paid c25. ©b Owner's Name .....................................................................................................................................' Address: — �C,.�. �C l 2. INSTALLER'S NAME C1�� �� ��0 f PHONE NO. 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 Daily Flow 1980 or older x 150 gal/bdrm = 1980—1991 x 130 gal/bdrm = 1991—present x 110 gal/bdrm = Garbage Grinder Installed yes_ / no �` QUEE�SgURY Spa or Hot Tub Installed yes ./ no VRG �� 100 D OF �[�to CODE 4: PARCEL INFORMATION: (circle applicable information&indicate measurements) o ture Ground Water Bedrock or Im ervious Material D Water Su 1Flat sand at ha epth at what depth municipal ollin�ah oam eet �(/�feet e 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 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: /DDO gallon (min. size 1,000 gal.) A., Tile Field: each trench ft._ Total System Length:/ ft. Seepage Pit(s): number of size of each: ll ft. by ft. Size If 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 Town of Queensbury Sanitary Sewage Disposal Ordinance. ignature of response a erson Date 1 tr ' :'I owtl of Quc;c,islsui•y s(;wer's and 5cwsit;c Di.,q)(wal Clis,l)lc•r • A' .�+UILi;'i'1(I�i I"II,I ,I.t ' SI�:I'11'ftA'i'IL)IN itI�LZI.)1 iti h]I��[�1'i':i St•itll w .._ _ _..._.• ._ ._._...� . �tit�1 POND WE-I.. 114 jlt.TF,'t- 4 �) r r lbu 3l: ( t�E • , tl,y. '�I1r>uS� G Tr , L„ A�rnRt'txa s t�tcu.a , 7. SIGNATURE &INFORMATION POP,�t:�YUN��fisL�t'�,�wv,� V,swra..,.�...:; ''•, Septic Inspection Report Office No. (518)761-8256 Date Inspection request received: 1 Queensbury Building&Code Enforcement Arrive: anilplik e art: /pm 742 Bay Rd., Queensbury,NY 12804 Inspector's Initials: ' NAME: , OM PERMIT NO.: _ZzbxA•— `'::?,\�A LOCATION: C�, INSPECT ON: RECHECK: Comments and/or diagram Soil Typk Sand am/Clay Type of Wate . u Well Water Waterline separation distance a 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 pV L4 is— Size: x Stone Size: Piping Size T e Building to tank — 1 Tank to Distribution Boxi LDIR Distribution Box to Field Pit R Opening Sealed: Y/N/Partial p° Location/Separations Foundation to tank ft. Foundation to absorption ft. Separation of Pits ft. Conforms as per Plot Plan N Location of System on Property: Front Rear Left Side Right Side iddle Front Middle Rear S stem 11Tse Statu Approved Partial Approved and needs to be re-inspected,please call the Building&Codes Office Disapproved LASuellemingway\Building.Codes.Inspection.FORMS\Septic Inspection Report.doc January 28,2003 0. - i TOWN OF OUEENbbum AND CODE ;� � ��_ t erg; -► ,J i 41 VIC , - - - - - -' - T "I have'seen or observed, or be,;ev , sa ,:r a - �N �Niells-trees, �cn��s, etc. - all objects such as do se, ! have sh!�wr� on tars d�t.�an nt. l af; z'r'epres� that - - �n r Ti?e dinar ces set f rti� on the diagram." persona 111j ease e.d — DATE SIGNATUht - —