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2004-311 TOWN OF QUEENSBURY 742 Bay Road,Queensbury,DIY 12804-5902 , (518)761-8201 Community Development- Building & Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE Permit Number: P20040311 Date Issued: Thursday, May 20, 2004 This is to certify that work.requested to be done as shown by Permit Number P20040311 has been completed. Tax Map Number: 523400-309-006-0001-027-000-0000 Location: 9 SUNSET Ave Owner: DAVID &MARCIA COMSTOCK Applicant: DAVID &MARCIA COMSTOCK 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: P20040311 Application Number: A20040311 Tax Map No: 523400-309-006-0001-027-000-0000 Permission is hereby granted to: DAWD &MARC;TA C OMSTOC;K For property located at: 9 SUNSET Ave 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: DAVID &MARCIA COMSTOCK Septic Alteration Residential P.O. BOX 3207 Total Value GLENS FALLS,NY 12801 r Contractor or Builder's Name /Address Electrical Inspection Agency Plans&Specifications 2004-311 $25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday, May 14, 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 of Q nsb rids , May 14, 2004 SIGNED BY �J. ; 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: ......................................................................................................................................: � �l/�y Office Use Location of installation: 22 File Permit No. Z C 1 Tax Map No. Fee Paid S O Owner's Name: ...................................................................................................................................... Address: 2. INSTALLER'S NAME "rl�l — G. n }HONE 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 gallbdrm = y✓�'d 198 — 1991 x 130 gal/bdrm = 199 present x 110 gal/bdrm. = Garbage Grinder Installed yes_ / no--"- Spa or Hot Tub Installed yes, / no V 4: PARCEL INFORMATION: (circle applicable information&indicate measurements) Touop-raDhv Soil Nature Ground Water Bedrock or Im ervious Material . Domestic Water Supply san at what depth at what depth nici al 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. I 5lj�r Septic Tank: °O© gallon (min. size 1,000 gal.) I Tile Field: each trench 50 ft. Total System Length: Seepage Pit(s): number of size of each: ft. by ft. Size of Stone to be used: '# t depth or thickness R-5 EIVEw Bed.System Size: x w) �' , ) 2004 Alternative System: length and/or size TOWN 0 CUEEN.QDF= 1 - 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 ' ary Sew ge Disposal Ordinance. Signature of responsible person Date . . . � •'fawn •ciT �Zutrc+rtstlnsr�+ ' St;tivta•s and Di.41tagstl (aist�ttt•i• • 1�Ititet�tii x • � A1�,`�t)IZ�'•/'1'I(k�I I�II��I,,I.) , SI:I'/1'RNIsIO N 1*11(Zt.1i It Till NI N.N'I':' 1 r . 1 pOND , . fi I'lEtt_ iH trhrE•t%• �•�• rt «•r4•1 •- ibv�E C G . t .. b� • � �'' t•aar. Z 1,1,J •� .i 1 J�.1_IY,. •� �' _......« 1 •�• �,♦ 1 Ut'riftjl�tltfr�f 1 1 w � rat t�trt5 1 t r w. . 11e1 7. SIQTN A►TURE &INFORMATION O!R I iY L � W ;i: f t�rt4�� ,t.i" � ,L\DV1.1 lOfRiv avr.v M Septic Inspection Report Office No. (518) 761-8256 Date Inspectionerequce,Queensbury Building&Code Enforcement Arrive: am/pm 742 Bay Rd., Queensburyy,NY 1,2804 Inspector's InitiNAME: i> -3 11 LOCATION: �l� E- \�C INSPECT ON: RECHECK: Comments and/or diagram Soil T e: Sand/Loam/Clay Type of Water: Municipal/Well Water Waterline separation 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 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/Partial Location/Separations Foundation to tank Foundation to absorption ft. `� Separation of Pits ft. Conforms as per Plot Plan Y N Location of System on Property: Front Rear Left Side Right Side Middle F nt Middle Rear System Use S tus• 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 Septic Inspection Report Office No. (518)761-8256 Date Inspection ques re eiv Queensbury Building& Code Enforcement Arrive: am/ m epart: 742 Bay Rd., Queensbury,NY 12804 Inspector's Initi NAME: RMIT NO.: r�/ LOCATION: SPECT ON: —OLA .RECHECK: cam,, � Comments and/or diagram Soil T San oam/Cl T e of ate unicip ell Water Waterline sep ti ance Well separation distance ft. Other wells: ft, -Absorption Field: Total length ft. Length of each trench Depth of trenches Size of Stone Seepage Pits: Number Size: x Stone Size: Piping Size Type Building to tank Tank to Distribution Box Hit Distribution Box 'eld Pit 0 Opening Seale Y Partial Location/Separations Foundation to tank Foundation to absorption ft. Separation of Pits ft Conforms as per Plot Plan Y N Location of System on Propei-ty: Fron Rear eft Side ht Side Middle ront Middle Rear C)v System Use Status: Status: pproved Pa�� roved an eeds to be re-inspected,please call the Building&Codes Office Disapproved LASueliemingway\Building. es.Inspection.F S\Septic Inspection Report.doc January 28,2003 CIV son OL3ai s �Lr NG & ® S REVIEWED BY DATE . �'�-n55] I ` I have seen or observed, or believe I saw evid RECEIVED II objects such as houses, wells, trees, fences, etc., Pe o n cn this document. I also represent that I havW�A f 2004r onall asured th 'stan s set forth on h a ram." ' '� 0 � g .NSBURY UI DI G AI I CODE W SIGNATURE 77DATL