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2004-457 r' TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201 Community Development- Building & Codes (518) 761-8256 CERTIFICATE 0-F COMPLIANCE Permit Number: ' 'P20040457 . Date Issued: Monday, June 28, 2004 This is to certify that work requested.to be-done as shown by Permit Number P20040457 has been completed. Tax Map Number: . .523400-279-015-0001-023-000-0000 Location: 17 AZURE Dr Owner: DAWN EDDY Applicant: DAWN EDDY 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 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: P20040457 Application Number: A20040457 Tax Map No: 523400-279-015-0001-023-000-0000 Permission is hereby granted to: DAWN EDDY For property located at: 17 AZURE 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: DAWN EDDY THOMAS CARPENTER Septic Alteration Residential Total Value 17 AZURE Dr QUEENSBURY, NY 12804 Contractor or Builder's Name/Address Electrical Inspection Agency ADVANCED EXCAVATORS 798-0176 NY 12804-0000 Plans&Specifications 2004-457 SEPTIC ALTERATION $25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Tuesday, June 21, 2005 (If a longer period is required,an application for an extension must be made to the code Enforcement Officer of the Town of Queensbury before the expiration date:) Dated at the To Queens nay, Jurie`21, 2004 SIGNED BY a A for the Town of Queensbury. Director of Building&yCodeNLIforcement J Application for Permit Septic Disposal System Town of Queensbury 742 Bay Road Queensbury,IVY 12804 (518)-761-8256 1. OWNER INFORMATION: �........ ..........................................f.i'..............................,.....,................................ Office-Use k Location of installation: 1 - r' �0�'1- 57 File Permit No. Tax MaP No. i i CS �,, � ` Fee Paid ca Owner's Name: boaz'� Cf Tm' ` ................_.............................,,............................................,,,.,...,....,................... ....,.,. Address: Live, Dr, b ,n (p 2. INSTALLER'S NAME :-)bhn V0d)CL kdV nbd FAPava.fc vS PHONE NO.�9?- d 1-7 3. RESIDENCE INFORMATION: (circle year of dwelling, indicate.#bedroom(s) and multiply #of a;a bedrooms with applicable gallons per bedroom to equal total daily flow) Year of House: No of Bedrooms x Computation = Total DL1.X Flow f 1,980 or older x 150 gallbdrm = cam 1980-1991 x 130 gandrm = 1991-present x 110 gal/bdrm = Garbage Grinder Installed yes_ 1 no Spa or Hot Tub Installed yes i no JUN 1.8 zoo4 TOWN OF QUEENSBURy 4: PARCEL INFORMATION: (circle applicable information&indicate measurement$)UlLpiNG AND CODE Topography- Soil Nature Ground Water Bedrock or Impervious Material . Domestic Water Supply Flat sand at what depth at what depth municipal Rolling loam feet feet well Steep slope clay if well;water supply _%slope other from any septic-system depth:' absorption is ft. -- -- Percolation Test: -(Yo--be completed.by licensed professional engineer or architect) Rate: n��. 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: each trench ft. Total System Length: ft. Seepage Pit(s): number of size of each: ft, by ft. Size�f Stone to be used: # / depth or thickness feet Bed System Size: x Alternative System: length and/or Am 6. HOLDING TANK SYSTEM: (if required) Number of tanks: ^ 7Size of each: gallons 7 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 Jn Signature of respon8ible person Date St;wcra and Sewttp;cc. Dispoig tll (:lts plot• /1hpomlix C. MISURIII IOM.. Ii'I ISM A.) ' SIs:I'/1'It�,'I'IWIN Itir(ZI,3tItI�Ttillt.I�1'I`� • U pQNq V�J�tt. ►-u tt�sx'sz• '` tit tc'�vt - ,•11ouaE c� t�tr � ' , ,�c?,�" t i�:>us>= G � � �' 0.0 tear H t ' Sc t't 1cr •��' -, I 1 1.1 '� l lt•11Y� r•� w ■ ••�--•� tGAti r • r 7. SIGN,A'l URE . w w r Septic Inspection Report " Office No. (518)761-8256 Date Inspection re er Queensbury Building&Code Enforcement Arrive: amlrt:742 Bay Rd., Queensbury,NY 12804 Inspector's Ini alNAME: � �T�0 P _L� LOCATION: ,`� �� •r p ,� SPECT OI RECHECK: Comments and/or diagram Soil Type: Sand/Loam/Clay T e of Water: Municipal/Well Water Waterline separation distance ft. Well separation distance ft. t Other.wells: ft. Absorption Field: Total length ft. �r 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 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 Y N Location of System on Property: Front Rear Left Side Right Side Middle F ont Middle Rear System Ilse S tus: Approved. Partial Approved and needs to be re-inspected,please call the Building&Codes Office Disapproved L:1SueHemingway\I3uilding.Codes.Inspection.FORMS\Septic Inspection Report.doc January 28,2003 i Septic Inspection Report Office No. (518) 761-8256 Date Inspectionfe . Queensbury Building&Code Enforcement Arrive: '� art: f m742 Bay Rd.,Queensbury,NY 12804 Inspector's IniNAME: OLIJqS LOCATION: RECHECK: Comments and/or diagram Soil T e. Sand oa ay Type of u al/Well W4LKJ Waterline separa n distance ft. Well separation distance 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 1., 11 l�t✓ ;' 1 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 Y N Location of System on Property: Fron Rear eft Side Right Side �� Middle Front Middle Rear � r� �I EC S stem Use t t' s: Approved Partial Approved and ne s to be re-inspected,please call the BixiTding&Codes Office Disapprove (� u, LASueHemingway\Building.Codes.Inspection.FORMS\Septic Inspection Report.doc January 28,2003 V�1 ®° CD C 00,) _ .. LIJ o� REVIEWkit) DATE - ' t 9ro `t' r of, ave seen or observed, or.believe I saw e ail c ,jests sack as hoasPs, ti^wells,trews, fences, etc., shoe ; v + this docanent. I also represent that i have Qerso�; ,,easared the distances set forth on the diagram" G . ' `SIGNAT RE DAT. WN OF i'".. UILDING & CODE DEFT :-,� r; �?1 Ur`idh'3Ljr 'ma .,sk � � CL?";�:?ii�r{»2 Lultfl i?t!r(:U71s"i�!?'i.`'i SI`S;;Ik EViEWED BY not firs construed as t FILECOPY ,ATE plans and�,peciP.,miiton&are ii,5)ii N s Plot Plan Dawn Eddy - 17 Azure Drive