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2004-982 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: P20040982 Date Issued: Friday, April 2% 2005 This is to certify that work requested to be done as shown by Permit Number P20040982 has been completed. Tax Map Number: 523400-296-014-0001-018-000-0000 Location: 53 SWEET Rd Owner: RICHARD &DIANA DEMPSTER Applicant: RICHARD &DIANA DEMPSTER 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: P20040982 Application Number: A20040982 Tax Map No: 523400-296-014-0001-018-000-0000 Permission is hereby granted to: RTCHARD &DTANA DEMPSTER For property located at: 53 SWEET 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: RICHARD &DIANA DEA PSTER SWEET Rd Septic Alteration Residential Total Value QUEENSBURY, NY 12804 Contractor or Builder's Name /Address Electrical Inspection Agency DANIEL D LEWIS 362B GATLEY HILL Rd. L;AKE,LUZERNE_ NY 12846 Plans&Specifications 2004-982 SEPTIC ALTERATION $25.00 PERMIT FEE PAID,-THIS PERMIT EXPIRES: Wednesday, December 28, 2005 (If a longer period is required,an application for an extension must he made to the.code Enforcement Officer of the Town of Queensbury before the expiration date.) Dated at the T .wn of eenA4*yrDecember28, 2004 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,IVY 12804 (518) 761-8256 . 1., OWNER INFORMATION: ............... ............... .................. .......... Office Use Location of installation: spyfrF Rz? File Permit No,;�;)009 �01\ Tax Map No. Fee Paid o4J Owner's Name: .,Rtak ........................................................ ............................ Address: SWFi=-:T cizA -7 q I- Og7t 2. INSTALLER'S NAME bA IV zgzv, f PHONE NO. �?w 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 X 1980 or older x 150 gallbdrm = ysy 1980- 1991 x 130 ga 1991 —present x 110 gaRF—CE Garbage Grinder Installed yes_' / no' DEC 2 8 2004 Spa or Hot Tub Installed yes_ / no TOWN OF QUEENSBURY BUILDING AND CODE 4.' PARCEL INFORMATION: (circle applicable information&indicate measurements) Topography Soil Nature Ground Water Bedrock or Impervious Material Domestic Water Supply Flat sand x at what depth at what depth municipal X Rolling loam Q feet feet well Steep slope clay if well; water supply /0%slope other from.any septic-system depth: absorption is 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: each trench ft. Total System Length: Seepage Pit(s): number of size of each: ft. by 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 pen-nit 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. ey, Signature of responsible person Dat6 �',` ''1• A 1'ow"ll of tZtiet:Ilsbu i•y .5rwta•a :ultl 4taysil;t; I)i�j)a�al (aisii)tt�I• AI)pmulix C. 1 PQNo H1t;. L tN 14►Tf.lk— rr 1-77 1buaE a ��ta�'r Its:>t G . E I• .l ., or • f�ta,� , ' 7, SlQN A►rJPX &INFORMATION FOR USYVNW,01 sr rr,"vA,"UJI-99 0•ou""I P Septic Inspection Report Office No. (518)761-8256 Date Inspection re est cei d: Queensbury Building&Code Enforcement Arrive: p apart: am/pm 742 Bay Rd.,Queensbury,NY 12804 Inspector's Initial : NAME: E PE IT NO.: �,DO1}— LOCATION: 553 ��_EFT" 2V PECT ON: _y—Zq—05— 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: Piping Size Type Building to tank Tank to Distribution Box Distribution Box t6 Field/Pit Opening Sealed: Y/N/Partial Location/Separations Foundation to tank ft. Foundation to absorption Separation of Pits Conforms as per Plot Plan Y �1�� Location of System on Property: Front Rear Left Side Right Side Middle Front Middle Rear S stem Use St tus: 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 InspectiVcQueensbury Building&Code Enforcement Arrive: rt: a742 Bay Rd.,Queensbury,NY 12804Inspector's InNAME: �N�PV)T T—' R LOCATION: ,� � {�n Z�-c - RECHECK: Comments and/or diagram Soil T e Sand__,/ oam/Clay Type of Vv"'�Munici al/Well Water Waterline separation 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 Seepa e Pits: Number Zj Size: x Stone Size: Piping Size Type Building to tank Tank to Distribution Box Distribution Box t el Pit L4 Opening Sealed /Partial Location/Separations Foundation to tank ft. Foundation to absorption 2zft. Separation of Pits Conforms as per Plot Plan Y N j Location of System on Property: Front Rear eft Side Right Side Middle Front Middle Rear System Use St tus: y Approved artial Approved and needs t e re-inspected,please call the Building&Codes Office Disapproved L:\SueHemingway\Building.Codes.Inspection.FORMS\Septic Inspection Report.doc January 28,2003 7VI- 0971 Septic Inspection Report Office No. (518)761-8256 Date Inspection re est e eiv Queensbury Building&Code Enforcement Arrive: m/p epart: a 742 Bay Rd., Queensbury,NY 12804 Inspector's Initia �cJ NAME: 1� � �` IT NO.: LOCATION:/ PECT ON: RECHECK: Comments and/or diagram Soil T San / ay Type of ate • unicipal ell Water Waterline septa' • ance _ft. Well separation istance 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 Ty pe Building to tank Tank to Distribution Box Distribution Box e /Pit Opening Sealed(Y /Partial Location/Separations Foundation to tank Foundation to absorption ft. Separation of Pits Conforms as per Plot Plan Y N Location of System on Property: Front ar Left Side Right Side fiddle Front ddle Rear System us. Approved Partial Approved and needs to be re-inspected,please call the Building&Codes Office Disapproved L:1SueHemingway\Building.Codes.Inspection.FORMS\Septic Inspection Report.doc January 28,2003 Septic Inspection Report Office No. (518)761-8256 Date Inspection re st r ived: Queensbury Building&Code Enforcement Arrive: am/p D rt: a pm 742 Bay Rd.,Queensbury,NY 12804 Ins ecto"s Initia . NAME: PN PE IT NO.: 0 LOCATION: ��ti c,�Q - _(� SPECT ON: — 7 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: 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 Front Middle Rear System Use Status: pproved Partial Approved and needs to be re-inspected,please call the Building&Codes Office Disapproved L:ISueHemingwaylBuilding.Codes.Inspection.FORMS\Septic Inspection Report.doc January 28,2003 d o bit IU Z� tit U L �- QLU LL CZ) C/)0 > i r:f 2 LLJ O R-1 � a 10 i 6 ") have see j� or obs rve� , bel�iev� I s w ide ce of, _ - bte is-siuch as- ous -,=lells�;treeSj�eoc tc., __- -^ --- - - ---- — --- -- - — sho non tl is document I Iso �eprese fth 'l i pe ()mally�inea ure� th distances et f rth on he diagelarn. SI'�GN�TUEI j7b�Yl—j R0PIE j I I I I I r' +r` Ql'iE-.r Ell.t.1fF ( "I have seen or observed, or believe I saw evidence of, BUR11�Z7 __ al1 objects such as houses, wells, trees, fences, etc., • R shown on this docurri :�i also to of tha h-ir --~ REVIEWED B pars ra ly mea tired the distan� set forth on the diagram." DATE 'Z SIGNATURE DATE