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2003-350 'SOWN OFQUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development-Building&Codes (518)761-8256 CERTIFICATE OF COMPLIANCE Permit Number:. P20030350` Date Issued: Wednesday,June 04,2003 .: This=is,to.certify that-fork requested.to be done as shown by Permit Number v P20030350 has been completed, Tax Map Number: 523400-289-009-0001'064-000-0000 Location: 357 GLEN LAKE Rd Owners SANDRA STROTHER Applicant: SANDRA STROTHER This structure may be occupied as a: By Otdet of Town Boatd Septic Alteration Residential , TOWN of QUEENSBURY Nectot of Building&(.ode Ei orcement TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development- Building&Codes (518) 761-8256 BUILDING-PERMIT Permit Number: P20030350 Application Number' A20030350 Tax Map No: 523400-289-009-0001-064-000-0000 Permission is hereby.granted to: SANDRA STROTBER -For property located at: 357 GLEN LAKE 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 Constructiozi Value Owner Address: SANDRA STROTHER Septic Alteration Residential 357 GLEN LAKE Rd Total value LAKE GEORGE, NY 12845 Contractor or Builder's Name/Address Electrical Inspection Agency Plans&Specifications BP 2003-350 Residential Septic Alteration as per plot plan and specifications $25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Saturday, May 29,2004 (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 TL of ens u da May 29, 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: Office Use Location of installation: SS Q-A File Permit NoC;Z03 --3 Tax Map No. Fee Paid Owner's Name-,Zz�. .......................... Address: J .. N.E C. VE ............ MAY 2 9 2003 2. INSTALLER'S NAME PHONET2 N L kuRy 0 AND -Z"I Y �U GQQI�F: 3. RESIDENCE INFORMATION: (circle year of dwelling, indicate#bedroom(s)and rn.1tiPT bedrooms with applicable gallons per bedroom to equal total daily flow) Year of House: No. of Bedrooms x Computation = Total Daily Flow x 150 gal/bdrm 44i1991.� x 130 gal/bdrm. 1991 -present x 110 gallbdrm Garbage Grinder Installed yes no Spa or Hot Tub Installed yes no >61 4. PARCEL INFORMATION: (circle applicable information&indicate measurements) Too ggjaphy Soil Nature Ground Water Bedrock or Impervious Material Domestic Water Sppl2ly (2Ea:7> —V Un,' a �d th at what depth muzzicipal -�am 4 'P 4 feet Rolling eet Steep slope clay if well; water supply —%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_ft. Size of Stone to be used: '# depth or thickness l feet Bed System Size: x Alternative System: length and/or size 6. HOLDING TANK-SYSTEM: (ifrequir Number of tanks: /(ize ch: gallons !TOTAL Capacity: iz' gallons X, to electrical work must be inspected by a Town approved Note: Alarm System andl�a so ' te g electrical inspection a , cy- 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. Signature of responsible person Date z -r tic:-vcrs and :(4-Wlx ;c: Disims:a•1 (:l,sttstt•i• 1\•ppitlidix A�.�.`it7�i��'•'•I'IC2I�i I�'11+3I�I) • V'(E•t.t_ i.l tI(�tiS'rk• •-:-•••"—�'^''''� t:t lc'ra••t ISovst= Ci AS , 1C;ye>ty•, ltr)v w>= • t-rc�.t.rr . ?. SIGNATURE &INFORMATION F4R I�SYCJNtixfisLs✓1�,:,c�s.,c<�„or.a. .....:; ` Septic Inspection Report Office No. (518)761-8256 Date Inspection request received: 3 Queensbury Building&Code Enforcement 'Arrive: -.9,5Q am/pni Depart—_W4a—m/pm. 742 Bay Rd., Quee bury,NY 12804 Inspector's Initials: Dk- -e NAME: PERMIT NO.: LOCATION: SPECT ON: RECHECK: Comments and/or diallra Soil Type: Clay Type of )al/ Waterline separation distance ft. Well separation distanced ft. Other wells: ft. Absorption Field: Total length 13a Length of each trench Depth of trenches Size of Stone Seepage Pits: Number Size: Stone Size: Piping Size Rpe Building to tank Tank to Distribution Box C- Distribution Box to Field Pit -Opening Sealed:UNI Partial -1-6-c-a—tion/Separations— Foundation to tank ft. Foundation to absorption Separation of Pits Conforms as per Plot Plan j e Y_, N Location of System on Property: Front <9 Left Side Right Side Middle Front Middle Rear System Use Status: Approved Partial Approved and needs to be re-inspected,please call the*Building&Codes Office Disapproved L.*\SueHemingway\Biiilding-Codes.inspection.FORMS\Septic inspection Report.doc January 28,2003 Septic Inspection Report Office No. (518)761-8256 Date Inspection request received: o Queensbury Building&Code Enforcement 'Arrive: /Dir am/])M Depart: am/pni 742 Bay Rd., Queensbury,NY 12804 Inspector's Initials: NAME: PERMIT NO.: 3P LOCATION: -Y-37 Cl-/e-- C-4-1, fea INSPECT ON: 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: Absorption Field: Total length .-Length of each trench ...Depth of trenches Size of Stone pi it -Seepage Pits: Number Size: x Stone Size: Piping Size Type Building to tank Tank to Distribution Box Distribution Box to Field l Pit Opening Sealed: Y/NI 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 Rear Left Side Right Side Middle Front Middle Rear System Use Status: Approved Partial Approved and needs to be re-inspected,please call the'Building&Codes Office Disapproved L"SucHen-tingway\Building,Codes.Inspection.FORM S\Septic Inspection Report,doc January 28,2003 ipr o 1'0�URY LANDS N/F OF 3UILDING& 5ULLIVAN Y. EPT. EVIEWED E83Y FIL� Copy I �Cvf(,- AIA Y )ATE 0 tovvN 0, LANDS N/F OF 'N FLANAGAN C OTHER LANDS OF TROTQ TOWN OFOUEENSBURYBul lvekel 5 �eo \\, W .'35 4,188 sq. Based On our limited a ING DEPARTMENT xam' fi,, 0.10 acres comakm With our not icaun Plans ancd"sp'eudetdka% d n g the =,ayn.k ce with theBu ,are in full S82-58'00 w Codes State. 126.34' CIRF O 1* T OTHER LANDS OF ¢ wo 0, E E ----5TROTMER B-L CARF 4+ CIRF 16 0 le LANDS N/F OF RIVETTE IPF pr