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2004-297 TOWN OF QUEENSBURY 742 Bay Road,Qiieensbury,NY 12804-5902 (518)761-8201 Community Development- Building & Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE Permit Number: P20040297 Date Issued: Thursday, May 13, 2004 This is to certify that work requested to be done as shown by Permit Number P20040297 has.been completed. Tax Map Number: 523400-301-005-0001-008-000-0000 Location: 794 WEST MT. Rd Owner: RUSSELL & JUDY HOWARD Applicant: RUSSELL & JUDY HOWARD . This structure may be occupied as a: By Order of Town Board Septic Alteration Residential TOWN OF QUEENSBURY Director of Building&Code Enforcement I TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 .(518)761-8201 Community Development-Building&Codes (518)'761-8256 BUILDING PERMIT Permit Number: P20040297 Application Number: A20040297 Tax Map No: 523400-301-005-0001-008-000-0000 Permission is hereby granted to: RITSSRTJ, 1TTDY HnWARD For property located at: 794 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: RUSSELL& JUDY HOWARD 794 WEST MT. Rd Septic Alteration Residential Total Value QUEENSBURY,NY 12804-0000 Contractor or Builder's Name /Address Electrical Inspection Agency OTTEENSBTTRY SEWER JAY SWEET Plans&Specifications 2004-297 SEPTIC ALTERATION $25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Wednesday, May 11, 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 Town o� ee/ bury; ues_ , ay 11, 2004 SIGNED BY `" �r 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: .............................................................................: QS Office Use Location of installation: Q File Permit o. 0 Tax Map No. Fee Pai Owner's Name: `J .................. .......... ............................................................................... .................. ..: Address: CI e S ( M I- d ✓mil n J 2. INSTALLER'S NAME PHONE NO. 7 �7 X7 3C y(J,per 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 80 or older x 150 gal/bdrm = 1980- 1991 x 130 gal/bdrm = 1991 -present x 110 gal/bdrm = c � Garbage Grinder Installed yes WAY .1. 1 2004 13UII_ Spa or Hot Tub Installed yes� /�. TOWN DI DING. �i,©CODE 4: PARCEL INFORMATION: (circle applicable information&indicate measurements) Topo2rqphv Soil Nature Ground Water Bedrock or Im ervious Material . Dgmestic Water Su 1 (ZElal LLag5at what depth at what depth n'ci Rolling loam feet feet well 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:/�� gallon (min. size 1,000 gal.) Tile Field: xach trench Total System Length: _2,o-C) 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:/141 (br6 length and/or size aba 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. j � /�� � Si natu f re onsible person Date 'l'awtt cif Queellalitti•y S(avut•s uric! Sc:wsit;c Dialmsal (3131plet• . ApI midix C, t A-11SOMI'VION 1,111P11.11.) SI,'PARNMON POND skit o VjELt_ t►! 1lM1*•FZ• _i at t<'rot . • •cx+rtcc c�5t►Ir; ram.... ..,�•— . 11ousE G , E ►. �......-. 1 \ '/�'" �N J IJt'i ittil•,t J 11r�t( � AM"oc% MONO C1r,K 7. SIGNATURE &INFORMATION FOIL R MSl'Ur AJ;$Lr,rz^z..L" w"Aaw aw"%v r 30 Septic Inspection Report Office No. (518) 761-8256 Date Inspection req st rec ' ed: Queensbury Building&Code Enforcement Arrive: pal e 742 Bay Rd., Queensbury,NY 12804 Inspector's Initial w NAME: PE NO.: O 1 I LOCATION: 7 c IN P CT ON: RECHECK: Comments and/or diagram Soil Type: lay Type of ate . unicipal ell Water Waterline sep s ance ft. Well separation distance ft. Other wells: ft. Absorption Field: Total length O ft. ,^ Length of each trench Depth of trenches ft. Size of Stone Seepage Pits: Number Size: x Stone Size: Piping Size Type Building to tank Tank to Distribution Box L— Distribution Boxtnieldkpit Opening Seale Partial Location/Separations Foundation to tank Foundation to absorption ft. Separation of Pits ft. Conforms as per Plot Plan V Y_N Location of System on Property: Front Rear eft Si t Side Middle Frol addle Rear System Use Sta s: Approved Partial Approved and needs to be re-inspected,please call the Building&Codes Office Disapproved LASueHemingway\Building.Codes.Inspection.FORMS\Septic Inspection Report.doc January 28,2003 "I have seen or observed, or believe I saw evidence of, 7_C / all objects such as houses, wells, trees, fences, etc., shown on this document. I also represent that I have. personally measured the distances set forth on the diagram." 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