2007-273 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. P20070273 Date Issued: Wednesday, May 23, 2007
This is to certify that work requested to be done as shown by Permit Number P20070273
has been completed.
Tax Map Number. 523400-296-014-0001-005-000-0000
Location: 94 MONTRAY Rd
Owner. JAY & PATRICIA MAYER
Applicant: JAY & PATRICIA MAYER
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, �F
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: P20070273 Application Number. A20070273
Tax Map No: 523400-296-014-0001-005-000-0000
Permission is hereby granted to: JAY&PATRICIA MAYER
For property located at: 94 MONTRAY 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. Tvpe of Construction Value
Owner Address: JAY&PATRICIA MAYER
94 MONTRAY Rd Septic Alteration Residential
QUEENSBURY, NY 12804 Total Value
Contractor or Builders Name/Address Electrical Inspection Agency
SANITARY SEWER
DAN DRELLOS
PO BOX 224
GLENS FALLS NY
Plans &Specifications
2007-273
SEPTIC ALTERATION RESIDENTIAL
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Wednesday,May 14,2008
(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 IVgt:.3Uy 14, 2007
SIGNED BY ` for the Town of Queensbury.
Director of Building&Code Enforcement
/_ OFFICE USE ONLY %
/
TAX MAP NO. PERMIT NO._(/�1� �ERMIT FEE ',
/ ,
APPROVALS: ZONING TOWN CLERK ; 0 TOVvn, t a 0RY
0,,,,I� BUILDING AND CODE
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT:
A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJE O REVIEW BEFORE ISSU CE OF A VALID
PERMIT.
OWNE _ INSTALLER: I flG� `
ADDRESS: / l I ��y 1�"✓/ ADDRESS: #0 0 U D3(
PHONE NOS. PHONE NOS.Z 96 — 0 �c
LOCATION OF INSTALLATION:
............................................................................................'................................... .................................................`.... . . . RESIDENCE INFORMATION:
NO.OF 3 ............................................................................ ESID
YEAR BUILT '• X I COMPUTATION= i TOTAL DAILY FLOW
BEDROOMS i
........................... ......................,......................................................................,,.....,......;..................... .... .... ............................................ GARBAGEGRIN
1980 or older X 150 gallon per bedroom = i ( INSTALLED?
.............................................................. ......................................... ...................................................................... ....
1981 1991 X 130 gallon per bedroom 1 = SPA OR HOT TUB
»..............................................................................................................................................................................:........................................................................... a
1992-present 1 X 110 gallon per bedroom I INSTALLED?
.................................................................................................................................................................................................................................
PARCEL INFORMATION:
✓ TOPOGRAPHY: FLAT RO LING ' STEEP SLOPE %SLOPE
✓ SOIL NATURE: SAND LOAM CLAY OTHER
✓ GROUNDWATER: AT WHAT DEPTH? BEDROCK/IMPERVIOUS MATERIAL: AT
WHAT DEPTH?
✓ DOMESTIC WATER SUPLY: MUNICIPAL " WELL
(IF WELL: WATER SUPPLY FROM ANY SEPTIC-SYSTEM ABSORPTION IS FT. )
✓ PERCOLATION TEST: RATE IS PER MIINUTE PER INCH (TEST TO BE
COMPLETED BY A LICENSED PROFESSIONAL ENGINEER OR ARCHITECT)
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:P� GALLON (MIN. SIZE IS 1,000 GAL.) TILE FIELD: EACH TRENCH FT.
✓ TOTAL SYSTEM LENGTH: ?"�j FT. SEEPAGE PIT(S): HOW MANY? WI,A-
✓ SIZE OF EACH FT. X FT.
✓ SIZE OF STONE TO BE USED: # '21— /DEPTH OR THICKNESS f2_-FT.
✓ BED SYSTEM SIZE: X
✓ ALTERNATIVE SYSTEM: LENGTH AND/OR SIZE
✓ HOLDING TANK SYSTEM:(If required) NO. OF TANKS: /SIZE OF EACH
✓ GALLONS./TOTAL CAPACITY.• GAL.
..................................:.....:.:.:.........................................................:...:...:.:...:.........:...:......................................... .... ..:. .
NOTE: ALARM SYSTEM AND ASSOCIATED ELECTRICAL WORK MUST BE INSPECTED BY A TOWN 1i
APPROVED ELECTRICAL INSPECTION AGENCY. PLEASE REVIEW LIST PROVIDED. I.
ii....................................................:.:.......:.....................:.:...:•:•i.:.....:..:.:.:.:...........�.:•�•..:.:�:.�:.:.:.:....:�.. : : i
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 thes d all requirements of the Town ofC1Q1UE:STIONS? CALL 761-8266 OR EMAILbury Sanitary ew a Disposal Ordinance. codes�aueensburv.netEBSITE FOR MORE INFORMATION
T/I
www.aueenaburv.net
Ign ure of Person ponsible Date
r Town of Queensbury ■ Community Development Office ■ 742 Bay Road, Queensbury, NY 12804
19/o
Septic Inspection Report
Office No. (518)761-8256 Date Inspectio
Queensbury Building &Code Enforcement Arrive: a p • . 1.�a
742 Bay Rd., Queensbury,JJNJ�,,Y 12804 Inspector's In
NAME: /��a�1►�2 • & P R NO.:
LOCATION: _ I CT ON: 7
1
RECHECK: l
Soil Tyt
Sand lay _ Comment /or diaoraM
Type of unici ell Water
Waterline sepa nce
Well separation distance ft,
Other wells: ft,
Absorption Field: Total length ft.
Le of each trench
Depth of trenches ft,
I Size of Stone
+ She Pits: Number
Size: 1 x
Stone Size:
LEM19ng Size Type
Buildi to tank
Tank to Distribution Box yt A 05
I Distribution Box Pit LA A k7v— .-Ji
I Owninq Sea d* Partial
I End Cap �F
I Iniet/Outlet Pipes&Baffles I Y N
Location/Separations
Foundation to tank
Foundation to absorption ft.
Separation of Pits ft.
1 Conforms as per Plot Plan Y N
En ineer Report and As-Built Y N
Location of System on Property:
Front ear Left Sld Ri ht
d
Middle Fro Middle Rear
Uftm Use
Approved
Partial Approved and needs to be re-inspected, please call the Building&Codes Office
Disapproved
Last revised 021006
Last revised 1/6/05
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