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2003-013 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: P20030013 Date Issued: Tuesday, January 21, 2003 This is to certify that work requested to be done as shown by Permit Number P20030013 has been completed. Tax Map Number: 523400-290-062-0001-009-000-0000 Location: 31 OVERLOOK Dr Owner: ROBERT & SARA SELLIG Applicant: ROBERT & SARA SELLIG This structure may be occupied as a: By Order of Town Board Septic Alteration Residential TOWN OF QUEENSBURY -( )Jwk-- 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: P20030013 Application Number: A20030013 Tax Map No: 523400-290-062-0001-009-000-0000 Permission is hereby granted to: ROBERT& SARA SF,T,T,TCr For property located at: 31 OVERLOOK 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: ROBERT& SARA SELLIG 31 OVERLOOK Dr Septic Alteration Residential Total Value QUEENSBURY,NY 12804 Contractor or Builder's Name/Address Electrical Inspection Agency TOWNSEND EXCAVATION NY 12904-0000 Plans&Specifications 2003-0013 SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS $25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Wednesday,January 21,2004 (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 thr o of QueA sb esday,January 21,2003 SIGNED BY\ for the Town of Queensbury. urY• Director of Building&Code Enforcement Application for Permit=Septic Disposal System Town of Queensbury 742 Bay Road Queensbury,NY 12804 (518) 761-8256 14 7 4� 1. OWNER INFORMATION: TDWH.p Zaa3....................: / ...............8. .. .. .............................. Location of installation: Ql1l®CSel1/�y► OQ File Permit No. Tax Map No. Fee aid 67-,) Owner's Name: G[-1 43-qV ............................................................................................................ : Address: 2. INSTALLER'S NAME %6biW 'f,14D 4,k61f-1-14-11 I'L PHONE 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) a Year of House: No. of Bedrooms x Computation = Total Daily Flow 1980 or older 3 x 150 gal/bdrm y. 1980- 1991 x 130 gandrm = 1991 -present x 110 gal/bdrm = S I Garbage Grinder Installed yes_ / no, Spa or Hot Tub Installed yes_ / no ` 4. PARCEL INFORMATION: (circle applicable information&indicate measurements) Topogrqphy Soil Nature Ground Water Bedrock or Impervious Material Domestic Water Supply Flirt- s at what depth at what depth munici Rollin loam feet feet well '-57eep slope c ay 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: 066 gallon (min. size 1,000 gal.) � 17— Tile Field: each trench — ft. Total System Length: ft. Seepage Pit(s): number of size of each: _�ft by ft. Size of Stone to be used: # 3 / 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. 0 � Tft6 o 3 Signature of responsible person Y Date .T tir (lucellsbu'ry sq%vels s►s►tl �t:wst);c: i)i�j>a::al (:I►s►�s(t•r AI)pczidix (% . 11.13.�OI�.i''�'IO�t I�'I1;IaI) • PoNo • SIB:I'/1•It�,'1'1�)1�1 ttl�tZt.3I1tI�hlIt;N'I'� • 1^JEiL ItJ 1/1►!JS',k• .► ft tc'rv., fir• _ ISoua� G nE I,,y I1�:�u�sE G . Sc vt le, • 1. .1 •� '� 11�•11y.. ,� �• _._.... 1 \ •/�,•'.- ram„ 1 LJt'�ltt�la,nt•t� ' sc A�Ymstt't,c�s .I �- ,WM) 7. SIGNATURE &INFORMATION FOR—Ml'uN;SWLZ wimpow AV"-/ TOWN OF QUEENSBURY BUILDING_& CODE ENFORCEMENT 742 Bay Road Queensbury NY 12804 (518)761-8256 �• SEPTIC DISPOSAL SYSTEM INSPECTION Name 19/ , '1 L 65 QV2. �C�-�? Location (Z�*w(4 402 Date i III �,05 Permit # Q SOIL TY=ation lay- Results Test- (if applicable) Rate-Minute/Inch TYPE OF SYSTEM: ABSORPTION FIELD: Total Length . Length of each trench Depth of trenches Size of stone SEEPAGE PITS: Number- I Size - � ft. x ft. Stone size PIPING: — Size Type Bldg. to Tank C15i/� Tank to Dist. Sox Dist. Box to Fi e1 d/P' ,� Sa2 35 Openings Sealed? Yes No Partial LOCATION/SEPARATION Foundation to Tank feet Foundation to Absorption feet Separation of Pits �� feet Conforms as per Plot Plan es No LOCATION OF SYSTEM ON PROPERT . . (circle Front - Rea)- LefDide - Right Side Middle t - Middle Rear COMMENTS: Ar )PFLv c101,1-a- 1 •D _8 ey- SYSTEM USE APPROVED: YES NO Arrived- Depart Building Inspector_ Septic Inspection Report Office No. (518)761-8256 Date Inspection request received: Queensbury Building&Code Enforcement Arrive: am/pm Depart: am/pm 742 Bay Rd.,Queensbury,NY 12804 Inspector's Initials: Q 3 `_ ®� NAME: %,, r�\ PERMIT NO.: cu5 LOCATION' Pam/ r INSPECT ON: % / 7 — O RECHECK: Comments and/or diagram Soil Type: Sand/Loam/Clay Type of Water: Municipal/Well Water Waterline separation distance ft. Well separation distance ft. � ��/� �� S'j'S Other wells: Absorption Field: Total length 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 S #us: proved artial Approved and needs to be re-inspected,please call the Building&Codes Office isapproved 01 RECEIVE JAN 1 7 20p,� "I have seen or observed, or believe l saw evidence of, all objects such as houses, welis,.trees, fences, etc., TOINNOFQUEENSBURy shown on this document. I also represent that I have BUlLplNGAN® ®E personally measurre�d the d� t nc ,s set north on the diagram." SIGNATURE DATE d�:s �I�,� Q ems' �7/l O �� y --6 I A-Qjto)b oN6-0 Per �.. C7. m J�N oxg P,r- W _ ��c.I �3 6Xg ti�w Pt.- w ✓ w N 02'26'40" W 10 1/C —� W < 376.86' CA SA SO £x�SnNc FOROP a�i�Nc ��• Q n PROP0S gU11��1�G 38.2' 3 -_ ci 4, W R:<43:00' L=1 4.77' 4