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2003-219 411a) TOWN OF QUEENSBURY F4TO742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201 Community Development - Building & Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE Permit Number: P20030219 Date Issued: Wednesday, April 30, 2003 This is to certify that work requested to be done as shown by Permit Number P20030219 has been completed. Tax Map Number: 523400-227-006-0001-008-000-0000 Location: 14 MAYFLOWER Ln Owner: SHIRLEY ARMSTRONG Applicant: SHIRLEY ARMSTRONG 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 WOO Community Development-Building&Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20030219 Application Number: A20030219 Tax Map No: 523400-227-006-0001-008-000-0000 Permission is hereby granted to: SHIRLEY ARMSTRONG For property located at: 14 MAYFLOWER Ln 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: SHIRLEY ARMSTRONG 14 MAYFLOWER Ln ac Alteration Residential PO BOX 75 Total Value KATTSKILL BAY,NY 12844 Contractor or Builder's Name /Address Electrical Inspection Agency CRANDALL CHRISTOPHER WOODCHUCK HILL ROAD LAKE GEORGE.NY Plans&Specifications 2003-219 SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS $25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday,April 30,2004 (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 wn o Quee ury• nesday,April 30,2003 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: Location of installation: J J Office Use �, er File Permit No©)503 'vZ1 Tax Map No. � S. b� Fee Paid Owner's Name: � 1 r l rn'i S ro r� I' Address: ka &k k 11 , Ea_c_.4 2. INSTALLER'S NAME : CrA-,1c euL f �►�-1,�p1l v PHONE NO.7M3 C4/3J 3. RESIDENCE INFORMATION: (circleyear of dwelling, indicate#bedroom(s) and multiply # g, P Y of bedrooms with applicable gallons per bedroom to equal total daily flow) Year of House: No. of Bedrooms x Computation = Total Daily Flow C 1980 or older Z x 150 gal/bdrm = 0-, 1980— 1991 x 130 gal/bdrm = 1991 —present x 110 gal/bdrm = Garbage Grinder Installed yes_ / no Spa or Hot Tub Installed yes_ / no )( APR 3 `,' TOWN OF QUEEN&; 4. PARCEL INFORMATION: (circle applicable information&indicate measurements) TIU't.DIN AND CO',_ a h Soil Nature Ground Water Bedrock or Im ervious Material Domestic Water Su 1 Flat sand at Ikhat depth at what depth municipal oiling oa 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: /0M gallon (min. size 1,000 gal.) Tile Field: each trench \ ft. Total System Length: \ ft. Seepage Pit(s): number of size of each: by ft. Size of 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. )- V no3 S' nature of respo Bible person ate ' /i' • .� • • '1'nmitl of tZttt.ettsitury ti-I 'Sewers :ttitl Sewstge Disposal (ilt:tptt•r • • Appendix +.. • AU SORPTION PIU 1 JD • • ' SEPARATION REQUIREMENTS • r •' WELL IN •)/MIt..•rk•• P:IND rt cc Syr ttt�uT cl�51►It'x �•... to 7 r � . t l •� 14 r M1�oRPt1at t • Ptr Lb • • • • 7. SIGNATURE &INFORMATION FOR EI rOlsi ,.x,LZ \i„w,,.•-•..,...:; •• • • r • • • g: .,°' Septic Inspection Report Office No.(518)761-8256 Date Inspection request received: Queensbury Building&Code Enforcement Arrive: a part: c am/pm r 742 Bay Rd.,Queensbury,NY 12804 Inspector's Initials: NAME: a,e,,.d�?., /,. PERMIT NO.: ' 0 I9' LOCATION: !j/fifriG46t/6 64/- INSPECT ON: RECHECK: • Comments and/or diagram Soil Type: Sand/Loam/Cla Type of Water: Municipal ell W: er tiG7 Waterline separation dista ce ft. tA/K "604/pee C 6.�� a 7 Well separation distance ft. Other wells: -� �-'4 ` ft. Absorption Field: Total lent h ft. Length of each trench ft. _ Depth of trenches ft. _ Size of Stone Seepage Pits: Number ____ Size: x Stone Size: Piping S' I1 Type Building to tank . 4i , 0 t Tank to Distributio Box a Z-. Distribution Bo o. ield/Pit O enin Seale : Y/N/Partial Location/Separations i, Foundation to tank /(1 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 gp4> 4 I' ,- Middle Fr nt Middle Rear System Use S atus: Approved Partial Approved and needs to be re-inspected,please call the Building&Codes Office Disapproved L:\SueHemingway\Building.Codes.Inspection.FORMS\Septic Inspection Report.doc January 28,2003 Septic Inspection Report Office No. (518)761-8256 Date Inspection request received: Queensbury Building&Code Enforcement Arrive: am/ Depart: 3 •- 2amlpm 742 Bay Rd.,Queensbury,NY 12804 Inspector's Initials: NAME: 1. l5 CRA`ti ,0044-c_ _ PERMIT NO.: er ��.�,�._ 3 -7 LOCATION: 'V k i F&X L.v INSPECT ON: F 23 a RECHECK: Comments and/or diagram Soil Type: 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: J i C C ( `-��' 5 . T Piping Size Type Building to tank Tank to Distribution Box Distribution Box to Field/Pit ' Opening Sealed: Y/NI 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 Front Middle Rear System Use Status: proved artial Approved and needs to be re-inspected,please call the Building&Codes Office Disapproved L:'\SueHemingway\Building.Codes.Inspection.FORMS\Septic Inspection Report.doc January 28,2003 .. -- .„.„...--------------N , , _cc', '? 1 _., _., ,. .... ...•....________„.. ..... . ,_ •-> _..............._ L'...1. _ _ APP- r ... . . . ... , 1 , I 1 i _....,_......._ I i in - - ------, .,, 1 1 i o unesNamozio m V t cooz c ,.-- dciv 03AI:10 '. 0 TOWN S! - ,4 01:70ENS677 J-RYBUILDlNG ;0 " pREVIEWEDY • f I / ; t T /6 / z aralf." ..•••••.,,,........Wewor.......• 1 1:7 i -4*.* I "00 , C.OCINE ------------______j e4/ , ,